Nursing Research Reviewer

What Is Nursing Research?

Research is systematic inquiry that relies on disciplined methods to answer

questions and solve problems. The ultimate goal of research is to gain
knowledge that can benefit many people. Nursing research is systematic
inquiry designed to develop evidence about issues of importance to nurses
and their clients.
Clinical nursing research—that is, research designed to guide nursing
practice and to improve the health and quality of life of nurses’ clients.
Typically begins with questions stemming from practice problems—problems
you may have already encountered.

Nurses are increasingly expected to understand research and to base their

practice on evidence from research—that is, to adopt an evidence-based
practice (EBP). EBP involves using the best evidence in making patient care
decisions, and such evidence typically comes from research conducted by
nurses and other health care professionals.
The need to base specific nursing decisions on evidence indicating that the
decisions are clinically appropriate, resulting in positive client outcomes, as
well as cost-effective.

Roles of Nurses in Research

a. 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.
b. Research is increasingly being conducted by practicing nurses who want to
find what works best for their clients.

Nursing Research: Past and Present

Florence Nightingale in the 1850s - skillful analysis of factors affecting soldier
mortality and morbidity during the Crimean War, she was successful in
bringing about changes in nursing care and in public health.

1950s - research by nurses began to accelerate.

The establishment of the journal Nursing Research.
1960s - practice-oriented research, and research-oriented journals started
publication in several countries.
1970s - research emphasis on improvements in client care.
Utilization of research findings in nursing practice.
1986 - the National Center for Nursing Research (NCNR) was established at
the National Institutes of Health (NIH) in the United States.
To promote and financially support research relating to patient care.
1993 - NCNR was promoted to full institute status within the NIH: The
National Institute of Nursing Research (NINR) was created.

Tradition and “Experts”

Some nursing decisions are based on untested traditions and “unit culture”
rather than on sound evidence.
“Sacred cows” (ineffective customs)
An authority - a person with specialized expertise. Their knowledge is often
unchallenged.

Clinical Experience and Trial and Error

Clinical experience is a functional source of knowledge—indeed, it is a
component of the EBP model.
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—alternatives tried successively until a solution to a problem is
found.

Disciplined Research
Considered the best method of acquiring reliable knowledge. Evidence-based
health care compels nurses to base their clinical practice to the extent
possible on rigorous research-based findings.

PARADIGMS AND METHODS FOR NURSING RESEARCH

Paradigm is a worldview, a general perspective on the world’s complexities.

Positivism - is a reflection of a broad cultural movement that emphasizes

the rational and scientific.
Constructivist paradigm/naturalistic paradigm - alternative system for
conducting research in nursing.

Research methods - techniques researchers use to structure a study and to

gather and analyze relevant information.

The Positivist Paradigm

Assumption - a principle that is believed to be true without verification.
Paradigms are associated with a set of assumptions.
Worldview of the Positivist Paradigm
There is a reality out there that can be studied and known.
Nature is ordered and regular.
Reality exists independent of human observation.
Assumption of determinism - that phenomena are not haphazard but
rather have antecedent causes.
Research activity - aimed at understanding the underlying causes of natural
phenomena.
Because of their belief in a factual reality, positivists prize objectivity.
Use of orderly, disciplined procedures with tight controls over the research
situation to test hunches about the nature of phenomena being studied and
relationships among them.

Phenomena are those things in which researchers are interested—such as a

health event, a health outcome, or a health experience.

Postpositivists recognize the impossibility of total objectivity, but they view

objectivity as a goal and strive to be as unbiased as possible.
(+) Barriers to knowing reality with certainty and therefore seek probabilistic
evidence—i.e., learning what the true state of a phenomenon probably is.

The Scientific Method and Quantitative Research

Using orderly procedures to gather primarily quantitative information.
Quantitative researchers move in a systematic fashion from the definition of
a problem to a solution. Quantitative researchers use methods designed to
control the research situation with the goal of minimizing bias and
maximizing validity.
Systematic - investigators progress through a series of steps, according to
a prespecified plan.
Empirical evidence—evidence that is rooted in objective reality and
gathered through the senses.
The information is quantitative—numeric information that results from
some type of formal measurement and that is analyzed statistically.
Generalizability - the ability to generalize research findings to individuals
who did not take part in the study is an important goal.

Quantitative researchers must deal with problems of measurement. To

study a phenomenon, scientists must measure it, that is, attach numeric
values that express quantity. Ex: psychological phenomena, such as stress,
resilience, or pain.
Nursing research focuses on human beings, who are inherently complicated
and diverse.
Quantitative studies typically focus on only a few concepts.

The Constructivist Paradigm

Worldview of the Constructivist Paradigm

Reality is not a fixed entity but rather a construction of the people
participating in the research; reality exists within a context, and many
constructions are possible.
Relativism: Multiple interpretations of reality that exist in people’s minds =
no process by which the ultimate truth or falsity of the constructions can be
determined.
The knowledge is maximized when the distance between the inquirer and
participants in the study is minimized.
The voices and interpretations of those under study are crucial to
understanding the phenomenon of interest, and subjective interactions are
the best way to access them.
Findings from a constructivist inquiry are the product of the
interaction between the inquirer and the participants.

Constructivist Methods and Qualitative Research

Emphasis is on the ability of humans to shape their own experiences, and the
idea that truth is a composite of realities.
Constructivist studies are focused on understanding the human experience
as it is lived, through the careful collection and analysis of qualitative
materials that are narrative and subjective.
Qualitative researchers: Traditional scientific method is reductionist— it
reduces human experience to the few concepts under investigation, and
those concepts are defined in advance rather than emerging from the
experiences of those under study.
Emphasis: on the dynamic, holistic, and individual aspects of human life.
Capture: these aspects in their entirety, within the context of those who are
experiencing them.
Flexible, evolving procedures are used to capitalize on findings that emerge
during the study.
The collection and analysis of information usually progress concurrently.
Inductive process (going from specifics to the general) - researchers
integrate information to develop a theory or description that illuminates the
phenomena under observation.
Yield rich, in-depth information that can potentially clarify the dimensions of
a complicated phenomenon.
The findings are grounded in the real-life experiences of people with
firsthand knowledge of a phenomenon.
Limitations.
1. Human beings are used - highly intelligent—but fallible—tools.
2. Subjectivity of constructivist inquiry.
3. Most constructivist studies involve a small number of participants =
generalizability of findings is a potential concern.
Researchers seldom discuss or even mention the underlying paradigm of
their studies in their reports.

Multiple Paradigms and Nursing Research

Paradigms are lenses that help to sharpen researchers’ focus on phenomena
of interest.
The availability of alternative paradigms for studying nursing problems can
maximize the breadth of new evidence for practice.

The two paradigms have many features in common:

1. Ultimate goals: to answer questions and solve problems. All researchers
seek to capture the truth with regard to the phenomena in which they are
interested.
2. External evidence. The word empiricism is often associated with the
scientific method, but qualitative researchers also gather and analyze
evidence gathered empirically, that is, through their senses.
3. Reliance on human cooperation. To understand people’s characteristics
and experiences, researchers must persuade them to participate in the study
and to speak candidly.
4. Ethical constraints. Research is guided by ethical principles.
5. Fallibility. Virtually, all studies have limitations. The fallibility of any
single study makes it important to understand and critically appraise
researchers’ methods when evaluating evidence quality.

Qualitative studies may have no tables with quantitative information,

or only one numeric table describing participants’ characteristics (e.g., the
percentage who were male or female).
Have “word tables” or diagrams and figures illustrating processes inferred
from the narrative information gathered.
Quantitative studies typically have several tables with numbers and
statistical information.

Research Purposes Linked to Evidence-Based Practice

Therapy/Intervention
To learn the benefits of specific actions, treatments, products, or processes.
Seek to identify effective treatments for ameliorating or preventing health
problems.
From evaluations of highly specific treatments (e.g., comparing two types of
cooling blankets for febrile patients) to complex multicomponent
interventions designed to result in behavioral changes (e.g., testing a nurse-
led smoking cessation intervention).
Foundational for evidence-based decision making; evidence for
changes to nursing practice comes from studies that have tested the effects
of intervening in a particular way.

Diagnosis and Assessment

Concern the rigorous development and testing of formal instruments to
screen, diagnose, and assess patients and to measure clinical outcomes—
that is, they address Diagnosis/assessment questions. High-quality
instruments with documented accuracy are essential for clinical practice and
for research.

Prognosis
Strive to understand the outcomes associated with a disease or a health
problem (i.e., its consequences), to estimate the probability they will occur,
and to predict the types of people for whom the outcomes are most likely.
Facilitate the development of long-term care plans for patients.
Provide valuable information for guiding patients to make beneficial lifestyle
choices or to be vigilant for key symptoms.
Etiology (Causation)/Prevention of Harm
How to prevent harm or treat health problems by knowing what causes them
—this is the focus of Etiology questions.
Determine the factors and exposures that affect or cause illness, mortality,
or morbidity.

Description
Quantitative description focuses on the prevalence, size, intensity, and
measurable attributes of phenomena.
Qualitative researchers, by contrast, describe the dimensions or the
evolution of phenomena.

Meaning and Processes

Health care activities can benefit from gaining insight into the clients’
perspectives, using qualitative research methods that address
Meaning/process questions.
1. Offers evidence about what health and illness mean to clients,
2. What barriers they face to positive health practices,
3. What processes they experience in a transition through a health care crisis
are important to evidence-based nursing practice.

Therapy/intervention research focuses on whether an intervention

causes improvements in key outcomes.
Prognosis research examines whether a disease or health condition causes
subsequent adverse consequences.
Etiology research seeks explanations about the underlying causes of
health problems.

Links Between Study Purposes and Evidence-Based Practice

Studies that address Therapy/intervention questions provide the
most direct evidence for EBP.
The findings from studies relating to only one of these questions is directly
actionable—the Therapy question.
Evidence regarding what “works” to improve nursing practice
comes from studies addressing Therapy questions.
BASICS OF EVIDENCE-BASED NURSING PRACTICE
Definition

Best Evidence
De-emphasizes decisions based on tradition or expert opinion.
The emphasis is on identifying and evaluating the best available
research evidence as a tool for solving problems.

Patient Preferences and Values

Patient’s preferences for type of treatment, being involved in decision
making, social or cultural values, involving family members in health care
decisions, priorities regarding quality-of-life issues, and spiritual or religious
values.
EBP decisions also require understanding patients’ circumstances, such as
the resources at their disposal.
Nurses thus need the skills to elicit and understand patient preferences and
their situations.

Nurses’ Clinical Expertise

Decision making in clinical practice also relies on clinicians’ expertise, which
is an amalgam of academic knowledge gained during training and continuing
education, experiences with patient care, and interdisciplinary sharing of
new knowledge.

Sources of “Best” Research Evidence

Several evidence-based journals publish synopses of original research (e.g.,
Evidence-Based Nursing, The Online Journal of Knowledge Synthesis for
Nursing), and the synopses are occasionally accompanied by commentary
about the clinical utility of the evidence.
Syntheses that integrate evidence from multiple studies on a given topic
are an especially important resource for EBP.
Systematic review - the most widely respected type of synthesis.
Systematic reviews are the basis for most clinical practice
guidelines.
A methodical, scholarly inquiry that summarizes and evaluates current
evidence on a research question.
Meta-analysis - integrated findings from quantitative studies using
statistical methods.
The findings from multiple studies on the same topic are combined and
analyzed statistically. Meta-analysis is an objective method of integrating a
body of findings and of observing patterns that might otherwise have gone
undetected.
Systematic reviews of qualitative studies often take the form of
metasyntheses.
Metasynthesis - information is amplified and interpreted.
Meta-aggregation - an aggregative (rather than interpretive) approach to
systematic synthesis called meta-aggregation.

Evidence Hierarchies and Level of Evidence Scale

Evidence hierarchies – guides on what is the best evidence.
In terms of their risk of bias, focusing mainly on risk of bias in studies
addressing Therapy questions.
Represented as pyramids, with the highest-ranking sources—those presumed
to have the least bias for making inferences about the effects of an
intervention—at the top.
Level of evidence (LOE) scales: Level I evidence is the best (least biased)
type of evidence.

Figure 1.2 In our scheme, the Level I evidence source is a systematic review
of studies called randomized controlled trials (RCTs), which are the “gold
standard” type of study for Therapy questions. An individual RCT is a Level II
evidence source. Going down the “rungs” of the evidence hierarchy for
Therapy questions results in evidence with a higher risk of bias in answering
questions about “what works.” (Technical terms in Figure 1.2, such as “quasi-
experiment,” are explained later in the book.)
Asking Well-Worded Clinical Questions for Evidence-Based Practice

The “5A” process: Ask, Acquire, Appraise, Apply, and Assess.

The first activity in EBP involves asking well-worded clinical questions that
can be answered with research evidence.
Acronyms PIO and PICO to help practitioners develop well-worded questions.

PICO form - identify four components:

P: the Population or patients (What are key characteristics of the patients or
people?)
I: the Intervention, influence, or exposure (What is the intervention or
therapy of interest? or, What is a potentially beneficial—or harmful—
influence?)
C: an explicit Comparison to the “I” component (With what is the
intervention or influence being compared?)
O: the Outcome (What is the outcome in which we are interested?)

For questions that can best be answered with qualitative information

(e.g., about the meaning of an experience or health problem), two
components are most relevant:
1. The population (What are the characteristics of the patients or clients?)
2. The situation (What conditions, experiences, or circumstances are we
interested in understanding?)

Points
Nursing research is systematic inquiry undertaken to develop evidence on
problems of importance to nurses.
Evidence-based practice (EBP) that incorporates research findings into their
decisions and interactions with clients.
Knowledge of nursing research enhances the professional practice of all
nurses—including both consumers of research (who read and evaluate
studies) and producers of research (who design and undertake studies).
Nursing research began with Florence Nightingale.
The National Institute of Nursing Research (NINR) affirms the stature of
nursing research in the United States.
Contemporary issues in nursing research: the growth of EBP, expansion of
local research and quality improvement efforts, research synthesis through
systematic reviews, patient centeredness, the applicability of research to
individual patients or groups, measuring the clinical significance of research
results.
Disciplined research
Disciplined inquiry in nursing is conducted mainly within two paradigms—
worldviews with underlying assumptions about reality: the positivist
paradigm and the constructivist paradigm.
In the positivist paradigm, it is assumed that there is an objective reality
and that natural phenomena are regular and orderly. The assumption of
determinism refers to the belief that phenomena result from prior
causes and are not haphazard.
Quantitative research (associated with positivism) involves the collection
and analysis of numeric information. Typically conducted within the
traditional scientific method, which is systematic and controlled. Quantitative
researchers base their findings on empirical evidence (evidence
collected by way of the human senses) and strive for generalizability
beyond a single setting or situation.
Constructivist paradigm - reality is not a fixed entity but is rather a
construction of human minds—and thus “truth” is a composite of multiple
constructions of reality.
Emphasis is on understanding human experience as it is lived through
the collection and analysis of subjective, narrative materials using
flexible procedures; this paradigm is associated with qualitative research.
A fundamental distinction that is especially relevant in quantitative research
is between studies whose primary intent is to describe phenomena and those
that are cause-probing—i.e., designed to illuminate underlying causes of
phenomena. Specific purposes on a description/explanation continuum
include identification, description, exploration, prediction/control, and
explanation.
EBP-related aims: Therapy/intervention, Diagnosis/assessment, Prognosis,
Etiology (causation)/prevention of harm, Description, and Meaning/processes.
Therapy questions are foundational for evidence-based decision making.
EBP is the conscientious integration of current best evidence and
other factors in making clinical decisions. The three “legs” of EBP are
(1) best research evidence, (2) patient preferences and values, and (3)
nurses’ own clinical experience and knowledge.
Primary studies of original research published in professional journals are
one source of evidence for EBP, but preprocessed (synthesized) evidence is
especially useful in addressing clinical queries. Systematic reviews,
considered the cornerstone of EBP, are important sources of evidence.
Systematic reviews are rigorous integrations of research evidence
from multiple studies on a topic.
Can involve either narrative approaches to integration (including
metasynthesis and meta-aggregation of qualitative studies) or quantitative
approaches (meta-analysis) that integrate findings statistically by using
individual studies as the unit of analysis.
“Best” evidence—evidence with the lowest risk of bias. Evidence hierarchies
reflect level of evidence (LOE) scales that rank order types of evidence
source—primarily for Therapy/intervention questions. In LOEs for Therapy
questions, systematic reviews of randomized controlled trials (RCTs) are
considered Level I sources.
EBP efforts typically start by asking a well-worded clinical question for which
evidence is then sought.
Involves four primary components, an acronym for which is PICO:
Population or patients (P), Intervention or influence (I), Comparison
(C), and Outcome (O).

Understanding Key Concepts and Steps

in Quantitative and Qualitative Research
The Faces and Places of Research
Studies with humans involve two sets of people: those who do the research
and those who provide the information.
In a quantitative study, the people being studied are called subjects or
study participants.
In a qualitative study, the people cooperating in the study are called study
participants or informants. The person who conducts the research is the
researcher or investigator.
Research can be undertaken in a variety of settings (the types of place
where information is gathered). A site is the broad location for the research.

Concepts, Constructs, and Theories

Studies are conceptualized in abstract terms. These abstractions are called
phenomena (especially in qualitative studies) or concepts.
A construct often refers to a more complex abstraction than a concept.
A theory is an explanation of some aspect of reality.
- concepts are knitted together into a coherent system to describe or explain
some aspect of the world.
- play a role in both qualitative and quantitative research.
- quantitative study: start with a theory and, using deductive reasoning,
make predictions about how phenomena would behave in the real world if
the theory were valid. The specific predictions are then tested.
- qualitative studies, theory often is the product of the research: The
investigators use information from study participants inductively to develop
a theory rooted in the participants’ experiences.

The reasoning process of deduction is associated with quantitative

research, and induction is associated with qualitative research.

Variables
In quantitative studies
Concepts are called variables.
A variable is something that varies.
Quantitative researchers seek to understand how or why things vary and to
learn how differences in one variable relate to differences in another.
Variables are the central building blocks of quantitative studies.
Key concepts or variables are often indicated in the study title.

Characteristics of Variables
Variables are often inherent human traits.
Some variables take on a wide range of values than can be represented on a
continuum.
Sometimes such variables convey quantitative information, but others
involve placing people into categories.

Dependent and Independent Variables

Many studies seek to understand the causes of phenomena.
The presumed cause is the independent variable, and the presumed
effect is the dependent or outcome variable.
The dependent variable is the outcome that researchers want to understand,
explain, or predict.
In terms of the PICO, the dependent variable corresponds to the “O”
(outcome). The independent variable corresponds to the “I” (the
intervention, influence, or exposure), plus the “C” (the comparison).
In a cause-probing study, researchers must always specify the
comparator (the “C”).
The terms independent variable and dependent variable also can be
used to indicate direction of influence rather than cause and effect.
Variables are not inherently dependent or independent. It can be an
independent or dependent depending on the function that it plays in a
particular study.

Conceptual and Operational Definitions

A conceptual definition is the theoretical meaning of a concept.
Researchers need to conceptually define even seemingly straightforward
terms.
In qualitative studies, conceptual definitions of key phenomena may be a
major end product, reflecting an intent to have concepts explained by
those being studied. In quantitative studies, researchers must define
concepts at the outset because they must decide how the variables
will be measured. An operational definition specifies what the
researchers must do to measure the concept and collect needed
information.
Definitional precision is important in communicating what concepts mean
within the context of the study.
In qualitative studies, researchers collect primarily qualitative data, that
is, narrative descriptions. Narrative data can be obtained by
conversing with participants, by making notes about their behavior in
naturalistic settings, or by obtaining narrative records, such as diaries.
Suppose we were studying depression qualitatively. In reports on qualitative
studies, researchers include excerpts from their narrative data to support
their interpretations.

Relationships
Studying phenomena in relation to other phenomena—they examine
relationships.
A connection between phenomena.
In quantitative studies, relationships are expressed in quantitative terms. For
each independent variable, we can make a prediction about its relationship
to the outcome.
Most quantitative research is conducted to assess whether
relationships exist among variables and to measure how strong the
relationship is.

Expressed in two basic forms.

Cause-and-effect (or causal) relationships. Within the positivist paradigm,
natural phenomena are assumed to have antecedent causes that are
discoverable. many quantitative studies are cause-probing—they seek to
illuminate the causes of phenomena.
Not all relationships can be interpreted as causal. This type of
relationship is sometimes referred to as an associative (or functional)
relationship rather than a causal one.

Qualitative researchers may seek patterns of association as a way of

illuminating the underlying meaning and dimensionality of
phenomena of interest. Patterns of interconnected concepts are identified as
a means of understanding the whole.

MAJOR CLASSES OF QUANTITATIVE AND QUALITATIVE

RESEARCH
Quantitative Research: Experimental and Nonexperimental Studies
In experimental research, researchers actively introduce an
intervention or treatment—usually to address Therapy questions.
In nonexperimental research, on the other hand, researchers are
bystanders—they collect data without introducing treatments (most
often, to address Etiology, Prognosis, Diagnosis, or Description
questions). In medical and epidemiological research, experimental
studies usually are called clinical trials, and nonexperimental inquiries
are called observational studies.

Experimental studies are explicitly designed to test causal

relationships—to test whether an intervention causes changes in the
outcome.

Qualitative Research: Disciplinary Traditions

Qualitative descriptive research.

Grounded theory research seeks to describe and understand key
social psychological processes.
Developed in the 1960s by Glaser and Strauss (1967).
The focus is on a developing social experience.
Phenomenology is concerned with the lived experiences of humans.
Phenomenology is an approach to thinking about what people’s life
experiences are like and what they mean. Phenomenological researchers ask
the questions: What is the essence of this phenomenon as experienced
by these people? or, What is the meaning of the phenomenon to those
who experience it?

Ethnography, the primary research tradition in anthropology, provides a

framework for studying the patterns and lifeways of a defined cultural
group in a holistic fashion. Ethnographers typically engage in extensive
fieldwork, often participating to the extent possible in the life of the culture
under study. Ethnographers strive to learn from members of a cultural group,
to understand their worldview, and to describe their customs and norms.

MAJOR STEPS IN A QUANTITATIVE STUDY

In quantitative studies, researchers move from the beginning point of a study

(posing a question) to the end point (obtaining an answer)

Figure 2.1 Flow of steps in a quantitative study.

Phase 1: The Conceptual Phase

The researchers rely on creativity, deductive reasoning, and a grounding in

research evidence on the focal topic.

Step 1: Formulating and Delimiting the Problem

Begin by identifying an interesting research problem and formulating
research questions. The research questions identify what the study variables
are. Substantive issues (Is this problem important?),
Theoretical issues (Is there a conceptual framework for this problem?),
Clinical issues (Will findings be useful in clinical practice?),
Methodologic issues (How can this question be answered to yield high-quality
evidence?),
Ethical issues (Can this question be addressed in an ethical manner?).

Step 2: Reviewing the Related Literature

To understand what is already known about a topic by undertaking a
thorough literature review before any data are collected.

Step 3: Undertaking Clinical Fieldwork

Spending time in relevant clinical settings (in the field), discussing the topic
with clinicians and observing current practices.

Step 4: Defining the Framework and Developing Conceptual

Definitions
The findings may have broader significance and utility. Researchers should
have a conceptual rationale and a clear vision of the concepts under study.

Step 5: Formulating Hypotheses

State researchers’ expectations about relationships between study variables.
Predictions of the relationships that researchers expect to observe in the
study data.
The research question identifies the concepts of interest and asks how the
concepts might be related; a hypothesis is the predicted answer. Most
quantitative studies are designed to test hypotheses through statistical
analysis.

Phase 2: The Design and Planning Phase

The researchers decide on the methods they will use to address the research
question.
Step 6: Selecting a Research Design
The overall plan for obtaining answers to the research questions.
Quantitative designs tend to be structured and controlled, with the goal of
minimizing bias. Indicate how often data will be collected and what types of
comparisons will be made. The research design is the architectural backbone
of the study.

Step 7: Developing Protocols for the Intervention

In experimental research, researchers introduce an intervention. An
intervention protocol for the study must be developed, specifying exactly
what the intervention will entail (e.g., who will administer it, over how
long a period will the treatment last, and so on) and what the comparative
condition will be. In nonexperimental research, this step is not
necessary.

Step 8: Identifying the Population

To specify what characteristics study participants should possess—that is,
they must identify the population to be studied. A population is all the
individuals or objects with common, defining characteristics (the “P”
component in PICO questions).

Step 9: Designing the Sampling Plan

Specifies how the sample will be selected and how many participants there
will be. The goal is to have a sample that adequately reflects the
population’s traits.

Step 10: Specifying Methods to Measure Research Variables

Methods to measure their research variables accurately.
The primary methods are self-reports (e.g., interviews and questionnaires),
observations (e.g., watching and recording people’s behavior), and
biophysiological measures (biomarkers)..

Step 11: Developing Methods to Safeguard Human/Animal Rights

Procedures need to be developed to ensure that the study adheres to ethical
principles.

Step 12: Reviewing and Finalizing the Research Plan

Assessments to ensure that procedures will work smoothly.
Critiqued by reviewers to obtain clinical or methodological feedback.
Researchers seeking financial support submit a proposal to a funding source.

Phase 3: The Empirical Phase

The third phase of quantitative research involves collecting the data.

Step 13: Collecting the Data

The plan typically spells out procedures for training data collection staff, for
implementing the sampling plan and collecting data (e.g., where and when
the data will be gathered), and for recording information.

Step 14: Preparing the Data for Analysis

Data collected in a quantitative study must be prepared for analysis

Phase 4: The Analytic Phase

Subjected to analysis and interpretation.

Step 15: Analyzing the Data

Quantitative data are analyzed through statistical analyses, which include
some simple procedures (e.g., computing an average) or complex methods.

Step 16: Interpreting the Results

Making sense of study results and examining their implications.
Conclusions about the clinical significance of the new evidence.

Phase 5: The Dissemination Phase

The questions posed at the outset are answered. The researchers’ job is
incomplete, however, until study results are disseminated.

Step 17: Communicating the Findings

The preparation of a research report that can be shared with others.

Step 18: Putting the Evidence Into Practice

Developing recommendations on how the evidence could be used in
practice, by ensuring that adequate information has been provided for a
meta-analysis, and by pursuing opportunities to disseminate the findings to
practicing nurses.

ACTIVITIES IN A QUALITATIVE STUDY

In qualitative studies, the progression is closer to a circle than to a straight

line. Qualitative researchers continually examine and interpret data and
make decisions about how to proceed based on what has been discovered
(Fig. 2.2).
Conceptualizing and Planning a Qualitative Study

Identifying the Research Problem

Begin with a fairly broad initial question that allows the focus to be
sharpened and delineated more clearly once the study is underway.

Doing a Literature Review

Qualitative researchers typically find a relatively small body of relevant
previous work because of the type of questions they ask.

Selecting and Gaining Entrée Into Research Sites

Before going into the field, qualitative researchers must identify an
appropriate site. Gaining entrée typically involves negotiations with
gatekeepers who have the authority to permit entry into their world.

Developing an Overall Approach

Qualitative researchers use an emergent design that materializes during
data collection. Qualitative studies rarely have rigid designs that prohibit
changes while in the field.

Addressing Ethical Issues

There are special concerns in qualitative studies because of the more
intimate nature of the relationship that typically develops between
researchers and participants.

Conducting a Qualitative Study

The tasks of sampling, data collection, data analysis, and interpretation
typically take place iteratively. Begin by talking with people who have
firsthand experience with the phenomenon of interest.
Data analysis involves clustering related narrative information into
a coherent scheme. Through inductive reasoning, researchers identify
themes and categories, which are used to build a rich description or theory
of the phenomenon.
Sampling decisions are guided by the data.
Principle of saturation - when participants’ accounts of their experiences
become redundant, such that no new thematic development can occur from
further data collection.
Qualitative researchers are the main data collection instrument and
must take steps to demonstrate the trustworthiness of the data. The central
feature of these efforts is to confirm that the findings accurately reflect the
viewpoints of participants.

Qualitative studies help to shape nurses’ perceptions of a problem, their

conceptualizations of potential solutions, and their understanding of patients’
concerns and experiences.

Summary
Points
Subjects/Study participants - people who provide information to the
researchers in a study in quantitative research, and study participants or
informants in qualitative research; collectively, they comprise the study
sample.
The site is the location for the research.
Concepts and phenomena (or constructs), which are abstractions
inferred from people’s behavior or attributes.
Concepts are the building blocks of theories, which are systematic
explanations of some aspect of the real world.
In quantitative studies, concepts are called variables. A variable is a
characteristic or quality that takes on different values (i.e., varies
from one person or object to another).
The dependent (or outcome) variable is the behavior, characteristic,
or outcome the researcher is interested in explaining, predicting, or
affecting (the “O” in the PICO format). The independent variable is the
presumed cause of or influence on the dependent variable. The
independent variable corresponds to the “I” and the “C” components in
the PICO scheme.
A conceptual definition describes the abstract meaning of a concept
being studied. An operational definition specifies how a variable will
be measured.
Data—the information collected during the course of a study
narrative information (qualitative data)
numeric values (quantitative data).
A relationship is a connection or pattern of association between
variables. Quantitative researchers study the relationship between
independent variables and outcome variables.
When the independent variable is a cause of the dependent variable,
the relationship is a cause-and-effect (or causal) relationship. In an
associative (functional) relationship, variables are related in a
noncausal manner.
Quantitative studies: Experimental research - researchers actively
intervene to test an intervention or therapy. Nonexperimental (or
observational) research, in which researchers collect data about
phenomena without intervening.

Qualitative research sometimes is rooted in research traditions:

grounded theory, phenomenology, and ethnography.
Grounded theory - describe and understand key social psychological
processes that occur in a social setting.
Phenomenology - on the lived experiences of humans and is an
approach to gaining insight into what the life experiences of people
are like and what they mean.
Ethnography - provides a framework for studying the meanings,
patterns, and lifeways of a culture in a holistic fashion.

In a quantitative study, researchers usually progress in a series of linear

steps, from asking research questions to answering them. The main phases
in a quantitative study are the conceptual, planning, empirical, analytic, and
dissemination phases.
The conceptual phase involves (1) defining the problem to be studied, (2)
doing a literature review, (3) engaging in clinical fieldwork for clinical studies,
(4) developing a framework and conceptual definitions, and (5) formulating
hypotheses to be tested.
The planning phase entails (6) selecting a research design, (7) developing
intervention protocols if the study is experimental, (8) specifying the
population (the “P” in the PICO format), (9) developing a sampling plan, (10)
specifying a data collection plan and methods to measure variables, (11)
developing strategies to safeguard participants’ rights, and (12) finalizing the
research plan.
The empirical phase involves (13) collecting data and (14) preparing data for
analysis (e.g., coding data).
The analytic phase involves (15) performing statistical analyses and (16)
interpreting the results.
The dissemination phase entails (17) communicating the findings and (18)
promoting the use of the study evidence in nursing practice.

The flow of activities in a qualitative study is flexible and less linear than in
a quantitative study. Qualitative studies typically involve an emergent design
that evolves during data collection.
Qualitative researchers begin with a broad question regarding a phenomenon
of interest, often focusing on a little-studied aspect. In the early phase of a
qualitative study, researchers select a site and seek to gain entrée into it,
which typically involves enlisting the cooperation of gatekeepers within the
site.

Once in the field, qualitative researchers select informants, collect data,

and then analyze and interpret them in an iterative fashion; experiences
during data collection help in an ongoing fashion to shape the design of the
study.
Early analysis in qualitative research leads to refinements in sampling and
data collection, until saturation (redundancy of information) is achieved.
Analysis typically involves a search for critical themes or categories in the
data.
Both qualitative and quantitative researchers disseminate their findings,
most often by publishing their research reports in professional journals.