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INTRODUCTION TO RESEARCH
Evolution of Nursing Research
THE HISTORICAL DEVELOPMENT OF NURSING RESEARCH
♦ Florence Nightingale in nursing research is said to be: a reformer, reactionary, and researcher
♦ In the 1960s until the 1970s, the significance of nursing research gradually attained prominence although few nurses had the
capability and educational training to conduct studies.
♦ In the 1980s and 1990s, research was considered .as a major force in the development of a scientific base for nursing practice.
♦ In the 21st century, nursing research gives impetus (forward motion) to the promotion of excellence in nursing science.
Increased focus on outcomes research is taking place. Outcomes research has been designed to assess the effectiveness of
health care service. (Burns and Grove, 1997; Polit and Beck, 2004).
HISTORICAL EVOLUTION OF NURSING RESEARCH
• Florence Nightingale – founder of professional nursing and the first nurse researcher
Researches were focused on:
➢ the importance of a healthy environment
♦ aspects of environment
♦ diet
Result of her research : Decrease in mortality rate within 6 months; used statistics to support her argument for reforms in medical care
in military and civilian hospitals,
NURSING RESEARCH IN 1900 TO 1050
Burns and Grove (1997) reported that following Nightingale's work from 1910, nursing research had minimal attention until the 1950s,
which means that from 1900 to 1950, there were limited research activities.
Incidentally, the first publication of the American Journal of Nursing happened in 1900 and late in the 1920s and 1930s, case studies
reported on in-depth analysis and systematic evaluation of a patient or a group of similar patients to promote awareness of nursing
interventions.
This was the beginning of practice-related research (Burns and Grove, 1997).
In 1940 until 1950, a trend in nursing research started with emphasis on organization and delivery of nursing services.
According to Gortner and Nahm (1977) studies undertaken dealt with:
♦ the number and kinds of nursing personnel
♦ staffing patterns
♦ patient classification system
♦ patient and personnel satisfaction, and
♦ Unit arrangement.
➢ - Studies conducted concerned: nursing education.
♦ Nursing was service oriented in training future nurses rather than education oriented.
♦ Nurse educators had no advanced educational preparation.
Result:
♦ Inadequacies existed in nursing education
♦ Advanced educational preparation was essential.
♦ School of nursing was established at Yale University.
1950's – Increase in nurses with advanced degrees.
♦ Journal of Nursing Research was started.
♦ Research was included in curriculum
Studies from 1940-1950
♦ Resulted into the formulation of Evaluative studies focused on types of care such as:
Comprehensive care
Home care, and
Progressive Patient care
Emergence of Research as a high priority
♦ Research was introduced and the steps of research process at baccalaureate level by nursing schools and increased funding
for research were provided.
♦ Five thousand US dollars was awarded for federal research in 1955 (de Tornyay, 1977).
♦ Prior to this, Nursing Research journal was published in 1952 providing nurses the opportunity for ventilating their findings.
♦ Studies conducted during these two decades dealt with:
nursing education; &
standards for nursing practice
nurses' characteristics; (including nursing students’ characteristics)
staffing patterns, (hospital personnel changes) &
Quality of care.
interaction between a dying patient
NURSING RESEARCH IN 1960
1960's - Introduction of such terms as:
♦ "conceptual framework",
♦ "conceptual model,"
♦ "nursing process,"
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DEFINITION OF RESEARCH
Being a major function of the higher education
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♦ Is significant in the development of any country, especially in the generation of new ideas and knowledge for productivity.
(Palispis 2004)
♦ National Aeronautics and Space Administration (NASA) has begun to appreciate the value of nursing research.
♦ In previous years, most of NASA's health care research has been physician driven
♦ According to Linda Plush, a NASA consultant, the administrators at NASA have started to realize that nurses often have more
expertise than physicians do like:
wound care,
medication delivery, and
Managing chronic conditions (Domrose, 2005).
The Value of Research
♦ Provide information for:
decision making
Performance of function effectively
The health condition of individuals.
FUNCTIONS OF RESEARCH
♦ It helps us answer questions, solve problems and make decisions.
♦ It enables us to see and understand how and why a situation or a problem exists.
♦ It helps us discover new things and ideas.
♦ It allows us to validate existing theories or generate new ones.
♦ lt helps us identify and understand the causes and effects of a situation or a phenomenon.
♦ To bring out the truth*(Dr. J.S. Esquerra)
The Role of Research in Improving Quality of Life
♦ New knowledge or technology is discovered.
♦ New knowledge can result in development or improvement of skills, behavior or practices, while newly discovered or developed
technology can lead to the development of new tools or devices.
➢ Improved skills, behavior or practices can lead to better conditions and better quality of life.
➢ new or improved tools or strategies can result in improved performance and/or better service delivery, which contribute to the improvement of
man's living conditions and quality of life.
♦ The connection between research and the improvement of man's welfare
Uses of Research as a Scientific Process
♦ As a scientific process, research can be used to:
determine/describe an existing situation (situation analysis),
describe a population (people, objects, institutions, etc.),
compare two conditions or groups of population,
determine existence, degree, or nature of relationship between two or more factors,
evaluate and/or compare effectiveness of an intervention, treatment or exposure, and
predict the value of a certain characteristic
The Role of Research in Development
♦ to improve the welfare of man like:
-development projects in education, health, housing, employment, business, agriculture, etc.
-Which involves planning, implementation, monitoring and evaluation. In each stage of development, research plays
an important role (Mercado,1994).
♦ Research is needed in describing and analyzing existing social or economic problems or conditions.
♦ Research data are important inputs lo planning and in designing a program/project/activity intended lo address an existing
problem.
♦ Data on the background and needs of target clients of a proposed program/project are needed in the preparation of the
intervention,
♦ Program managers or project implementers should continue collecting, analyzing and using relevant data to determine if, or to
make sure that a project/program is being implemented as planned.
♦ Project implementation should be closely monitored to check progress and quality of implementation. Monitoring requires
accurate information about the status of project implementation, including rate of completion, financial standing, and quality of
performance (inputs and outputs).
♦ Upon completion of a project, its performance or impact needs to be evaluated
.ex:, the effect of a breastfeeding among premature infants:
♦ - new teaching strategy may be evaluated in terms of its effectiveness in improving Client’s
performance.
♦ - A training intervention can be evaluated in terms of the skills learned and applied by the training
participants.
GOALS FOR CONDUCTING NURSING RESEARCH
♦ Aim of EBNP:
to provide the best possible care based on the best available research.
to provide a service to society, and this service should be based on accurate knowledge
♦ To back up the importance of EBNP, Sigma Theta Tau International, Honor Society of Nursing and Blackwell Publishing
initiated a new journal in 2004 titled Worldviews on Evidence-Based Nursing.
It is a quarterly peer-reviewed journal.
♦ Cost effective health care
Ex:
♦ follow-up care by a nurse specialist is safe and cost effective
♦ telephone nursing (TN)
♦ providing home nursing visits
♦ nurse case management program with patients (Bourdeaux et al. (2005)
♦ admission nurse role
♦ Nursing Research
Classification of nursing research:
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♦ General Classification– It aims to answer or solve perplexities relevant to the nursing profession thereby developing a
scientific knowledge based for nursing practice.
Cost effective
A
P
♦ Specific Classification:
Purposes of Nursing Research
Identification – naming an unknown phenomenon in relation to nursing practice.
Example: What are the social problems experienced by people with cancer.
Description – describing a phenomenon affecting the nursing profession
Example: Changes, experiences of people with cancer.
Exploration – investigating a phenomenon.
Example: To what extent is IQ related to passing board exams.
Explanation - clarifying, understanding the "Why“
Prediction - estimating the effects of a given situation or prevailing condition
Control - specifying psychological and physiological reactions possible to nursing intervention.
Clinical nursing research
Nursing research involving clients or studies that have the potential for affecting the care of clients, such as animals
or so called normal subjects
Focuses largely on prevention & health prevention as opposed to medical model, which is the treatment /testing
research model (Williams, 2005)
Ex: pt. Symptom management and involves behavior intervention.
SOURCES OF NURSING KNOWLEDGE
♦ Tradition.
♦ Authority.
♦ used trial and error
♦ scientific research - the most objective and reliable source of nursing knowledge.
SCIENTIFIC RESEARCH
Characteristics of Traditional scientific research:
Use of systematic, orderly, and objective methods of seeking information.
♦ The scientific method uses empirical data, which are data gathered through the sense organs.
♦ Information is gained in the form of data or facts that are obtained in an unbiased manner from some aspect of the real world.
Researcher tries to exercise as much control as possible over the research situation, to minimize biased results.
The researcher's of a study opinions and personal biases should not influence the findings.
SCIENTIFIC RESEARCH
Characteristics of Traditional scientific research:
Have many similarities between scientific research and the problem-solving approach that is familiar to all nurses.
Both processes includes:
♦ identifying a problem area,
♦ establishing a plan,
♦ collecting data, and
♦ evaluating the data.
Unit I Chapter 2 B
Research Process vs. problem solving process
Research is a process.
• Process includes a purpose or directions, a series of actions, goal.
NURSING RESEARCH AND NURSING PROCESS
Similarities between Nursing Process and Research process
• Both involve: abstract, critical thinking and complex reasoning.
• They identify new information, discuss relationships and make predictions about phenomena.
- Information is gathered, observations are made, problems are identified, plans are developed and actions taken in both process.
• Both are reviewed for effectiveness and efficiency.
• Implementing both expands and refines the user's knowledge.
Differences:
1. Knowledge of nursing process will not enable you to conduct the research process.
Research is more complex than nursing process.
Research involves the rigorous application of a variety of research methods and requires the understanding of a unique language.
2. The focus of research-is broader than nursing process.
Example: Nursing process focuses on a specific client and his family:
3. Researcher should be knowledgeable about the world of nursing in order to identify a phenomenon requiring investigation.
Knowledge is obtained from clinical experience and research literature.
4. Theoretical underpinnings of the research process are mush stronger than nursing process.
All steps of the research process are logically linked and are also linked to the theoretical framework of the study.
5. The conduct of research requires greater precision, rigor and control than the implementation of the nursing process.
Problem Solving, Nursing Process &Research Process Compared
Problem Solving Nursing process Research
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collection
analysis
Evaluation & revision Evaluation & modification Outcomes & dissemination of findings
Solving
Unit 1 Chapter 2 C
3 General Types of Research
descriptive research,
correlation or association research and
experimental or intervention research (Fraenkel and Wallen, 1996).
➢ Descriptive Research:
answer to the questions who what, when, where and how.
It describes a situation or a given state of affair in terms of specified aspects or factors.
What may be described are characteristics of: individuals or groups (client, health provider, students, administrators, entrepreneurs,
patients, etc.) or physical environments (schools, business establishments, hospitals, cooperatives, etc), or conditions (epidemic,
calamities, leadership styles, anxiety level, sales and profit, productivity, etc.).
Ex:
"The management style of school administrators in Benguet State University College of Nursing"
"Tardiness and absenteeism among college school students“
"The medicinal components of the approved DOH medicinal plants"
"Smoking habits of health service providers in government and private hospitals"
"The Medicinal properties of pepper"
➢ Explanatory or Correlation Research
goes beyond description of the problem or situation.
• IT attempts to explain the possible factors related to a problem which has been observed in a descriptive study.
This type of study answers the questions why and how?
The factors related to the problem, however, need not be viewed as real "causes" of the problem, but factors which are
associated with or may contribute to the occurrence of the problem.
It investigates Relationships between factors or variables. Certain factors are "assumed" to explain or contribute to the existence of a
problem or a certain condition or the variation in a given situation.
The researcher usually uses a theory or a hypothesis to account for or explain the forces that are "assumed to have caused"
the problem.
For example, relationships between the following pairs of variables can be studied:
♦ Local government employees' knowledge about the local government code---------------Work performance
♦ Knowledge about cancer ------------------------- Compliance with medication
♦ Nutritional status -----------------------------------academic performance
♦ Music therapy ---------------------------------------pain experiences
Examples of research explanatory or correlation category topics
♦ Knowledge on Local Government code and work performance of Local government employees”
♦ "Knowledge About Cancer and Compliance with Medical Regimen Among Cancer Patients"
♦ Nutritional status and academic performance
♦ “Effects of Music therapy and pain management during labor
♦ "Attitudes Towards Health and Smoking Habits of Health Service Providers in Government and Private Hospitals in the
Philippines "
➢ Intervention or Experimental Research.
evaluates the effect or outcome of a particular intervention or treatment.
It studies the “cause" and effect' relationship between certain factors on a certain phenomenon under controlled conditions.
The subjects of the study are randomly assigned to the experimental group and to the control group and both groups are exposed lo
similar conditions, except for the intervention/treatment.
For example,
♦ one can assess or compare the effect or outcome of two or more methods of verbal suggestion on the teaching ability of
students with regards to pain management , two or more health management practices on the recovery of patients, or two or
more management styles on employees' productivity.
Ex:
♦ "The Effect of Verbal Suggestion on Overt Pain Reaction of Selected Post- Operative Patients" (Parrenas, 1994)
♦ "The Effect of Oxygen, antacids and diet among decubitus clients“
➢ Pure (Basic and is used mostly by scientists(Original)) or applied (using research items done by others).
• To include outcome researches
The distinction between basic and applied research have more to do with financial support for the project than with the purpose of the
study. Thus, basic research may imply that the researcher is provided support to work on a particular project without having to
indicate the immediate practical usefulness of the findings.
➢ Exploratory vs. Explanatory Research
Exploratory Research. Exploratory studies - used to describe an existing problem situation and examine the underlying '
factors that contribute to the emergence of the problem, the nature of which is not yet well known.
Explanatory Research. The primary goal of an explanatory study is to understand or explain a prevailing situation or explain a
relationship between factors which may have already been identified in exploratory studies, and why the relationship exists.
♦ Explanatory studies seek more specific answers to "why'' and "how" questions. ,;
Examples of Exploratory Research Topics
♦ "Domestic Violence: Ideas, Experiences, and Needs of Married Working Women in the City of Baguio"
♦ "Menopause: Working Women's Perceptions, Experiences and Coping Strategies"
Examples of Explanatory Research Topics *
♦ "Relationship Between Alcohol Intake and Domestic Violence Among Married Men in the Municipality of Alimodian"
♦ "Extent of Exposure to Advertising Materials and Expenditure Patterns of Young Professionals in Northern Luzon"
➢ Scientific method suits well to nursing research as it intertwines all procedures that scientists use three methodologies
QUANTITATIVE RESEARCH, kinds:
♦ Descriptive Research - explanation or description of phenomena in real life. It describes the characteristics, situations, state
of affairs, of groups ( students, nurses, administrators, etc.); physical environment (schools, hospitals, etc); conditions
(performance, anxiety levels, skills, etc).
Purpose: To examine the relationship among variables where enough information exists.
Examples:
♦ The management styles of deans of colleges of nursing
♦ The effect of tardiness among nursing students
♦ Attitudes and behaviors of senior student nurses in the Operating rooms
♦ Explanatory or Correlation Research – It attempts to explain the possible factors related to a problem which has been
observed. It investigates the relationships between factors or variables.
Purpose: to explain the nature of relationship in the real world, not to determine the cause and effect.
Examples:
Relationship between tardiness and socioeconomic factors among nursing students.
Attitude and behaviors of senior student nurses and their performance in the operating room.
♦ Experimental or Intervention Research – It evaluates the effect or outcome of a particular intervention or treatment among
groups that are as equal as possible.
Features:
♦ A controlled manipulation an independent variable:
♦ Experimental group and Control group
♦ Subjects are randomly selected
Examples:
♦ The effect of In-house review on the performance of nursing graduates in the local board exams
♦ The effect of verbal suggestion on overt pain reaction of selected post op patients
♦ Quasi - experimental research - Seeks to explain relationship, clarify why certain events happened or both.
It serves as basis for predicting a phenomenon.
Unlike the experimental technique, it manipulates the independent variable but lack randomization of control
group o may not have a control group.
Convenience sampling is done.
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TRIANGULATION of METHODS
Refers to the use of two or more research methods in the study of a particular phenomenon.
The combination of qualitative and quantitative methods enhances the technical ability to rule out conflicting explanations. (Hinds, 1989)
The most reliable findings are located when using both methods. (Field and Morse, 1985)
Careful analysis of data from several sources and use of differing methods allows for richer, fuller description of a study than a single
approach. (Thurmono, 2001)
IMPORTANCE OF RESEARCH TO NURSING
1. It validates nursing as a profession.
Nursing as a profession must be based on a well defined body of specialized knowledge.
2. It provides a scientific basis for nursing practice.
Topics include the nursing profession as whole, characteristics of nurses, practice of the profession.
3. It demonstrates accountability of the profession.
Accountability implies a duty or obligation to clients to provide quality patient care and predictable instances.
4. It improves the standards of nursing care by providing the basis for sound nursing action as:
Planning, Predicting and Controlling patient care outcomes.
5. Nurses need scientific knowledge to improve their decision-making regarding:
What care to provide patients and How to implement that care.
6. The knowledge generated through research is essential to provide a scientific basis:
For description, Explanation Prediction and Control of nursing practice
➢ They are challenged to question constantly every intervention they perform or see performed.
➢ Questions to ask include:
➢ Am I performing this intervention because someone told me to or maybe even because this is the intervention that has always been
used?
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What evidence exists that this is the most effective intervention for the problem?
✔ If an intervention is not based on research evidence,
✔ there is no way to determine that this intervention is the optimum one.
NURSING RESEARCH ONTHEWEB
For additional online resources, research - activities, and exercises, go to www. prenhall.com/nieswiadomy. Select Chapter
1 from the drop-down menu.
The roles of nurses in research according to level of educational preparation were identified by the American Nurses Association Council
of Nurse Researchers in 1981.
The guidelines were revised in 1993 and 1994. These guidelines, in the form of a position statement, may be found at
http://www.nursingworld.org/readroom/ position/research.
Expectations are presented for nurses prepared at the following educational levels:
♦ associate degree in nursing,
♦ baccalaureate degree in nursing,
➢ should be able to read research critically and determine if research results are ready for use in clinical practice.
➢ should be able to identify clinical problems that need to be investigated.
➢ should assist experienced investigators to gain access to clinical sites.
➢ should help select appropriate data collection methods and collect data.
➢ should implement research findings in their practice.
♦ master's degree in nursing, -
➢ Be able to make applied experimental studies on experiences
➢ Individual generation of a conceptual/construct theory
♦ doctoral education, and
➢ Generate a theory
♦ postdoctoral education.
➢ Individual generation of a theory.
The American Association of College of Nursing (AACN) published a position statement on nursing research in 1999. which includes:
♦ lists of research expectations and outcomes for graduates of:
➢ baccalaureate,
➢ master's,
➢ doctoral, and
➢ postdoctoral programs.
• These expectations are similar to those of the American Nurses Association. This position statement may be
found at http://www.aacn.nche.edu/Publications/ positions/rscposst.htm.
The latest revision of the American Nurses Association guidelines and the AACN guidelines include:
♦ expectations of those with postdoctoral preparation.
➢ Postdoctoral study involves agreements between:
♦ novice researchers,
• usually with recent doctorates, and
• established investigators.
♦ These seasoned investigators agree to mentor the novices for a period of 2 or 3 years.
♦ Private and federal funding is available for postdoctoral preparation.
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➢ quality of life,
➢ participation in decision making about treatment in advanced disease,
➢ patient/family education,
➢ participation in decision making about treatment, and
➢ pain management.
♦ Clinical nursing research is essential for the profession, However, other types of research are also needed.
➢ Grier (1982)
• patient care research had become the "sacred cow" for nursing research.
➢ Brown, Tanner, and Padrick (1984) wrote that research regarding:
• nurse characteristics,
• nursing education, and
• nursing administration should not be abandoned because these factors affect the care that nurses provide.
➢ Abdellah and Levine (1994) also called for studies other than clinical studies.
• They wrote that we need reliable tests to predict clinical performance by students and research on
occupational choice.
♦ Clinical nursing research is essential for the profession, However, other types of research are also needed.
➢ Fitzpatrick (1999)
• contended that nursing education research should receive the same recognition as clinical research.
• She mentioned the pressure in recent years to transform nursing educational programs to meet changing health
care needs and contended that any changes should be based on research.
➢ Tucker-Alien (2003) wrote an editorial on nursing education research is not always respected.
• She called for nurse educators to conduct research:
♦ on both clinical issues and educational issues.
Replication studies should be a high priority for nursing research. Which involve:
♦ Repeating a study with all the essential elements of the original study held intact.
➢ Different samples and settings may be used.
♦ Replication studies in nursing have not been numerous,
➢ The lack of these studies has hindered the development of a cumulative body of nursing knowledge.
♦ This type of study is of particular importance in clinical nursing research.
➢ Because of the small nonrandom samples
SUMMARY of Unit 1
Nursing research is defined as the systematic, objective process of analyzing phenomena of importance to nursing. It includes studies
concerning nursing practice, nursing education, nursing administration, and nurses themselves. Clinical nursing research is research that has the
potential for affecting the care of clients.
Nursing knowledge has come from tradition, authority, trial and error, and scientific research. Scientific research uses empirical data (data
gathered through the senses) and is a systematic, orderly, and objective method of seeking information.
Basic research, also called pure research, is concerned with generating new knowledge; applied research seeks solutions to immediate
problems. Most nursing studies have been applied research. Many studies, however, contain elements of both basic and applied research.
The most important goal for conducting nursing research is the promotion of evidence-based nursing practice. Evidence-based nursing practice
(EBNP) means that nurses make clinical decisions based on the best research evidence, their clinical expertise, and the health care preferences
of their patients/clients. Other goals for conducting nursing research are to ensure credibility of the nursing profession, provide accountability for
nursing practice, and document the cost effectiveness of nursing care.
Quantitative research is concerned with objectivity, tight controls over the research situation, and the ability to generalize findings. Qualitative
research is concerned with the subjective meaning of an experience to an individual. Outcomes research focuses on measurable outcomes of
interventions with certain patient populations.
Nurses act as principal investigators, members of research teams/identifiers of researchable problems, evaluators of research findings, users of
research findings, client advocates during studies, and subjects/participants in research. Research utilization focuses on the implementation of
findings from specific research studies.
Because nurses were not prepared to conduct research, many of the early nursing studies were conducted by members of other disciplines. Some
of these studies, such as the Goldmark Report in 1923 and the Brown Report in 1948, contributed important information about nursing and nursing
education. As nurses began to receive advanced degrees, these degrees were generally in the field of education. Many of the studies conducted by
the first nurse researchers in this country, therefore, were in the area of nursing education. Although Florence Nightingale recommended clinical
nursing research in the mid-1800s, this type of research was scarce until the 1970s. Many nursing organizations have identified clinical nursing
research priorities for the future. Also, replication studies are needed in nursing. Replication studies involve repeating a study with all the essential
elements of the original study held intact. The National Institute of Nursing Research (NINR) was established in 1993. Funding by Congress has
increased from $16 million in 1986 to the National Center for Nursing Research, the precursor to the NINR, to over $138 million to NINR in 2005.
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