Chapter 1: Introduction to Nursing Research

Roles of Nurses in Research

- Consumers of nursing research —nurses who read research reports to keep up-to-date on findings that may affect their practice. EBP depends on well-informed nursing research consumers. - Producers of nursing research: nurses who actively design and undertake studies. At one time, most nurse researchers were academics who taught in schools of nursing, but research is increasingly being conducted by practicing nurses who want to find what works best for their clients.

Future Direction for Nursing Research

- Continued focus on EBP. Encouragement for nurses to use research findings in practice is sure to continue. This means that improvements will be needed in the quality of nursing studies and in nurses' skills in locating, understanding, critiquing, and using relevant study results. Relatedly, there is an emerging interest in translational research—research on how findings from studies can best be translated into practice. - Stronger evidence through confirmatory strategies. Practicing nurses rarely adopt an innovation on the basis of poorly designed or isolated studies. Strong research designs are essential, and confirmation is usually needed through replication (i.e., repeating) of studies in different clinical settings to ensure that the findings are robust. - Continued emphasis on systematic reviews. Systematic reviews are a cornerstone of EBP and have assumed increasing importance in all health disciplines. Systematic reviews rigorously integrate research information on a topic so that conclusions about the state of evidence can be reached. - Expanded local research in health care settings. Small studies designed to solve local problems will likely increase. This trend will be reinforced as more hospitals apply for (and are recertified for) Magnet status in the United States and in other countries. - Expanded dissemination of research findings. The Internet and other technological advances have had a big impact on the dissemination of research information, which in turn helps to promote EBP. - Increased focus on cultural issues and health disparities. The issue of health disparities has emerged as a central concern, and this in turn has raised consciousness about the cultural sensitivity of health interventions. Research must be sensitive to the beliefs, behaviors, epidemiology, and values of culturally and linguistically diverse populations. - Clinical significance and patient input. Research findings increasingly must meet the test of being clinically significant, and patients have taken center stage in efforts to define clinical significance. A major challenge in the years ahead will involve incorporating both research evidence and patient preferences into clinical decisions.

Purpose of Quantitative Nursing Research

- Description - Exploration - Prediction and control - Explanation

Limitations of Constructivist Methods and Qualitative Research

- Human beings are used directly as the instrument through which information is gathered, and humans are highly intelligent—but fallible—tools. - the subjectivity of constructivist inquiry, which sometimes raises concerns about the idiosyncratic nature of the conclusions - the generalizability of findings from constructivist inquiries is an issue of potential concern - Researchers who reject the traditional scientific method believe that a major limitation is that it is reductionist—that is, it reduces human experience to only the few concepts under investigation, and those concepts are defined in advance by researcher

Purpose of Qualitative Nursing Research

- Identification - Description - Exploration - Explanation

Research Purposes Linked to EBP

- Therapy, treatment, or intervention - Diagnosis and assessment - Prognosis - Etiology and harm - Meaning and processes

Nursing Research

- systematic inquiry used to answer questions or problems to guide nursing practice - Nursing research is systematic inquiry designed to develop trustworthy evidence about issues of importance to nurses and their clients. - Nursing research is about real people with real problems, and studying those problems offers opportunities to solve or address them through improvements to nursing care.

Constructivist Paradigm Definition

An alternative paradigm to the positivist paradigm that holds that there are multiple interpretations of reality and that the goal of research is to understand how individuals construct reality within their context; associated with qualitative research; also called naturalistic paradigm.

Meaning and Processes

Barriers or what motivates people to comply ex.) What is the meaning of life experiences, and what is the process by which they unfold?

Basic vs. Applied Research

Basic research is appropriate for discovering general principles of human behavior and biophysiologic processes. Applied research is designed to examine how these principles can be used to solve problems in nursing practice.

Clinical Experience and Trial and Error

Clinical experience is a functional source of knowledge. Yet, personal experience has limitations as a source of evidence for practice because each nurse's experience is too narrow to be generally useful, and personal experiences are often colored by biases Trial and error involves trying alternatives successively until a solution to a problem is found. Trial and error can be practical, but the method tends to be haphazard, and solutions may be idiosyncratic.

Etiology and Harm

Determine cause or factors that affect illness, mortality, morbidity ex.) What factors cause or contribute to the risk of a health problem or disease?

What Nurses May do for Research

Even if you never conduct a study, you may do one of the following: 1. Contribute an idea for a clinical inquiry 2. Assist in collecting research information 3. Offer advice to clients about participating in a study 4. Search for research evidence 5. Discuss the implications of a study in a journal club in your practice setting, which involves meetings to discuss research articles

Empirical Evidence

Evidence rooted in objective reality and gathered using one's senses as the basis for generating knowledge. Used by Quantitative researchers

Prognosis

Examine the consequence of disease or health problem ex.) Does exposure to a disease or health problem increase the risk of subsequent adverse consequences?

Assembled Information

In making clinical decisions, health care professionals also rely on information that has been assembled for various purposes. For example, local, national, and international benchmarking data provide information on such issues as the rates of using various procedures (e.g., rates of cesarean deliveries) or rates of clinical problems Quality improvement and risk data, such as medication error reports, can be used to assess practices and determine the need for practice changes. Such sources offer useful information but provide no mechanism to actually guide improvements

Magnet Recognition Program

Magnet Recognition Program to recognize health care organizations that provide high-quality nursing care. To achieve Magnet status, practice environments must demonstrate a sustained commitment to EBP and nursing research. Changes to nursing practice are happening every day because of EBP efforts.

Nursing Research Past and Present

Nursing research began with Florence Nightingale back in the mid-19th century. · -Changed nursing care and in public health. · -1950s-nursing research improved · -1960s-practice-orientated research evolved · -1970s-emphasis began to shift to nursing practice. · -1980s-National Center for Nursing Research (NCNR) was established. v -promote and financially support nursing research v increase training to improve patient care · -1990s-integration of EBP into practice · -1993-National Institute of Nursing Research was established.

Generalizability

Quantitative researchers strive to go beyond the specifics of a research situation; the ability to generalize research findings to individuals other than those who took part in the study (referred to as generalizability) is an important goal. he degree to which the research methods justify the inference that the findings are true for a broader group than study participants; in particular, the inference that the findings can be generalized from the sample to the population.

Cause- Probing Research

Research designed to illuminate the underlying causes of phenomena. Most EBP-related purposes (except diagnosis and meaning) involve cause-probing research

Diagnosis and Assessment

Rigorous development of formal instruments to screen, diagnose and assess patients ex.) What test or assessment procedure will yield accurate diagnoses or assessments of critical patient conditions and outcomes?

Tradition and Authority

Some nursing interventions are based on untested traditions, customs, and "unit culture" rather than on sound evidence. term-3 Another common source of knowledge is an authority, a person with specialized expertise. Reliance on authorities (such as nursing faculty or textbook authors) is unavoidable. Authorities, however, are not infallible—particularly if their expertise is based primarily on personal experience; yet, their knowledge is often unchallenged.

Evidence Based Practice

The best evidence in making patient care decisions. v Base decisions on the evidence v Clinical appropriate v Cost-effective v Result in positive client outcomes Ex.) Magnet Recognition Program

Positivist paradigm definition

The paradigm underlying the traditional scientific approach, which assumes that there is an orderly reality that can be objectively studied; often associated with quantitative research. research activity is often aimed at understanding the underlying causes of natural phenomena.

Therapy, Treatment or Intervention

Treatment or interventions to improve health ex.) What therapy or intervention will result in better health outcomes or prevent an adverse health outcome?

What is a major assumption of the constructivist paradigm world view? a. Reality is mentally constructed by individuals. b. The researcher is independent from those researched. c. Values and biases are held in check. d. Subjectivity is not desirable.

a. Reality is mentally constructed by individuals.

Disciplined Research

considered the best method of acquiring reliable knowledge that humans have developed. Evidence-based health care compels nurses to base their clinical practice, to the extent possible, on rigorous research-based findings rather than on tradition, authority, or personal experience. However, nursing will always be a rich blend of art and science.

Quantitative vs. Qualitative Research

key methodologic distinction is between quantitative research, which is most closely allied with positivism, and qualitative research, which is associated with constructivist inquiry

Assumption

principle that is believed to be true without verification Adherents of positivism assume that nature is ordered and regular and that a reality exists independent of human observation. In other words, the world is assumed not to be merely a creation of the human mind.

Assumption of Determinism

refers to the positivists' belief that phenomena are not haphazard but rather have antecedent causes. If a person has a stroke, a scientist in a positivist tradition assumes that there must be one or more reasons that can be potentially identified.

Research Methods

techniques researchers use to structure a study and to gather and analyze relevant information. The two paradigms correspond to different methods of developing evidence.

Multiple Paradigms

the two paradigms have many features in common, some of which are mentioned here: - Ultimate goals. The ultimate aim of disciplined research, regardless of paradigm, is to answer questions and solve problems. Both quantitative and qualitative researchers seek to capture the truth with regard to the phenomena in which they are interested. - External evidence. The word empiricism is often associated with the scientific method, but researchers in both traditions gather and analyze evidence gathered empirically, that is, through their senses. - Reliance on human cooperation. Human cooperation is essential in both quantitative and qualitative research. To understand people's characteristics and experiences, researchers must encourage people to participate in the study and to speak candidly. - Ethical constraints. Research with human beings is guided by ethical principles that sometimes interfere with research goals. Ethical dilemmas often confront researchers, regardless of paradigms or methods. - Fallibility. Virtually all studies have limitations. Every research question can be addressed in different ways, and inevitably, there are tradeoffs. Financial constraints are often an issue, but limitations exist even in well-funded research. This means that no single study can ever definitively answer a research question. The fallibility of any single study makes it important to understand and critique researchers' methods when evaluating evidence quality.

Phenomena

those things in which researchers are interested—such as a health event (e.g., a patient fall), a health outcome (e.g., pain), or a health experience (e.g., living with chronic pain).

Constructivist Paradigm

v Aligns with qualitative research v Reality is constructed by individuals v Subjectivity and values are desirable v Researcher interacts with participants v Findings are derived from the interactive process v Narrative v Seeks in-depth understanding v Nonquantifiable

Positivist paradigm

v Aligns with quantitative research v Understanding the underlying cause of a natural phenomena v Orderly, disciplined procedures v Focus on objective findings; quantifiable v Seeks to generalize results v Uses statistical analysis v Values and bias are held in check v Measured v Objectivity is sought