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INTRODUCTION TO RESEARCH

What is a university?
University is a place where ideas are collected, stored and utilized

NURSING RESEARCH
Chapter 1
Evolution of nursing
Definition of nursing research
Importance of nursing research
Roles of Nurses in Research

I. Evolution of Nursing Research

THE HISTORICAL DEVELOPMENT OF NURSING RESEARCH
 Florence Nightingale initiated nursing research more than 140 years ago, influencing health care in general, and nursing in particular.
 After Nightingale's work in 1850 up to 1910, minimal attention in research was provided until the 1950's.
 Florence Nightingale in nursing research is said to be a reformer, reactionary, and researcher

THE HISTORICAL DEVELOPMENT OF NURSING RESEARCH

 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, and Outcomes research has been designed to assess the effectiveness of health care service. (Burns and
Grove, 1997; Polit and Beck, 2004).
 Florence Nightingale –
 Founder of professional nursing.
 First nurse researcher by keeping meticulous record and statistics of mortality rates among the sick and wounded British soldiers.

 Researches were focused on importance of a healthy environment in promoting patient's physical and mental well-being, aspects of
environment such as ventilation, cleanliness, purity, water and diet to determine the influence on patient's health

Result of her research were Decrease in mortality rate within 6 months and use of 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.
 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.
 1900-1940 - studies conducted concerned nursing education, Nursing was service oriented in training future nurses rather than education
oriented, and Nurse Educators had no advanced educational preparation.
 Resulted into inadequacies existed in nursing education, advanced educational preparation was essential; School of nursing was
established at Yale University.

 Recommendation
 Education of nurses occurs in collegiate setting.
 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: a. comprehensive care b.
home care, and c. Progressive Patient care Results of these studies helped in the development of self-study manuals, quality assurance manuals of
today.

NURSING RESEARCH IN 1950 AND 1960 - Emergence of Research as a high priority which was support from nursing leaders Henderson and
Abdellah.
Research was introduced and the steps of research process at baccalaureate level by nursing schools and increased funding for research were
provided.
Resulted into an increased number of masters prepared nurses who took up research; some able to complete their thesis, thus enabling them to
conduct research.
 Five thousand US dollars was awarded for federal research in 1955 (de Tornyay, 1977).
 Prior to this, Nursing Research journal was published in 1952
 Studies conducted during these two decades dealt with: a. nursing education; b. standards for nursing practice, c. nurses' characteristics;
(including nursing students’ characteristics); d. staffing patterns, (hospital personnel changes) & e. quality of care interaction between a dying patient
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 NURSING RESEARCH IN 1960’s - Introduction of such terms as "conceptual framework”; "conceptual model," "nursing process,"
"theoretical base of nursing practice."

NURSING RESEARCH IN 1970 - One significant result of nursing research was observed in 1070’s when the groundwork for clinical research
was started, and it stays a priority up to the present (Burns and Grove, 1997). It could also be noted that results of reviewed studies published in
Nursing Research from 1970 to 1974 revealed: that 71 or 26% of the 275. Studies published focused on the improvement of nursing practice
(O'Connell and Duffey, 1976).

 New research journals published were:

 A. Advances in Nursing Science by Chinn in 1978 which incorporated the works of nursing theorists and research conducted on theories
relevant to nursing
 B. Image in 1967 by Sigma Theta Tau, the international Honor Society for Nursing (Barnard, 1980) which included various articles on the
research process and relevant studies.
 C. Research in Nursing & Health, and
 D. Western Journal of Nursing Research (1979) these journals published in 1978 and 1979 helped in the communication of research
findings in the 1970s.
 1970's - establishment of a national commission by American Nurses Association and The National League for Nursing to study nursing
and nursing education.
 Result: increase undertaking of researches in both nursing practice and education; rapid acceleration of nursing research; improvement of
client care.
NURSING RESEARCH IN 1980- The focus of nursing research in the 1980s was the conduct of clinical nursing research.
 1987, Scholarly Inquiry for Nursing Practice was published and in
 1988, two more journals were published, namely: Applied Nursing Research, and Nursing Science Quarterly.
 1997, Burns and Grove reported the publication of varied clinical journal namely: Cancer Nursing, Cardiovascular Nursing, Dimensions
of Critical Care Nursing, Heart & Lung, Journal of Obstetric, Gynecologic and Neonate Nursing, Journal of Neurosurgical Nursing, Pediatric
Nursing, and Rehabilitation Nursing,
 Activities of nursing research in 1980 includes: Publication of new research journals, Research conferences, Result of the publication of
numerous studies & research conferences: improved nursing practice. Improved educational level and Improved research background of nurses.
 In 1980’s – it characterized nursing research a potent force in the development of a solid base for research productivity up to 1990.
 1980's - establishment of National Center for Nursing Research in 1986
 Purpose of the center was to promote and support research training and research relating to patient care.
 Funding for nursing research activities - as provided by the National Center for Nursing Research (NCNR) created in 1985....

NURSING RESEARCH IN 1990 (PRESENT AND FUTURE) resulted into more on clinical researches with nursing diagnosis as framework.
The National Center for Nursing Research (NCNR) created in 1985 to fund nursing research activities was renamed the National Institute for
Nursing Research (NINR). This move under the direction of Dr. Hinshaw
Purpose of the move was: provides for better recognition of nursing as a research discipline and hopes for an increased funding for nursing research.
NINR research priorities that need funding to the year 2000: a. community-based nursing models; b. effectiveness of nursing interventions in
HIV/AIDS. C. cognitive impairment; d. living with chronic illness, and e. biobehavioral factors related to immunocompetence (NINR, 1993)
Focus of researches in 1990: health promotion, illness prevention, Primary care since everyone aims to attain an improved quality and
quantity of his life.
 Outcomes research has come out as an important methodology which documents the effectiveness of health care services.
 The primary concern of outcomes research in the 1980s was patient health status and cost related to medical care.
 Recommendation of outcome research:
 That patient outcome researches related to nursing that has received little attention in the early 1990s should become the major focus for
nursing studies in the future (Bowers, 1994; Johnson, 1993; Jones, 1993; Higgins, McCaughan, Griffiths and Carr-Hill, 1992, and Hegyvary, 1991).

Summary: Historical Events Affecting Nursing Research

 1  Florence Nightingale  first nurse researcher,
850 -  published Notes On Nursing
 1  -American Nursing Journal  first publication
900  published clinical case studies
 1  COLUMBIA UNIVERSITY  offered the first DOCTORAL program for nurses
923  GOLDMARK REPORT  With recommendations for nursing education was published.

1929 YALE UNIVERSITY – offered the FIRST MASTER’s IN NURSING DEGREE

1930 American Journal of Nursing published clinical case studies
1932 The Association of Collegiate Schools of Nursing Was organized
1948 BROWN Published Reports on inadequacies of nursing education published
1950 American Nurses’ Association (ANA) Study of nursing functions and activities
1952 The journal nursing Research was published

1953 Institute of Research and Service in Nursing education was established

1955 American Nurses’ Foundation Inception (start) of the sponsoring of nursing research
1957 Walter Reed Army Institute of Research established nursing research center at the institution
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1963 International Journal of Nursing Studies Started publication of nursing studies

1965 American Nurses' Association began sponsoring nursing research conferences
1957 Walter Reed Army Institute of Research established nursing research center at the institution
1966 MUGAR Library, Boston University Established Nursing History archive (collection)
1967 IMAGE Was 1st published by Sigma Theta Tau Publication
1968 CANADIAN JOURNAL OF NURSING RESEARCH Was 1st published
1970-71 ANA Established a COMMISSION ON NURSING RESEARCH
1970 More nursing journals published

1973 1st Nursing Diagnosis Conference was held

1976 Stetlet & Marram Published guidelines on assessing research for use in practice

1978 The Journals RESEARCH IN NURSING & HEALTH & ADVANCES IN

NURSING SCIENCE began publication
1979 WESTERN JOURNAL OF NURSING RESEARCH 1st publication
1982^82 CONDUCT & UTILIUZATION OF RESEAR%CH 1st publication
IN NURSING (CURN)
ANNUAL REVIEW OF NURSING RESEARCH
1985 ANA Cabinet on Nursing Research Established research priorities
1986 NATIONAL CENTER FOR NURSING RESEARCH Was established within U.S. National Institutes of Health
(NCNR)
1987 The journal SCHOLARLY INQUIRY FOR was first published
NURSING PRACTICE
1988 The Journals APPLIED NURSING RESEARCH and' began Publication; Conference on Research Priorities (CORP #1) by
NURSING SCIENCE QUARTERLY NCNR
1989 U.S. AGENCY FOR HEALTH CARE POLICY AND was established; Clinical practice guidelines were first published by the
RESEARCH (AHCPR) AHCPR
1987 The journal SCHOLARLY INQUIRY FOR was first published
NURSING PRACTICE
1992 CLINICAL NURSING RESEARCH; Publication of the journal began was published by the Department of
HEALTH PEOPLE 2000 Health and Human Services
1993 NATIONAL CENTER FOR NURSING was renamed the NATIONAL INSTITUTE OF NURSING
RESEARCH (NCNR) RESEARCH (NINR);
CONFERENCE ON RESEARCH PRIORITIES was convened to establish priorities for 1995-1999;
(CORP #2)
1993 The Cochrane Collaboration was established; publication begun
The journal OF NURSING MEASUREMENT
1994 journal QUALITATIVE HEALTH Publication of RESEARCHES started
1997 CANADIAN HEALTH SERVICES RESEARCH Was established with federal funding
FOUNDATION
1993 The Cochrane Collaboration was established;
The journal OF NURSING MEASUREMENT publication begun
1999 AGENCY FOR HEALTH CARE POLICY AND Was renamed AGENCY FOR HEALTH CARE RESEARCH &
RESEARCH (AHCPR) QUALITY (AHRQ)
2000 NATIONAL INSTITUTE FOR NURSING Issued funding priorities for 2000-2004; annual funding exceeded $100
RESEARCH (NINR) million
CANADIAN INSTITUTE OF HEALTH RESEARCH Was launched
BIOLOGICAL RESEARCH FOR NURSING Began publication
JOURNAL

2 – A. DEFINITION OF RESEARCH
Unit 1 Chapter 2
• Being a major function of the higher education
– 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.
• According to Linda Plush, a NASA consultant, the administrators at NASA have started to realize that nurses often have more expertise
than physicians do (Domrose, 2005).

• The Value of Research

• Provide information for: decision making
• Performance of function effectively
• The health condition of individuals.
• Teachers need to know what teaching approaches and materials can be used to help students learn better.
• Health service providers need health-related data:
• in developing health programs,
• in improving delivery of health services and
• in identifying interventions that will improve
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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.
• It helps us identify and understand the causes and effects of a situation or a phenomenon.

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

New Knowledge New skills/practice/behaviors

Improved
Conditions/welfare
RESEARCH

New technology new tools devices/approach

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

1. 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).
2. Research is needed in describing and analyzing existing social or economic problems or conditions.
3. Research data are important inputs lo planning and in
designing a program/project/activity intended to address an existing problem.
4. Data on the background and needs of target clients of a proposed program/project are needed in the preparation of the intervention,
5. 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

A) PROMOTE EVIDENCE-BASED NURSING PRACTICE (FROM "IMPROVEMENTS IN NURSING CARE) to foster optimum care for
clients
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.
AIM OF EBNP:
1. To provide the best possible care based on the best available research.
2. 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.
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It is a quarterly peer-reviewed journal.

(B) ENSURE CREDIBILITY OF THE NURSING PROFESSION,

In the past, nursing was frequently thought of as a vocation rather than a profession.
Criteria for a profession is the existence of a body of knowledge that is distinct from that of other disciplines
Nursing has traditionally borrowed knowledge from the natural and social sciences, and only in recent years have nurses
concentrated on establishing a unique body of knowledge that would allow nursing to be clearly identified as a distinct
profession.
The most valid means of developing this knowledge base is scientific research.
Americans have ranked nurses highest in honesty and ethical standards when comparing them to other professionals,
• (C) PROVIDE ACCOUNTABILITY FOR NURSING PRACTICE, and
As nurses have become more independent in making decisions about the care of clients, their independence has brought about a greater need for
accountability.
There is an old saying that every privilege is accompanied by a corresponding duty.
Although nurses have generally been glad to achieve some degree of independence from the medical profession, in some ways life was easier when
physicians were considered to be responsible for all aspects of health care.
The general public has gained more knowledge of health care, and expectations of nurses as providers of care have increased
To be accountable for their practice, nurses must have a sound rationale for their actions, based on knowledge that is gained through scientific
research.
Nurses have the responsibility of keeping their knowledge base current, and one of the best sources of current knowledge is the research
literature.
The ability to critique research articles and determine findings that are appropriate for practice is a skill that is needed by all nurses.

(D) DOCUMENT THE COST EFFECTIVENESS OF NURSING CARE.

• Because of nursing's humanistic and altruistic tradition, it has been difficult for nurses to consider the cost effectiveness of nursing care.
• The goal has been to help people achieve or maintain health, regardless of cost.
• With the increased cost of health care, all disciplines within the health care field have been called on to demonstrate their value in a dollar-
and-cents fashion.
• Consumers have become more cognizant of the cost of health care and are asking for explanations of services they receive.
• These consumers need to be made aware of the importance of nursing care in relation to maintaining the health of well
clients and in promoting the recovery and rehabilitation of ill clients.
• Nursing services can consume a large percentage of a hospital's budget.
• With prospective payment systems determining the amount of reimbursements that hospitals receive, nursing care services are being
closely examined.
• It is not difficult to determine that hospitals could cut costs by curtailing nursing services.
• If nursing care can be demonstrated to be cost effective, hospitals will look to other sources for "cutting the fat."
• If effective nursing care can allow clients to leave hospitals in better condition and in less time than predicted, hospitals will
make more profit or, in the case of nonprofit
Cost effective health care
Ex:
• follow-up care by a nurse specialist is safe and cost effective
Effects:
✔ potentially decreases iatrogenic illness (illness unintentionally done by doctors) and hospital-acquired infections,
✔ enhances Family interaction, and
✔ significantly reduces hospital costs for care telephone nursing (TN)
✔ Resulted into: the dollar savings for 1 month
✔ providing home nursing visits
✔ Home visits were significantly less costly than were the visits to the emergency department.
✔ nurse case management program with patients (Bourdeaux et al. (2005)
✔ Length of stay was reduced by 0.15 days over the 12 months of the case management program for diagnosis-related group (DRG)
✔ admission nurse role
✔ Nurse initiates and completes the health history and assessment and promotes consumer satisfaction.
✔ A time study revealed 30 to 60 minutes less staff nurse time was needed for new admissions

CLASSIFICATION OF NURSING RESEARCH:

• General Classification– It aims to answer or solve perplexities relevant to the nursing profession thereby developing a scientific
knowledge based for nursing practice.
– Nursing is accountable to society for providing cost-effective care and finding ways in enhancing the care.
– Deductively, nurses are accountable to their patients.
– Nursing research provides evidence of actions taken by the nurse which are believed to be that effective in
promoting positive patient out come.
• Specific Classification:
Purposes of Nursing Research
1. Identification – naming an unknown phenomenon in relation to nursing practice.
Example: What are the social problems experienced by people with cancer.
2. Description – describing a phenomenon affecting the nursing profession
Example: Changes, experiences of people with cancer.
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3. Exploration – investigating a phenomenon.

Example: To what extent is IQ related to passing board exams.
4. Explanation - clarifying, understanding the "Why“
5. Prediction - estimating the effects of a given situation or prevailing condition
6. 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

1. Tradition.
2. Authority.
3. used trial and error
4. Scientific research - the most objective and reliable source of nursing knowledge.

• The scientific method is only one source of nursing knowledge. It is, however, generally considered to be the most reliable source of
knowledge.

SOURCES OF NURSING KNOWLEDGE

1. Tradition involves the handing down of knowledge from one generation to another and leads to actions that occur because "we've always done it
that way."
2. Authority. Experts or authorities in a given field often provide knowledge for other people. In the past, nurses looked to physicians for a great deal
of their practice knowledge. It has only been in recent years that nurses have begun to build a unique body of nursing knowledge.
3. Used trial and error as a means of discovering knowledge. If one approach did not work, another one was used. Finally, when a certain approach
was found to be effective, the trial-and-error process ceased. Frequently, the reasons behind the failure or success of a certain method were not
determined. The goal was "If it works, we'll use it."
4. the most objective and reliable source of nursing knowledge is scientific research.
Our other sources have not been the most reliable sources of nursing knowledge.

SCIENTIFIC RESEARCH
Characteristics of Traditional scientific research:
2. Have many similarities between scientific research and the problem-solving approach that is familiar to all nurses.
Both processes include:
– identifying a problem area,
– establishing a plan,
– collecting data, and
– Evaluating the data.

2- B Research Process vs. problem solving process

Unit I Chapter 2 b
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:
• 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.
• 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.
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Problem Solving, Nursing Process &Research Process Compared

Problem Solving Nursing process Research
Data Assessment Data Collection & Knowledge of nursing; Clinical
collection interpretation experience
Problem Definition Nursing diagnosis Problem & purpose Identification
Plan-Goal setting; Identifying Plan-Goal setting; Planned Methodology-design, sample,
solutions interventions statistics
Implementation Implementation Data collection &
Analysis
Evaluation & revision Evaluation & modification Outcomes & dissemination of
findings
Problem Nursing process Research
Solving

2-C General Types of Research

Unit I 2c

Three General Types of Research

• descriptive research,
• correlation or association research and
• Experimental or intervention research (Fraenkel and Wallen, 1996).

Three General Types of Research

1. 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"
2. 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:
1 .Local government employees' knowledge about the local government code---------------Work performance
2. Knowledge about cancer ------------------------- Compliance with medication
3. Nutritional status -----------------------------------academic performance
4. Music therapy ---------------------------------------pain experiences
Examples of research explanatory or correlation category topics
1. Knowledge on Local Government code and work performance of Local government employees”
2. "Knowledge about Cancer and Compliance with Medical Regimen among Cancer Patients"
3. Nutritional status and academic performance
4. “Effects of Music therapy and pain management during labor
5. "Attitudes towards Health and Smoking Habits of Health Service Providers in Government and Private Hospitals in the Philippines "
3. 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)
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• "The Effect of Oxygen, antacids and diet among decubitus clients“

OTHER CLASSIFICATIONS OF RESEARCH (Jackson, 1995, Mercado, 1994)
• Pure (Basic) or applied,
• exploratory or explanatory, and
• Quantitative or qualitative.
- To include outcome researches
Other Classification of Research according to the general purpose of the study,
1. Basic research is concerned with generating new knowledge on an 1. Applied research is concerned with using knowledge to solve
existing situation of behavior using either or both qualitative and quantitative immediate problems.
research 3. Applied research is directed toward generating knowledge that
techniques. can be used in the near future
• Undertaken to acquire new knowledge • Focused on finding solutions to existing problems.
• Refine a theory without any nursing application or use. The results are expected to be used by
• It does not specify an application of the findings. respondents/clients.
• The results tend to influence the way individuals think about
behaviors and situations
2. Basic research is referred to as pure research.
3. Basic research is conducted to develop, test, and refine theories and 3. Conducted to seek solutions to existing or immediate
generate new knowledge (Kerlinger, 1986; Oman, Krugman, & Fink, 2003; solution to a problem. (Burns & Grove, 2005; Kerlinger, 1986;
Polit & Beck, 2004). Polit & Beck, 2004).
Refine a theory without any nursing application or use. The study is expected to be used to remediate or modify a
It does not specify an application of the findings. given situation.
The results tend to influence the way individuals think about
behaviors and situations.

4. Basic research seeks "knowledge for knowledge's sake.“
• basic research seeks to:
• generate or develop theories,
• Immediate application of the results usually does not occur.
5. Basic research often uses laboratory animals as subjects.
Examples of Pure/Basic Research Topics
"Factors Associated with Tardiness and Absenteeism among BSN III
Students"
"Attitudes Towards Health and Smoking Habits of Health Service Providers".,
4. Majority of nursing studies have been examples of applied
research.
5. Studies have focused variables or factors which can be
changed by nursing interventions in order to achieve a desired
goal for patients and their families.
Applied research is an experimental study comparing the
effectiveness of two methods.
Examples of Applied Research Topics
"The Effect of Gender Sensitivity Training on Men's
Involvement in Child Care"
“IN House Review: Its Effect on the Performance in the
board exam"

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.
2. 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"
• "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"
3. Quantitative vs. Qualitative Research
Quantitative research Qualitative
Concerned with objectivity, tight controls over the Concerned with the subjective meaning of an experience to an individual.
research situation, and the ability to generalize
findings.
seeks to quantify or reflect in numbers the It emphasizes verbal descriptions and explanations of human behavior and practices in
observations on the characteristics of an attempt to understand how the units or members of the study population experience or
the population being studied explain their own world.
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It emphasizes: makes use of one or a combination of the following techniques:

- precise measurement & - participant observation,
- requires statistical analysis of data or - key informant interview,
- the testing of hypotheses based - focus group discussion,
On a sample of observations. - direct observation, and
• Others view quantitative research as - In-depth analysis of a single case.
hard science - collectively, referred to as naturalistic
• Still others view both research investigations due to the fact that it
approaches as scientific. studies phenomena within the
• Uses the traditional approach - used by Everyday world.
other disciplines - Data is gathered through sustained
interaction of researcher with people
in their own language and
Environment.
Purpose:
- To explore, describe, or expand knowledge about how reality is experienced.
concerned with the level of pain that these Concerned with what it means to be living with chronic pain.
people were experiencing,
"The Effects of extracurricular activities of students "Experiences and Needs of Victims of Student athletes”
in their academic performance” “Andropause: Men's Perceptions and Experiences"
"Health Seeking Behavior and Health Status of
Single mothers”
METHODOLOGIES IN NURSING RESEARCH
Scientific method suits well to nursing research as it intertwines all procedures that scientists use.
Three methodologies
I. Quantitative research
II. Qualitative research
III. Outcomes research
QUANTITATIVE RESEARCH, kinds:
1. 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
2. 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.
3. 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
• Among the different research methods, the experimental method yields the most conclusive research findings
4. Quasi - experimental research
- Seeks to explain relationship, clarify why certain events happened or both.
- It serves as basis for predicting phenomena.
- Unlike the experimental technique, it manipulates the independent variable but lack randomization of control group or may not have a
control group.
• Convenience sampling is done.
Kind of Qualitative Researches:
1. Phenomenological Studies (defined)
• It describes the * lived experiences* of study participants.
• The focus is subjective meaning of an experience to an individual
• Examples: Lived Experiences of Breast cancer patients
Lived Experiences of HIV + individuals
Lived Pregnancy Experiences of Women in Prison
Men's views about hysterectomies and women who have them
2. Grounded Theory - Based on
– Symbolic Interaction Theory (SIT).
– It explores how people define reality and how their beliefs are related to their actions.
• Reality is created by attaching meanings to situations.
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– The researcher compares what is found in real life with that of what is written in books.
• Examples: Pain management by staff nurses.
How do family members manage disclosure to a child who has acquired HIV
3. Ethnographic Research-
– Originated from anthropological perspective with focus on culture, life-ways in the natural setting.
– Ethnography means "Learning from people"
– It focuses on the question: "What is the culture of this group of people?“
– important criteria for Ethnographic research: Intensive field work, immersion, live-in activities
– Techniques to be used. Interview, direct participation and observation
4. Historical Research
• Examines the events of the past and how these events affect the present, used to determine the growth and development of a group,
organization or institution.
• Data are obtained from: documents, relics, artifacts, oral reports, maps, books, diaries, letters, etc.
• Sources of data: primary and secondary
• Evaluation of historical researches:
• a. External criticism - determine authenticity of collected data
• b. Internal criticism - evaluates the accuracy of data
5. Case Studies - In depth examination of experiences of a particular patient.
- The result is not generalized to other groups of people.
- Hypotheses are not tested.
- Subject selection is done with care as they may decide to discontinue their participation.
– Data evaluation is through content analysis or examining answers and messages.
PURPOSE OF RESEARCH PROCESS BASED ON KIND OF RESEARCH
Basic Research Applied Research
To extend the base knowledge Formulation or refinement of • To finding solutions for existing problems
theory • Focuses on factors which can be changed by intervention to
achieve a desired goal
For discovery of general principles For solving problems
Quantitative Research Qualitative Research
Associated with positivist tradition (there is reality out there that Associated with Naturalistic inquiry (reality is not a ft entity but rather a
can be studied and known) construction of individual participatory research.)
Gathers numerical values as its data Gathers narrative description as its data

• Investigates concepts, constructs, variables • Investigates phenomena, and concepts

• Use inductive process
• Use deductive reasoning
Use control (imposing condition so that biases are minimized and Use subjectivity that enriches the analytical insight!
validity and precision are maximized)
Gather empirical evidence (from objective reality collected Gather information, insights that lead to search fm (mil.*. evidence
through senses) (subjective)
Takes place both in natural as well as in contrived laboratory Takes place in the field
setting
Exploratory Research Explanatory Research
To describe an existing problem situation and examine the To understand or explain a prevailing situation; to explain a relationship
underlying factors that contributes to the emergence of the between factors which may have already been identified in exploratory
problem. studies and why the relationship exists.
III. OUTCOMES RESEARCH or EVIDENCED-BASED NURSING PRACTICE
– Focus: the need to answer the: growing demand of justifying the quality of interventions, systems of care as regards improving
patient lives, and spiraling cost of health care.
• Definition: Translating knowledge into practice
– Significance:
• Nurses attend to patients most of the time. They attend personally to interventions given by doctors.
• Nurses influence the treatment given due to cart delivery techniques.
• The health outcomes depend on many factors where nurses are involved.
• Nurses are on the forefront of examining outcomes of programs designed and implemented in the communities.
• The professional nurse is in an excellent position to create change that demonstrates quality care that is cost effective
• outcomes research
Has come to be associated with "how the organization of nursing impacts nursing (e.g., burnout), system (e.g., retention), and patient (e.g., 30-day
mortality) outcomes rather than on the efficacy of an individual nursing intervention"
Focuses on measurable outcomes of interventions with certain patient populations.
The increased interest in this type of studies is tied in with the high cost of health care.
Health care policymakers, such as managed care organizations, want to know if the care that is being provided is cost effective.
Consumers also want to know if the services that they purchase will improve their health. Therefore, outcomes become very important.
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Been placed in a separate category because the types of designs, methods, and sampling procedures used in these studies may be somewhat
different from those used in the traditional quantitative or qualitative studies.
For example,
Rather than exercising tight control over the sample, the goal might be deliberately:
To include a wide range of patients with varying levels of health status and co morbidities
To determine how effective an intervention or treatment might be for this varied group of people.
As outcomes research continues to emerge, you will want to seek further information in the latest clinical and research journals.
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 defining methods allows for richer, fuller description of a study than a single approach.
(Thurmono, 2001)
3 - IMPORTANCE OF NURSING RESEARCH

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
6. The knowledge generated through research is essential to provide a scientific basis:
7. Research knowledge will help student & nurses to become excellent nurses.
– They are challenged to question constantly every intervention they perform or see performed.

IMPORTANCE OF NURSING RESEARCH

• 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?
– 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.
4-ROLES OF NURSES IN RESEARCH
• The roles of nurses in research according O 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.
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• 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.
ROLES OF NURSES IN RESEARCH
1. Principal Investigator
Nurses can and should serve as principal investigators in scientific investigations.
To be a principal investigator, special research preparation is necessary.
It might be possible for a beginning researcher to conduct a small-scale survey study,
But preparation beyond the baccalaureate level is necessary for independent investigator status in most nursing research studies.
2. Member of a Research Team
Nurses can serve as members of a research team.
They may act as data collectors or administer the experimental intervention of the study.
As nurses increasingly participate in research,
It is possible that interest and enthusiasm to conduct their own investigations may grow.
3. Identifier of Researchable Problems
– All nurses, from associate degree to doctoral-level preparation, have the responsibility of trying to identify areas of needed research.
– Nurses at the bedside are particularly well situated to identify patient-related researchable problems.
4. Evaluator of Research Findings Every nurse should be involved in the evaluation of research findings. As research consumers, nurses have
the obligation to become familiar with research findings and determine the usefulness of these findings in the practice area. Beginning
researchers should critique research articles, first with the help of an experienced researcher and eventually on their own, through the use of
knowledge gained in a structured research course (either in their basic nursing education program or in a continuing education course).
5. User of Research Findings
• Through the years, nurses have tended to carry out nursing procedures and provide nursing care "the way we've always done. After
evaluating research findings, nurses should use relevant findings in their practice. The primary goal of nursing research is the improved care of
clients.
Research utilization and evidence-based nursing practice
– Are related because both processes place emphasis on research findings.
– However, nurses must be judicious in their use of research findings.
– The results of one small study conducted with a sample of 15 volunteers would not provide sufficient evidence for a change in nursing
practice.
However, nurses must be judicious in their use of research findings. The results of one small study conducted with a sample of 15 volunteers would
not provide sufficient evidence for a change in nursing practice.
4-B RESEARCH PRIORITIES FORTHE FUTURE
UNIT I

Research priorities of the BSU CON (Tentative)

1. Qualitative study
2. Replication
3. Preventive & Promotive

• Research priorities were developed by Professional nursing organizations and individual nurse leaders
• They were united in identifying the need for research that will help build a scientific knowledge base for nursing practice.
– In 1980 the ANA Commission on Nursing Research identified priorities for nursing research. Which were:
• health promotion and preventive health practices for all age groups,
• health care needs of high-risk groups,
• life satisfaction of individuals and families, and
• the development of cost-effective health care systems.
– In 1985 the ANA Cabinet on Nursing Research identified 10 priority areas. Which were:
• (a) promote health, well-being, and the ability to care for oneself among all age, social, and cultural groups;
• (b) minimize or prevent behaviorally and environmentally induced health problems that compromise the quality of life and
reduce productivity; and
• (c) minimize the negative effects of new health technologies on the adaptive abilities of individuals and families experiencing
acute or chronic health problems.

In November 1987 Dr. Ada Sue Hinshaw, director of the National Center for Nursing Research (NCNR), invited nursing organizations to identify
their research priorities.
Research priorities for people with Alzheimer's disease were identified at a research conference held in 1988 (Duffey, Hepburn,
Christensen, & Brugge-Wiger, 1989).
The top priority was given to research on:
– the management of physical problems (i.e., incontinence of bowel and bladder, falls, sleep disturbance, gait disturbance,
maintenance of adequate nutrition).
– Management of disruptive behaviors (i.e., agitation, wandering) was listed as the second priority.
The National Association of Orthopaedic Nurses identified a list of priorities in 1990 (Salmond, 1994).
They used a Delphi technique to survey experts in the field.
"Some of the highest ratings were given:
– to preventing confusion in elderly patients post-hip fracture,
– determining the most effective safety measures to use with the patient with acute confusional state, and
 P a g e | 13

– differentiating pain responses according to diagnoses, ages, and pain management interventions. In 1997 Sedlak et al. (1998)

replicated the 1990 study.

need for more research on pain and patient complications,
– such as deep vein thrombosis (DVT).
The authors expressed some concern about this particular priority because of the large amount of published research on DVT.
Sedlak et al. called for an ongoing and wider dissemination of research results.
In 1999 Pullen, Tuck, and Wallace published a list of priorities in mental health nursing.
These priorities were obtained by examining the published literature from 1990 to 1996.
– No specific mental health nursing agenda was found.

Six broad categories were identified:

– support,
– holism,
– mental health nursing practice,
– quality care outcomes,
– mental health etiology, and
– mental health delivery systems.

These authors cautioned that as nursing promotes evidence-based practice; there is a need for clear research priorities.
– They called for mental health nursing experts and organizations to propose a national/international mental health research agenda.
The Emergency Nursing Association conducted a Delphi study on national research priorities for emergency nurses in the United States
(Bayley, MacLean, Desy, & McMahon, 2004).
Three rounds of mailed surveys were used to gather data.
Responses were received from 101 emergency nursing leaders.
The study was completed in summer 2001.
– Interventions for pain management received the highest ranking.
– Emergency nurses were also concerned with:
» staff shortages and overcrowding of emergency departments and the effects of these two conditions on patients.
A survey was conducted among members of the Oncology Nursing Society (ONS)
to determine research priorities for 2005 to 2008 (Berger et al, 2005).
Responses were received from 431 members.
The top 20 research priorities were identified:
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 I

• 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.
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• 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.
• NURSING RESEARCH ON THE WEB
• For additional online resources, research - activities, and exercises, go to www. prenhall.com/nieswiadomy.
E. Ethics in research
ETHICAL STANDARDS IN RESEARCH
• Ethics is generally concerned with rules and principles to govern the complex nature of human behaviors.
• Since nursing research employs human beings and subjects, ethical guidelines should care for the rights of the subjects to be protected
against misconduct (if any), in research.
• The same consideration applies to nurses as well who will be involved in research, either
as subjects or investigators.

ETHICAL CONSIDERATIONS IN RESEARCH

• Ethics - form of philosophical inquiry used to investigate morality. It is based on scientific ethical principles that are used to justify
actions and assist in the resolution of moral dilemmas.
ETHICAL STANDARDS IN RESEARCH
The ethical code for research:
1. Researcher must inform subjects about the study.
2. Researcher must try to avoid injury to research subjects.
3. Researcher must be qualified to conduct research.
4. Researcher or the subjects can stop the study if problems occur.
5. Researcher must be good for the society.
6. Research must be based on animal experiments, if possible.

Three Major Ethical Principles in Research

1. Beneficence 2. Respect for Human Dignity
• Protection of
participants from
physical and
psychological harm
• Protection of
participants from
exploitation
• Performance of some
good
3. Justice
• Right to self determination • Right to fair treatment
(participants have the freedom to • Right to privacy (anonymity)
control their own activities, • Confidentiality (safeguard
including study participation) the information participants
provided)
• Right of Self Disclosure
(researcher have fully described to
prospective participants their rights
and full nature of the study)

Ethical Issues in Research

Ethical Principle Research Issue
 P a g e | 15

1. Autonomy 1. Informed consent

2. Beneficence 2. Information
3. Nonmaleficence 3. Understanding
4. Social justice 4.1. Free choice/proxy; no coercion
knowledge 4.2. Anonymity/confidentiality
4.3. Benefit to:
• research subject; society; or to knowledge
4. 4. Avoidance of harm to research subject;
• reduce risks to subjects, Weigh risks versus benefits
4. 5. Right:
• to be represented in the sample;
• right to equal access to
• not to be discriminated against according to class or category
• the principle of social justice is beginning to be discussed in research circles

E Ethics in research
. Feminists assert, and rightly, that women have as much right to know what will happen in their bodies when they take a certain drug as men do.
This is the principle of social justice.
• The operationalization of this principle is to include both men and women in any study of human beings.
• Problems Involving Ethics
• Informed Consent
• Balancing Potential Benefit against Actual Cost
• Maintaining Anonymity and Confidentiality
• Federal Guidelines on the Submission of Proposals for Review
• Ethical Principles Underlying Protection of Human Subjects
• Recommended Readings
Nuremberg trials
• The movement to protect human rights in research began after the Nuremberg trials that followed World War II.
• The world was so appalled by the biomedical experiments conducted on concentration camp prisoners that a code of behavior for researchers
was drafted.

Nuremberg Code
• Problems resulting from biomedical research were the subject of hearings in 1973.
• Two of the most famous were the Tuskegee case and Willowbrook case.
• The Willowbrook case concerned an experimental in which children living in an institution for the mentally retarded we injected with
hepatitis virus.
• In the Tuskegee case, black male prisoners we used for a classic experimental design for treatment of syphilis. One group infected men
received no treatment, and their disease progressed to stage syphilis. These cases, among others, raised several ethical issues requiring a set of
guidelines and principles on which to judge the ethical nature research.

Historical Development of Ethics in research

Event benefits reason for the event
Helsinki Code remedied that omission by The scandal that erupted :following the birth of the babies
(written in 1965 and including child if parental with severe birth defects born to women took thalidomide
rewritten in 1975 the permission was obtained and led to amendments to the US Food, Drug and Cosmetic
World Health the mentally incompetent
Organization)

In 1974, Congress This commission explored basic The Belmont Report summarized the basic ethical principles
established the ethical issues of human subjects developed the informed consent
National Commission in research and identified • to keep subjects informed throughout a research
for the Protection of principles to assist with the project including risks and benefits fully in order
Human Subjects of planning and conducting of to ensure subjects' understanding. These
Biomedical and ethical research. recommendations applied to all health-related
Behavioral Research. research including nursing studies.

Canada, the Tri- Guiding Ethical Principles for • standards widely accepted in the international
Council Policy health research. community.
Statement • protection of human subjects

The International developed a "Code for Nurses I 1953 recent update (2000)
Council of Nurses
Nuremberg Code
• Problems resulting from biomedical research were the subject of hearings in 1973.
• But you may ask "Why do we need to bother about ethical guidelines for research? Aren't people protected by law?"
 P a g e | 16

• The law is a written mandate for behavior, based on what people believe is good and bad behavior—their ethics.
• Before writing down laws, people must decide what they believe in.
• Frequently, laws are a set of instructions on what you are not allowed to do rather than a set of instructions on what you should
do.
• Ethics outlines a set of principles that can be used to determine which actions are right and which are wrong.
• Ethical judgments are the decisions a person makes on whether a particular act is right or wrong.
• ethical theory provides a means of understanding ethical principles and bioethics is the application of general moral principles to
the area of health/illness action and events.
• When an action deriving from an ethical principle becomes law, people can be punished for immoral behavior.
• The law is normally in a "catch-up" position in relation to ethical values and practices. Ethical values and practices change
over time and there may be a need to enact laws to ensure that these are observed.
• The question of do-not-resuscitate (DNR) protocols is a good example of a change in practice based on ethics.
• The development of laws to ensure that DNR protocols are allowed in particular circumstances is occurring throughout the west.

PROBLEMS INVOLVING ETHICS

• Anything that violates an individual's basic rights becomes an ethical issue
• Most violations arise from difficulty of obtaining truly informed consent, whether this stems from subject's lack of understanding or the
researcher's failure to inform the subject adequately.
• Expert views on the topic of informed consent vary widely, those who believe that everyone has a moral obligation to participate in
medical research for the good of humanity, to those who think that no but another researcher in the same field can truly give "informed" consent.
The chances that the subject has complete understanding of the research and feels totally free to make a choice are perhaps unlikely. If the subject is a
patient in the health care system, there are additional constraints to free choice.
The patient may feel it is necessary to please those on whom he or she is dependent, such as the physician or\ nurse.
In nursing, as in other professions, the state of the art cannot move forward without research. Therefore, human subjects must be solicited
in order to test ideas and answer questions.
The protection of the subject is the obligation of every nurse researcher.
If the subject is not aware of the true nature of the research and the subject gives consent willingly to participate in a research project, the
consent is not informed.
The researcher has not obtained an informed consent if only partial information is given about the study in general terms or if false
information about the purpose of the study or the procedures to be followed is provided.
Both methods of obtaining consent are questionable in that both inhibit the right of free choice. The use of deception is considered more
unethical than the withholding of information, although the line separating the two may be undistinguishable.
Withholding of information is widely used in studies where it is believed that complete information about the purpose of the study will
influence the subject's response. Thus, subjects are told they will be participating in a study to "improve nursing care," when the
actual question could be, "What are patients' attitudes toward male nurses?" or "What is the relationship between ethnic background and
perception of pain?"
Another instance of withholding information is found in the use of placebos to compare the effect of the "real" treatment.
Participants are not informed whether they are receiving the placebo or the real treatment.
For example, when testing the effect of a new teaching method on the abilities of diabetic individuals to control blood sugar before con-
senting is rarely considered.
The President's Commission for the Protection of Human Subjects has considered the problem of withholding information from subjects. , study
participants might not be told whether they are receiving the new or the old teaching method in an attempt to prevent this knowledge from
influencing the results. These practices are so widely accepted that the participant's right to complete knowledge
The report states strongly that such research can be justified only if the researcher can demonstrate that informing the subjects would
truly invalidate the research and not just cause the researcher inconvenience.
In addition, there can be no undisclosed risks to the subjects. If these criteria are met, the research might be approved, but there must
also be a plan for giving the subjects complete information after the study is over.
Under no circumstances may the investigator lie to the subject, even though a direct answer may make that particular subject ineligible
for the study.
Professionals use a number of rationalizations for withholding information from participants.
• One is that informed consent is necessary only when there is some risk for the participant.
• If the researcher determines that no risk exists, that individual may reach the conclusion that subjects do not need complete
information about the study.
• Another rationalization is that researchers are obligated to give only the information that the subject requests about the
study and that the responsibility for ensuring informed consent, therefore, belongs to the subjects.
• An assumption that often underlies this rationalization is that people are not really interested in the research question, only in
what will happen to them as subjects.
• None of these positions can override the subject's basic right to autonomy and respect, and, therefore, none are acceptable
practices.
Deliberate deception of human subjects was a common practice among researchers at one time.
• A number of outstanding studies based on deception produced far-reaching results and provided previously unavailable informa-
tion about human behavior. This practice was based on the belief that the data would not have been obtainable if the subject knew
the true nature of the research.
• For that reason, subjects were deliberately misled about the study or the experiment.
• In some cases, subjects received the results of the study after it was completed.
• In others, the subjects never knew.
• Examples of deceiving research subjects include:
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• telling subjects that they are being tested for one thing when they are being tested for something else
• not telling control subjects that they have received a placebo when they have
come for the experimental item (such as birth-control methods), telling subjects that someone else is being observed and not they as
subjects, and not telling subjects that they are involved in a research project even when they ask.
• Deception of research subjects is unethical nor Coercion of Subjects to Participate
The assumption behind the concept of informed consent is that, given sufficient information on which to base a decision, the subject's
consent to participate is made freely. However, there are various ways in which consent may be partly, or even wholly, coerced by the
circumstances under which it is obtained.
• Many times, the researcher is in a position to influence subjects' participation in the study. For instance, the researcher may be
the subject's employer or teacher and thus may exert considerable control. An employer or a teacher may require that individuals
participate as a condition of remaining employed or passing a course. Without question, this is coercion
Another type of coercion occurs when individuals are required to give consent to participate in research in order to be accepted for treatment
at a particular health care facility.
This might happen in medical centers and specialty hospitals such as those specializing in the treatment of catastrophic illnesses.
The individual is likely to feel that the "last chance" of being accepted rests with that institution and, therefore, feels compelled to consent
to anything.
Coercion also occurs when people are given the option to refuse but with the sense that refusal will not go unpunished.
For instance, when a nursing supervisor brings questionnaires to a nursing unit, distributes them, and says she will be back to pick them up
in an hour, at least some of the nurses are likely to feel that a refusal will offend their supervisor, even though they are given the option,
perhaps thinking it will have an effect on their days off or their shift rotation.
Health care clients are particularly vulnerable to requests to participate in research when the person making the request is someone on
whom the individual must depend for critical needs.
The physician and the primary nurse can easily take advantage of an individual's vulnerability.
The ethical position is to recognize that people are never obligated to assist with research.
Many times it may seem obvious that it will be to the advantage of the individual to participate in the research. Perhaps the individual will
benefit from extra nursing care or a special teaching program. Perhaps employees will reap the benefits of shorter working hours, less shift
rotation, or improved supervision. While this may be true, it is still the individual's right to decide. Thus, although the advantages of
participation can be mentioned as part of the information needed for informed consent, the decision should never be made for that person.
Withholding Benefits from Control Subjects
This issue is particularly critical for studies in which the new treatment would be of value to all the subjects, including the control group, or
when a control group is deprived of something the members of the group had access to earlier in order to obtain a more accurate assessment
of the new treatment.
Both instances provide ethical dilemmas for researchers. Remember, however, the majority of control groups suffer no deprivation.
Sometimes problems with control group deprivation occur because of the overzealousness of an inexperienced researcher, when, in fact, they are
not necessary.
For example, in a study to test the effectiveness of a preoperative teaching program on postoperative anxiety, the nursing staff was told not
to answer any questions from the participants in the treatment or the families in the control group. This overzealousness deprived the
control group of expected privileges and introduced a new variable—withholding of information—which was not part df the research
question. This kind of mistake can easily be identified in the proposal if the researcher addresses the topic of human rights for all subjects,
including the control group.
In some experimental studies, the benefit of the experimental variable is so obvious that those who are cooperating with the researcher in
carrying out the study will refuse to deprive the control group of the benefit.
This kind of study is particularly difficult for nurses to carry out, as their primary responsibility is the care of people and not
experimentation. Dedicated nurses would find it difficult to deprive a group of individuals of an obvious beneficial treatment, such as a
simple relaxation exercise that relieves postoperative pain. If this difficulty could be predicted, perhaps control data should be collected
before introducing the experimental variable, thus avoiding the problem for the attending nurse.
Sometimes, withholding benefits from the control group can be rectified at the end of the experiment by making the benefits available at that
time.
A method of teaching diabetics that has proved immensely successful could be provided for the control patients after the data have been
collected. Remember, however, that this effort must be planned in advance along with the actual experiment, so that time and money are
budgeted for carrying it out.
INVASION OF PRIVACY
All research has the potential of being invasive, whether it is simple observation and recording of behavior or an experimental design.
If you, the, researcher, decide to take movies of persons leaving a bar, a church, or a jail,! you may unintentionally be taking movies of
people who don't want others to I know where they were. When you show these movies publicly, you are invading the privacy of the
persons you have photographed. When you go to people's homes for interviews, particularly when the topic is sensitive, you are again
invading individuals' privacy. These persons have a right to refuse to participate in your research or to have all identifying data about
themselves removed from your study.
Another violation of privacy is observing individuals on units when they are living in a health care facility such as a long term or continuing care
institution.
These individuals have as much right to privacy in the hospital as you do in your home. Because their privacy is limited, it must be
protected even more. Hospital records are private documents—not to be shared for the sake (A curiosity. As private citizens, we have the
right not to have our private lives

INFORMED CONSENT
spread all over the front page of a newspaper or be placed on TV for the purpose of research. Without our permission, researchers simply don't have
the right to violate that principle of INFORMED CONSENT
Just as all patients entering the health care delivery system have the right to know what will happen to them and to sign a consent form for any
procedures, so do the participants in a research project.
The protection of the rights of the research subject revolves around the concept of informed consent.
Informed consent has three major elements:
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the type of information needed by the research subject;

the degree of understanding required of the subject in order to give consent; and,
the fact that the subject has a free choice in giving consent.
INFORMATION
All research subjects need to know in full detail what will happen to them during the research project.
In order to receive consent, the researcher must explain the study and the subject's participation in the study.
the "informed" portion refers to the amount and type of information that should be given so that the research subject is
thoroughly oriented.
The information needed by research subjects includes:
the nature, duration, and purpose of the study;
the methods and procedures by which data will be collected;
how the data will be used;
all the inconveniences, potential harm, or possible discomforts that may reasonably be expected from the research protocol;
the benefits to be gained from the study; the results, effects, and
side effects that may come from participation in the study; and
the alternatives available to the subjects.
the researcher must inform the subjects that they may withdraw from the study at any time without prejudice.
Subjects should also be told if they will receive any compensation for being in the study and, if so, what, and how any injuries
resulting from participation will be treated.
In an experimental design in which the researcher manipulates the independent variable (such as in a clinical trial or clinical
experiment), subjects must be told about the entire experiment, including the risks and benefits, and that they may be assigned
to either the control or the experimental group.
Free Choice - This last aspect of informed consent implies that the subject should not be coerced, in any way, to participate in the study.
Kinds of Coercion:
1. mild coercion such as the offering of remuneration that may be irresistible to severe coercion such as threat of failure in school, refusal of
treatment, physical punishments, and so on. When an individual feels coerced threatened, choice is not free. Similarly, excessive rewards limit
freedom choice.
GUIDE LINES of informed consent in your research proposal.
A)Write down exactly how you intend to tell research subject about the study.
B) Write out what you will say in simple laguage and look up synonyms for words you think may not be clearly stood.
C) make sure that the nature and amount of information your subjects will be given,
D) State the steps you intend take to ensure freedom of choice, are present in the informed consent por of your proposal.

Proxy Consents for Research

Ethical guidelines for research demand that the subject's informed consent be based on enough information, comprehension of that information, and
freedom to choose. There are certain groups in society who do not meet these basic criteria for informed consent.
1. Those who are cognitively impaired may lack the ability to comprehend.
2. Children, because of their parents' legal rights, may lack the right to make a free choice.
3. the comatose and the fetus.
The researcher who wishes to study any of these groups has an additional burden to assume—
A. that of assuring that the human rights of the subjects will be protected and
B. obtaining legal permission (usually by proxy from the parent or guardian).
POTENTIAL BENEFIT AGAINST ACTUAL COST
In all disciplines, scientists must develop new knowledge through research. In any research proposal, the researcher is obligated to weigh the
potential contribution of the research, both to the discipline and to society, against the costs to participants in the study. In some cases there is no
problem. Full, informed consent can be obtained from the participants. They can make a free choice based on sufficient information. In other cases,
because of the nature of the question and the procedures necessary to elicit the required data, there is some violation of the rights of the subjects. The
benefits of the research must be carefully examined in light of the cost of these subjects.
The process of weighing the costs and benefits is always a subjective one. The investigator will always be slanted in favor of the research. To reduce
subjectivity, three areas should be addressed: potential contribution to knowledge, practical value to society, and benefit to the subject. The first
includes the development of theory to explain nursing practice and an improvement in the consumer's understanding of health care delivery. The
second involves improvement in the delivery of health care to the public and improved assessment of the health care needs of ethnic minorities. The
third might be more rapid recovery from illness because of improved nursing care or increased understanding of preventive health measures.
Addressing one or more of these three areas should produce substantial evidence to balance the potential cost to the subject.
The process of balancing potential benefits and costs requires analysis of degree as well as benefit or cost.
How important is the problem under study? It is frequently difficult to say. Questions about current issues in nursing will assume more
relevance and importance than those of interest only to the researcher. The same question can be asked of the potential cost to the subject.
How serious is the potential infringement on the subject's rights? How much harm might it do? Is it likely to be fleeting or lasting? Answers
to both questions will meet with considerable disagreement among colleagues. Once again, the researcher is likely to be biased in favor of
the research. Therefore, all possible resources should be used to help make the decision to go ahead possible.
Consultation can be obtained from a number of sources to evaluate the protection of the rights of subjects in the proposal.
People who are interested in the same or similar research area are a valuable resource. You may obtain helpful advice on how to proceed
from other researchers who have faced the same dilemma. There is one shortcoming to using colleagues: they may be as biased as you are
in favor of the proposed research. Since it is difficult for one closely involved in the field to be objective about balancing pluses and
minuses, there may be a tendency to view the potential contribution more much more valuable than would be the case by someone not
involved in the research subject.
Before they consent to participate, your subjects need to be told that you intend to publish the results of your study.
In studies of groups of people, it is frequently impossible to maintain anonymity of the group when publishing your findings. It may be the
only group of its kind, so that, even disguising names and location, it is possible to identify the members. This possibility can prove
embarrassing to the individual members, and they need to be aware of it before they can give full consent to participate in the study.
Your method of data analysis can cause loss of anonymity for your subjects if you are not careful.
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If, for instance, you are reporting findings in an attitude study of staff nurses, and you cross-tabulate them by shift, unit, and position, you
may find that there is only one R.N. on the night shift of a particular unit, and her responses will be easily identified. To maintain
anonymity, you may be required to omit some of your data analysis from the published report.
These potential difficulties in maintaining confidentiality can be avoided by planning ahead.
It is not enough just to avoid promising what you "can't deliver." The key is on the research to inform the subject that some or all of the
data will become public knowledge or that some individuals other than the researcher will have access to them. Otherwise, the subject has
the right to assume that all data will be kept confidential.

ETHICAL CONSIDERATIONS IN RESEARCH

Main Principles / Human Rights that Require Protection
• Right to Self Determination/ Autonomy - based on the principle of respect for persons and indicates that humans are capable of
controlling their own destiny.
Prospective subjects have the right to voluntarily decide whether or not to participate in a study without the risk of incurring any penalties.
Subjects have the right to decide at any point to: terminate their participation, refuse to give information, to ask for clarification about the purpose of
the study.
It also means freedom from coercion.
ETHICAL CONSIDERATIONS IN RESEARCH
1. Principle of Beneficence - "one should do good, and above all do no harm"
– Right to protection from discomfort and harm from study.
• Discomfort and harm can be physical, emotional, social, economical.
• Physical - adverse reaction to an experimental study
• Social - participation in a sensitive topic, such as alcoholism, HIV could result in the loss of privacy of the subject.
• Emotional - increase in anxiety secondary to being a research subject
• Economic - financial threats such as loss of job, money, work if participation in the study is known.
2. Principle of Justice
– Right to fair treatment - fair and non-discriminatory selection of subjects. Being respectful and courteous to the prospective subjects
– Right to privacy - Privacy is the freedom an individual has to determine the time, extent, general circumstance under which private
information will be shared with or withheld from others,
– Anonymity is an important consideration. Researcher cannot link a subject with the information for that subject.
3. Informed consent -
– subjects have adequate information regarding the research?
– Respondents have the power of free choice enabling them to voluntarily consent to participate in the or decline participation
Elements of informed consent
1. adequate information on the following aspects:
– • purpose, methods, procedures
– • possible uses of the findings, benefits to individual and society
– • potential harms, risks, inconvenience and discomforts, side effects
– • available alternatives
– • right to refuse to participate
– • identity of the researcher and how to contact
2. comprehension - understanding of the:
purpose and potential risks and benefits in participating in the study.
• The consent form should be brief, clear and well-written.
People with lower educational and vocabulary levels may need more help in processing information.
3. Mental competence -" sound enough in body and mind" to fully give or make an informed choice.
• Mentally competent individuals are those who are capable of understanding the benefits or risks of the proposed study.
• Mentally incompetent subjects include those with diminished autonomy because of legal or mental incompetence, terminal illness, or
confinement to an institution.
• Vulnerable subjects may be incapable of giving fully informed consent.
– They include the following:
• • children - legally and ethically children are not competent to informed consent
• mentally and emotionally disabled persons
• some people with physical disability, eg deaf or institutionalized people
• • pregnant women due to physical and psychological risks
4.Freedom from Coercion-freedom to
(1) choose to participate or not in a research study;
(2) to do so free of undue influence or coercion.
II - Evidence-Based Nursing Research
• Definition of evidence – based nursing research
• Importance of building an evidence-based nursing research
• Utilization of evidence- based nursing research
• EVIDENCE-BASED MEDICINE (EBM)
• EBM, a paradigm in health care practice, is the integration of the best research evidence (clinically relevant patient centered research)
with clinical expertise (ability to use clinical skills and past experience for patient's unique needs) and patient values (unique preferences, concerns
and expectations of clients).
FUNDAMENTAL PRINCIPLES OF EBM:
• Evidence alone is never sufficient to make a clinical decision.
– Hence, clinicians must always trade the benefits and risks, inconveniences, and costs associated with alternative management strategies,
 P a g e | 20

– and in so doing considers the patient's values.

EBM posts a hierarchy of evidence to guide clinical decision-making.
EVIDENCE-BASED NURSING IS A 5-STEP PROCESS
The 5 "A's" will help you to remember the EBN process:
(1) ASK: Information needs from practice are converted into focused, structured questions.
(2) AQUIRE: The focused questions are used as a basis for literature searching in order to identify relevant external evidence from research.
(3)APPRAISE : The research evidence is critically appraised for validity.
(4)APPLY: The best available evidence is used alongside clinical expertise and the patient's perspective to plan care.
(5)ASSESS: Performance is evaluated through a process of self reflection, audit, or peer assessment.
THE PURPOSE OF EBNP
• to help you as a professional make informed decisions by learning from what others in your field are researching and learning.
• to make it easier to apply current quality evidence from research in clinical and healthcare decisions.
• evidence-based research
• instrumental in the care of patients today,
• a new endeavor for most staff nurses in the development and implementation of research.

Evidence-based nursing - integrates the best evidence from research with :clinical expertise, patient preferences, and existing resources into
decision making about the health care of individual patients.
Evidence-Based Nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise
and patient preferences."
[Source: University of Minnesota Evidence Based Nursing page]
– Magnet hospitals: research and evidence-based practice mandates –
• "Quality patient care is provided through sustaining excellence in nursing services."
– Solves problems encountered by nurses by carrying out four steps below...
•
OUTCOMES RESEARCH or EVIDENCED-BASED NURSING PRACTICE
Focus:
• the need to answer the growing demand of justifying: the quality of interventions, systems of care as regards improving patient lives, and
spiraling cost of health care.

Definition:
• Translating knowledge into practice
Chapter 2 Importance of building an evidence-based nursing research

Significance (importance of EBNR):

Nurses attend to patients most of the time. They attend personally to interventions given by doctors.
1. Nurses influence the treatment given due to cart delivery techniques.
– The health outcomes depends on many factors where nurses are involved.
– Nurses are on the forefront of examining outcomes of programs designed and implemented in the communities.
2. The professional nurse is in an excellent position to create change that demonstrates quality care that is cost effective
3. Initiative in producing health outcomes comes from nurses themselves after a thoroughly examination of particular clinical conditions
that are more specific to nursing’s impact on:
– prevention,
– health promotion,
– symptom management & t
– he amelioration of the effects of acute & chronic illness

UTILIZATION OF EVIDENCE – BASED NURSING RESEARCH

• Promoting research utilization in nursing: the role of the:
• individual,
• organization, and
• environment

Joan Royle, RN, MScN, Jennifer Blythe, PhD, MLS

School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
UTILIZATION OF EBN RESEARCH:
1. To practice evidence-based nursing, clinical nurses need effective strategies for extracting relevant information from the many publications
that are currently available.
– The quality of information that nurses demand and how effectively they evaluate and use it for clinical decision making
will influence patient outcomes and, ultimately, the part nurses play in the delivery of health care.
The term "information society" was introduced in the 1980s to describe the information explosion precipitated by new technologies.
2. Nursing practice is information intensive.
– Even 10 years ago, Mowry and Korpman estimated that nurses spent 40% of their time on information related tasks.
3. The rapid growth of nursing information means that nurses cannot rely on knowledge acquired as students and must constantly update their
practice.
4. independent home health care nurse who knows the importance of implementing evidence-based practice in the clinical setting (Jennifer S.
Couvillon, PhD, RN, FNP)
5. ability to access, summarize, and apply information from the literature to day-to-day clinical problems".
6. Evidence based practice "requires an emphasis on systematic observation and experience and a reliance on the research literature to
substantiate nursing decisions."
– Evidence based practice allows practitioners to meet a daily need for valid information about clinical situations.
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7. Evidence based practice allows nurses to enrich their clinical training and experience with up to date research.
– With the large amount of research and information that exists in the medical field, learning the skills of evidence based practice allows
nurses to: search for, assess, and apply the literature to their clinical situations.

4 STEP PROCESS IN THE USE OF EBP:

1. Clearly identify the issue or problem based on accurate analysis of current nursing knowledge and practice
Define your search question
– Flemming, K. Asking Answerable Questions. Evid Based Nurs 1998; 1:36-37.
2. Search the literature for relevant research
Select appropriate resources: Google/Google Scholar, CINAHL, PubMed, others
Design search strategy that optimizes value of selected databases and their features
Use thesaurus terms whenever possible
Select limits
Review results; modify
3. Evaluate the research evidence using established criteria regarding scientific merit
Criteria for critical appraisal of qualitative students (under qualitative EB Nursing
4. Choose interventions and justify the selection with the most valid evidence

• KEY FORMATS FOR EBP:

• Original research
• Individual studies
• Evidence summaries
• Systematic reviews: integrative reviews; meta-analysis
• Translation literature
• Care Plans
• Clinical Innovations
• Critical Path
• Practice guidelines
• Protocols
• Standards

What is Evidence Based Medicine?

• "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of
individual patients.
• The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical
evidence from systematic research."
• Quotation from: Sackett, David L, et al. "Evidence Based Medicine: What It Is and What It Isn't." BMJ 1996; 312: 71-72. Available:
http://www.bmj.com/cgi/content/full/312/7023/71

Why Evidence Based Nursing?

• Evidence-based nursing is one approach that may enable future healthcare providers to manage the explosion of new
literature and technology and ultimately may result in improved patient outcomes.
• Nursing students spend a great deal of preclinical preparation time designing care plans, reviewing pathophysiologic
rationale, and memorizing pharmacologic interactions.
– Although these activities are useful, they cannot be the only methods of preparing students for nursing practice.
• Sole reliance on textbooks and expert faculty knowledge does not promote the critical thinking skills that nurses must
have to survive in the current fast paced clinical settings.
– Students must learn to develop independent, evidence-based methods of clinical decision making.
• Evidence based practice (EBP) "involves an ability to access, summarize, and apply information from the literature to
day-to-day clinical problems".
– Evidence based practice "requires an emphasis on systematic observation and experience and a reliance on the research literature to
substantiate nursing decisions."
– Evidence based practice allows practitioners to meet a daily need for valid information about clinical situations.
• Evidence based practice allows nurses to enrich their clinical training and experience with up to date research.
– With the large amount of research and information that exists in the medical field, learning the skills of evidence based practice allows
nurses to search for, assess, and apply the literature to their clinical situations.
• Quotations from: Kessenich CR, "Teaching nursing students’ evidence-based nursing." Nurse Educator, Nov/Dec 1997, 22(6):
25-29.

Isn't EBN just "cookbook" medicine?

• Evidence Based Practice does more than just identify research, it integrates the best possible evidence with individualized patient care.
• Clinicians using evidence based practice do not simply "follow a recipe", but use their own clinical experience and apply the evidence to the
specific clinical situation.

OUT COME RESEARCH THEORETICAL BASIS:

• Theory of quality health care by Donabedian (1987).
His theory of conducting outcomes research was based from evaluation research.
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three aspects of evaluation in appraising quality are structure, process, and outcome.
For beginners, outcomes research is not advised because examination of all aspects will be needing large samples of various structures, each one
with the different processes being compared and large samples of subjects who have experienced the outcomes of those processes.
Even seasoned researchers may encounter difficulties in doing outcomes research because the funding and the cooperation necessary to attain
this goal are not that so available at present (Burns and Grove, 1997).

OUTCOMES STUDIES METHODOLOGIES

• As a new trend in nursing research, outcomes research methodologies
are still developed.
• The Patient Outcomes Research Team (PORT) in its projects has been required to conduct:
– literature reviews and synthesis;
– analyze practice variations and associated patient outcomes,
– Use of available data augmented by primary data collection where desired;
– disseminate research findings, and
– evaluate the effects of dissemination (U.S. Congress, 1994).

Implementing research as broad as a PORT

– is next to impossible without the financial support.
• The development of an outcome research tradition on a smaller scale may become a reality by having these steps. Burns and Grove (1997)
pointed out that these steps were combinations of PORT plans in 1990 by Freund, Diltus, Fitzgeral, and Heck; Sledge in 1993, and Turk and Rudy in
1994.

OUTCOMES STUDIES METHODOLOGIES

The steps on Outcomes Research:
1. Perform a critical review of the published literature or a meta-analysis.
2. Conduct large database analyses based on the results of the critical literature review.
3. Identify outcomes measures for use in the study and evaluate their sensitivity to change.
4. Identify variables that might affect the outcomes.
5. Achieve consensus on definitions for all variables to be used in the research program.
6. Develop assessment instruments or techniques;
7. Conduct patient surveys or focus groups to gain information on outcomes such as level of functional status and perceived pain and how these
outcomes may improve or regress over time.
8. Determine patterns of care (who provides care at what points of time for what purposes?).
9. Perform a cohort (group) analysis.
– Follow a cohort of patients, some of whom will receive one treatment and others of whom will not receive the treatment to assess changes
in outcomes over time.
– Use a telephone survey at selected intervals to gather information.
– Evaluate the proportion of patients who improve as well as the group mean differences.
10. Determine, through follow-up studies,
– differences in patient selection or interventions that are associated with different outcomes.
– Evaluate the durability of change by:conducting sufficiently long follow-up.
– Determine the percentage of patients dropping out from different treatments and, when possible, determine the reasons for dropping
11. Determine the: clinical significance of improvement as well as the statistical significance.
12. Determine the cost-benefit and cost-effectiveness of the treatments under evaluation.
13. Use decision analyses to synthesize information regarding patients‘ outcomes and preferences for various types of outcomes.
14. Disseminate information to both patients and health care providers about which individuals would and which would not benefit from the
procedure.
15. Conduct a clinical trial to evaluate the effects of the intervention.
16. Incorporate findings into treatment guidelines.
17. Modify provider and patient behavior so that proven, effective treatment is applied to those who are most likely to benefit (Burns and Grove,
1997).

MAJOR GOAL OF THE NURSING ASSOCIATION

• Facilitating the development,
• implementation, and
• dissemination of research.
Which includes:discussion of potential research areas and providing the venue for proposal submission (Vessey & Campos, 1991).

Kinds Evidence – based research models:

1. Stetler's Model of Research Utilization,
2. the Ottawa Model and
3. the Iowa Model of Evidence-Based Practice to Promote Quality Care (Polit & Beck, 2004).
Iowa Model
• is the most straightforward and simplistic in nature.
• research projects typically begin as knowledge or problem-focused "triggers" (Polit & Beck,

The Iowa Model research project with three critical questions:

1. Is this problem a priority for the organization?
2. Is there sufficient research pertaining to this problem?
3. Is a change indicated and if so is it feasible for adoption by the organization?
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PROCESSES TO UTILIZE IN IOWA MODEL.

1. choose a model.- to determine the form that could be developed using the model decision points such as:
– a mechanism to explore, and
– introduce a research idea.
2. Individuals submitting projects or research should complete the model decision points, a form used prior to their presentation.
3. The principal investigator sends the completed form to the Nursing Research Council Chair prior to the meeting and
4. The principal investigator presents an overview of the project to the Nursing Research Council members.
5. Once a project gains approval, the Nursing Research Council Chair or designee then assists the Principal Investigator in preparing for the
Institutional Review Board.

OVERVIEW OF THE RESEARCH PROPOSAL INCLUDES

1. Title of Project.
2. Purpose of Project.
3. Is the project - • Problem-Focused
• Knowledge-Focused
4. Is this topic a priority for the hospital? • Yes • No
5. Team members.
6. Brief critique and synthesis of relevant research & literature.
7. Is there a sufficient research base? • Yes No • Unknown
8. Brief description of intervention to be carried out.
9. Planned duration of intervention.
10. Anticipated outcomes to be achieved.
11. Describe/collect baseline data.
12. Proposed pilot unit.
13. Is change appropriate for adoption in practice? • YES • NO
V. PHASES OF THE RESEARCH PROCESS
Unit 5
THE RESEARCH PROCESS
Phases of the research process:
Phase I
A. Conceptual phase
B. Designing and Planning Phase

THE RESEARCH PROCESS

Phases of the research process:
Phase II.
1. Empirical Phase
2. Analytical Phase
3. Dissemination Phase

THE RESEARCH PROCESS

Phases of the research process:
Phase II.
1. Empirical Phase
A. Developing and fine tuning research Instruments.
B. Identifying methods in determining quality of research instruments
• Quantitative-reliability
• Qualitative -Trustworthiness
C. Methods of Data gathering
D. Steps in the conduct of data gathering

THE RESEARCH PROCESS

Phases of the research process:
Phase II.
2. Analytical Phase
A. Analyzing Quantitative data
Criteria for selecting statistical tool
Descriptive data analysis
Inferential data analysis
B. Analyzing Qualitative data
Content Analysis
Establishing categories, themes
C. Utilization of computers in analysis data

THE RESEARCH PROCESS

Phases of the research process:
Phase II.
3. Dissemination Phase
A. Communicating the research findings
Writing the final research study
B. steps in preparing for publication and poster presentation
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C. Presentation of research findings

D. Final defense – panel
E. Conference / student forum
BASIC METHODS OF RESEARCH
• Nursing research should be made easy yet its conduct should be systematically and accurately performed by a nurse researcher. Thus, the
presentation of the most commonly utilized research methods and the specific purposes for which they are applied.
METHOD OF RESEARCH PURPOSE
A. Experimental Research • Investigates probable cause-and-effect relationship by having one or more experimental groups
1. True experimental exposed to one or more treatment conditions and comparing the results to one or more control groups
not receiving the
treatment.
2. Quasi-experimental • Approximates the conditions of true experiment in a setting that does not allow control and/or
manipulations of all relevant variables.
B. Non-experimental Research • Objective and accurate reconstruction of the past in relation to the tenability of a hypothesis.
1. Historical
• Describes systematically, factually and accurately the nature of a phenomenon under investigation after
2. Descriptive a survey of trends, practices and conditions relevant to that phenomenon.
• Investigates patterns and sequence of growth and/or change as a function of time on a certain
phenomenon,
3. Developmental
4. Correlational • Examines the extent to which variations in one variable correspond with variations in one or more
other variables based on correlation coefficient.
5. Case and FieId • Studies intensively to interpret the
background, current status, and
environmental interactions of a given
social unit: an individual, group,
community or institution.
6. Causal-Comparative or "Ex • Investigates possible cause-and-effect relationships by observing some
Post Facto" existing consequences or effects and searching back through the data for any plausible cause
6. Causal-Comparative or "Ex • Investigates possible cause-and-effect relationships by observing some
Post Facto" existing consequences or effects and searching back through the data for any plausible cause
7. Action • Develops new skills or new approaches to solve problems with direct application on nursing
intervention or other applied setting.
PROBLEM IDENTIFICATION AND DEFINITION
Chapter 1

PROBLEM IDENTIFICATION AND DEFINITION

• Every research starts with a problem.
– Without a problem, there is no need to conduct a research.
• The development of a research problem depends upon:
– one's imagination,
– insight,
– ingenuity.

Common Sources of Problems:

• Experience - immediate problems that need solutions or that excite the curiosity are relevant and interesting.
• Nursing Literatures - published reports may suggest
problem areas indirectly by stimulating the reader's
imagination.
• Theories - theoretical systems and conceptual schemes developed in nursing and other disciplines.
• Ideas from others/ issues one has been arguing about
• Result of a clinical situation encountered
• Unresolved issues in literatures.
• A research priority identified by a professional nursing organization

Defining the Research Problem.

• The problem definition explains the existence and seriousness of the problem.

questions are usually answered In defining :

1. does the problem really exist?
– What are the evidences of the problems existence?
2. Is the problem serious?
– Who and how many are affected by it?
3. What places are affected?
– How widespread is it?
– How often does the problem occur?
4. It is important that researcher presents a valid justification for the study.
 P a g e | 25

– To do so, the definition should present relevant data from service statistics and related literature.

Characteristics of a Good Research Problem

• A research problem must be relevant.
– The problem should be worth investigating and worth the time, money, effort to be spent.

Question to be considered:
• Will answers to the research questions help advance knowledge?
• Will the answers help in improving practices/behaviors/performance?
• Will answers improve human condition?
2. A research problem must be feasible.
– Feasibility means the availability of money, time, appropriate tools and devices and personnel.
• It may be relevant, but if funds are not available and there are no skilled researchers or data, it would not be feasible.
3. A research problem must be clear.
– The statement should be clear.
– Major variables should be measurable.
– The use of ambiguous terms should be avoided.
4. A research problem must be ethical.
– The conduct of the study must not pose any danger, embarrassment, hurt or risk to the respondents.
– Information needed to answer the research questions can be collected without violating the rights of the source/s of information.
– The privacy of respondents must be protected.

• Purposes Served by Detailed Description of Problem:

• 1. It serves to ascertain and make explicit the cause of the problem to be defined and investigated.
• 2. It identifies and makes explicit factors that-.may theoretically or in actuality enhance,-support, or maintain the problem.
• 3. If puts the cause of the problem into perspective with its related structure with the total problem defined.
• 4. It relates the problem to the larger, typical, setting in which it occurs and to other problems in that setting.
• 5. It suggests varied avenues toward pursuit of potentially pertinent new knowledge
• 6. It requires and stimulates speculative thinking about interrelationships of elements in the situation of science theories that may serve

Elements of research problem

(update: basic steps in planning nsn research by Wood et al., 2006)
elements
Review of the • Rationale to literature, point of view on the subject – all of which are substantiated by facts,
literature theories & arguments from readings.
• The problem is the statement of what you are doing & why.
- if you are hesitant about your idea, your problem will be hesitant
- if uninterested in the study, the problem will be dull
Rationale for - if you did not do your readings, the problem will just be buckets n bolts.
developing the • You problem is the expression of your self
question
Theoretical or
conceptual
framework

to explain them.
• 7. It includes information for identification of relevant criterion measures and data to used to accomplish the stated purpose of the
study.
• 8. It provides a framework within which to hang findings from the investigation.
• 9. It provides bases for conclusions and recommendations to be derived from the findings.
• 10. It portrays the potential relationship of the "bit of knowledge" anticipated as an outcome of the investigation to other knowledge in
the area of interest. 'It provides for contribution to the "body of knowledge" rather than adding one more bit to the many unrelated bits and pieces of
knowledge.
•

REVIEWING LITERATURE
A review of literature is a process of:collecting, selecting, and reading books, journal articles, reports abstracts, and other reference materials,
including electronic sources (CD-ROM) and the world wide web (www/http) to get relevant information about the problem under investigation.
– a waste of time
– Is a series of references.
• Only literatures used to substantiate the background of problem is included in the literature review
• Rationale for incorporating review of literature:
– To substantiate what you say through literatures through direct personal quotes
• Thus the need to separate RRL is just a waste of time
Why Review Literature?
 P a g e | 26

1. Literature review is a must in research.

– It helps the researcher identify and define a problem, A new problem may arise from vague results, conflicting findings.
– Helps justify the need for studying a problem.
2. It prevents duplication of a study.
3. They are sources of theoretical basis for the study.
4. It helps conceptualize a problem and properly
5. identify and operationally define study variables.
6. It helps refine research instruments.
7. Results of related study provide lessons for data
analysis and interpretation.
8. Findings can be compared to findings of related study.
• RESEARCH OBJECTIVES
– statements of what the researcher intends to do.
– It communicates what researcher plans to do.
– Structurally, the objectives are seen as small particles which constitute the problem.
• They are usually written in declarative form and start with infinitives like:
– "to determine,"
– "to find out,
– " to describe,
– " to compare,"or
– "to test"
• Examples:
• To determine the extent of nursing students' participation in school activities.
– To test the effectiveness of oresol in the treatment of diarrhea.
• Some researchers may state their objectives in form of a question.
– Example: This study sought to answer the following questions:
• What is the level of performance of BSN IV students in rendering care to post op patients?
• Is their a significant difference on the level of performance of BSN IV students when the following variables are considered: sex, age,
religion?
Types of Objectives:
1. Immediate or General Objectives
– relates directly to the research problem and
– states clearly what the researcher will do and expects to finds out.
– It specifies the activity/ies that will take place and the variables to be examined.

1. Specific Objectives –
– It specifies the variables to be studied,
– the variables are expressed in measurable terms
– and it suggests the type of analysis to be done.

Example:
Title: Extent of Caring Behavior of Student Nurses in Rendering Care in the Clinical Area
• General Objective: This study aims to find out the extent of caring behavior of student nurses in rendering care in the clinical area.
• Specific objectives: Specifically, this study aims to answer the following:
• What is the extent of caring behavior of student nurses in the clinical area along four aspects which are physical, psychological, social and
spiritual as perceived by student nurses and patients.
• Is there a significant difference on the caring, behavior of duty nurses in the different clinical areas like CDP, EENT, Gyne, Medicine,
ortho and surgery?
• Is there a significant difference in the extent of <»n;ng behaviore of^ent nurses in the dffierent clinical areas when the following vana&es
are considered. Year
Example 2:
Title: Demographic and Socoeconomic Determinants of Health-seeking behavior of the elderly in Baguio City
• General Objective- This study will be conducted to identify demographic and Determinants of health seeking behaviors of the elderly in
Baguio City.

• Specific Objectives: Specifically it aims to:

• determine whether there is significant factors, such as, age, sex, civil status of the elderly and their health-seeking behavior
• Determine whether there is significant relationship between selected socio economic involvement, occupation, income and their health-
seeking behavior.
tips in formulating research objectives:
1. Use simple language
2.Focus attention on the specific actions that will be performed
3. State exactly what will be done and what variables will be measured
4. Write objectives in behavioral terms like:
– to determine,
 P a g e | 27

– to describe,
– to compare, etc.

HYPOTHESES - is an educated guess or tentative answer to a question.

– It is a statement about the expected relationship between two or more variables that can be empirically tested.
– It suggests the type of analysis that must be done in order to measure relationship.
– They are tentative answers to the research question.
– It is not proven, its is only tested.
• On many occasions a hypothesis may be borne out by a study and a similar hypothesis may obtain findings that are different or
reverse from the first hypothesis.
Attributes of a Good Hypothesis:
1. It is strong enough to compel an inquiry.
– It serves as the focus for the inquiry in which it is involved.
2.When substantiated through research, it moves to a realm of theory
3. It can be used to explain phenomena, guide actions, and predict outcomes.
4. It adequately explains observed facts.
5. It offers the simplest explanation under the circumstances.
6. It offers explanation that is as complex as necessary under, the circumstances.
7. It can be brought into an agreement of disagreement with observations.
• A good hypothesis then is easily understood, specific conceptually clear, and can be tangibly measured.
– It should be related to a body of theory so that the findings will be relevant and provide valuable information.
– It should be logical, testable, related to the research problem, factual and theory based.
Source of Hypothesis
1. The hypothesis may be based on astute observation of some phenomenon within the environment, or
2. on other hypothesis that have been tested.
3. Experience may also be a source of hypothesis.
4. Types'of Hypothesis can be:
5. 1. Simple Hypothesis
6. 2. Complex Hypothesis
7. 3. Directional Hypothesis
8. 4. Non-Directional Hypothesis
9. 5. Null Hypothesis
Functions of HYPOTHESES :
1. A single hypothesis might state that an independent variable is associated with a dependent variable.
– Examples:
• There is no significant difference between the perception of patients and student nurses regarding the caring behaviors rendered
in the clinical area along the four aspects of care.
• There is a significant association between level of knowledge about the dangers of smoking and habits of young professionals.
2. Sometimes a hypothesis specifies that, under certain conditions, variable A can influence or is associated with variable B
– Example:
• There is a significant association between level of knowledge about the dangers of smoking and smoking habits among young
professionals who have a positive attitude towards life.
Condition: if they have a positive attitude
3. Some hypothesis may state that a particular characteristic of a person or object varies according to another variable.
– Example:
• The proportion of women who have experienced domestic violence is higher in the rural areas than in urban areas.
• Board performance of nursing graduates varies according to the type of school they graduated from.

KINDS OF Definition Example:

HYPO -
THESES
1. Null - a negative statement which indicates the – There is no significant relationship between
Hypothesis absence of a relationship/correlation between mass media exposure and attitude towards smoking
two variables, an absence of a significant among high school students.
difference between the proportions of two
groups of people or objects possessing a
particular characteristic.
2. Alternative - a positive form of the null hypothesis. It may There is a significant relationship between mass media
Hypothesis or state significant relationship between exposure and attitude towards smoking among high
Research school students.
Hypothesis
3. Non- - It does not specify the direction of – Students‘ who attend tutorial classes perform
directional relationship between variables. better than those who do not attend.
hypothesis – It merely states the presence or Taking vitamins regularly tend to improve a workers' total
absence of relationship. health status.
4. Simple - predicts the relationship between one – Performance in the college of nursing is related
 P a g e | 28

Hypothesis independent variable and one dependent to success in the nurses' board examination.
variable.
FORMULATION OF RESEARCH FRAMEWORK
• Framework for study is simply an explanation, based on the literature you have read, of how the variables in your study are expected
to relate to each other and why.
• • In explaining the existence of a problem, a research may be based on a theory.
• The connection between theory and the problem is explained in the theoretical framework.
• The theoretical framework may be further explained and illustrated in concrete terms using a Conceptual framework
• It presents a theory that explains why a problem under study exists, and the connection between certain factors and the problem.

Theoretical framework –
– When the variables have been studied before and have been found to be related to one another
– It has an available theory that will provide an explanation for the action of your variables or
– There is a proposed explanation given by another author to explain the findings of a study of the same variable.
• This framework will then be tested by the researcher & will either be supported or refuted by the result of the study.
• Conceptual framework.
– when the explanation is based on literature and researches about the variables, or
– When the literature does not contain a particular theory that explains the relationship among your variables.

Framework levels: (update: basic steps in planning research by Wood et al., 2006)

level • Definition recommendation

L • Framework based on existing Develop a rationale for the study to support the need for exploratory research & to
E literature discuss the usefulness of the findings
V • No prior researches on the topic
E chosen.
L Sometimes are based on theories or concepts • Since applicability is not known to the other population. A flexibility in
that have been studied in other population. design of the study is used.
I
• Framework of study includes discussion of the theory as it would be
used in the study & provide a summary of previous research on the
theory from the standpoint of cultural & ethnic background of the
subject.
L • is looking for relationship among • provide a conceptual framework of study
E specific predetermined variables to • Develop a probable explanation for the action that might occur among
V answer questions about the different the variables
E • Findings might lead to the development of a theory that could then be
L tested in further researches
II

L • are based on the findings of level II
E studies, you always know the
V relationship of the variables in
E advance & can predict its direction.
L
III
• always have theoretical frameworks to explain what the researcher
expects to find.
• The prediction can be supported by theoritical framework that explains
why the variables affect one another.

Functions of Theoretical Framework:

1. It provides the general framework which can guide data analysis.
2. It identifies the variables to be measured.
3. It explains why one variable can affect another
variable.
4. It limits the scope of data relevant to framework by focusing on specific variables.
5. It stipulates the specific frame of mind of viewpoint that the researcher will take in analyzing and interpreting data.

VARIABLES
- It is a concept that stands for a variation within a class of objects or persons.
- A characteristic or property that can take different values or attributes.
- Variables are the basic elements which are measured in a study.
- They are observable and measurable.
Examples: age, sex, status, income, type/place of work, type of school, degree of malnutrition, educational attainment, etc.

Types of Variables
1. Dependent - It is the "assumed effect" it is the change that .* occurs in the study population when one or more factors are changed or when an
intervention is introduced. Usually the problem itself is the dependent variable.
2. Independent - It is the "assumed cause", the assumed reason for any "change" or variation in a dependent variable.
3. Intervening - It is a factor that works "between" the dependent and independent variables.
– It can weaken or strengthen the effect of the independent on the dependent variable.
 P a g e | 29

– It is also called facilitating, moderator or control variable.

4. Other classifications:
a. Continuous - represented in a continuum; range of different values.
– E.g. age -20 - 30; temperature - 25 - 35.
b. Categorical - smaller range of values, e.g sex - mfl; race - black/white
c. attribute - pre-existing characteristics that the researcher simply observes or measures.

Examples:
Title: The relationship between Exposure to mass media and smoking among student nurses.

Independent v. Dependent v

Exposure to mass media Smoking habits

A persons smoking habits is assumed to change or vary depending upon his exposure to mass media.

Variables – are Drawn diagramrnatically, the relationship between the independent and dependent variable
– It is similar to the stimulus-response model developed in the field of psychology (Pavlovian theory) where a stimulus (S) applied to an organism
(O) will produce a response (R).

S O R
Independent variables target population dependent variable

Specific examples of variables in hypothesis are: 1. 1. Non-Directional Hypothesis

There is a difference in the level of anxiety of pre-surgical patients who receive pre-operative instruction and
patients who receive no instruction pre-operatively.

IV TP DV
Presence or absence of pre-op Surgical patients Level of anxiety High or low
instruction

2. Directional Hypothesis
There would be significant increase in the rate of healing of decubitus ulcer in subjects who receive regular,
application of topical insulin than those who do not

IV TP DV
Use or non use of Patients with decubiti Rate of healing
Topical insulin (increase or not)

3. Null Hypothesis - No significant difference in test means will be found to exist between students having a
hospital laboratory experience and students having a free day preceding the day of test administration.

IV TP DV
kind of day preceding exam student taking exam student taking exam
-with laboratory experience
-free day

Other examples of variables within hypothesis are:

Example:
A) Graduates of the baccalaureate degree program are more proficient at the bedside than graduates of
the diploma program.

IV TP DV
Type of education program Graduate of both BSN & GN degree of proficiency at the
bedside
 P a g e | 30

Other examples of variables within hypothesis are:

Example:
B) The use of tranquilizers is more effective than shock therapy in treating disturbed mental patients

IV TP DV
Kind of treatment disturbed mental effectivity rate
• Tranquilizer
• shock therapy
Defining Variables.
1. Operational definition- how it is used in the study.
– Gives specific meaning to the variable
– Clarifies how a variable or a term is used and measured in the study.
– A variable must be defined in terms of events/units of measurement that are observed by the senses
– It specifies how a term or variable is interpreted in the study and sets the procedure for measuring the variable
– operational definition of a variable may differ from that employed in another study
• Ex:
– Age - refers to the respondent’s current age.
– Educational attainment - refers to the highest grade/ year completed by respondent.
– Student Nurse - It refers to 3rd or 4th year level nursing student
– Patient - refers to clients confined in BGHMC or BEGH and have been cared for/handled by student nurses.

2. Textual definition- copied from a source or book.

3. Lexical definition- dictionary definition.

guidelines in defining variables operationally:
1. List your independent, dependent and intervening (if any) variables.
2. Write an operational definition for each variable.
• Identify the possible categories of each variable and determine if the categories:
- can be clearly understood,
- are mutually exclusive (do not overlap) and
- exhaustive.
The list of categories is complete so that all respondents can be categorized.
• List the key terms which may be interpreted differently by different people, unless they are operationally defined.
- Write an operational definition for each term.

5. When defining a variable or a term, be guided by the following questions:

a. Does the definition clearly specify the way the variable will be measured?
b. Are the categories of each variable mutually exclusive? c. Are the* categories exhaustive?

Defining Terms
To define terms, the researcher must look first to his statement of purpose.
This must delineate the phenomena about:
– which information will be sought,
– the subjects to be studied and
– the setting
The statement of purpose - identifies these entities in general terms.
The definition of terms, however, makes each one specific and pertinent to particular investigation.
Scope, Limitations, and Delimitations
Scope - deals with the extent of the study to be made
limitations are perceived weakness of the study and are identified, discussed and reported. –
– Includes those that are recognized but are beyond the control of-the researcher and those that are oversights; and anticipated.
– These are valuable in future references of literature review
Certain limitations of the research are:
1. Limitation of the researcher himself such as insufficient background and skills to study the subject area, 'identify the problem or carry through
the research process.
2. Lack of available information regarding the study to be undertaken.
3 Insufficiencies of tools of measurement to assess and analyze data.
Delimitations - are restrictions the researcher places on the study prior to the data gathering and could enter in at every decision point as the
study is being made.
– These are intermeshed with the operational definitions in the written research report.
• Researchers should point out the limitations themselves and should alert the reader to these difficulties such as:
– the impact of sampling deficiencies,
– design constraints,
– data quality problems, and
• The reader will then know that these limitations were not ignored in the development of the interpretations.
Assumptions
• An assumption is a statement describing a fact or condition that is accepted as being true on the basic of logic and reason.
 P a g e | 31

– The reason for accepting the conditions on this basis is so that the investigation may get on with study he wishes to do without having
to stop to demonstrate that the stated conditions are needed as logic or reason would lead knowledgeable people to believe them to be.
• Examples of Assumption:
• 1. All nurses like to give adequate nursing, care, however, there factors that prevent them from devoting their full time to the care of
patients.
• 2. The patient who faces surgery has fears and anxieties which may be manifested or not
• 3. Nurses can detect the fear and anxieties manifested by pre-surgical patient.

Chapter 1
• Introduction
– Orient reader on what prompted the researcher to under take the study.
– Brief Narrative intro of the nature & background of the problem area in general & the rationale for the study

1. background of the study

2. theoretical framework
3. conceptual framework
4. Statement of the problem
5. hypothesis
6. scope & limitations
7. importance of the study
8. definition of terms
. PROBLEM IDENTIFICATION AND DEFINITION
Chapter 1
• Every research starts with a problem.
– Without a problem, there is no need to conduct a research.
• The development of a research problem depends upon:
– one's imagination,
– insight,
– ingenuity.
Common Sources of Problems:
• Experience - immediate problems that need solutions or that excite the curiosity are relevant and interesting.
• Nursing Literatures - published reports may suggest
problem areas indirectly by stimulating the reader's
imagination.
• Theories - theoretical systems and conceptual schemes developed in nursing and other disciplines.
• Ideas from others/ issues one has been arguing about
• Result of a clinical situation encountered
• Unresolved issues in literatures.
• A research priority identified by a professional nursing organization

Defining the Research Problem.

• The problem definition explains the existence and seriousness of the problem.

questions are usually answered In defining :

1. does the problem really exist?
– What are the evidences of the problems existence?
2. Is the problem serious?
– Who and how many are affected by it?
3. What places are affected?
– How widespread is it?
– How often does the problem occur?
4. It is important that researcher presents a valid justification for the study.
– To do so, the definition should present relevant data from service statistics and related literature.

Characteristics of a Good Research Problem

1.A research problem must be relevant.
– The problem should be worth investigating and worth the time, money, effort to be spent.

Question to be considered:
• Will answers to the research questions help advance knowledge?
• Will the answers help in improving practices/behaviors/performance?
• Will answers improve human condition?
2. A research problem must be feasible.
– Feasibility means the availability of money, time, appropriate tools and devices and personnel.
• It may be relevant, but if funds are not available and there are no skilled researchers or data, it would not be feasible.
3. A research problem must be clear.
 P a g e | 32

– The statement should be clear.

– Major variables should be measurable.
– The use of ambiguous terms should be avoided.
4. A research problem must be ethical.
– The conduct of the study must not pose any danger, embarrassment, hurt or risk to the respondents.
– Information needed to answer the research questions can be collected without violating the rights of the source/s of information.
– The privacy of respondents must be protected.
RESULTS AND DISCUSSION & SUMMARY
[presentation, analysis, and interpretation of data per problem]
Chapter 3
DATA ANALYSIS AND INTERPRETATION
DATA ANALYSIS is a process of:
– summarizing trends and patterns observed in the data,
– determining major differentials or relationships among variables used in the study, and
– the application of appropriate statistical tests on a set of data to answer the objectives.

Kinds of data analysis

1. Descriptive Analysis - used to describe the nature and characteristics of an event or a population under investigation.
2. Inferential analysis - method of analysis used in testing hypothesis.

SCALES OF MEASUREMENT For Data Analysis

1. Nominal scale - has no mathematical value. Also called categorical scale.
– Example: Sex: Male Female *
2. Ordinal scale - a measure in which data or categories of a variable are ordered or ranked into two or more levels or degrees such as from
highest to lowest or least to most.
– The distance between the first and second ranks, however, is not the same as distance between second and third ranks.
3. Interval scale - The data have numerical value. The distance between two points is the same, but there is no zero point
4. Ratio scale - the same as interval data but the zero point is fixed.

DATA INTERPRETATION
1. Review the objectives, hypothesis and the theoretical/conceptual framework.
2. describe the data. Focus on the extreme numbers( highest and lowest). Enumerating the tabulated data should be avoided.
3 The data serves as serves as supporting facts to the text.
4. If hypothesis is being tested, it should be stated that the hypothesis is either rejected or accepted.
– One may also state that “ the findings support / do not support the hypothesis that…”the generalization must be supported by the data from
the Table.
5. The findings of related studies should be compared with results of the study.
– Do the findings contradicts or supports findings of previous study?
– What are the contradictions ?
– What are the possible reasons for the contradictions?
QUALITATIVE ANALYSIS
• Results of key informant interview and focus group discussion are summarized, categorized and described.
– No statistical analysis is required.
• In addition to descriptions, relevant direct quotes of the respondents may be included in the analysis.
– Unique situations and views or "voices" of the respondents or key informants can be directly quoted and included in the
discussion.
ORGANIZING AND PROCESSING THE DATA
The main steps in transforming the data from their raw state to a furnished product include:
1. editing the raw material,
2. coding,
3. scoring and sealing the data and
4. summarizing the data into statistical tables.
– These data are processed either by mechanical or electronic equipment.54
The main summary measures are: -
1. For qualitative data - rates, percentage
2. For quantitative data: ,
a.. Measures of central tendency: mean, median, mode
b., Measures of variation: range, standard, deviation
• Methods used in ORGANIZING AND PROCESSING THE DATA
1. The use of electronic data should be explored in the planning stage of the study.
2. Planning for the processing of the data - is important so that errors may be avoided and that the researcher will not proceed through the costly
data collection procedures only to find that the data gathered not serve to answer the questions earlier posed.
• He should be able to sort from all phenomena only those of pertinence to his cancer, to determine if these really exist and the extent to
which they exist.
• The first concern in planning organization patterns for the data - will have been identified by the statement of the purpose of the study.
– The investigator will think first of the data he will need to test his hypothesis, to answer his questions, -or to describe the
many elements composing the situation he proposed to explore.
– He will attempt to visualize ways to arrange those data most closely pertaining to the primary purpose of his study.
 P a g e | 33

• They must be so arranged as to serve as a basis for generalization of what the data tell about the particular facet of the problem that he has
chose to study.
3. The researcher moves facts from the researcher tools to one of more organized forms so that he can view at one glance the relationship of the
specific facts among a group of subjects.
4. examine organized data to determine that they meet a series of criteria.51

Criteria for organized data:

a. The data must readily identify materials in a single organizing form or a series of essentially identical forms, the experiences of all his subjects in
relation to a common fact.
b. generalized identification about the subjects as a group.:
c. must be able to identify another experience common to all of his subjects and make a generalization about the relationship , between these two
types of experiences for the group.
d. must be able to organize data in relation to many different common experiences.
• When the researcher has gathered his data he has to present them in an orderly fashion to show relations.
– If he is testing a hypothesis he should present his 'data in a visual form that shows whether the hypothesis is accepted or rejected.
• -Ideally, his data is expressed both in words and-in graphic form or in tables, figures, or diagrams

ANALYZE AND INTERPRET DATA

• The order of the presentation of results should be systematic and logical.
Reminders in analyzing & interpretation of data:
1. This part of the study should never contain raw data but should begin with a statement of more general findings and move to the more
specific data results. ( From General to Specific findings/results)
– More important results should be described first.
– The reported data must be relevant to the research problem and sufficient to answer the research questions.
– The outcome measures or dependent variables should be clearly identified.37
2. Statistics appropriate to the research design must be reported.
– It should be clear from the design which statistics are relevant to each research question.
– Result should be organized and presented in a way that the reader would clearly understand which statistics bear on which research
hypothesis.
– How the scores relate should be described explicitly.

Reminders in analyzing & interpretation of data:

3. The order of the presentation of results should be systematic and logical.
4. If some of aspect of the method used to analyze the data appears to have violated some of the assumptions of the statistical tests used, this
should be contained in the report.
– For example, different treatment groups may have contained, unequal numbers of subjects
5. In an analysis of variance has been performed, the investigator should have checked the data for normality and homogeneity of variance.
– If this has not been done, interpretation of results becomes problematic and conclusions drawn should be regarded with skepticism.
6. Care should be taken in the presentation of tables and figures.
– Titles, labels and captions should be appropriate and complete.
– The information in each table or figure should be referred to in narrative report. ,
7. As with other sections of the report, this too, should be presented in a reasonable, logical order.
– Ideally, the discussion should follow the same sequence as the one used to report the results of the study.
– Discussion of more general and important results should precede discussion of specific and less important ones.
8. Each finding should be discussed in terms of the original problem.
– All reported finding should be discussed.
– Conclusions should be stated followed by a discussion of the relevant data and the argument which established the conclusion.
– Findings should be compared and contrasted with other relevant findings in the literature both in terms of implications for further research.
If data do not seem
to warrant discussion, they probably should not have been included in the reported results. '
9. Honesty in reporting should be observed in analyzing and interpreting the data.
– This means that findings that do not show the relationship among the variables studied are also reported and included.
– The results or the analysis should be presented in a verifiable form.

Acceptance or Rejection of the Hypothesis.

– the researcher should be able to say if 'his hypothesis was accepted or rejected.
• If he is using statistics, he should say at what level the hypothesis was accepted or rejected and what the correlations were.
• Testing the hypothesis is the whole point of the research effort, so it is extremely important that the investigator be able to report, in
definite terms, just what the test revealed.
– In the use of a null hypothesis, when the findings reveal it as rejected, then the difference should be stated.
– if a directional hypothesis was used, it should also be reported whether such was accepted or rejected.

CONCLUSIONS & RECOMMENDATIONS

Chapter 4

FORMULATE CONCLUSIONS AND RECOMMENDATION

Conclusion are the investigators judgment about the data collected;
Recommendations are the investigator's suggestion of possible application of findings.
• Critics and consumers should beware of extravagant claims which are sometimes made in the discussion section of a report.
– The researcher should check to be sure that the conclusions and recommendations are justified by the data.
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Recommendations for nursing, psychosocial and education practice should be evaluated with caution.
• Whether mentioned by the author or not, the reader should keep in mind possible confounding which could limit generalizability of the
conclusions.
three .questions asked in determining the significance of a study to nursing
(Fleming and Hayter (1974),
• 1. Has the collected facts useful to nursing?
• 2. Has the study solved a nursing problem?
• 3. has the study expanded nursing knowledge?
Implications CONCLUSIONS AND RECOMMENDATION
• The researcher draws meaning from his conclusions and states them as possible needs of the population in general.
– Thus, if a study showing the babies born of mothers who had prenatal care weighed more and were healthier than those who did not have
prenatal care,
• The implications is that prenatal care is necessary to have healthy babies.
WRITE THE RESEARCH REPORT
• The study is not considered finished until a written report of the results have been completed.
– The report of the study serves as a guide for implementations and also furnishes a mode! for planning are or additional investigations.
• The report may be prepared for subsequent publication in a professional journal or it may serve as a source of information within a
hospital, a public health agency, or a country.
– The style of the report is determined by its purpose and readership.
• The main purpose of the written report is to disseminate information on the findings.
– Sharing both the method and findings of an .investigation increases the value of study.
– If a series of studies is planned, the written reports of all the studies will serve as a source of future reference.
– This type oft investigation reporting is as economical way of keeping other agencies informed because information is shared, studies will
not be duplicated.
• Organizing Materials For Writing'
1. Initially, it is helpful to write down the major points of the study ,in chronology order.
– This may be done as each step carried out or it ,may be done following the analysis of data.
The chronology serves as
• A blueprint, or guide, for preparing a detailed outline.
– It also furnishes the divisions and subdivisions for the written report format,
– The preliminary steps gives the author the opportunity to see relationship of content and subject matter.
• 2. Following the chronological listing, the next step in organizing the material for the report is preparing a detailed outline.
– Although this outline is the basis for the organization of the report, it should not place undue restrictions on the author's style of writing.
– In this manner all related material may be included under the appropriate heading.
Applying the Results
• If soundly designed and implemented, research is successful in providing new insights, or introducing, the results have meaning
beyond the specific setting which generated the data. These may be applicable to hospitals, nurses, schools or students.
• If the researcher believes sufficiently in the importance of the implications of his research and if genuine change is ever to come about
after research, then he must agitate for actions the research suggests.