Chapter 1.
Evidence-Based Practice- involve making
INTRODUCING NURSING RESEARCH
FOR EVIDENCE-BASED PRACTICE
NURSING RESEARCH IN PERSPECTIVE
What is Research?
Research involves scientifically studying a
certain issue or topic. According to American
sociologist Earl Robert Babbie, "Research is a
systematic inquiry to describe, explain, predict,
and control the observed phenomenon,". This
may involve the synthesis and analysis of prior to
the extent that leads to original results
(Fleetwood, 2018).
Research is a methodical investigation that
employs disciplined techniques to answer queries
and solve problems. The ultimate purpose of
research is to acquire knowledge that can benefit
numerous individuals (Polit & Beck, 2022).
Re- repeat (to verify) to seek other opinion or (to
validate) to confirm
Search- Look for (answers, truth and knew
knowledge)
Research starts with a problem and ends with
an answer
Nursing Research
Research in the nursing profession is
evidence-based investigation focused on clinical
nursing research, which is research done by
nurses to inform their practice and ultimately
benefit the health and quality of life of their
patients and clients (Polit & Beck, 2022).
Importance of Research to Evidence-Based
Nursing
decisions regarding patient care based on
evidence from research conducted by nurse and
other healthcare professionals. (Polit & Beck,
2022)
Roles of Nurses in Research
Consumers of Nursing Research- who read
research reports to keep up-to-date on findings
that may affect their practice
Producers of Nursing Research-nurses who actively
undertake studies
1. Contribute an idea for a study
2. Gather information from those taking part in the
study
3. Advise clients about participating in a study.
4. Search for research evidence to address a practice
problem.
5. Discuss the implications of a study in a journal
club in your practice setting, which
involves meetings (in groups or online) to
discuss research articles.
Nursing Research : Past and Present
1950s- research by nurses began to accelerate.
Increased numbers of nurses with advanced
degrees, growth in research funding and
establishment of Journal Nursing Research.
1960s- practice oriented research began to emerge
and publication of research journals in some
countries started.
1970s- changes in research emphasis from areas
such as teaching and nurses’ to improve clients care.
Began to utilize research findings in nursing practice,
1986- National Center for Nursing Research (NCNR)
was established at the National Institutes of Health
(NIH) in the US. NCNR purpose is to support
financially research related to patient care.
1990s- birth of several more journal for nurse
researchers.
1993- NCNR was promoted to full institute status the
National Institute of Nursing Research (NINR) was
created were nursing research activities enjoyed by
other health discipline. Funding opportunities for
nursing research also expanded to other countries.
PARADIGMS AND METHODS FOR
NURSING RESEARCH
Paradigms is a worldview, set of assumptions
and perceptual orientation shared by members of
a research community. A general perspective on
the worlds, complexities (Polit & Beck, 2022). It
investigates how knowledge is understood and
studied, and it outlines clearly the objective,
motivation, and anticipated results of the
research. There are variables, arrows showing
their relationship and how to conduct the study.
Characteristics of a Paradigm
1. Presents an overview of set of
assumptions on how your research will
be done.
2. Paradigms is presented in diagram that
presents the model of the study.
3. Examples of Research Paradigm
IPO model (Input, Process, and Output)- utilized to
illustrate the conceptual framework of the
educational research (Isagani, 2020).
The Input variables that causes problem,
phenomenon or transformation
The Process the method bby which the variable
are collected and synthesized
The Output the problem, phenomenon, or
transformation; outcome of variables
IV- DV model (Independent Variable and
Dependent Variable Model)- relationship of 2
variables. Usually use for experimental
research.
Independent Variable- is a variable that is
controlled by a researcher to see if it causes a
change in another variable. (Makakaapekto)
Dependent Variable- variables that is measured
and anticipated to be dependent on the IV.
(Maapektuhan)
Predictor Criterion- assess the influence of variables
in other variables. (Cause of comparative research)
Intervention Model- Intervention or a plan based on
the output / findings of the study.
Proposed Original Model- create your own model.
Research Paradigms is a research methodology,
model, or pattern. It is a set of ideas, beliefs, or
understandings that allow theories and practices
to operate. (Abbadia, 2022)
3 Types of Research Paradigms
1. Positivist Paradigm- use an objective manner
of approach statistically to investigate the
relationships of variables. It is unified can be
measured and understood. (Single
reality).Reality can be measured and known
The Scientific Method and Quantitative
Research
Scientific Method- involves using orderly
procedures to gather primarily quantitative
information. it consists of series of steps
accordingly,
Empirical Evidence- evidence gathered through
senses and not because of personal beliefs. These
evidences were undergone scientific
investigation using instruments to collect the data
needed information.
Quantitative- numeric information that results
from some type of measurement and was
statistically analyzed. It helps to generalized
research findings to individuals who did not take
part in the study (referred to as generalizability).
2. Interpretivism Paradigms – a subjective
manner of approach to investigate the
relationships of variables. There is multiple
realities and these realities need to be
interpreted.
3. Pragmatism Paradigms- reality is constantly
renegotiated and interpreted. In addition, the
realities can be interpreted and measured.
Chapter 2
Understanding Key Concepts and
Steps in Quantitative and Qualitative
Research
THE BUILDING BLOCKS OF RESEARCH
Research, like any discipline, has its own
language its own jargon that can sometimes be
intimidating.
The Faces and Places of Research
In a quantitative study, the people being
studied are called subjects or study
participants. In a qualitative study, the people
cooperating in the study are called study
participants or informants. The person who
conducts the re- search is the researcher or
investigator. Studies are often undertaken by a
research team rather than by a single researcher.
Concepts, Constructs, and Theories
Research addresses real-world
problems, but studies are conceptualized in
abstract terms. For example, pain, fatigue, and
obesity are abstractions of human attributes.
These abstrac tions are called phenomena
(especially in qualitative studies) or concepts.
Researchers sometimes use the term construct,
which also refers to an abstraction, but often
one that is deliberately invented (or
constructed). The terms constract and concept
are sometimes used interchangeably, but a
construct often refers to a more complex
abstraction than a concept.
A theory is an explanation of some
aspect of reality. In a theory, concepts are
knitted together into a coherent system to
describe or explain some aspect of the world.
Variables
In quantitative studies, concepts are
called variables. A variable, as the name
implies, is something that varies. Weight,
anxiety, and nausea are all variables–they vary
from one person to another. Most human
characteristics are variables.
Characteristics of Variables
Variables are often inherent human
traits, such as age or weight, but sometimes
researchers create a variable.
Some variables take on a wide range of values
than can be represented on a continuum (e.g., a
person’s age or weight). Other variables take on
only a few values, sometimes such variables
convey quantitative information (e.g., number
of children), but others simply involve placing
people into categories (eg, blood type A, B, AB,
or O).
Dependent and Independent Variables
Many studies seek to understand causes of
phenomena. Does a nursing intervention cause
improvements in patient outcomes? Does
smoking cause lung cancer? The presumed
cause is the independent variable, and the
presumed effect is the dependent or outcome
variable.
The terms independent variable and dependent
variable also can be used to indicate direction
of influence rather than cause and effect. For
example, suppose we compared levels of
depression among men and women diagnosed
with pancreatic cancer and found men to be
more depressed We could not conclude that
depression was caused by gender.
Conceptual and Operational Definitions
The concepts of interest to researchers are
abstractions, and researchers’ worldview shapes
how those concepts are defined.
conceptual definition is the theoretical
meaning of a concept.
operational definition specifies what the
researchers must do to measure the concept and
collect needed information.
Data
Research data (singular, datum) are the pieces
of information gathered in a study.
The actual values of the study variables
constitute the data.
Quantitative researchers collect primarily
quantitative data—information in numeric
form
In qualitative studies, researchers collect
primarily qualitative data, that is, narrative
descriptions.
Relationships
Researchers usually study phenomena in
relation to other phenomena-they examine
relationships. A relationship is a connection
between phenomena; for example, researchers
repeatedly have found that there is a
relationship between frequency of turning
bedridden patients and the incidence of pressure
ulcers
Variables can be related to one another in
different ways, including cause-and-effect (or
causal) relationships.
Not all relationships can be interpreted as
causal. There is a relationship, for example,
between a person’s pulmonary artery and
tympanic temperatures: People with high
readings on one tend to have high readings on
the other. We cannot say, however, that
pulmonary artery temperature caused tympanic
temperature, or vice versa. This type of
relationship is sometimes referred to as an
associative (or functional) relationship rather
than a causal one.
MAJOR CLASSES OF QUANTITATIVE
AND QUALITATIVE RESEARCH
Quantitative Research: Experimental and
Nonexperimental Studies
A basic distinction in quantitative studies is
between experimental and nonexperimental
research.
In experimental research, researchers actively
introduce an intervention of treatment—usually
to address Therapy questions.
In nonexperimental research, on the other
hand, researchers are bystanders—they collect
data without introducing treatments (most often,
to address Etiology, Prognosis, Diagnosis, or
Description questions).
In medical and epidemiological re- search,
experimental studies usually are called clinical
trials, and nonexperimental inquiries are called
observational studies.
Qualitative Research: Disciplinary
Traditions
The majority of qualitative nursing studies can
best be described as qualitative descriptive
research.
Grounded theory research seeks to describe
and understand key social psychological
processes. Grounded theory was developed in
the 1960s by two sociologists, Glaser and
Strauss (1967). 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.
Phenomenology is concerned with the lived
experiences of humans. Phenomenology is an
approach to thinking about what people’s life
experiences are like and what they mean.
Ethnography, the primary research tradition in
anthropology, provides a frame- work for
studying the patterns and lifeways of a defined
cultural group in a holistic fashion.
MAJOR STEPS IN A QUANTITATIVE
STUDY
In quantitative studies, researchers move from
the beginning point of a study (posing a
question) to the end point (obtaining an answer)
in a reasonably linear sequence of steps that is
broadly similar across studies
• The conceptual phase involves (1)
defining the problem to be studied, (2)
doing a literature review, (3) engaging
in clinical fieldwork for clinical studies,
(4) developing a frame- work and
conceptual definitions, and (5) for-
mulating hypotheses to be tested.
• The planning phase entails (6) selecting
a research design, (7) developing
intervention protocols if the study is
experimental, (8) specifying the
population (the “P” in the PICO format),
(9) developing a sampling plan, (10)
specifying a data collection plan and
methods to measure variables, (11) de-
veloping strategies to safeguard
participants’ rights, and (12) finalizing
the research plan.
• The empirical phase involves (13)
collect ing data and (14) preparing data
for analysis leg. (e.g., coding data)
• The analytic phase involves (15)
performing statistical analyses and (16)
interpreting the results
• The dissemination phase entails (17)
communicating the findings and (18)
promoting the use of the study evidence
in nursing practice.
• The flow of activities in a qualitative
study is flexible and less linear than in a
quantitative study. Qualitative studies
typically involve an emergent design
that evolves during data collection.
• Qualitative researchers begin with a
broad question regarding a phenomenon
of interest, often focusing on a little-
studied aspect. In the early phase of a
qualitative study, researchers select a site
and seek to gain entrée into it, which
typically involves enlisting the
cooperation of gatekeepers within the
site
• Once in the field, qualitative researchers
select informants, collect data, and then
an alyze and interpret them in an iterative
fash ion: experiences during data
 collection help in an ongoing fashion to
shape the design of the study.
• Early analysis in qualitative research
leads to refinements in sampling and data
collection, until saturation (redundancy
of information) is achieved. Analysis
typically involves a search for critical
themes or categories in the data
• Both qualitative and quantitative
researchers disseminate their findings,
most often by publishing their research
reports in professional journals.
CHAPTER 3
Reading and Critically Appraising Research
Articles
TYPES OF RESEARCH REPORTS
• Both qualitative and quantitative
research- ers disseminate their findings,
most often by publishing reports of their
research as journal articles, which
concisely describe what researcher did
and what they found.
Many research articles are structured using the
IMRAD format. This format organize content
into four main sections—Introduction, Method,
Results, and Discussion. The paper starts with a
title and an abstract and concludes with
references.
• Research reports are often difficult to
read because they are dense, concise, and
con- tain jargon. Quantitative research
reports may be intimidating at first
because, com- pared to qualitative
reports, they are more impersonal and
report on statistical tests.
• Statistical tests are used to test
hypotheses and to evaluate the reliability
of the findings. Findings that are
statistically significant have a high
probability of being “real”
• A goal of this book is to help students to
pre- pare critical appraisals of the
strengths and limitations of a study, to
assess the worth of the evidence for
nursing practice.
• Researchers face numerous challenges,
the solutions to which must be appraised
because they affect the inferences that
can be made.
• An inference is a conclusion drawn from
the study evidence, taking into account
the methods used to generate that
evidence. Researchers strive to have their
inferences correspond to the truth.
• Reliability (a key challenge in
quantitative re- search) refers to the
accuracy of information obtained in a
study. Validity broadly concerns the
soundness and rigor of the study’s
methods—that is, whether the evidence is
convincing and well grounded.
• Trustworthiness in qualitative research
en compasses several different
dimensions, including credibility,
dependability, confirm ability,
transferability, and authenticity.
• Credibility is achieved to the extent that
the methods engender confidence in the
truth of the data and in the researchers’
interpretations.
• Triangulation, the use of multiple
sources to draw conclusions about the
truth is one approach to enhancing
credibility.
• A bias Is an influence that produces a
distortion in the study results. In
quantitative studies, research control is an
approach to addressing bias. Research
control is used to hold constant outside
influences on the dependent variable so
that the relationship between the
independent and dependent variables can
be better understood.• Researchers seek
 to control confounding (or extraneous)
variables—variables that are extraneous
to the purpose of a specific study.
• For quantitative researchers,
randomness— having certain features of
the study established by chance—is a
powerful tool to eliminate bias.
• Blinding (or masking) is
sometimes used to avoid biases stemming
from participants’ or research agents’
awareness of study hypotheses or
research status.
• Reflexivity, the process of reflecting
criti- cally on the self and of scrutinizing
personal values that could affect data
collection and interpretation, is an
important tool in qualitative research.
• Generalizability in a quantitative study
concerns the extent to which the findings
can be applied to members of a
population who were not included in the
study sample.
• A similar concept in qualitative studies is
transferability, the extent to which
qualitative findings can be transferred to
other settings. One mechanism for
promoting transferability is a rich and
thorough description of the research
context so that others can make
inferences about contextual similarities.
• of Ethics, published a revised Code of Ethics for
CHAPTER 4
ATTENDING TO ETHICS IN RESEARCH
ETHICS AND RESEARCH
In research with humans or animals, researchers
must take ethical issues into consideration.
Ethical concerns are prominent in nursing
research because the line between what
constitutes the expected practice of nursing and
the collection of research data sometimes gets
blurred.
Historical Background
The Nazi medical experiments of the 1930s and
1940s are the most famous example of recent
disregard for ethical conduct.
The Nazi program of research involved using
prisoners of war and “racial enemies” in medical
experiments. The studies were unethical not only
because they exposed people to harm but also
because subjects could not refuse participation.
Codes of Ethics
In response to human rights violations, various
codes of ethics have been developed. The ethical
standards known as the Nuremberg Code were
developed in 1949 in response to the Nazi
atrocities.
Several other international standards have been
developed, including the Declaration of
Helsinki, which was adopted in 1964 by the
World Medical Association and was most
recently revised in 2013.
In the United States, the American
Nurses Association (ANA) issued Ethical
Guidelines in the Conduct, Dissemination, and
Implementation of Nursing Research in 1995
(Silva, 1995).
The ANA, which declared 2015 the Year
Nurses with Interpretive Statements, a
document that not only covers ethical issues for
practicing nurses primarily but also includes
principles that apply to nurse researchers.
In Canada, the Canadian Nurses
Association published a revised version of Code
of Ethics for Registered Nurses in 2017.
the International Council of Nurses (ICN)
developed the ICN Code of Ethics for Nurses,
updated in 2012 but it is currently being revised.
Government Regulations for Protecting Study
Participants
Governments throughout the world fund research
and establish rules for adhering to ethical
principles.
Ethical Dilemmas in Conducting Research
Research that violates ethical principles typically
occurs because a researcher believes that
knowledge is potentially beneficial in the long
run. For some research problems, participants’
rights and study quality are put in direct conflict,
posing ethical dilemmas for researchers.
ETHICAL PRINCIPLES FOR
PROTECTING STUDY PARTICIPANTS
The Belmont Report articulated three primary
ethical principles on which standards of ethical
research conduct 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—more typically—for others.
This principle covers multiple aspects.
The Right to Freedom From Harm and
Discomfort
Researchers have an obligation to prevent or
minimize harm in studies with humans.
Participants must not be subjected to
unnecessary risks of harm or discomfort, and
their participation in research must be necessary
for achieving societally important aims. Ethical
researchers must use strategies to minimize all
types of harms and discomforts, even temporary
ones.
The Right to Protection From Exploitation
Involvement in a study should not place
participants at a disadvantage. Participants
need to be assured that their participation, or
information they provide, will not be used
against them. For example, people reporting
illegal drug use should not fear being reported for
a crime.
Respect for Human Dignity
Respect for human dignity is the second ethical
principle in the Belmont Report. This principle
includes the right to self-determination and the
right to full disclosure.
The Right to Self-Determination
The principle of self-determination means that
prospective participants have the right to decide
voluntarily whether to participate in a study,
without risk of prejudicial treatment. It also
means that people have the right to ask
questions, refuse answering questions, and
drop out of the study.
A person’s right to self-determination includes
freedom from coercion. Coercion involves
explicit or implicit threats of penalty from failing
to participate in a study or excessive rewards
from agreeing to participate.
The Right to Full Disclosure
Respect for human dignity encompasses people’s
right to make informed decisions about study
participation, which requires full disclosure. Full
disclosure means that the researcher has fully
described the study, the person’s right to refuse
participation, and potential risks and benefits.
In such situations, researchers sometimes
use covert data collection (concealment), which
is collecting data without participants’
knowledge and thus without their consent.
 A more controversial technique is the use
of deception, which can involve deliberately
withholding information about the study, or
providing participants with false information.
For example, in studying high school students’
Justice
The third principle articulated in the Belmont
Report concerns justice, which includes
participants’ right to fair treatment and their right
to privacy.
The Right to Fair Treatment
One aspect of justice concerns the equitable
distribution of benefits and burdens of research.
The selection of participants should be based on
research requirements and not on people’s
vulnerabilities.
The Right to Privacy
Researchers should ensure that their research is
not more intrusive than it needs to be and that
privacy is maintained. Participants have the right
to expect that any data they provide will be kept
in strict confidence. Health Insurance Portability
and Accountability Act of 1996 (HIPAA), which
articulates federal standards to protect patients’
medical records and health information
PROCEDURES FOR PROTECTING
STUDY PARTICIPANTS
• Procedures have been developed to safe
guard study participants’ rights,
including the performance of a
risk/benefit assessment, the
implementation of informed con sent
procedures, and methods to safeguard
participants’ confidentiality.
• In a risk/benefit assessment, the
potential benefits of the study to
individual participants and to society are
weighed against the costs to individuals.
• Informed consent procedures, which
provide prospective participants with
information needed to make a reasoned
decision about participation, normally
involve signing consent form to
document voluntary and in formed
participation.
• Privacy can be maintained through
anonymity (wherein not even
researchers know participants identities)
or through formal confidentiality
procedures that safeguard the
participants’ data.
• Some U.S. researchers obtain a
Certificate of Confidentiality that
protects them against the forced
disclosure of confidential information
through a court order.
• Researchers sometimes offer debriefing
sessions after data collection to provide
participants with more information or an
opportunity to air complaints.
• Vulnerable groups require additional
protection. These people may be
vulnerable be- cause they are not able to
make an informed decision about study
participation (e.g., children), because of
diminished autonomy (e.g., prisoners),
or because their circumstances heighten
the risk of harm (e.g., pregnant women,
the terminally ill).
• External review of the ethical aspects of
a study by a human subjects committee
or Institutional Review Board (IRB) is
highly desirable and is often required by
universities and organizations from
which participants are recruited.