NOTES NIL USHY: MODULE T1: OVERVIEW OF NURSING
RESEARCH
1. NURSING RESEARCH
A. Definition
Research
- is a systematic inquiry that uses disciplined methods
to answer questions or solve problems.
- GOAL: The ultimate goal of research is to develop,
refine, and expand knowledge.
Nursing Research
- is systematic inquiry designed to develop trustworthy
evidence about issues of importance to the nursing
profession, including nursing practice, education,
administration, and informatics.
Clinical Nursing Research
- research designed to guide nursing practice and to
improve the health and quality of life of nurses’
clients.
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● Although there is not a consensus about what types of
“evidence” are appropriate for EBP, there is general
agreement that research findings from rigorous studies
provide especially strong evidence for informing nurses’
decisions and actions.
● Nurses are accepting the need to base specific nursing
actions and decisions on research evidence indicating that
the actions are clinically appropriate, cost-effective, and
result in positive outcomes for clients.
● In the United States, research plays an important role in
nursing in terms of credentialing and status.
● The American Nurses Credentialing Center (ANCC)
- an arm of the American Nurses Association and the
largest and most prestigious credentialing organization
in the U.S.
- developed a Magnet Recognition Program to
acknowledge healthcare organizations that provide
very high-quality nursing care, and to elevate the
standards and reputation of the nursing profession
● In 2008, a new Magnet application process was instituted.
A key component is “new knowledge, improvements, and
innovations” that are viewed as affecting quality of care,
which are represented by empirical (research-based)
outcomes at the center of the model.
● Changes to nursing practice now occur regularly because
of EBP efforts
C. Consumer-producer continuum
CONSUMERS of nursing research
- nurses who read research reports or research
summaries for relevant findings that might affect their
practice
- EBP depends on well-informed nursing research
consumers
PRODUCERS of nursing research
- nurses who actively participate in generating evidence
by doing research.
- At one time, most nurse researchers were academics
who taught in schools of nursing, but research is
increasingly being conducted by practicing nurses who
want to find what works best for their patients.
D. Purposes
● GENERAL PURPOSE: to answer questions or solve
problems of relevance to nursing.
○ Applied and Basic Research
➢ basic research- is undertaken to extend the base of
knowledge in a discipline, or to formulate or refine a theory.
➢ Basic research is appropriate for discovering general
principles of human behavior and biophysiologic
processes.
➢ Some types of basic research are called bench research,
which is usually performed in a laboratory and focuses on
the molecular and cellular mechanisms that underlie
disease.
➢ Applied research- seeks solutions to existing problems and
tends to be of greater immediate utility for EBP.
➢ Applied research is designed to indicate how these
principles can be used to solve problems in nursing
practice.
➢ In nursing, the findings from applied research may pose
questions for basic research, and the results of basic
research often suggest clinical applications.
○ Research to Achieve Varying Levels of Explanation
➢ Cause-probing -is designed to illuminate the
underlying causes of phenomena.
● SPECIFIC PURPOSES:
E. RESEARCH PURPOSES LINKED TO EBP:
Treatment, Therapy, or Intervention
- undertake studies designed to help nurses make
evidence-based treatment decisions about how to
prevent a health problem or how to address an existing
problem
- Range from evaluations of highly specific treatments
or therapies (e.g., comparing two types of cooling
blankets for febrile patients) to complex multi session
interventions designed to effect major behavioral
changes (e.g., nurse-led smoking cessation
interventions). Such intervention research plays a
critical role in EBP.
Diagnosis and assessment
- concern the rigorous development and evaluation of
formal instruments to screen, diagnose, and assess
patients and to measure important clinical outcomes
- High Quality instruments with documented accuracy
are essential both for clinical practice and for further
research.
Prognosis
- examine outcomes associated with a disease or health
problem, estimate the probability they will occur, and
indicate when (and for which types of people) the
outcomes are most likely.
- facilitate the development of long-term care plans for
patients
- provide valuable information for guiding patients to make
lifestyle choices or to be vigilant for key symptoms
 - can also play a role in resource allocation decisions.
Prevention of harm
- Providing useful information to patients about such harms
and how best to avoid them, and taking appropriate
prophylactic measures with patients in care, depends on the
availability of accurate evidence.
Etiology or Causation
- identifying factors that affect or cause illness, mortality, or
morbidity is an important purpose of many nursing studies.
Meaning and process
- provides evidence about what health and illness mean to
clients, what barriers they face to positive health practices,
and what processes they experience in a transition through
a healthcare crisis are important to evidence-based nursing
practice.
F. Paradigms and Methods
● Paradigm
- is a worldview, a general perspective on the complexities of
the world.
- two broad paradigms, positivism and constructivism.
● POSITIVISM PARADIGM
- dominated nursing research for decades
- also called logical positivism
- rooted in 19th century thought
- guided by such philosophers as Mill, Newton, and Locke
- reflects a broader cultural phenomenon that, in the
humanities, is referred to as modernism, which emphasizes
the rational and the scientific.
- a fundamental assumption of positivists is that there is a
reality out there that can be studied and known
- assumption- is a basic principle that is believed to be true
without proof or verification
- Determinism- refers to the positivists’ belief that
phenomena are not haphazard, but rather have antecedent
causes.
- much research activity is directed at understanding the
underlying causes of phenomena
- Positivists value objectivity and attempt to hold personal
beliefs and biases in check to avoid contaminating the
phenomena under study.
- there is still a belief in reality and a desire to understand it
- post positivists recognize the impossibility of total
objectivity. They do, however, see objectivity as a goal and
strive to be as neutral as possible. Post Positivists also
appreciate the impediments to knowing reality with
certainty and therefore seek probabilistic evidence.
- remains a dominant force in nursing research.
● CONSTRUCTIVISM PARADIGM
- often called the naturalistic paradigm
- began as a countermovement to positivism
- Weber and Kant
- an outgrowth of the cultural transformation called
postmodernism.
- deconstruction—taking apart old ideas and structures
- reconstruction—putting ideas and structures together
in new ways.
- represents a major alternative system for conducting
disciplined research in nursing
- reality is not a fixed entity but rather is a construction
of the individuals participating in the research; reality is
not a fixed entity but rather is a construction of the
individuals participating in the research
- take the position of relativism: If there are multiple
interpretations of reality that exist in people’s minds,
then there is no process by which the ultimate truth or
falsity of the constructions can be determined.
- assumes that knowledge is maximized when the
distance between the inquirer and those under study is
minimized.
- Findings from a constructivist inquiry are the product of
the interaction between the inquirer and the
participants.
G. Paradigms and Methods: Quantitative and
Qualitative Research
● Research methods- are the techniques researchers
use to structure a study and to gather and analyze
information relevant to the research question. The two
alternative paradigms correspond to different methods
for developing evidence
● QUANTITATIVE RESEARCH is most closely allied with
positivism
● QUALITATIVE RESEARCH is associated with
constructivist inquiry—although positivists sometimes
undertake qualitative studies, and constructivist
researchers sometimes collect quantitative information
The Scientific Method and Quantitative
Research
● scientific method- refers to a set of orderly,
disciplined procedures used to acquire information.
● Quantitative researchers use deductive reasoning
to generate predictions that are tested in the real
world.
● They typically move in a systematic fashion.
● Systematic-- we mean that the investigator
progresses logically through a series of steps,
according to a specified plan of action.
● plan of action. Quantitative researchers use various
control strategies.
● Control- involves imposing conditions on the
research situation so that biases are minimized and
precision and validity are maximized.
● Quantitative researchers gather empirical evidence
● Empirical evidence- —evidence that is rooted in
objective reality and gathered through the senses.
● Empirical evidence consists of observations
gathered through sight, hearing, taste, touch, or
smell.
● Evidence for a study in the positivist paradigm is
gathered according to an established plan, using
structured methods to collect needed information.
● quantitative— numeric information that is
obtained from a formal measurement and is
analyzed statistically.
● generalizability - The degree to which research
findings can be generalized to individuals other
than those who participated in the study
 ● One important limitation—common to both quantitative
and qualitative research—is that research cannot be used
to answer moral or ethical questions.
● The traditional research approach also must contend
with problems of measurement.
● nursing research focuses on humans, who are inherently
complex and diverse
● nursing research focuses on humans, who are inherently
complex and diverse
● Traditional quantitative methods typically concentrate on
a relatively small portion of the human experience (e.g.,
weight gain, depression) in a single study
● quantitative research within the positivist paradigm has
been accused of an inflexibility of vision that does not
capture the full breadth of human experience.
Constructivist Methods and Qualitative Research
● Researchers in constructivist traditions emphasize the
inherent complexity of humans, their ability to shape and
create their own experiences, and the idea that truth is
a composite of realities.
● constructivist studies are heavily focused on
understanding the human experience as it is lived,
usually through the careful collection and analysis of
qualitative materials that are narrative and subjective
● reductionist—it reduces human experience to the few
concepts under investigation, and those concepts are
defined in advance by the researcher rather than
emerging from the experiences of those under study.
● Constructivist researchers tend to emphasize the
dynamic, holistic, and individual aspects of human life
and attempt to capture those aspects in their entirety,
within the context of those who are experiencing them.
● Constructivist inquiry usually takes place in the field (i.e.,
in naturalistic settings), often over an extended time
period.
● the collection of information and its analysis typically
progress concurrently;
● Through an inductive process, researchers integrate
information to develop a theory or description that helps
illuminate the phenomenon under observation.
● Findings from in-depth qualitative research are typically
grounded in the real-life experiences of people with first-
hand knowledge of a phenomenon.
● LIMITATION: Human beings are used directly as the
instrument through which information is gathered, and
humans are extremely intelligent and sensitive—but
fallible—tools.
● LIMITATION: the subjectivity of constructivist inquiry,
which sometimes raises concerns about the idiosyncratic
nature of the conclusions.
COMMON FEATURES OF THE TWO PARADIGM:
● Ultimate goals
● External evidence
● Reliance on human cooperation
● Ethical constraints
● Fallibility of disciplined research
H. MAJOR CLASSES OF QUANTITATIVE AND
QUALITATIVE RESEARCH
Quantitative Research: Experimental and
Nonexperimental Studies
● Experimental- researchers actively introduce an
intervention or treatment.
● Non- experimental- researchers are bystanders—
they collect data without intervening
● Clinical trial- experimental study
● Observational study- non-experimental inquiry
Qualitative Research: Disciplinary Traditions
● The majority of qualitative studies can best be
described as qualitative descriptive research.
● are rooted in research traditions that originated
in anthropology, sociology, and psychology
● grounded theory tradition
➢ roots in sociology, seeks to describe
and understand the key social
psychological processes that occur in a
social setting.
➢ Glaser and Strauss (1967)
➢ focus of most grounded theory studies
is on a developing social experience—
the social and psychological stages and
phases that characterize a particular
event or episode
➢ major component of grounded theory
is the discovery of a core variable that
is central in explaining what is going on
in that social scene.
➢ Grounded theory researchers strive to
generate explanations of phenomena
that are grounded in reality.
● Phenomenology
➢ rooted in a philosophical tradition
➢ Husserl and Heidegger
➢ is concerned with the lived
experiences of humans.
➢ an approach to thinking about what
life experiences of people are like
and what they mean.
➢ What is the essence of this
phenomenon as experienced by
these people? Or, what is the
meaning of the phenomenon to
those who experience it?
● Ethnography
➢ primary research tradition within
anthropology, and provides a
framework for studying the lifeways
and experiences of a defined cultural
group.
➢ typically engage in extensive
fieldwork, often participating in the
life of the culture under study
➢ in some cases concerned with
broadly defined cultures
➢ sometimes focuses on more narrowly
defined cultures
➢ Ethnographers strive to learn from
members of a cultural group, to
understand their world view, and to
describe their customs and norms
SUMMARY POINTS:
● Nursing research is systematic inquiry to develop
knowledge about issues of importance to nurses. Nurses
are adopting an evidence-based practice (EBP) that
incorporates research findings into their clinical decisions.
● Knowledge of nursing research enhances the professional
practice of both consumers of research (who read and
evaluate studies) and producers of research (who design
and undertake studies).
● Nursing research began with Florence Nightingale but
developed slowly until its rapid acceleration in the 1950s.
Since the 1970s, nursing research has focused on
problems relating to clinical practice.
● The National Institute of Nursing Research (NINR),
established at the U.S. National Institutes of Health in 1993,
affirms the stature of nursing research in the United States.
● Contemporary emphases in nursing research include EBP
projects, replications of research, research integration
through systematic reviews, multisite and interdisciplinary
studies, expanded dissemination efforts, and increased focus
on health disparities.
● Disciplined research is considered a better evidence source
for nursing practice than other sources such as tradition,
authority, personal experience, trial and error, intuition, and
logical reasoning.
● Nursing research usually is conducted within one of two
broad paradigms, which are world views with underlying
assumptions about the complexities of reality: the positivist
paradigm and the constructivist paradigm.
● In the positivist paradigm, it is assumed that there is an
objective reality and that natural phenomena are regular and
orderly. The related assumption of determinism is the belief
that phenomena are not haphazard and result from prior
causes.
● In the constructivist (naturalistic) paradigm, it is assumed
that reality is not fixed, but is rather a construction of human
minds; thus, “truth” is a composite of multiple constructions
of reality.
● The positivist paradigm is associated with quantitative
research—the collection and analysis of numeric information.
Quantitative research is typically conducted within the
traditional scientific method, which is a systematic, controlled
process. Quantitative researchers gather and analyze
empirical evidence (evidence collected through the human
senses) and strive for generalizability of their findings beyond
the study setting.
● Researchers within the constructivist paradigm emphasize
understanding the human experience as it is lived through
the collection and analysis of subjective, narrative materials
using flexible procedures that evolve in the field; this
paradigm is associated with qualitative research.
● Basic research is designed to extend the base of information
for the sake of knowledge. Applied research focuses on
discovering solutions to immediate problems.
● A fundamental distinction, especially relevant in quantitative
research, is between studies whose primary intent is to
describe phenomena and those that are cause-probing—that
is, designed to illuminate underlying causes of phenomena.
Specific purposes on the description/explanation continuum
include identification, description, exploration,
prediction/control, and explanation.
● Many nursing studies can also be classified in terms of a key
EBP aim: treatment/therapy/ intervention; diagnosis and
assessment; prognosis; harm and etiology; and meaning and
process.
2. Evidenced-Based Practice
A. Definition
- According to pioneer David Sackett, evidence based
practice “is the integration of best research evidence with
clinical expertise and patient values”
- Sigma Theta Tau International: “The process of shared
decision making between practitioner, patient, and
others significant to them based on research evidence,
the patient’s experiences and preferences, clinical
expertise or know-how, and other available robust
sources of information.” A key ingredient in EBP is the
effort to personalize “best evidence” to a specific
patient’s needs within a particular clinical context.
- A basic feature of EBP as a clinical problem solving
strategy is that it de-emphasizes decisions based on
custom, authority, or ritual.
- The emphasis is on identifying the best available
research evidence and integrating it with other factors.
- Because research evidence can provide invaluable
insights about human health and illness, nurses must
be lifelong learners who have the skills to search for,
understand, and evaluate new information about
patient care—as well as the capacity to adapt to
change.
- is the conscientious integration of current best
evidence with clinical expertise and patient preferences
in making clinical decisions; it is a clinical problem
solving strategy that de-emphasizes decision making
based on custom.
B. EBP in Nursing
ADVOCATES/ SUPPORTERS POV:
● Supporters argue that EBP offers a solution to
improving health care quality in cost-constrained
environments.
● EBP is viewed as a rational approach to providing
the best possible care with the most cost-effective
use of resources.
● Advocates also note that EBP provides a framework
for self-directed lifelong learning that is essential in
an era of rapid clinical advances and the
information explosion.
CRITICS POV:
● Critics worry that the advantages of EBP are
exaggerated and that individual clinical judgments
and patient inputs are being devalued.
● They are also concerned that, in the current EBP
environment, insufficient attention is being paid to
the role of qualitative research.
OVERVIEW OF THE EBP MOVEMENT:
● Cochrane Collaboration
- founded in the United Kingdom
- based on the work of British epidemiologist: Archie
Cochrane.
- Cochrane published an influential book in the 1970s that
drew attention to the dearth of solid evidence about the
effects of health care. He called for efforts to make
research summaries of clinical trials available to health
care providers. This eventually led to the development of
the Cochrane Center in Oxford in 1993, and an
international partnership called the Cochrane
Collaboration, with centers established in over a dozen
locations throughout the world.
- AIM: to help providers make good decisions about
health care by preparing and disseminating systematic
reviews of the effects of health care interventions.
- The Cochrane Collaboration got under way, a group from
McMaster Medical School in Canada (including Dr. David
Sackett) developed a clinical learning strategy they called
evidence-based medicine.
● EBP is considered a major shift for health care education
and practice.
● In the EBP environment, a skillful clinician can no longer
rely on a repository of memorized information, but rather
must be adept in accessing, evaluating, and using new
evidence that emerges in systematic research.
Research Utilization and EBP
● Research utilization (RU)- is the use of findings from a
study or set of studies in a practical application that is unrelated
to the original research.
● In RU, the emphasis is on translating new knowledge into real-
world applications.
● EBP is broader than RU because it incorporates research
findings with other factors, as just noted.
● RU begins with the research itself (how can I put this new
knowledge to good use in my clinical setting?), the start-point
in EBP is a clinical question (what does the evidence say is the
best approach to solving this clinical problem?).
SUMMARY POINTS:
● Research utilization (RU) and EBP are overlapping concepts
that concern efforts to use research as a basis for clinical
decisions, but RU starts with a research-based innovation that
gets evaluated for possible use in practice.
● • Evidence-based clinical practice guidelines combine a
synthesis and appraisal of research evidence with specific
recommendations for clinical decision making. Clinical practice
guidelines should be carefully and systematically appraised, for
example using the Appraisal of Guidelines Research and
Evaluation (AGREE) instrument
● Resources to support EBP are growing at a phenomenal pace.
Among the resources are systematic reviews (and electronic
databases that make them easy to locate); evidence-based
clinical practice guidelines, care bundles, and other decision
support tools; a wealth of other preappraised evidence that
makes it possible to practice EBP efficiently; and models of EBP
that provide a framework for undertaking EBP efforts.
● For individual-level EBP efforts, the major steps in EBP include
the following:
1. Asking clinical questions that can be answered with
research evidence
2. Searching for and retrieving relevant evidence
3. Appraising and synthesizing the evidence
4. Integrating the evidence with your own clinical
expertise, patient preferences, and local context
5. Assessing the effectiveness of the decision,
intervention, or advice
3. Key Concepts in Research
A. Faces and Places
FACES
- Studies with humans involve two sets of people: those
who do the research and those who provide the
information.
- Subjects or study participants = people being studied
(quantitative)
- Informants, key informants or study participants = people
being studied (qualitative)
- Both in qualitative and quantitative studies, study
participants comprise the sample.
- Researcher or investigator = person who conducts a
study
- principal investigator (PI) = the person directing the study
when study is done by team.
- Co-investigator = two or three researchers collaborating
equally
- Reviewers = called to critique a study and offer feedback
- Peer reviewers = Reviewers that are at a similar level of
experience to the researchers
PLACES
- Settings = specific places where info is gathered
- Naturalistic settings = people’s homes (ex)
- Laboratory settings
- Researchers make decisions about where to conduct a
study based on the nature of the research question and
type of information needed.
- Qualitative researchers = likely to engage in
fieldwork and natural settings.
- Site = overall location for the research
- Multisite studies = use of multiple sites (larger and
more diverse samples)
B. Building Blocks
Phenomena, Concepts, and Constructs
- Concepts = abstractions of particular aspects of
human behavior and characteristics. (phenomena
in qualitative research)
- Construct = an abstraction inferred from situations
or behaviors.
Theories and Conceptual Models
- Theory = systematic, abstract explanation of some
aspect of reality.
- Quantitative researchers may start with a theory,
framework, or conceptual model. Based on theory,
they make predictions about how phenomena will
behave in the real world if the theory is true.
Specific predictions deduced from theory are tested
through research; results are used to support,
reject or modify the theory.
- In qualitative research, theories may be used in
various ways. Sometimes conceptual or sensitizing
frameworks, derived from qualitative research
traditions.
Variables
- Variables = concepts in quantitative studies
- A variable is something that varies. (ex. Weight
anxiety, blood pressure)
- Heterogenous = when an attribute is extremely
varied in group under study
- Homogenous = If the amount of variable is limited
- Continuous variables = have values along a
continuum and can assume an infinite number of
values between two points.
- Discrete variable = finite number of values between
any two points representing discrete quantities.
- Categorical variable = Variables that take on a
handful of discrete nonquantitative values.
- Dichotomous variables = when categorical
variables take on only two values.
- Dependent variable = presumed effect
- Independent variable = presumed cause
- Outcome variable = capturing the outcome of
interest in lieu of dependent variable.
- Conceptual definition = presents the abstract or
theoretical meaning of the concepts being studied.
- Operational definition = concept specifies the
operations
Data
- Data = pieces of info obtained in a study.
- Quantitative data = data in numeric form
C. Relationships
- Relationship = bond or connection between
phenomena.
- Cause and effect (casual) relationship
- Functional (associative) relationship
4. Phases of Research
A. Conceptualization Phase
- include reading, conceptualizing, theorizing, and
reviewing ideas with colleagues or advisers. During
this phase, researchers call on such skills as
creativity, deductive reasoning, and a firm
grounding in previous research on the topic of
interest.
B. Design and Planning Phase
- researchers make decisions about the methods they will use
to address the research question.
- usually have considerable flexibility in designing a study, and
they make many decisions.
- These methodologic decisions have crucial implications for
the integrity of the resulting evidence.
- If the methods used to collect and analyze research data are
flawed, then the evidence from the study may have little
value.
C. Empirical Phase
- studies involves collecting data and preparing the data for
analysis. Often, the empirical phase is the most time
consuming part of the investigation. Data collection typically
requires many weeks, or even months of work.
D. Analytic Phase
- Quantitative data are not reported in raw form (i.e., as a mass
of numbers). They are subjected to analysis and
interpretation, which occurs in the fourth major phase of a
project.
E. Dissemination Phase
- the researcher comes full circle
- questions posed at the outset are answered. Researchers’
responsibilities are not completed, however, until study
results are disseminated.
- In Australia, three nursing organizations collaborated
to develop the Code of Ethics for Nurses in Australia
(2008).
B. Government Regulations
- National Health and Medical Research Council issued
the National Statement on Ethical Conduct in
Research Involving Humans in 2007 and also
issued a special statement about incentive payments
to study participants in 2009.
- In the United States, the National Commission for the
Protection of Human Subjects of Biomedical and
Behavioral Research adopted a code of ethics in 1978.
(established by the National Research Act), issued the
Belmont Report, which provided a model for many
disciplinary guidelines.
- served as the basis for regulations affecting
research sponsored by the U.S. government,
including studies supported by NINR
- The U.S. Department of Health and Human Services
(DHHS): Title 45 Part 46 of the Code of Federal
Regulations (45 CFR 46).
- These regulations, revised most recently in
2005, are among the most widely used
guidelines in the United States for evaluating
the ethical aspects of studies.

C.
5. Ethical Guidelines in Research
A. Codes of Ethics
- The Nuremberg Code : developed after Nazi atrocities
were made public in the Nuremberg trials, was an
international effort to establish ethical standards.
- The Declaration of Helsinki, another international set
of standards, was adopted in 1964 by the World
Medical Association and was most recently revised in
2008.
A.1. the American Nurses Association(ANA) issued
Ethical Guidelines in the Conduct, Dissemination, and
implementation of Nursing Research (Silva, 1995).
The International Council of Nurses (ICN)updated in 2006
- ANA also published in 2001 a revised Code of Ethics for
Nurses with Interpretive Statements, a document that
covers primarily ethical issues for practicing nurses but that
also includes principles that apply to nurse researchers.
- In Canada, the Canadian Nurses Association published a
document entitled Ethical Research Guidelines for
Registered Nurses in 2002.
Ethical Principles
- The Belmont Report articulated three broad
principles on which standards of ethical conduct in
research are based: beneficence, respect for human
dignity, and justice.
Beneficence - imposes a duty on researchers
to minimize harm and maximize benefits.
Human research should be intended to produce
benefits for participants or—a situation that is
more common—for others.
1. The Right to Freedom from Harm and Discomfort -
Researchers have an obligation to avoid, prevent, or
minimize harm (nonmaleficence) in studies with
humans . Ethical researchers must use strategies to
minimize all types of harms and discomforts, even ones
that are temporary.
2. The Right to Protection from Exploitation - Involvement
in a study should not place participants at a
disadvantage or expose them to damages. Participants
need to be assured that their participation, or
information they might provide, will not be used
against them.
Respect for Human Dignity
1. The Right to Self-Determination - Humans should be
treated as autonomous agents, capable of controlling
their actions. Self-determination means that
prospective participants can voluntarily decide whether
to take part in a study, without risk of prejudicial
treatment. It also means that people have the right to
ask questions, to refuse to give information, and to
withdraw from the study.
a. A person’s right to self-determination includes
freedom from coercion, which involves
threats of penalty from failing to participate in
a study or excessive rewards from agreeing
to participate.
2. The Right to Full Disclosure - People’s right to make
informed, voluntary decisions about study participation
requires full disclosure.
- Full disclosure means that the researcher has fully
described the nature of the study, the person’s right to
 refuse participation, the researcher’s responsibilities, and the group not receiving the drug may be denied a
likely risks and benefits beneficial treatment.
a. covert data collection (concealment), which - Another dilemma can ariseif nurse researchers are
is the collection of data without participants’ confronted with conflict-of interest situations, in which
knowledge and consent. their expected behavior as researchers conflicts with
i. In some cases be acceptable if risks are their expected behavior as nurses (e.g., deviating from
negligible and participants’ right to a research protocol to give assistance to a patient).
privacy has not been violated.
ii. Covert data collection is least likely to be
ethically tolerable if the study is focused
on sensitive aspects of people’s behavior,
such as drug use or sexual conduct.
b. Deception which involves deliberately
withholding information about the study or
providing participants with false information.

Justice
1. The Right to Fair Treatment - Participant selection should
be based on study requirements and not on a group’s
vulnerability.
a. The principle of justice imposes particular
obligations toward individuals who are unable to
protect their own interests (e.g., dying patients)
to ensure that they are not exploited.
2. The Right to Privacy - Researchers should ensure that their
research is not more intrusive than it needs to be and that
participants’ privacy is maintained continuously.
Participants have the right to expect that their data will be
kept in strictest confidence.
a. Health Insurance Portability and Accountability Act
of 1996 (HIPAA), which articulates federal
standards to protect patients’ health information
b. the U.S. Department of Health and Human
Services issued the regulations Standards for
Privacy of Individually Identifiable Health
Information.
c. Most healthcare providers who transmit health
information electronically, compliance with these
regulations, known as the Privacy Rule, was
required as of April 14, 2003.

6. Research Misconduct
 Research question: Are nurses equally empathy in their
treatment of male and female patients in the ICU?
Ethical dilemma: Ethics requires that participants be
aware of their role in a study. Yet if the researcher
informs nurse participants that their empathy in
treating male and female ICU patients will be
scrutinized, will their behavior be “normal?” If the
nurses’ usual behavior is altered because of the known
presence of research observers, then the findings will
be inaccurate.
 Research question: What are the coping mechanisms
of parents whose children have a terminal illness?
Ethical dilemma: To answer this question, the
researcher may need to probe into the psychological
state of parents at a vulnerable time; such probing
could be painful or traumatic. Yet knowledge of the
parents’ coping mechanism might help to design
effective interventions for dealing with parents’ grief
and stress.
 Research question: Does a new medication prolong life
in patients with cancer?
Ethical dilemma: The best way to test the effectiveness
of an intervention is to administer the intervention to
some participants but withhold it from others to see if
difference between the groups emerge. However, if the
intervention is untested (e.g., a new drug), the group
receiving the intervention may be exposed to
potentially hazardous side effects. On the other hand,
PRE-RECORDED OF SIR GAVIOL AND MDM TIONGCO
RESEARCH REVIEW RELEVANT VIDEOS
● Research - is an inquiry that may be applied to all field of
practice
- It is a systematic inquiry that uses disciplined
method to answer questions and solve problems
- With the disciplined method it may incorporate
quantitative or qualitative approaches to be
discussed later on
- Academe, evaluating research tool, developing
new methods for research
➔ SIR GAVIOLA EXPLANATION:
- When we move to the paradigm of nursing
research that is now the application of research
discipline principle strategy in the field of practice
of nursing focusing on researches that caters
through the individual responses either the
individual, family, population and community in
general so we can have those areas of practice
either quantitative or qualitative
● Nursing Research - is a systematic inquiry designed to
develop trustworthy evidence about issues of importance to
the nursing profession, including nursing practice,
education, administration and informatics.
IMPORTANCE OF NURSING RESEARCH
★ Research findings from rigorous studies provide strong
evidence for informing nurses’ decisions and actions
➔ SIR GAVIOLA EXPLANATION:
- In your nursing informatics our accusation of
data information and knowledge leads to the
development of wisdom
★ Research plays an important role in nursing terms of
credentialing and status it helps the practice in nursing not
only those who are doing researches but nurses in general
to elevate their credential and profession to the ladder of
professionalism to achieve magnet status, administration
needs to create, foster and sustain an environment where
research is integrated in the delivery of nursing care.
➔ SIR GAVIOLA EXPLANATION:
- FYI, when you have come to hear that
principals have may be doctor of philosophy
of education or doctor of education, so there
is a distinction there between the two
professional achievements that they have
reached and it applies in the practice in
nursing as we have philosophy base, doctor
degree and we also have the professional
doctorate degree.
- In CDU, we have the philosophy base PHD
and that is your doctor of philosophy in
nursing science and gears nurses of higher
professional credentials to engage in
developing knowledge
Fundamental Concepts and Terms
● The RESEARCHER conducts the RESEARCH, while
INVESTIGATOR STUDY INVESTIGATION
● The STUDY PARTICIPANTS provides the data and they
may be called depending on the approach used in research:
○ SUBJECTS - for elemental
○ INFORMANT/KEY INFORMANT - for
qualitative researches
○ RESPONDENTS - quantitative researches in
general
○ POPULATION/SAMPLE
● Research can be undertaken in a NATURALISTIC or
LABORATORY setting
○ Naturalistic setting is mostly applied in the
qualitative approach that the researcher allows the
phenomenon to happen in a natural setting,
maybe in a community or in an organization, or
care facility
○ Laboratory setting most of the researchers are
experimental as it is controlled, it is concurrent
with the design of the study being conducted
● Research data are pieces of information obtained in a study.
○ QUANTITATIVE data is numeric, it provides us
numbers and we are the ones who will interpret
those numbers
○ QUALITATIVE data is narrative, wherein its an
experience field narrative with an observation field
narrative, that's why the composition of the
findings in qualitative researches are more on
narrative, description, and interpretation about a
phenomena
● Nurse researchers study about particular aspects of human
behavior, characteristics or experience which are referred
to as:
○ CONCEPTS
○ CONSTRUCTS
○ PHENOMENON
● Concepts in quantitative studies are referred to as
VARIABLES.
○ Ex. studying on the attitude, willingness, the
knowledge, the compliance, the practice, self-
determination, those may be aspects of study or
what you call variables
FUNDAMENTAL CONCEPTS AND TERMS
- Variables should be conceptually and operationally defined to
be measurable.
A. Conceptual Definition- presents the theoretical meaning
of concepts. Ex. pain
B. Operational Definition- presents the operations used to
measure it.
ex. Identify the conceptual and operational definition/s of
anxiety.
ANXIETY
1. “...feelings of apprehension, tension, nervousness, and
worry as measured by the State of Anxiety scale.
Operational Definition: that is how the term anxiety is used
in this particular study based on the state anxiety scale.
2. “..physiologic manifestations of uneasiness as measured by
the palmar sweat index…”
Operational Definition: Because it is being defined by the
tool.
3. “...a feeling of worry, nervousness, or unease, typically
about an imminent event or something with an uncertain
outcome..”
Defined because of the established theories and models of
anxiety of the theorist.
Classification of variable
According to type of data:
1. Categorical- categorizes the different data when it comes
from the qualitative
2. Discrete
3. Continuous
According to degree of variability: ● Minimize bias, maximize precision and validity
1. Homogeneous
2. Heterogenous 4. EMPIRICAL
● Objectivity in data collection
According to relationship:
5. GENERALIZATION
● Relate research findings to the general population
According to relationship:
● That is why most quantitative researches requires
a huge number of samples coming from a
Associative Casual population group

1. Independent “antecedent” “cause” 6. QUANTITATIVE DATA

● Numeric, formal measurements, statistical
2. Dependent “effect”
analysis

3. Extraneous External factors Side Discussion:

APPLIED AND BASIC RESEARCH
Basic Research
- Extends the basic knowledge in a discipline
- discovers general principles of behavior and processes
- no explicit direction application
- There is no application of knowledge but rather you may be
describing a certain phenomena, you may be establishing a
relationship on that one but that does not imply you are
developing solutions for that particular problem.
Applied Research
- Seeks solutions to existing problems
- Greater immediate utilization for evidence-based practice.
Time stamp: 15-20 minutes (BRIGOLE)
Applied Research
- seeks solution to existing problems especially when we
implore experimental methods
- Greater immediate utilization for evidence-based practice
● Categorical data is not directly associated with qualitative
research because sometimes we use the categorical
variables in our variables in quantitative research like
gender. We should not assign them with a number so that
they can be computed statistically. That is what it speaks,
that is, it uses quantitative data meaning it should be
numeric, there is formal measurement and statistical
analysis.
● There is no question with interval and ratio because those
are true values of numbers but on qualitative types of data
like gender, religion, order of birth, we should be able to
quantify them for them to be computed later on.
● Nominal Data: doesn't follow chronology (ex: variables such
as gender and religion)
● Ordinal Data: it follows order (ex: such as order of the child,
groupings, honor sequence)
● Discrete Data: talks about something that can be measured
(ex: probability test such as number of coin flips)
● Continuous Data: Cannot be counted but can be measured
by a certain tool
● Interval Data: those that don't have a true value in them
(ex: temperature)
● Interval Ratio: has an absolute zero value (ex: 0 weight, 0
height)

CHARACTERISTICS OF QUALITATIVE RESEARCH

RESEARCH PARADIGMS
1. INDUCTIVE REASONING
- “Construct” ● Develop a general theory from specific data
- How do you see the world? ● Inductive as you start with nothing
- What is the nature of reality?
2. IMMERSION
POSITIVIST CONSTRUCTIVIST ● Experiential, contextual data collection

● Nature is ordered ● “Naturalist”

3. EMERGENT
and regular ● Reality is mentally
● Reality exists constructed and ● Flexible, evolving procedures
independent of subjective with multiple
human interpretations 4. NATURALISTIC SETTING
consciousness ● Most likely anchored on ● Field work
● Most likely anchored qualitative research ● You don’t apply measures of control
on quantitative ● You want to have a natural phenomena occurring
research

5. QUALITATIVE DATA
QUANTITATIVE AND QUALITATIVE RESEARCH ● narrative , subjective
● Non-numeric (gender, beauty, etc.)
CHARACTERISTICS OF QUANTITATIVE RESEARCH
PHASES OF NURSING RESEARCH
1. DEDUCTIVE REASONING
● Develop specific predictions from general Phase 1: Conceptual Phase
principles 1. Formulation and delimiting the problem
2. Reviewing the related literature
2. SYSTEMATIC 3. Undertaking clinical fieldwork
● Logical series of steps according to plan of action ● To acquire experience of that particular subject
you are focusing
3. CONTROL 4. Defining the framework and definitions
5. Formulating hypothesis
● Some parts here don’t apply for qualitative research like
developing a hypothesis because you don’t don't
hypothesize and you don't predict something to establish a
relationship or an effect because you are allowing the
natural phenomena.
● If you do it in qualitative research, that may be a form of
bias that may affect the findings and analysis that you will
be making later on.
Phase 2: Design and Planning Phase
1. Selecting the research design
● What is the appropriate research design based on
how the variables are being measured and what
kind of output will you be looking for
2. Developing intervention protocols
3. Identifying the population
4. Designing the sampling plan
5. Specifying methods to measure variables
6. Procedures to safeguard participants
7. Finalizing the research plan
Phase 3: Empirical Phase
1. Collecting the data
2. Preparing the data for analysis
Phase 4: Analytic Phase
1. Analyzing the data
2. Interpreting the results
Phase 5: Dissemination Phase
1. Communicating the findings
2. Utilizing the findings in Practice
- These are the phases of qualitative research
- The planning phase of the study wherein we have to
identify the research plot problem . If its phenomenology,
what is the phenomenon? To describe if its hemeneutics .
If its ethnography, what culture do we understand?
- We develop a literature review and develop an overall
approach selecting and gaining entry into research sites by
establishing rapport and develop of safeguard to
participants.
- Next is to develop data collection strategies decides what
type of data to gather and how to gather them.
Verbalization=interview/ group discussion
- To decide from whom to collect the data = from entire
population? Is it from specific population? And decide how
to enhance trustworthiness
- Gathering and analysis of data - organize, analyze and
evaluate data. Determine the saturation, and if u are not
satisfied with the saturation of the data
- Last phase will be disseminating of findings and conclusion
thus communicating the findings and utilizing findings in
practice and for future research
Triad of Evidence-Based Practice
- Best Scientific Evidence
- Clinical Experience
- Client Preferences
Ex. tepid spongebath is proven by research
Application of EBP
- DOH embarked on Essential Newborn Care (program that
addresses neonatal deaths in country).
- This program is an evidence-based strategic intervention
aimed at improving newborn care and helping cub neonatal
mortality.
Ethical Transgressions from the Past:
- Nazi Medical Experiments (1933-1945)
- Tuskegee Syphilis Study (1932-1972)
- Willowbrook Study (1960’s)
- Jewish Chronic Disease Hospital Study (1960’s)
CODE OF ETHICS
Code of Ethics are made to establish ethical standards and
prevent human rights violation
The Belmont Report based on the US National Research Act
in 1978, provided a model for many disciplinary guidelines
- all of our ethics proceedings are based on this report
The ICN Code of Ethics for Nurses was developed by the
International Council of Nurses (ICN)
ICN CODE OF ETHICS FOR NURSES
- An international code of ethics for nurses adopted by the
International Council of Nurses in 1953
- Latest review and revision completed in 2012
Principal Elements of the ICN Code of Ethics for Nurses
1. Nurses and people
2. Nurses and practice
3. Nurses and the profession
4. Nurses and co-workers
- All of these covers ethical practices
Government and Institutional Ethics Guidelines
Philippine Health Research Ethics Board (PHREB)
- Created by the DOST (Department of Science and
Technology) Special Order No. 091 of 2006
- Objective: ensure adherence to the universal principles for
the protection of human participants in research
National Governance Structure for Ethics Review
Institutional Review Board (IRB)
- Sometimes called human subject committees, ethical
advisory boards, research ethics committees,
research ethics boards
- Provide guidelines for treatment of human participants
- Ensure that proposed plants meet requirements for ethical
research
Informed Consent
- Ensure that participants know the full nature of the study
and are given the option to withdraw or participate
voluntarily
Components of Informed Consent: B. Respect for Human Dignity
1. Self-determination
1. Participant status - Voluntary participation
2. Study goals - Absence of coercion or threats
3. Type of data
4. Procedures 2. Full Disclosure
5. Nature of commitment - Describe the full nature of the study
6. Sponsorship
7. Participant selection C. Justice
8. Potential risks 1. Fair treatment
9. Potential benefits - Equal distribution of benefits and burdens
10. Alternatives - Honor all agreements made with participants
11. Compensation
12. Confidentiality pledge 2. Privacy
13. Voluntary consent - Keep data confidential
14. Right to withdraw and withhold information - Protect participants’ health information
15. Contact information
RESEARCH MISCONDUCTS
Sample: Informed Consent Form (Polit & Beck, 2012) “... fabrication, falsification or plagiarism in proposing,
performing, or reviewing research, or in reporting research
results...” U.S Public HEalth Service Regulation (2005)

Fabrication- making up data or study results (should be

supported with evidence)
Falsification- manipulating research materials, equipment,
processes or data
Plagiarism- appropriation of someone’s ideas without due
credit (tantamount to stealing)
- Cite the authors properly !!!!

Sample: Informed Consent Form (Burns & Grove, 2001) CDUCN CORE VALUES

How do you apply the CDU-CN core values as a

researcher?

Compassionate and Courtesy (Good Manners)

Dedication and Discipline (Sense of Responsibility)
Uprightness (Personal and Professional Integrity)
Competence and Commitment (To God through Man)
Neatness

PRE-RECORDED VIDEO PART 2

PROTECTING STUDY PARTICIPANTS Why is it necessary to have ethics in research?

Anonymity
- Research data should not be linked in the participants
- Using codes in manuscript
Ex: assign identification number to each participant and use it
instead of their names when filling up questionnaires
Confidentiality
- Avoid reporting results in public using personal identifies
- Report them through decoy names or general population
- - restrict data access to authorized individuals
- “We can’t simply do our science and not worry about
the ethical issues”
- They should go hand-in-hand most especially when
humans are involved as participants of the study and
so care must be exercised very well to ensure that their
rights are protected
- However, in the past ethical consideration has not
always been given adequate attention
- In fact, there were many research studies involved with
ethical issues.
- These ethical transgressions paved way to the
formation of what ethics is in research now

ETHICAL PRINCIPLES IN RESEARCH Highly publicized unethical experiments:

1. Nazi Medical Experiments (1933-1945)
A. Beneficence - doing good
1. Freedom from Harm
- Use strategies to avoid, prevent, minimize all types of
harms or discomfort (physical, emotional or financial)
2. Protection from Exploitation
- Adhere to research-participant relationship
- Avoid placing participants to a disadvantageous situations
or damages
- Famous example of disregard of ethical conduct
- Numerous unethical experiments conducted to
produce a population of racially pure Germans
(“good nazis”)
- Issues:
- Selection of subjects was racially biased (unfair
selection)
- It involved the use of prisoners of war and racial
enemies in experiments that tests human
endurance and reaction to untested drugs
 - No opportunity to refuse participation
- Experiments frequently result to permanent
damage or death
2. Tuskegee Syphilis Study (1932-1972)
- Concerned by the US public health service the research
initiated the study of syphilis in black men to determine the
course of action of syphilis
- Issues:
- Participants were not informed about the nature
of the study
- Some were unaware that they were subjects of
the study
- Subject did not receive treatment for syphilis even
after penicillin was determined to be an effective
treatment
- Information about the effective treatment was
withheld from the subjects
3. Willowbrook Study (1960s)
- Dr. Saul Krugman conducted a study on hepatitis at
willowbrook, an institution for mentally retarded children
- Issues:
- Subjects were all children
- Parents were forced to give their permission for
their child to be a subject in the study
- “ the subjects, all children.. Were deliberately
infected the hepatitis virus; early subjects were
fed extracts of stool from infected individuals and
later subjects received injections of more purified
virus preparations”
4. Jewish Chronic-Disease Hospital Study (1960s)
- Conducted by a physician of a cancer institute to determine
the patients’ rejection responses to cancer liver cancer cells
- Issues:
- No informed consent
- Subjects were not informed that injections that
they received were liver cancer cells
- Research project was not reviewed by a research
committee
Code of Ethics
- Are made to establish ethical standards and prevent human
rights violation
Code of Ethics
● The Nuremberg Code
○ Developed after the Nazi atrocities were made
public in the Nuremberg trial.
○ Was an international effort to establish ethical
standards.
● Declaration of Helsinki
○ Another international set of standards
○ Adopted in 1964 by the World American
Association
○ Recently revised in 2008
● American Nurses Association
○ Issued ethical guidelines in the conduct,
dissimenation and implementation of nursing
research
○ Published in 2001 a revised code of ethics for
nurses with interpretative statements
■ A document that covers primarily ethical
issues for practicing nurses
■ Also includes principles that apply to
nurse researchers
● Canadian Nurses Association
○ Published Ethical Research Guidelines for
registered nurses in 2002
ICN Code of Ethics
- Developed by the International Council for Nurses
- updated last 2006
- 4 principal elements that outline the standards of ethical
conduct:
a. Nurses and the people
b. Nurses and practice
c. Nurses and the profession
- Nurse assumes the major role in
determining and implementing
acceptable standards of clinical nursing
practice, management, research and
education
- Nurse is also active in a core research
based professional knowledge that
supports evidence-based practice
d. Nurses and co-workers
2. Government regulations
Governments through the world fund research and
establish rules for adhering to ethical principles.
● Belmont report
○ Based on the US National Research Act in 1978
○ Which provided a model for many disciplinary
guidelines
○ Served as a basis for regulations affecting
research sponsored by the US government
3. Ethical Principles
Belmont report articulated three (3) broad principles on
which standards of ethical conduct in research are based:
1. Beneficence
a. Freedom from Harm
i. Use strategies to avoid, prevent or
minimize all types of harms or discomfort
(physical, emotional or financial)
b. Protection from Exploitation
i. Adhere to research-participant
relationship
ii. Avoid placing participants to a
disadvantageous situations or damages
2. Respect for human dignity
3. Justice
2. RESPECT FOR HUMAN DIGNITY
● SELF-DETERMINATION
- Voluntary participation; participation is voluntary
given
- Humans should be treated as autonomous agents
meaning they are capable of controlling their
action, this means that prospective participants
CAN voluntarily decide if they want to partake or
take part in the research study, they will also have
the right to ask questions, to refuse to give
information, and to withdraw from the study
- Absence of coercion or threats
- Freedom from coercion-- meaning this does not
involve threats of penalty from failing to
participate or excessive reward should not be
given if they agree to participate.
● FULL DISCLOSURE or RIGHT TO FULL DISCLOSURE
- The research has to describe the full nature of the
study which can be articulated in the informed
consent
- Informed consent
- Full disclosure means that the researches have
fully described the nature of the study, the
person’s right to refuse participation, and the
researchers responsibility, and the risk and
benefits of the study.
3. JUSTICE
● Fair treatment
- Equal distribution of benefits and burdens
- Honor all agreements made with participants
- Meaning, the selection of participants should not be
based on study requirements and not on the group’s
vulnerability
- Before, participants selections were involving lower
social standing like for example, the poor people or
prisoners as participants so the principle of justice
imposes a particular obligation towards individuals who
are unable to protect their own interests, and
- This is to ensure that they are not also exploited.
- Fair treatment principle covers issues other than that of
participant selection, the right to fair treatment means
that also the researcher must treat people who decline
to participate in a non-prejudicial manner, and that they
must also honor the agreement made with the
participants.
● Privacy / Right to privacy
- Keep data confidential
- Protect participants’ health information
- Anonymity
- Confidentiality
- Meaning that the researchers should ensure that the
research is not more intrusive than it needs to be, and
that the participants’ privacy is maintained continuously.
- Participants have the right to expect that their data will
be kept in a strictest confidence.
● INSTITUTIONAL REVIEW BOARD
- Most institutional researches are conducted and have
formal committees to review research = human subject
committees, ethical advisory boards or research ethics
committees.
- You have to go through ethics committee before
implementing the study.
- External review
- Provides guidelines for treatment of human participants
- Ensure that proposed plans meent requirements for
ethical research.
● RESEARCH MISCONDUCT
- “ is the fabrication, falsification or plagiarism in
proposing, performing or reviewing research or
interpreting research results.”
- May be due to researcher fraud or interpretation.
- Must have to be committed intentionally and knowingly
or recklessly.
- Fabrication = making up data or study results
- Falsification = manipulating research materials,
equipment, processes or data
- Plagiarism = appropriation of someone’s ideas without
due credit.

PROCEDURES FOR PROTECTING STUDY PARTICIPANTS:

● iNFORMED CONSENT
- Ensure that participants know the full nature of the study
and are given the option to withdraw or participate
voluntarily
- READ FURTHER DAW SA BOOK -.- (Tiongco, 2021)
● DATA SECURITY
- Anonymity
- Confidentiality
- Study participants have the right to expect that data they
provide will be kept in a strict confidence
- Participant’s right to privacy is protected through various
confidentiality procedures, we have:
 Anonymity - should not be linked to participants
(can be done through assigning an identification
number to each participant and use it instead of
their names when they fill up the questionnaires )
 Confidentiality - if there is a need or absence of
anonymity. When anonymity is impossible,
confidentiality procedures need to be implemented.
A promise of confidentiality is a pledge that any
information the participants will provide will not be
publicly reported in a manner that identifies them
and will not be accessible to others.
 Research information should not be shared to
strangers nor with known people to the
participants.