Theoretical Basis, II

Qualitative Study:

Elements influencing robustness of the study Statement of the phenomenon of interest Many of the topics examined in research studies are of an abstract nature in that the particular experience may be interpreted differently by another individual, or by the same individual under different circumstances. The topic being studied should be clearly identified by the researcher. Purpose/significance of the study The researcher should explain next why the study needs to be undertaken and what he/she expects to glean from it. The researcher should also state why the study will be of significance and how it will add to the general body of information on the phenomenon. Literature review The function of a literature review in research studies is to provide an objective account of what has been written on a given subject. This in turn should reflect prominent emerging themes and inform the conceptual framework of the study. Research question In qualitative research, a research question that reflects the identified phenomenon of interest is used to direct the course of the research. A research hypothesis is never used in qualitative research, unlike quantitative research Theoretical framework: Many qualitative studies are described as inductive/a theoretical or theory-generating research. This means that the purpose of the study is to develop theory not test it. Therefore, the researcher does not use an existing or known theory to direct the study. This known as grounded theory. Ethnography and phenomenology are also classed as theory generating. It is important that the researcher indicates this in the study and justifies the adoption of such a stance. Some qualitative studies use known theories to 'frame' their studies. This provides boundaries or parameters for the study and guides all stages, including the literature review, data collection, analysis and presentation of findings. An important point for qualitative descriptive/exploratory research is that there are some limits or boundaries to what is being studied. Methodology: research design Design in qualitative research incorporates a range of approaches within what is often referred to as the naturalistic, interpretive or constructivist world view. The important point here is that such a view of the world incorporates a set of beliefs about knowledge and how this knowledge is developed. Sampling: In qualitative research, participants are usually recruited to a study because of their exposure to or their experience of the phenomenon in question. This type of sample tends to ensure richness in the data gathered and is known as purposive or purposeful sampling. Samples can also be selected as a result of themes that emerge from the data analysis. Ethical considerations: In qualitative research the most common tools used for data collection are interview and participant observation. The participants are therefore known to the researcher and anonymity is not possible. The researcher must therefore assure participants that their identities will not be revealed to the reader and the raw data collected will not be released to any third party. Participants should always have the right to give informed consent regarding their participation in any research study. In order to do this, participants should be fully aware of the purpose of the study, what sort of information is being sought, bow it will be used and the implications for them as contributors to the research. This moral principle is known as autonomy. Data collection: In qualitative study any number of strategies can be adopted when collecting data, including non-numerical questionnaires with open-ended questions, interviews (semi-structured and unstructured), participant observation, written texts such as diaries or emails, and historical or contemporary documents. The researcher should outline the rationale for the chosen method of data collection and offer sufficient information of the process. Data analysis: In qualitative research the process by which data analysis is undertaken is fundamental to determining the credibility of the findings. Essentially it involves the transformation of raw data into a final description, narrative, or themes and categories. There is considerable variation in how this is undertaken, depending on the research question and the approach taken. Rigour (trustworthiness): Qualitative research or naturalistic inquiry concerns itself with processes and meanings that cannot always be experimentally examined. Rigour is the means of demonstrating the plausibility, credibility and integrity of the qualitative research process. The rigour, or trustworthiness, of a study may be established if the reader is able to audit the actions and developments of the researcher. The critique of qualitative research requires an appraisal of the rigour in documentation, procedural rigour, and ethical rigour: Rigour in documentation ensures there is a correlation between the steps of the research process and the study in question, commencing with the phenomenon of interest and following through to the recommendations and implications for practice. Procedural rigour refers to appropriate and precise data collection techniques and incorporates a reflective/critical component in order to reduce bias and misinterpretations. Ethical rigour describes bow confidentiality issues and the rights of participants are dealt with during the research process. The researcher needs to identify the criteria used and the reader should be able to clearly follow each step of the research process: Credibility refers to the faithfulness to the description of the phenomenon in question. Dependability (auditability) is an integral component of rigour and involves the researcher giving the reader sufficient information to determine how dependable the study and the researcher are. Transferability (fittingness) refers to whether or not findings can be applied outside the context of the study situation. Confirmability requires the researcher to demonstrate how conclusions and interpretations have been reached. Goodness is another criterion against which the trustworthiness and authenticity of qualitative research can be measured. Findings and discussion As stated above, findings from qualitative studies can be represented as a narrative (story), themes, description if the phenomenon under study or an interpretive account of the understanding or meaning of an experience. Conclusions, implications and recommendations The researcher should conclude by placing the findings in a context that indicates how this new information is of interest, and its implications for nursing. These conclusions should reflect the study's findings and ideally should offer recommendations as to how they may be developed. References An accurate list of all the books, journal articles, reports and other media referred to in the study should be included in a reference list at the end of the study. Conclusion Critical analysis of a qualitative study involves an in-depth review of how each step of the research was undertaken.

Ways in Which Theory Influences Nursing Practice:

1) Identifies recipients/clients of nursing care. 2) Describes settings and situations in which practice should occur. 3) Defines data to collect and how to classify the data. 4) Outlines actual and potential problems to be considered. 5) Aids in understanding of nursing diagnoses. 6) Clarifies objectives and establishes expected outcomes 7) Specifies actions or interventions. 8) Sets standards for practice. *Differentiates nursing practice from other health care disciplines. Promotes responsibility and accountability for nursing care. Identifies areas of research.

Determine best strategies to search the literature to identify relevant theories to guide practice. PP #4 part 1 pg. 1-3, 7 Developin

1. Developing a PICO question results in an effective search that yields the best, relevant information and saves lots of time. 2. A research question's purpose is to generate new knowledge. 3. EBP question is designed to make decisions about patient care based on the best current evidence gathered from a systematic problem-solving approach. 4. EBP incorporates a systematic search for evidence and a critical appraisal of the findings with clinical expertise of the nurse and the patient's and family's values and preferences to provide the best patient care 5. Prefer theory driven research-based information rather than evidence obtained by tradition, authority, trial and error, personal experience and intuition. Usage of Primary sources original researcher/author who generated the information 6. Peer reviewed and refereed sources: published as primary resources with rigorous evaluation by experts and editors 7. Scholarly, trade, and popular categories: scholarly are edited by professionals in the discipline (e.g., Journal of Nursing Scholarship, Stroke, New England Journal of Medicine)

Guidelines for Application of theory in Nursing Practice:

1. Question Process for determining application to practice Are theory goals and practice goals congruent? Examine the goal of the theory and compare it with the outcomes or goals of nursing practice (standards of practice, personal views of nursing) 2. Is the context of the theory congruent with the practice situation? Examine the theory to determine context for application and compare it with the context of the situation at hand. 3. Is there similarity between the theory variables and your practices variables? Compare the theoretic variables (concepts) and the variables recognized to directly influence the practice situation to determine whether all essential concepts are addressed in the theory. 4. Are explanations of the theory sufficient to be used as a basis for nursing action? Use expert judgement about nursing actions that are implied or explicit within the theory to determine sufficiency; examine correlation between theoretical and practice variables. 5. Does research evidence support the theory? Conduct a review of the literature for research support of the theory: critically examine study findings for validity and applicability to practice. 6. How can the theory influence nursing practice in your setting? Consider ways in which an approach will affect nursing practice and a nursing unit; plan changes including observation and recording of factors relevant to the theory's application.

Identify the key aspects included in a well written research article abstract. Quantitative and qualitative critique article

Abstract Should include information regarding the purpose of the study, method, sample size and selection. The main findings and conclusions and recommendations. From the abstract the reader should be able to determine if the study is of interest and whether or not to continue reading.

Differentiate clinical reasoning from critical thinking. PP#4 pg. 3 and Book: pg. 15

Critical thinking Utilize scientific facts, principles, and laws to identify, relate and control actual and potential concepts and propositions. Clinical reasoning Is a higher level than critical thinking and represents understanding and ability to translate the information into effective nursing practice.

Recognize major barriers and/or facilitators that can affect the selection of theories to guide practice. NIH website and PP#4 part 2, pg. 2, 5

Critical thinking is inherent in making sound clinical reasoning. Clinical reasoning stands out as a situated, practice-based form of reasoning that requires a background of scientific and technological research-based knowledge about general cases, more so than any particular instance. It also requires practical ability to discern the relevance of the evidence behind general scientific and technical knowledge and how it applies to a particular patient. In doing so, the clinician considers the patient's particular clinical trajectory, their concerns and preferences, and their particular vulnerabilities (e.g., having multiple comorbidities) and sensitivities to care interventions (e.g., known drug allergies, other conflicting comorbid conditions, incompatible therapies, and past responses to therapies) when forming clinical decisions or conclusions. Expert nurse demonstrates understanding of the complexity of the nature and significance of actual potential, and perceived variables, proposition and assumptions surrounding situations that had both quantitative and qualitative aspects. Factors affecting the selection of theories result from barriers and facilitators in critical thinking and clinical reasoning: 1. Knowledge 2. Skills & competence 3. Values 4. Meanings 5. Experience

Determine how specific nursing theories can be applied to practice situations and also expand nursing knowledge to guide practice. Review Book: pg. 418

Determine how specific nursing theories can be applied to practice situations and also expand nursing knowledge to guide practice. Book: pg. 418 Practice theories are nursing theories used in the actual delivery of nursing care to clients. Furst, they are used to carry out nursing interventions and often include or lead to the performance of psychomotor procedures or are r/t communication. Second, practice theories may be derived from grand or middle range theories, from clinical practice, and/ or from research, including lit reviews, and may describe, explain, or prescribe specific nursing practices. Third, practice theories combine a set of principles or directives for practice and often have a role in testing theories. Finally Practice theories may benefit nursing practice and the development of nursing knowledge by allowing for an in- depth analysis of a particular nursing intervention or practice. The term situation- specific theory is at times used to describe practice theory. Practice theories are clinically specific and reflect a particular context that may include directions or blueprints for action. In comparison to grand or middle range theories, practice theories have a lower level of abstraction, are context specific and are easily applied in nursing research ad practice. Practice theoaries often emerge from grounded theory research or from synthesizing and integrating research findings and applying this knowledge to a specific situation or population. The intent is to develop a framework or blueprint to understand that particular situation or group of clients.

Review the hierarchy of research evidence and its relevance to the perceived strength of the evidence and applicability to practice. Facchiano article pg. 582-583

Levels of evidence are important to the NP as higher levels of evidence reflect stronger evidence. Stronger evidence leads to clinical decisions being made with confidence that is more reliable and precise (trustworthy). NPs frequently access and reference clinical practice guidelines for utilization within their clinical practices. Clinical practice guidelines are considered summarized research reviews based on a variety of strength and quality of evidence. Clinical practice guidelines therefore would be considered Level I or VI research depending on the strength of the studies cited. If the guidelines are based on systematic reviews, then the quality and strength of the resultant guideline would allow consideration as Level I evidence. If case-controlled studies are used as the basis of the guideline, a Level IV would be assigned. Guidelines based solely on expert opinion may introduce error and/or bias. It is important to remember that the highest level of study design may not always be available to answer the clinical question. In the absence of top levels of evidence, one must move down the pyramid to find the best available evidence to answer the question being considered.

Determine the different parts of a research article and what is typically included in each section. Qualitative critique article

Qualitative Studies: Authors, qualifications/position should be indicated Report title should be clear, accurate, 10- 15 words in length and unambiguous. Abstract should offer a clear overview of the study including the research problem, sample, methodology, finding and recommendations Statement of the phenomenon should identified, and consistent with the research question. Purpose/significance of the study should identify the purpose of the study/research question. Literature review, should review the literature, identify conceptual and theoretical framework, Theoretical framework should be described, identified, and appropriate for study. Sample, should be identified, as well as its size, and sampling methods. Ethical consideration, stating if the participants were fully informed about the nature of the research, the autonomy/confidentiality of the participants guaranteed, were the participants protected from harm, or whether the ethical permission was granted for the study. Data collection/ data analysis, describe the data collection strategies, strategies used to analyze the data described. Rigour should be discuss, as well as credibility, dependability, transferability and goodness. Findings/discussion, should discuss the findings, address the original purpose of the study. Conclusions/ implications and recommendations should identify the importance and implications of the findings and discuss recommendations made to suggest how the research findings can be developed. References should include all the books, journals and other media used in the study accurately.

Describe the essential aspects examined in the critique of a research article (e.g., purpose statement, hypotheses/research questions, design, results, limitations, etc.). Plus, determine what are acceptable standards (e.g., what a purpose statement as well as hypothesis should include, what expect to be stated when describing study method, what are generally include in the statement of limitations etc.). Refer to what you were asked to do when you critiqued the theory based research article in Module 5. Quantitative and qualitative critique article

Quantitative Studies: Author(s) The author(s') qualifications and job title can be a useful indicator into the researcher(s') knowledge of the area under investigation and ability to ask the appropriate questions. Report title The title should be between 10 and 15 words long and should clearly identify for the reader the purpose of the study Abstract Should include information regarding the purpose of the study, method, sample size and selection. The main findings and conclusions and recommendations. From the abstract the reader should be able to determine if the study is of interest and whether or not to continue reading. Purpose of the study/research problem A research problem is often first presented to the reader in the introduction to the study Logical Consistency There should also be a clear link between the steps beginning with the purpose of the study and following through the literature review, the theoretical framework, the research question, the methodology section, the data analysis, and the findings Literature review The primary purpose of the literature review is to define or develop the research question while also identifying an appropriate method of data collection. It should also help to identify any gaps in the literature relating to the problem and to suggest how those gaps might be filled. The literature review should demonstrate an appropriate depth and breadth of reading around the topic in question. Theoretical framework A theoretical framework framework can be a conceptual model that is used as a guide for the study or themes from the literature that are conceptually mapped and used to set boundaries for the research. A sound framework also identifies the various concepts being studied and the relationship between those concepts. Aims and objectives/research question/ research hypothesis The purpose of the aims and objectives of a study, the research question and the research hypothesis is to form a link between the initially stated purpose of the study or research problem and how the study will be undertaken. Sample and sample size The degree to which a sample reflects the population it was drawn from is known as representativeness and in quantitative research this is a decisive factor in determining the adequacy of a study. Ethical Consideration Autonomy infers that an individual has the right to freely decide to participate in a research study without fear of coercion and with a full knowledge of what is being investigated. Non-maleficence implies an intention of not harming and preventing harm occurring to participants both of a physical and psychological nature. Beneficence is interpreted as the research benefiting the participant and society as a whole. Justice is concerned with all participants being treated as equals and no one group of individuals receiving preferential treatment because, for example, of their position in society. Confidentiality and privacy. The latter pair are often linked and imply that the researcher has a duty to respect the confidentiality and/or the anonymity of participants and non-participating subjects. Ethical committees or institutional review boards have to give approval before research can be undertaken. Their role is to determine that ethical principles are being applied and that the rights of the individual are being adhered to. Operational definition To ensure this any concepts or terms referred to should be clearly defined Methodology: research design Methodology refers to the nuts and bolts of how a research study is undertaken. Methodology: data collection In a quantitative study any number of strategies can be adopted when collecting data and these can include interviews, questionnaires, attitude scales or observational tools. Methodology: instrument design Researchers have the choice of using a previously designed instrument or developing one for the study and this choice should be clearly declared for the reader. But the overall aim is that the final questions will be clearly linked to the research questions and will elicit accurate information and will help achieve the goals of the research. This, however, needs to be demonstrated by the researcher. Methodology: validity and reliability One of the most important features of any instrument is that it measures the concept being studied in an unwavering and consistent way. These are addressed under the broad headings of validity and reliability respectively. In general, validity is described as the ability of the instrument to measure what it is supposed to measure and reliability the instrument's ability to consistently and accurately measure the concept under study. Analysis and results The researcher should clearly identify what statistical tests were undertaken, why these tests were used and what were the results. Discussion/conclusion/recommendations The discussion of the findings should flow logically from the data and should be related back to the literature review thus placing the study in context. If a theoretical or conceptual framework was used in the study then the relationship with the findings should be explored. The significance of the findings should be stated but these should be considered within the overall strengths and limitations of the study. In this section some consideration should be given to whether or not the findings of the study were generalizable, also referred to as external validity. The researcher should have explored the clinical significance and relevance of the study. The researcher should make relevant and meaningful suggestions for future research in the area. References The research study should conclude with an accurate list of all the books; journal articles, reports and other media that were referred to in the work Conclusions It is not a criticism but rather an impersonal scrutiny of a piece of work using a balanced and objective approach, the purpose of which is to highlight both strengths and weaknesses, in order to identify whether a piece of research is trustworthy and unbiased.

Determine the different parts of a research article and what is typically included in each section. Quantitative critique article

Quantitative Study: Authors, qualifications/position should be indicated Report title should be clear, accurate, 10- 15 words in length and unambiguous. Abstract should offer a clear overview of the study including the research problem, sample, methodology, finding and recommendations Purpose of the study/research problem should identify the problem clearly. Literature review should have a balanced critical analysis of the literature, with recent literature, from primary sources and of an empirical nature. Conceptual or theoretical framework should be identified, described and appropriate for study. Aims/ objectives/ research question/ hypothesis, of a research question or hypothesis should be identified, and reflect the information presented in the literature review. Sample should represent the target population and be clearly identified, how it was selected, size, inclusion and exclusion criteria. ? Ethical Consideration, should include if participants fully informed about the nature of the research, was the autonomy/ confidentiality of the participants guaranteed, were the participants protected from harm and was ethical permission granted for the study? Operational definitions, clearly defined in the study for all the terms, theories and concepts mentioned. Methodology should clearly identify the research design, describe the data gathering instrument, state if instrument appropriate, how it was developed, reliability and validity testing undertaken and discuss results, and if a pilot study was done. Data Analysis, should identify what type of data and statistical analysis was undertaken, how much of the sample participated and significant findings. Discussion should discuss the findings, link them back to the literature review, discuss if a hypothesis was supported if used, the strengths and limitations of the study including generalizability should be discussed, and recommendations for further research made. References should include all the books, journals and other media used in the study.

Theory- generating Research:

Research that generated theory (i.e descriptive research0 is designed to develop and describe relationships b/w and among phenomena without imposing preconceived notations of what these phenomena mean. It is inductive and includes grounded theory, field observations and phenomenology. During the theory-generating process, the researcher moves by logical thought from fact to theory by means of a proposition stated as an empirical generalization.

Review Graham (2006) article and what can be learned in terms of nursing theories affecting a specific practice situation. Article

Review Graham (2006) article and what can be learned in terms of nursing theories affecting a specific practice situation. Article The incorporation of nursing theory into the clinical care of patients can enhance the overall care that is administered. Theory helped to provide the knowledge that is needed to improve nursing practice. This theoretical knowledge increases nursing's power and provides professional autonomy through its ability to guide practice, education and research. Orem's self- care model, uses the concept of self- care with increased emphasis on health promotion and illness prevention. Orem defines self- care as "the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health and well- being. Self- care includes the care that is given by health care workers, family or friends when an individual can't provide aspects of, or complete care to themselves in the short or long term. Orem model includes participation in the decision- making that requires the selection of a treatment modality, compliance with strict dietary and fluid restrictions, compliance with complex medication regimens and compliance with their prescribed treatment. Neuman's System Model can be used to facilitate nurses to practice with a goal- directed and holistic approach to patient care. Peplau's Theory of Interpersonal Relationships, requires the need for mutual respect between the nurse and the pt to be an imp part of the therapeutic process. The professional expertise that is required to ensure that the patient understands the need for appropriate care and to ensure that this is provided can be obtained through ongoing education and revision of theory. Peplaus' approach to establishing this nurse- client relationship is by having the nurse manage her own behavior rather than that of the patients. Although not all nursinf theories/ models are appropriate to every clinical areas of nursing, through careful selection, an appropriate theory or model can be used to assist in the improvement of pt care.

Theory- testing Research:

Sometimes a study is conducted for the purpose of testing a theory or assessing its explanatory value in a specific situation. In theory- testing research, theoretical statements are translated into questions and hypotheses. Theory testing requires a deductive reasoning process that also follows several steps. First, the researcher chooses a theory of interest and selects a specific propositional statement from the theory (rather than the entire theory) to be tested. Next, the researcher develops a hypothesis or hypotheses that must have specific measurable variables that reflect the propositional statement. The researcher conducts the study and interprets findings. The interpretation determines if the study supports or contradicts the propositional statement and for further use of the theory in nursing practice. Another reason there has been little theory- testing research related to interpretation and evaluation of the research.

Evaluate the level of evidence of a selected article. Facchiano article pg. 582-583

Strongest evidence, is study designs from systematic reviews or meta-analyses of all relevant randomized control trials (RCTs). Level II is evidence obtained from a well-designed RCT that introduces a treatment in order to study effects on treated patients compared with patients not receiving the treatment or intervention. Level III is evidence obtained from well-designed controlled trials without randomization. Level IV is evidence from well-designed case-controlled and cohort studies. Level V is evidence from single descriptive or qualitative studies. Level VI is evidence from the opinion of authorities and/or reports of expert committees.

Theory Testing Research

Study is conducted for the purpose of testing a theory or assessing it explanatory value in a specific situation. Theoretical statements are translated into questions and hypotheses. Requires deductive reasoning process.

Identify the essential factors affecting the selection of a theory to guide nursing practice and/or research. Book: pg. 415, PP #4 part 1 pg. 6

The application of theory in practice requires an understanding of concepts and principles associated with the needs of a particular client, group of clients, or community, and recognition of when and how to use these concepts and principles when planning and implementing nursing care.

Expand your knowledge of how theories can specifically influence nursing practice. Book: pg. 413- 414, PP #4 Part 1 pg. 5

The primary purpose of theory in nursing is to improve practice and thereby positively influence the health and quality of life of persons, families, and communities. In nursing, there should be a reciprocal relationship b/w theory and practice. Practice is the basis for nursing theory development, and nursing theory must be validated in practice. Theory is rooted in practice and refined by research, and it should be reapplied in practice. Theory provides nurses with a perspective with which to view client situations and a way to organize data in daily care. Theory allows nurses to focus on imp info while setting aside less imp, or irrelevant data. Theory may assist in directing analysis and interpretation of the relationships among data and in predicting outcomes necessary to plan care. Further, a theoretical perspective allows the nurse to plan and implement care purposefully and proactively and when nurses practice purposefully and systematically, they are more efficient, have better control over the outcome of care and can better communicate that care with others. Nurses need to is theoretical perspectives to help understand what information is important, how information, findings and data are related: what can be predicted by relationships and what interventions are needed to deal with special relationships.

Theory Development

global term referring to process and methods used to create, modify, or refine theory Generally begins with one or more concepts derived with a discipline's philosophy. Then these concepts are further refined and related to one another to form propositions or relationship statement that can be submitted for empirical testing.

Deductive

starts with a rule or a law or a principle, then looks at specific examples to see if the idea applies to them. This is reasoning from the top (principle) down (to the example). Inductive reason starts with specific examples and tries to see if a principle emerges. This is reasoning from the bottom (as many examples as possible) up (toward a ruling principle). Deductive reasoning is favored by the sciences because one only has to see if an example "cooperates" with the particular principle to know if it is valid in the matter at hand. Deductive reasoning would start with the principle that gravity causes objects to fall to the ground. You let go of a shoe in midair, and, sure enough, it drops to the ground. Deductive reasoning tells you that the principle of gravity is at work. Deductive reasoning: start broad and then narrow Theory laws principles lead to deductive reasoning and then explanation of phenomena. Start with broad established facts, principles, laws or theories. E.g.: Pain is contributing to patient's hypoventilation and reluctance to move (immobility).

Inductive reason

starts with specific examples and tries to see if a principle emerges. This is reasoning from the bottom (as many examples as possible) up (toward a ruling principle). Inductive reason, based as it is on examples, is limited because it is impossible to try every scenario, so one always has to consider that there might be an exception somewhere along the way. Inductive reason would have you drop a shoe, a ball, a magazine, a spoon, and when they all fall to the ground, suspect that there is a force causing them to do so. You would, like Newton, surmise that gravity exists. If I interview people and ask them about how they are coping with their new diagnosis of cancer -- and then use their responses to build a model about the common ways people cope -- I am using inductive reasoning. I am starting with specific cases and using them to develop general principles. Inductive Thinking: start narrow and go broader Observed phenomena lead to inductive reasoning and then theory, laws, principles, facts Begins with narrow, smaller concepts/ variable and formulate new propositions. E.g.: Conduct statistical polling to project what citizens consider important issues and then develop a specific national platform. Or A migrant worker who is illiterate, non- English speaking and uninsured was just diagnosed as a type 2 diabetic. Or Leads APN to be creative and develop new portable bilingual audio and visual teaching materials and make sure in free medical clinics.