Chapter 1

Introduction to Nursing Research

(Lecture 3 hours)

What is Research?

 Research is derived from an old French word “CERCHIER” which means to seek or to
search.
 The prefix “re” means to do it again. It implies that a person must find out or take
another look.
 “Research is a studious inquiry or examination, investigation, or experimentation aimed
as the discovery and interpretation of facts, revision or accepted theories or laws in the
light of new facts or practical application of such new or revised theories or laws”-
Webster, 1971
 Research is an attempt to gain solutions or problems. IT is a collection of data in a
rigorously controlled situation for the purpose of prediction or explanation.” – Treece
and Treece, 1973
 “Research is a formal and systematic intensive process of carrying on a specific analysis
for the purpose of discovery and development of an organized body of knowledge”-
Best, 1968
 “Research is an honest, scientific investigation undertaken for the purpose of discovering
new facts or establishing new relationship among facts already known which will
contribute to the present body of knowledge and can lead to an effective solution of
existing problems”- Committee on Research of the Philippine Nurses Association

What is Nursing Research?

 “Systematic inquiry designed to develop knowledge about issues of importance to the

nursing profession, including nursing practice, education, administration and
informatics.”- Polit and Beck, 2004)
 “Scientific process that validates and refines existing knowledge and generates new
knowledge that directly and indirectly influences nursing practice.” Burns and Grove,
2005

Importance of Research to the Nursing profession

1. Practice-evidence based practice (EBP)

 Nurses increasingly are expected to adopt an evidence-based practice (EBP),
which is broadly defined as the use of the best clinical evidence in making
patient care decisions.
 There is general agreement that research findings from rigorous studies
constitute the best type of evidence for informing nurses’ decisions, actions, and
interactions with clients.
  Nurses are accepting the need to base specific nursing actions and decisions on
evidence indicating that the actions are clinically appropriate, cost-effective, and
result in positive outcomes for clients.
 Nurses who incorporate high-quality research evidence into their clinical
decisions and advice are being professionally accountable to their clients. They
are also reinforcing the identity of nursing as a profession
2. Education
 Research finding provide updates that are valuable in the nursing profession.
Since nursing must be responsive to the current health care demands of the
society, nursing education must be updated and relevant through research
findings.
3. Health care policy
 Nurses need to document the social relevance and effectiveness of their practice,
not only to the profession but to nursing care consumers, health care
administrators, third-party payers (e.g., insurance companies), and government
agencies.
4. Cost-benefit
 Some research findings will help eliminate nursing actions that do not achieve
desired outcomes. Other findings will help nurses identify practices that improve
health care outcomes and contain costs as well.
5. Distinguish nursing as a profession
 Nursing research is essential if nurses are to understand the varied dimensions of
their profession.
 Research enables nurses to describe the characteristics of a particular nursing
situation about which little is known; to explain phenomena that must be
considered in planning nursing care; to predict the probable outcomes of certain
nursing decisions; to control the occurrence of undesired outcomes; and to
initiate activities to promote desired client behaviour.

Who are involved in Research?

1. The Producer (Researcher)

 Nurses who actively participate in designing and implementing research 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 patients
2. The Consumers
 Read research reports to develop new skills and to keep up to date on relevant
findings that may affect their practice.
 Nurses increasingly are expected to maintain this level of involvement with
research, at a minimum.
 Research utilization—the use of research findings in a practice setting—
depends on intelligent nursing research consumers

Activities that can enhance the Nurses’ professionalism

 1. Participating in a journal club in a practice setting, which involves regular meetings
among nurses to discuss and critique research articles
2. Attending research presentations at professional conferences
3. Discussing the implications and relevance of research findings with clients
4. Giving clients information and advice about participation in studies
5. Assisting in the collection of research information (e.g., distributing questionnaires to
patients)
6. Reviewing a proposed research plan with respect to its feasibility in a clinical setting and
offering clinical expertise to improve the plan
7. Collaborating in the development of an idea for a clinical research project
8. Participating on an institutional committee that reviews the ethical aspects of proposed
research before it is undertaken
9. Evaluating completed research for its possible use in practice, and using it when
appropriate

SOURCES OF EVIDENCE FOR NURSING PRACTICE

1. Tradition
 Many questions are answered and problems solved based on inherited customs or
tradition. Within each culture, certain “truths” are accepted as given.
2. Authority
 Authorities—people with specialized expertise—in every field
3. Human experience
 The ability to generalize, to recognize regularities, and to make predictions based
on observations
i. May be restricted
ii. May be prejudiced or subjective
4. Trial and error
 In this approach, alternatives are tried successively until a solution to a problem is
found.
 We likely have all used trial and error in our lives, including in our professional
work.
 For example, many patients dislike the taste of potassium chloride solution. Nurses
try to disguise the taste of the medication in various ways until one method meets
with the approval of the patient.
 Trial and error may offer a practical means of securing knowledge, but it is fallible.
This method is haphazard, and the knowledge obtained is often unrecorded and,
hence, inaccessible in subsequent clinical situations.
5. Intuition
 Intuition is a type of knowledge that cannot be explained on the basis of reasoning
or prior instruction.
 Although intuition and hunches undoubtedly play a role in nursing practice—as they
do in the conduct of research—it is difficult to develop policies and practices for
nurses on the basis of intuition.
6. Logical reasoning
i. Inductive reasoning
 The process of developing generalizations from specific observations.
  For example, a nurse may observe the anxious behavior of (specific)
hospitalized children and conclude that (in general) children’s separation
from their parents is stressful
ii. Deductive reasoning
 The process of developing specific predictions from general principles.
 For example, if we assume that separation anxiety occurs in hospitalized
children (in general), then we might predict that (specific) children in
Memorial Hospital whose parents do not room-in will manifest symptoms of
stress.
7. Disciplined research
 Research conducted within a disciplined format is the most sophisticated method
of acquiring evidence that humans have developed.

PARADIGMS FOR NURSING RESEARCH

 A paradigm is a world view, a general perspective on the complexities of the real

world.
 Paradigms for human inquiry are often characterized in terms of the ways in
which they respond to basic philosophical questions:
o Ontologic: What is the nature of reality?
o Epistemologic: What is the relationship between the inquirer and that
being studied?
o Axiologic: What is the role of values in the inquiry?
o Methodologic: How should the inquirer obtain knowledge?
 Disciplined inquiry in the field of nursing is being conducted mainly within two
broad paradigms, the POSITIVIST and the NATURALISTIC.
Classification of Research

General Classification

 Basic research
o Undertaken to extend the base of knowledge in a discipline, or to formulate or
refine a theory.
o For example, a researcher may perform an in-depth study to better understand
normal grieving processes, without having explicit nursing applications in mind.
 Applied research
o Focuses on finding solutions to existing problems.
o For example, a study to determine the effectiveness of a nursing intervention to
ease grieving would be applied research.
 Action Research
o The process involves the study of a certain problem and from that experience,
decisions, actions and conclusions are drawn.

Classification according to Research Design

1. Quantitative Research
 Most closely allied with the positivist tradition
 The traditional, positivist “scientific method” refers to a general set of
orderly, disciplined procedures used to acquire information.
 Researchers use deductive reasoning to generate hunches that are tested in
the real world
 Usually (but not always) the information gathered in such a study is
quantitative—that is, numeric information that results from some type of
formal measurement and that is analyzed with statistical procedures
 Types of Quantitative Research
o Descriptive
o Correlational
o Experimental
o Quasi-experimental
2. Qualitative Research
 Most often associated with naturalistic inquiry
 Naturalistic investigations place a heavy emphasis on understanding the
human experience as it is lived, usually through the careful collection and
analysis of qualitative materials that are narrative and subjective.
 Types of qualitative research
o Phenomenological
o Grounded theory
o Ethnographic
o Historical case study

The Building blocks of a research study

  Phenomenon is a fact, occurrence, or circumstance observed or observable
 Concept is a generalized idea of a collection of phenomena, based on knowledge of
common properties of instances in the collection
 Construct a construct refers to an abstraction or mental representation inferred from
situations or behaviours
o Kerlinger and Lee (2000) distinguish concepts from constructs by noting that
constructs are abstractions that are deliberately and systematically invented (or
constructed) by researchers for a specific purpose.
o For example, self-care in Orem’s model of health maintenance is a construct.
 Theory is a systematic, abstract explanation of some aspect of reality. In a theory,
concepts are knitted together into a coherent system to describe or explain some aspect
of the world. Theories play a role in both qualitative and quantitative research.
o In a quantitative study, researchers often start with a theory, framework, or
conceptual model

Chapter Evaluation

1. Name five continuous, five discrete, and five categorical variables; identify which, if any,
are dichotomous.
2. In the following research problems, identify the independent and dependent variables:
a. How do nurses and physicians differ in the ways they view the extended role concept
for nurses?
b. Does problem-oriented recording lead to more effective patient care than other
recording methods?
c. Do elderly patients have lower pain thresholds than younger patients?
d. How are the sleeping patterns of infants affected by different forms of stimulation?
e. Can home visits by nurses to released psychiatric patients reduce readmission rates?
 Chapter 1

Introduction to Nursing Research

Laboratory (2 Hours)

Workshop 1: Your Worldview of the Nursing Profession and the Health Care System

What are some of the current changes occurring in the health care delivery system, and how
could these changes influence nursing?

Current Changes /Challenges in the Influence to nursing Research,

health care system education or administration
1.

2.

3.

4.

5.
 Chapter 2:

Overview of the Research Process in Quantitative and Qualitative studies

(Lecture: 5 hours)

The Research Process

Research is scientific and systematic, hence, it employs step-by-step process. Here are
the steps in doing research.

1. Identifying the research Problem

2. Conduct a Review of Related Literature
3. Define the actual problem and objectives in clear specific terms
4. Formulate the hypothesis and define the study variables
5. Construct the research and sampling design
6. Design the tool for data collection
7. Design the plan for data analysis
8. Collect the data
9. Process the data
10. Analyse the data
11. Write research report
12. Disseminated and utilize the result

Identifying a Research Problem

Research starts with curiosity. When we ask questions about certain phenomena or
observations about issues and conditions, we arrive at a topic or a problem.

But how do we decide on what research topic to pursue? Here are the factors that we
need to consider.

1. Personal Interest
 A researcher must have enough motivation to conduct a scientific
investigation, and it must be driven by personal interest and curiosity.
2. Experience and Capacity
 One must have the experience or capacity of the chosen topic. An engineer
example cannot or do not have the capacity and experience to do a research
on public health, because of limited or lack of knowledge and skills on health
care.
3. Published Literature
 Review of related literature is strongly encourage in order to justify the
relevance of the research topic. It is important that a researcher must have
an extensive knowledge on previous researches related to the chosen topic.
4. Ethical Issues
  A research topic is only valid and allowed to be undertaken if it has no ethical
or moral violations.
5. Feasibility
 A researcher must ascertain that there is sufficient resources to conduct the
study. Money, time, human resource and the availability of the subject or
location must be taken into consideration.
6. Research Priorities
 Research priorities are created by different health care agencies and
academic institutions to guide the researchers on the priority areas that has
to be researched on. These areas are identified based on their relevance to
the current issues and concerns, and on the thrust of an organization.

Sample of Research Priorities or Research Agenda

1. National Unified Health Research Agenda (NUHRA) by the DOST

2. Commission on Higher Education Research Agenda
3. Philippine Development Plan (NEDA)
4. UNESCO Moving Forward the 2030 Agenda for Sustainable Development
5. Institutional Research Agenda of Medical Colleges of Northern Philippines
6. College of Nursing Research Agenda of MCNP

Conduct of Review of Related Literature

Review of literature is one of the most important aspects of the research process.

Significance of Review of Related Literature

 Provides the historical background of your topic

 The RRL demonstrate the researcher's understanding of the research issues,

 Show awareness of the most important and relevant theories, models, studies and
methodologies

 Result to identification of the gaps (both theoretical and practical), limitations or areas
that have not been covered adequately, in the researcher’s opinion, from
previous/current literature;

 As such the researcher conclude or imply what he will contribute by covering the gaps
and doing research in the particular area;

 This also result to the formulation of the conceptual framework for the reader so that
the research question and methodology can be better understood

 Demonstrates to the expert reader that the researcher is aware of the breadth and
diversity of literature that relates to the research question.

Ethical Consideration

 Proper citation of the source of research article must be done to avoid plagiarism
  A researcher can be taken to court if presentation of research results from other writers
was done without quoting the author.
 Therefore, appropriate referencing procedures should always be followed in research
proposals and reports.

Formulation of Hypothesis

A hypothesis is a statement of the researcher’s expectations about relationships

between the variables under investigation. Hypotheses, in other words, are predictions of
expected outcomes; they state the relationships researchers expect to find as a result of the
study

We based our hypothesis from the statements of the problems or objectives and on the
conceptual framework for causality.

Types of Hypothesis

1. Simple Hypothesis

Predicts that, there is exist a relationship between the independent and ependent
variables

Example: Wearing of mask decreases the risk of acquiring COVID 19 infection.

2. Complex hypothesis predicts that there exist a relationship between two or more
independent an dependent variables

Example: Wearing of mask, wearing of face shield and using alcohol for hand hygiene
decrease the risk of acquiring COVID 19 infection.

3. Directional Hypothesis

Predicts the direction of the relationship between the independent and dependent variables

Example: High quality education leads to high quality nursing practice

4. Non-Directional

Predicts the relationship between the independent and dependent variables but does not
specify the direction of relationship.

Example: Online Virtual Learning influences student’s learning behaviour

5. Causal hypothesis predicts cause and effect relationship or interaction between the
independent and dependent variables.
The independent variable becomes the treatment or experimental variable and the
dependent variable becomes the outcome variable.
Example: Early Postoperative ambulation leads to faster recovery
6. Null Hypothesis is also called statistical hypotheis because this hypothesis is usually used
for statistical testing and statistical interpretation.
The null hypothesis predicts that there is no relationship between the independent and
dependent variables.
 Example: Social isolation has no significant relationship to behavioural changes among
teenagers during pandemic.
7. Alternative Hypothesis predicts a positive relationship between the independent and
dependent variables.
Example: Social isolation has a significant relationship to behavioural changes among
teenagers during pandemic

Conceptual Framework

Activities

1. Reading Assignment (Research Agenda)

Guidelines:
1. Research on the different research agenda enumerated above such as the NUHRA
and Philippine Development Plan (NEDA).
2. Make an outline of the agenda and highlight those that you are interested into
3. Write your outline in your notebooks.
2. Reading Assignment (APA format)
Guidelines:
1. Search the APA format 6th edition in the internet
2. Read the guidelines on proper citation of research articles, journals, books and
publications. Also review the in-citation and bibliography referencing.
3. Write the summary of APA guidelines in your noteboks.
 Chapter 2

Identification of Research Problem and Performing Preliminary Review of Related

Literature

(Laboratory 2 Hours)

Workshop 2: Identification of problem

Direction:

1. Based on your readings of the various research agenda, identify 3 areas or topics that
you are interest in.
2. From these three topics identify at least 3 sub-topics. And from the 3 sub topics arrive at
a research title.
Workshop 2: Literature Matrix

Direction:

1. Search 3 related literature for each of the major topics you have identified.
2. To search for a related literature follow this instructions:
 Go to online research websites or in google scholar
 Type the keyword or research topic that you wish to search
 A list of related literatures will display on screen, Click on them and choose as
much as possible researches that are recent (5 years back); and are complete
(introduction to result an ddiscussion)
 I discourage you to include literatures which you were only provided with
abstract because you will not have an access to the complete methodology and
result and discussion owhich are very important in literature review.
3. After reading the literatures, make a literature matrix using this template.

Reference Objectives Keywords and Conclusion Recommendations

their operational
definition
Follow the APA You can find the After the From the On the latter part
format for objectives in the abstract, you findings you can of the research
referencing introduction can find the find the article is the
part. keywords of the conclusion of recommendation.
study. the study.

Define the
keywords based
on how they
were used in
the study.
 Chapter 3

Defining the framework and developing conceptual and theoretical frameworks

(5 hours)

Variables

A characteristic or measurement whose value differs from one individual to another or

from one period to another in the same individual

Qualitative vs Quantitative Variables

1. Qualitative Variables

 categories are merely expressed as labels to distinguish one group from another
 numerical representation of the categories are for labeling/coding and not for comparison
(greater or less)
 e.g. sex, educational level, occupation, religion, place of residence, sick or not sick

2. Quantitative Variables

o values indicate a quantity or amount and can be expressed numerically

o values can be arranged according to magnitude
o e.g. age, height, weight, # of patients, blood pressure

Independent vs Dependent Variables

1. Independent Variables- the presumed cause

2. Dependent Variable- the presumed effect

Types of variables

1. Continuous variables have values that can be represented on a continuum

Example: Height and weight

2. Discrete variable, has a finite number of values between two point

Example: Number of children

3. Categorical variables have distinct categories that do not represent a quantity

Example: Gender, blood type

Level of Measurement

1. Nominal
  number or names which represent a set of mutually exclusive and exhaustive classes to
which individuals or objects (attributes) may be assigned.
 -e.g. sex (male, female), geographic regions, race, blood groups, seatbelts in car
2. Ordinal

 same characteristics as for nominal scales with the additional feature that the classes
can be ordered
 Example: Severity of the disease (mild, moderate, severe)
 psychosocial scales ( strongly disagree, disagree,agree, strongly agree)
 educational attainment (elem, high school, college)
3. Interval

 same characteristics as for ordinal scales with the additional feature that the distances
between all adjacent classes are equal
o conceptually, these scales are infinite, in that they have neither beginning, nor
ending
 -e.g. Temperature measurement (zero is not absolute);
4. Ratio

 same characteristics as for ordinal scales with the additional feature that the a
meaningful zero point exists
 e.g. weight, blood pressure, height, doctor visits, number of DMF teeth

How do we define variables?

Conceptual definition elucidates the abstract or theoretical meaning of the concepts being
studied.

Operational definition is the specification of the procedures and tools required to measure a
variable.

Defining the variables conceptually and operationally

Example: SMOKER

Conceptual definition: One who smokes tobacco

Operational definition: One who smokes at least 3 sticks of cig/day within the past 6
months

Conceptual Framework

 It provides a bridge which links the available body of knowledge with the proposed
research
 Needed only for studies which have ‘cause and effect’ objectives (e.g. studies on
association, comparison and effectiveness)
 Shows the lineage (i.e. origin) of the research problem from the background of the existing
knowledge, previous investigations, or contemporary practice (in the case of applied
research)
 What do we already know or do?

 – diagram that shows the relationships of the different variables being studied

 Required for studies on association

Smoking Hypertension

Age
 Chapter 3

Writing the Preliminaries for the Proposal Paper

(Laboratory 6 hours)

Workshop 3: Preliminary Capsule Writing

This activity prepares you in writing the Final proposal for your research. Accomplish the
table below following the guidelines provided on the first column.

Parts / Instructions Proposed Text

Assigned
member
Proposed Write the title of the research
Title you wish to undertake.
Introductio In writing the introduction or
n background of the study you
need to include the following:
 Topic: What is all about
your research title? This
should be included in the
first paragraph.
 Importance: In here you
can include current
issues, problems or
opportunities you learned
about your topics. You
can include facts from
different sources like
statistical information or
evidences that justify the
importance of the topic.
 Reason: You need to
discuss the “Knowledge
Gap”, or the information
that is not yet available in
this particular topic which
may be produced when
 you conduct this study.
 Purpose: Simply state
what benefit can this
research contribute to
the society.
Objectives/ Provide a list of goals and
Statement objectives that will be achieved
of the through the proposed research.
Problem Present the general statement of
the problem and then the
specific statement of the
problem.
EX.

Generally, the study seeks

to…

Specifically, the study seeks

to answer the following
questions:

1.
2.
3.

Operational Identify the variables of the

Definition of study (all that is found in your
terms statement of the problem). Then
define them according to how
will they be used in the study
(operational). Organize them
alphabetically.
Theoretical From your Review of related
Framework literature search for a theory
that is related to your study or
which you can test its
applicability or relevance through
your study.
Conceptual Use the IPO format in writing
Framework/ your research paradigm. The
Research IPO format is Input-Process-
Paradigm Output format which is the
format being used in the
institution.
References Outline your references here
using the APA referencing.
 Chapter 4

The Design and Planning Phase

Research Design

 Research design is the overall plan for obtaining answers to the questions being studied
and for handling some of the difficulties encountered during the research process. A
wide variety of research designs is available for quantitative studies, including numerous
experimental and nonexperimental designs.
 In designing the study, researchers specify which specific design will be adopted and
what controls will be used to minimize bias and enhance the interpretability of results.
In quantitative studies, research designs tend to be highly structured, with tight controls
over extraneous variables.
 Research designs also indicate other aspects of the research—for example, how often
subjects will be measured or observed, what types of comparisons will be made, and
where the study will take place. The research design is essentially the architectural
backbone of the study

Nonintervention/ Observational Studies

 The researcher just describes and analyses researchable objects or situation but does
not intervene
 Types
o Descriptive Studies
 Case Study
 Case series
 Ecologic study
 Cross-sectional study
o Analytic studies
 Cross-sectional study
 Cohort study
 Case-control study
Intervention/ Experimental Studies

 The researcher manipulates objects or situations and measures the outcome of his
manipulation

Descriptive Studies

 These studies involve systematic collecstion and presentation of data to give a clear
picture of a particular situation

1. Case Study or Case Report

o Most basic type of descriptive study
o Give detailed report of the profile of single patient
o Documents unusual medical occurences
o Represents first clues in the identification of a new disease or adverse effects of
exposures
2. Case Series
o Collection of individual case reports which may occur within a fairly short period
of time
o Historical importance : used as means to identify the beginning or presence of an
epidemic
o Example:
 HIV/AIDS
 COVID 19
3. Ecologic Study
o Also referred to as correlational study
o Involves the group as the unit of analysis
o Group is often defined geographically

Analytic Designs

1. Cross sectional study

o Study examines the relationship between diseases/health related characteristics
and other variables of interst as they exist in a defined population at one
particular point in time
o Involve the collection of data at one point in time: the phenomena under study
are captured during one period of data collection.
o Cross-sectional studies are appropriate for describing the status of phenomena
or for describing relationships among phenomena at a fixed point in time.
o For example, we might be interested in determining whether psychological
symptoms in menopausal women are correlated contemporaneously with
physiologic symptoms.
 Longitudinal Design
 A study in which data are collected at more than one point in time
over an extended period uses a longitudinal design.
  Example: A study involving the collection of postoperative patient
data on vital signs over a 2-day period would not be described as
longitudinal.
2. Case-control study
o A type is of observational analytic epidemiologi investigation
o Subjects are selected on the basis of whether they do or do not have a particular
disease under study
o The groups are compared with respect to the proportion having a history of an
exposure or a characteristics of interest.
3. Cohort Design
 A group or groups of individuals are defined on the basis of presence or absence of
exposure to a suspected risk factor of a disease
 Are a particular kind of trend study in which specific subpopulations are examined over
time. The samples are usually drawn from specific age-related subgroups.
 For example, the cohort of women born from 1946 to 1950 may be studied at regular
intervals with respect to health care utilization.
 In a design known as a cross-sequential design,* two or more age cohorts are studied
longitudinally so that both changes over time and generational (cohort) differences can
be detected.

Experimental Designs

 A basic distinction in quantitative research design is that between experimental

and nonexperimental research. In an experiment, researchers are active agents,
not passive observers
 Characteristics of a true experiment
o Manipulation
 Involves doing something to study participants.
 The introduction of that “something” (i.e., the experimental
treatment or intervention) constitutes the independent variable.
 The experimenter manipulates the independent variable by
administering a treatment to some subjects and withholding it
from others (or by administering some other treatment).
 The experimenter thus consciously varies the independent
variable and observes the effect on the dependent variable.
o Control
 is achieved in an experimental study by manipulating, by
randomizing, by carefully preparing the experimental protocols,
and by using a control group
 Groups:
 Control group refers to a group of subjects whose
performance on a dependent variable is used to evaluate
the performance of the experimental or treatment group
 Experimental group or treatment group is the group that
receives the intervention on the same dependent variable.
 o Randomization
 (Also called random assignment) involves placing subjects in
groups at random.
 Random essentially means that every subject has an equal chance
of being assigned to any group.
 If subjects are placed in groups randomly, there is no systematic
bias in the groups with respect to attributes that could affect the
dependent variable

Types of Experimental Designs

1. Post Test only

2. Pre-test-Posttest design
3. Solomon four-group
4. Factorial
5. Randomized Block
6. Cross over/ repeated measure