Research in nursing practice revision

Research
in
Nursing Practice
B. Sunil S. De Silva
RN, BScN(OUSL), MScN(RES)(Australia)
Head/Senior Lecturer
Department of Health Sciences
The Open University of Sri Lanka

12/05/16 Research in Nursing Practice 2
Objectives
 Describe the importance of the
nursing research to practice.
 Identify historical aspects.
 Identify ethical issues.
 Critique research problems,
variables, literature review &
hypotheses.

Objectives…
 Identify different research designs,
samples & populations.
 Define internal & external validity.
 Identify different methods of data
collection & data analysis.
 Disseminate research findings to
develop nursing knowledge.

Introduction to Nursing
Research

What is Research?
 Research – search again or to
examine carefully.
 Research is systematic inquiry that
uses disciplined methods to answer
questions or solve problems (Polit &
Beck, 2006)
 The ultimate goal of research is to
develop, refine, & expand a base of
knowledge.

Types of Research
Research
Basic/Pure research Applied research
Develop theories
that
will strengthen
our understanding
of the nursing process
are part of basic research
Find solution
to
clinical
problems
as part of
applied research

Major areas of nursing research
 Nursing Characteristics
 Patient Characteristics
 Nursing Administration
 Nursing Education
 Clinical Practice

Purposes of Scientific Research…

Research Process
 Conceptual phase - Think it out
 Empirical phase - Go & Do it
 Interpretive phase - See what it all
means
 Research Study Evaluation Guide based on
these three phases.

Research Process

Historical Aspects of
Nursing Research

Historical Aspects of Nursing Research…
 Initiate from the time of F. Nightingale.
 Recent trend to focus nursing practice than
the nursing education & administration.
 After 1950’s nursing research began to
publish.
 Future focus on health prevention, & illness
prevention.
 Theory development increase the body of
knowledge.

Ethical Issues
in
Nursing Research

Code of ethics
 Many countries have developed codes
of ethics for research concerning
human subjects.
 It helps that the research remains
ethical as well as scientific.
 Recent guidelines, established in the
Belmont Report (1978) ensure unbiased
review.

Belmont Report
 It rely on two historical documents;
 The Nuremberg Code
 First international accepted code.
 Introduced informed consent.
 The Declaration of Helsinki
 Initially develop for the doctors for clinical research.
 In nursing research – inform research subjects – No
personal benefits & avoid any understated suggestion.

Basic Rights of Research
Subjects Belmont Report served as model for
many of guidelines adopted by specific
disciplines & outlined three primary
ethical principles;
 Beneficence
 Respect for human dignity
 justice

The Principle of Beneficence
 It is the right of ‘Freedom from harm’
 Freedom from harm/ risk of harm includes physical,
emotional, legal, financial, & social harm
 Freedom from exploitation/use
 Information do not use against them
 Benefits from research
 should know potential benefits
 Risk/Benefit Ratio
 Risk should be minimal

The Principle of Respect for
human dignity
 The right of self-determination
 Voluntary decide to participate or not (at any time)
 The right to full disclosure
 Fully informed – purpose, benefits, risks or on
going & end results.

The Principle of justice
 The right to fair treatment
 Fair & nondiscriminatory selections of subject
 Not on convenience or bias
 No harmful treatments for give up or refuse to
participate
 The right to privacy
 Maintain anonymity & confidentiality

Mechanisms for Ethical Standards
 Informed Consent
 Subject status
 Study purpose
 Type of information
 Nature of commitment
 Sponsorship
 Subject selection
 Procedures
 Potential risk &
benefits
 Confidentiality
 Voluntary consent
 Right to withdraw
 Alternatives
 Contact information

Mechanisms for Ethical
Standards…
 Vulnerable Subjects
 Not capable of giving informed consent.
 Children
 Mentally or emotionally disabled people
 Physically disabled people
 Peoples who are in hospitals or prisons
 Pregnant women
 Review Boards

Characteristic of ethical research
 Scientific objectivity – aware personal values & biases
 Cooperation – work with ethical committees
 Integrity – should not withhold any information, risks, benefits…
 Equability – acknowledge the contributions
 Nobility – Protect from harm
 Truthfulness – Openness; purpose, procedure, methods…
 Anonymity & confidentiality -
 Honesty – reveal scholarships, any findings…
 Communication – Disseminate the findings

Identifying Research
Problems

Sources of Research Problem
 Experience & interests – lead to clinical
research
 Existing research – published research
 Theory development – stem from
scientific interest
 External sources – pattern or trend
occurring in health care
 Social issues – Domestic violence
 Reader – Edgar(1985),Fraleigh(1986)

Developing a Research Question…
 Research problem - Broad topic of interest
 Problem statement - Articulate/clear the
problem to be addressed.
 Statement of purpose – Goal
 Research questions – the specific queries to
answer in addressing a research problem.
Direct rewordings of statement of purpose,

Feasible Problem
 Feasibility involves several factors which
the researcher needs to consider before
beginning the research;
 Time
 Availability of subjects
 Cooperation of others
 Facilities & equipment
 Financial support
 Ethical considerations

Variables

Definition of Terms
 Concepts - ideas that the researcher
wants to study.
 Construct – narrow the focus of the study
to identify key concepts.
 Variable – after concepts are made
measurable, they are referred to as
variables. The variables are the
observable, measurable concepts which
you propose to study.
12/05/16 29Research in Nursing

Types of Variables
 Independent variables
 Dependent variables
 Correlated variables
 Extraneous variables
12/05/16 Research in Nursing 30

Review of the
Literature

The Lit. review in a study serves several
functions;
 Presents theoretical frame work for the study.
 Offers a critical analysis of developments
related to the study’s topic.
 Give credibility / trustworthiness to the study
by showing that is a precedence / priority.

Conducting the lit. review involves;
 Checking for appropriate & relevant
literature.
 Making notes on the relevant articles located
through the search.
 Doing a critical analysis of each article.

Lit. review should include the following
types of literature
 Relevant nursing research.
 Theoretical literature.
 General & specialty nursing literature.
 Methodological literature.
 Research literature from other disciplines.
 Popular lit. from sources written for general
population.

The Hypothesis

Hypothesis…
 A hypothesis is the formal statement of the
expected relationships between two or more
variables in a specified population.
 Its provide specific direction for subsequent
aspects of design, data collection & analysis.
 Correlation, qusi-experimental & experimental
studies need to include hypothesis.

Categories of Hypothesis
 Different type of hypotheses depending
upon the relationships & number of
variables identified in the research
problem,
 Associative versus casual
 Simple versus complex
 Directional versus non directional
 Statistical versus research hypothesis.

Associative versus casual
 Associative
 Positive associative relationship.
 smoking & lung cancer
 Negative associative relationship.
 health & illness
 Casual
 Causal relationship – independent variable causes to
change dependent variable.
 prenatal education cause on a mother’s labor outcome

Simple versus complex
 Simple hypothesis – relationship
between two variables (associative or
causal)
 Complex hypothesis – relationship
among three or more variables.

Directional vs non directional
 A directional hypothesis is also an
associative hypothesis, and states the
direction of the predicted relationship
 Positive
 As X increases, Y increases
 As X decreases, Y decreases
 Negative
 As X increases, Y decreases
 As X decreases, Y increases

Statistical/Null vs Res. hypothesis
 No relationship between variables.
 used for statistical testing & interpreting the
results of statistical analyses.
 simple or complex & associative or causal.
 It may not always be stated, but it is indirect, as it
is the opposite of the res. hypothesis.
 Ex; - There is no difference in measures of perceived stress
(a dependent variable) & blood pressure (a dependent
variable) between subjects who do & do not participate in a
program of meditation (independent variable).

Hypothesis…
 An hypothesis try to answer the question posed by the
research problem.
 It can be associative or casual, simple or complex, directional
or non directional & research or statistical.
 When testing the validity of the assumptions made from the
theoretical frame work , the hypothesis bridges the theoretical
& real worlds.
 A hypothesis is a declarative statement about relationship
between two or more variables that predicts expected
outcome.

Hypothesis…
 It should clear statement, contain the components
of population, variables, & predicted outcome.
 Two criteria used to critique are justifiable &
testable.
 Hypothesis…
 Exploratory studies – (-)
 Descriptive/correlational studies – (+/- ) Res. Question
may be use
 Quasi-experimental/experimental - (+)

Research Design

Research Design…
 After developed research , specified variables, &
derived a hypothesis, then should determine the
research design.
 The ‘design’ is the structure of an investigation,
through which answers to research questions are
sought and outside influences are controlled
(extraneous variables)
 The two categories of research, qualitative &
quantitative, refer both to the method of data
collection & to the type of data collected.

Two main categories of research
 Qualitative
 Quantitative

Quantitative research
experimental Nonexperimental
1. True experimental
- must have three criteria;
control, manipulation &
randomization
2. Quasi-experimental
- randomization or control are
missing.
- Most often random selection
or random assignment not
possible.
• Least amount of control over extraneous
variables in the study
• Describe the relationship between
variables & unable to determine cause &
effect.
• Correlation study - Examine the
relationship between variables in a single
group.
• Descriptive study - Describe each
variable rather than manipulation &
relationships.
• Survey design
• Qualitative designs are nonexperimental & used new area of
knowledge which is little is known.
• Time, setting, & reasoning must be considered when determining the
strength of the design.
The research design chosen for the study depends on the purpose of the studyThe research design chosen for the study depends on the purpose of the study

Qualitative Nonexperimental
research
 It is exploratory in nature & aims to
describe & explore concepts in natural
settings.
 Most common types;
 Ethnography – cultural studies
 Phenomenology – lived experiences
 Grounded theory – discover social processes.

Basic Sampling Concepts
Population
 A population is an entire set of elements
(person, event or behavior…)
 Target population is the entire population
in which the researcher is interested.
 Accessible population is accessible to the
researcher for the study.

Basic Sampling Concepts…
Samples & Sampling Criteria
 Sample consists of a subset of the
elements/people.
 Sampling involves selecting a group of elements
to conduct a study.
 Sampling criteria list the essential
characteristics for membership in the target
population.
 Sample need to represent target population to
generalize the findings.

Probability/Random Sampling
 It refers to the fact that every element of the
population has a probability higher than zero of
being selected for a sample.
 The method of equal opportunity is referred to as
random sampling.
 Experimental design, Survey design usually use
random sampling procedure.
 To achieve representative sample random sampling
develop four types; simple, stratified, cluster, &
systematic sampling.

Nonprobability Sampling
 Elements are chosen by nonrandom
methods.
 Though representativeness is less, it has
been commonly used in nursing studies.
 There are four nonprobability sampling;
convenience, quota sampling, purposive
sampling & network sampling.

Sample Size
 Historically minimum sample size is 30. but
now it depends on the population.
 Do the power analysis for determine sample
size.
 Power is the capacity of the study to detect
differences or relationships that actually
exist in the population.
 Initial sample size will need to be larger than
the calculated number as most studies lose
subjects.

12/05/16 Basic Scientific Reserach 55
Data Collection
 Physiological Measurement – weight, BP…
 Observational Measurement – researchers’
observations
 Self-Report Measurement – interviews,
questionnaires, & scales.

12/05/16 Basic Scientific Reserach 56
Data Analysis, Discussion &
Conclusions…
 Data analysis depends on the type of
research design & the purpose of the
analysis.
 Discussion & Conclusions…
 Interpretation of findings
 Limitation of the study
 Implication & generalizability
 Recommendations
 Dissemination the findings to build body of
knowledge in nursing.

Summary
 Introduction to Nursing Research
 Historical Aspects of Nursing Research
 Ethical Issues in Nursing Research
 Identifying Research Problems
 Variable
 Review of the Literature
 The Hypothesis
 Research Design
 Population and Sample
 Data Collection
 Data Analysis, Discussion & Conclusions…

The End
Research
in
Nursing Practice

Research in nursing practice revision

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