Research Methods 850 Week 3, 2011/12

Daphne Cockwell School of Nursing, Post Diploma Degree Program, Ryerson University

Reviewing the Literature, Defining the Research Problem, Purpose & Question and Ethics in Research
Loiselle et al. (2011) chapter 5, 6 & 7. Prepared by Dr. Elaine Santa Mina

Learning Objectives
1. 2. 3. 4. 5. 6. 7. To describe the purpose of a literature review To identify the steps of a literature review To be able to conduct a literature search Describe how the literature review supports the research problem, question (s) and hypothesis (es) To describe the standards of ethical research practice To describe the underlying ethical principles of the Tri Council

Literature Review
is the background to the research topic includes a thorough empirical literature review of key concepts of the research question.

Literature Review: research purposes

to efficiently and accurately assemble knowledge on the topic; for researchers and clinicians to inform the researcher of current knowledge and determine implications for questions to identify methodological problems in relevant research literature

Literature Reviews: research purposes

to identify the research problem, refine the research question, and establish hypotheses to reveal need for research replication with different populations, under different conditions or with different methodologies

Literature Reviews: purposes for non researchers

to inform and guide practice to develop evidence based protocols to revise nursing curricula to develop policy statements and practice guidelines to keep current with practice

Where and How is the Relevant Literature Located

the traditional method of literature searches is the manual search through card catalogues.

Where and How is the Relevant Literature Located

computer based searches are making manual searches obsolete. literature searches are an important professional skill to acquire as a foundation of academic work and to facilitate the clinician to seek and critique the current literature to support best practices.

Where and How is the Relevant Literature Located

electronic searches are most frequently done online via the internet can also be done with a CD ROM. but files of references on a CD ROM are limited to the date of production, whereas the online catalogues and journals are updated as frequently as every week.

Where and How is the Relevant Literature Located

Ryerson library is online for your literature searches and can be reached through this web site http://www.ryerson.ca/library. in addition to electronic and manual searches also search the references at the back of articles, texts, and books.

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Where and How is the Relevant Literature Located

the online library has numerous search engines: eg OVID and indexes that are subject based eg. CINAHL.

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Where and How is the Relevant Literature Located

Examples of other specialty indexes are: PUBMED, Medline, Proquest Nursing, Ageline, AIDSLINE. Child Abuse and Neglect, Contemporary Womens Issues, CPI.Q (Canadian Periodical Index Quarterly), Dissertations Abstract, Health Star, Ingenta, PsychINFO, Cochrane Library,

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What are the Relevant References for a Topic?

How does an investigator determine which references of literature are appropriate for the specified topic? a process with a bit of a trial and error

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What are the Relevant References for a Topic?

but start with a systematic approach and keep notes so that if your search is not as fruitful as you expect, then you can make decisions about how to modify it. Document your plan and findings and plan revisions

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What are the Relevant References for a Topic?

authors can expect to be asked to explain the search strategy so others will be able to follow your decision making plan it is comparable to an audit trail.

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Search strategy example

Research Question: What is the effect of diabetic education on the compliance with diet and medication in patients with diabetes? *Note: literature searches are time consuming; anticipate that until you become skilled in the search process it is time consuming, even for a skilled researcher, it takes time, trial and some error

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Step 1. Key Terms.

Identify the key terms in the research question. include all concepts and any common synonyms in the search to ensure inclusiveness

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Step 1. Key Terms

Eg. key terms are probably diabetic education, compliance, diet, medication, & diabetes. Is population of interest young or old, or with Type I or II diabetes? Are there synonyms for diabetic education? How do we allow for these criteria in the search?

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Step 2. Search Engine

Choose a search engine and a data base For this particular question the OVID search engine and CINAHL data base would be appropriate Why?

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Step 3. Enter search with limits

List the key terms in the search words section. set limits for your search by looking at the topic and key terms and make decisions regarding the limits Full text? English only? human subjects only, year limits?

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Step 3. Enter search with limits

eg diabetes is a broad topic and has been generally well researched so there may be many articles on this subject. --You may decide you want only the most recent literature on this topic. Why might you decide this?

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limits are important!

for either too many articles or not enough, or the content retrieved is not complete, you may want to edit your search and try again with different limits, or a different database or even revise the key search terms.

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limits are important!

You can also search the terms separately if a only a few articles are found. Then you can use the Boolean operator term at the top of the search and combine search findings from each key term with either and or or to limit or expand the combinations

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Step 4. Notes on retrievals

Make note of the number of articles or hits retrieved from the search. gives an idea of the breadth or narrowness of your findings

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Step 4. Notes on retrievals

you may want to go back to the beginning (yes to step 1) and revise the topic, terms, and search strategy to either expand or limit your findings. This is a skill that takes time and practice to develop The more you know your topic area the more adept you will be at efficiently searching for relevant literature.

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Step 5. Save search strategy

. Save a copy of your search on your computer so you will be able to retrieve it

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Step 6. Retrieve Article

Step 6. (and most fun step!) Retrieve the article! save or print, and read and enjoy!!!

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Step 7. Preparation of the Articles from a Literature Review

Literature reviews can be large and overwhelming Organize a plan to gather, collate and retrieve pertinent information from the articles

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Preparation of the Articles from a Literature review

The following is a suggested series of steps to follow: identify references as per process above screen references: title, abstract, conclusion, references decide if it is a primary source (written by the original author) or a secondary source (reports by other authors) summarize key findings for each article

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Preparation of the Articles from a Literature review

then: with your topic in mind and key concepts: create a table: for each article list the pertinent information such as: author (s), year, key concepts and content, study design, the problem, question, hypotheses, the population and sample, what is known, the description of the findings, what are the gaps, problems, implications for practice or future research, any other measure of comparison appropriate to the reason for your search

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Preparation of the Articles from a Literature review

save and print a copy of your table write your narrative from the points of comparison and the data in the cells

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Style of the Review

not a subjective or emotional value laden exercise (avoid I think, I feel, I believe statements) is an objective accounting of what is present and what is absent in the research and or theoretical literature. Key attributes of a literature review are:

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Style of the Review

Objective: the reader could go back to the original article and find the same information and draw similar conclusions Hypotheses from research are not proved, but they may be supported or refuted by the findings

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Style of the Review

Theories also are not verified, but may be either supported or refuted by the findings. The review is written with the language of tentativeness: suggests, indicates, documents, demonstrates rather than proves. It is not value laden.

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How long should it be??

The length of the review depends on its purpose: Eg: i) a thesis is lengthy; ii) proposals are comprehensive; iii) journal articles are succinct; iv) meta analyses are extensive as they integrate statistical research findings across studies, each study is the unit of analysis

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From the Literature Review to the Problem, Purpose and Question

the research problem is the broad issue to be pursued the literature review develops the argument that defines the specific problem statement that the study will address the literature review presents the case that supports the presence of a problem

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Example of a literature review to support a BPG

Read RNAO BPG for Assessment and care of adults at risk of suicide p 15 18 to see complexity of a literature review to support the development of a BPG for evidence based practice rather than to support one research study.

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From the Research Problem Statement to the Research Purpose

from the identification of the research problem, the overall aim of the study or its goal is clarifiedthis is the research purpose. yet this in itself is not measurableso

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From the Research Purpose to the Research Question

the purpose is then reframed as a question to be answered, that question must be worded in congruence with the chosen paradigm for the study: either the qualitative paradigm or the quantitative paradigm.

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Qualitative questions
are broadly worded, with the general phenomenon of interest, and can be answered by a narrative format and the population specified

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Quantitative Questions
are very specifically worded, with the relationship between or among independent and dependent variables articulated the wording must direct objective, numeric measures.

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Quantitative Questions
each word in the question, and its placement in the question, can have a profound change in the intent of the question and subsequent hypotheses and if slightly rephrased will infer completely different relationships among the variables

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From the Research Question to the Hypothesis

Hypotheses are only found in quantitative studies, never in qualitative studies. a hypothesis tests the relationship between the variables with statistical significancemore on that in the next few weeks

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From the question to an ethically conducted study

All research questions, qualitative and quantitative, must be investigated ethically.

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A Definition of Ethics
Health care ethics, also known as bioethics has been defined as the systematic study of the moral dimensions including moral vision, decisions, conduct and policiesof the life sciences and health care, employing a variety of ethical methodologies in an interdisciplinary setting. Reich, W.T. (1995). Encyclopedia of Bioethics. New York:
Simon & Schuster MacMillan (p. xxi).

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What are some ethical dilemmas facing nurses?

Can you suggest some ethical dilemmas that confront you in your practice?

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What are some ethical dilemmas facing nurses?

Tube feedings Testing of new products Prolonging life by artificial means Research with human subjects (medications, treatments, etc.) Use of restraints

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Ethical dilemmas facing nurses conducting research?

Amount, nature of information about the study to share with nurses

Capitalizing on vulnerable clients/family to conduct research during stressful times

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What are some ethical dilemmas facing nurses conducting research?

Providing a research intervention to selected groups only

Establishing relationships with research participants that may lead to sharing of privileged information

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Codes of Ethics
International Standards Nuremberg Code (1949) post Nazi atrocities

Declaration of Helsinki (1964) by World Medical Assembly

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Codes of Ethics
US: Belmont Report (1978) National Commission for the Protection of Human Subjects and Behavioral Research Principles of: beneficence, human dignity, justice

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Canadian Standards
Canadian Nurses Association Centennial Edition(2008): Code of Ethics for Registered Nurses available on website:http://www.cnanurses.ca/CNA/practice/ethics/code/default_e .aspx

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Content of Code of Ethics for RNs (CNA)

Values Safe, competent and ethical care Health and well-being Choice, informed consent

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Content of Code of Ethics for RNs (CNA)

Dignity Privacy and Confidentiality Justice and Inclusiveness Accountability Quality Practice Environments
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Codes of Ethics (contd)

Policy Statement: Ethical Conduct for Research Involving Humans
Tri-Council (Canadian Institute of Health Research [CIHR]; Social Sciences and Humanities Research Council of Canada [SSHRC] & National Sciences and Engineering Research Council of Canada [NSERC])
Note a revision may be released during the delivery of this course

http://www.pre.ethics.gc.ca/policy-politique/tcpseptc/docs/TCPS%20October%202005_E.pdf
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Principles underlying Tri Council Guidelines

Respect for Free and Informed Consent Respect for Vulnerable Persons Respect for Privacy and Confidentiality Respect for Justice and Inclusiveness Balancing Harms and Benefits Respect for Human Dignity

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College of Nurses of Ontario

Ethical Framework for RNs and RPNs in Ontario (2009) http://www.cno.org/docs/prac/41034_Ethics.pdf Client well-being Client choice Privacy and confidentiality

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College of Nurses of Ontario

Respect for life Maintaining commitments (To clients, to oneself; to nursing colleagues, to the nursing profession; to health team members, to quality practice settings) Truthfulness Fairness

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Ethical Principles Guiding Research

The 8 ethical principles are summarized in 3 core values: 1. Beneficence 2. Respect for Human Dignity 3. Justice

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1. Beneficence:
above all, do no harm
Freedom from Harm
Physical and/or psychological Assurance that participation in a study will not disadvantage subjects Degree of risk to participants should never exceed potential benefits.
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Freedom from exploitation Risk/benefit ratio

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2. Respect for Human Dignity

Right to self-determination

Voluntary participation No coercion

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2. Respect for Human Dignity

Right to full disclosure Full nature of the study has been described to participants.

Informed consent Participants have adequate information, comprehend the information, and have power of choice, can withdraw at any time
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3. Justice
Right to fair treatment
Fair selection of participants Non-prejudicial treatment of people who decline Anonymity Confidentiality

Right to privacy

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Consent
Must include: Information that it is a research project, Statement of the 1. 2. 3. research purpose, identity of the researcher, expected duration

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Consent
nature of participation, confidentiality a description of research procedures;

A description of harms and benefits

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Consent contd.
An assurance that prospective subjects are 1. free not to participate, 2. have the right to withdraw at any time without penalty 3. will be given continuing opportunities for deciding whether or not to continue to participate.

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Consent contd.

The possibility of commercialization of research findings, and the presence of any apparent or actual or potential conflict of interest on the part of researchers, their institutions or sponsors.

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Institutional Review Boards

Formal committees that review research protocols, May be called Human subjects committees (In Canada called Ethics Review Boards or Research Ethics Boards), Studies must be approved by REB before they can proceed, REB at Ryerson http://www.ryerson.ca/ORS

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Critiquing Ethical Aspects of A study

Were subjects exposed to any harm? Did benefits outweigh risks? Was there any coercion?

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Critiquing Ethical Aspects of A study

Were vulnerable populations used? Were participants deceived? Was privacy safeguarded? Was research approved and monitored by an IRB or ERB?

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CNO Professional Standards (2008)

A nurse in a researcher role demonstrates ethical practice by: Ensuring the safety & well-being of the client above all other objectives, including the search for knowledge Ensuring client has all information necessary to make informed decisions, Advocating for nursing involvement on ethical review boards,
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CNO Professional Standards (2008)

Participating in ethical review of research

Ensuring ethical guidelines are followed to protect research participants.

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CNO Professional Standards (2008)

Identifying research methods useful to the nursing profession; Identifying resources to answer research questions; & sharing knowledge gained through research Supporting & evaluating practice through research; facilitating the involvement of others in the research process; ensuring high standards are used in the research process

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CNO Professional Standards (2008)

Communicating research findings; promoting nursing research; educating staff about the research process; promoting nursing through research that improves or validates professional practice & advocating for nursing representation on research review committees

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References
Burns, N., Grove, S. K. (2001). The Practice of Nursing Research: Conduct, Critique, & Utilization 4th Edition. Philadelphia: W. B. Saunders. Loiselle, C.G., Profetto-McGrath, J., Polit, D., F. & Beck, C. T. (2011). Canadian Essentials of Nursing Research 3rd Edition. Philadelphia: Lippincott Williams & Wilkins. Polit, D., F. & Beck, C. T. (2004). Nursing Research: Principles and Methods 7th Edition. Philadelphia: Lippincott Williams & Wilkins. Reich, W.T. (1995). Encyclopedia of Bioethics. New York: Simon & Schuster MacMillan

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