Class 3/4: Nursing Knowledge and Research

Study Design

The blueprint that ensures research is structured, organized and reliable. It outlines:

The research question/problem being studied

The paradigm of study (qualitative, quantitative or both)

Sampling methods (participants)

How data will be collected

How data will be analyzed

Systematic review

Type of literature review that retrieves, evaluates and summarizes recently published research on a specific topic. Includes:

Comprehensive, transparent literature review

Methodical: Inclusion/exclusion criteria for choosing studies. Describes steps for choosing the study

Critical appraisal: Authors evaluate quality and reliability of the studies using a critical appraisal tool

Summary of findings: Author presents a synthesis of the best available evidence

Most common data base used for systematic review

Cochrane systematic reviews

Hierarchy of evidence: Level 1

Systematic review or meta-analysis of randomized control trials

Evidence informed clinical practice guidelines based on systematic reviews

Hierarchy of evidence: Level 2

A well designed RCT

Hierarchy of evidence: Level 3

Controlled trial without randomization (quasiexperimental study)

Note: dont really use term “quasi” anymore, would just say a non RCT

Hierarchy of evidence: Level 4

Single nonexperimental study (case control, correlational, cohort studies)

Hierarchy of evidence: Level 5

Systematic reviews of descriptive and qualitative studies

Hierarchy of evidence: Level 6

Single descriptive or qualitiative study

Hierarchy of evidence: Level 7

Opinion of authorities and/or reports of expert committees

Bottom levels of hierarchy of evidence

Still important, create a foundation for other research to build upon

Fawcett’s 5 components of nursing knowledge

Metaparadigm

Philosophy

Conceptual model

Theory

Empirical indicator

Metaparadigm

Most abstract level of knowledge in nursing. The worldview of discipline. Includes:

Person

Environment

Health

Nursing

Philosophy

Addresses fundamental questions concerning existence, reality, knowledge and ethics, particularly in relation to nursing

Foundation of knowledge and how it is generated

Paradigm

A set of assumptions about reality, knowledge and what is valuable to study

All nursing research is based on philosophical beliefs

Ontology

Way of “being” in the world

Address 2 questions:

1. What exists/what is real?

2. What categories can existing things be sorted into?

Epistemology

“knowing”

Addresses 4 questions:

1. What is knowledge

2. What/who are the sources of knowledge

3. What are the ways we come to know something, in contrast to believing, wondering, guessing or imagining

4. What is truth and what roles does it play in knowledge

Positivism

Aims for objectivity and impartiality, with the goal of prodcuing unbiased, generalizable research

Doesnt really account for error/bias (not as realistic)

Post Positivism

Objectivity is usually impossible.

Our observations are subject to error and bias (more realistic)

Researchers all have different values, opinions etc

What type of research do positivism and post positivism inform

Quantitative research

Constructivism

Referred to as interpretivism or relativism

Knowledge and truth is derived from peoples experiences, social/cultural constructs, values, perspectives and language

Construcing knowledge through reality

What kind of research does constructivism inform

Qualitiative research

Critical realism

Social entities exist independently of human understanding

Not everyone will view things the same way

Example: Discrimination/power imbalances exist regardless of whether people recongize their influence

Conceptual models

Consist of a collection of concepts that encompasses broad, overarching ideas relevant to nursing as a profession

Theory

Turns abstract concepts into measurable questions that can then be examined through empirical methods such as instruments, experiments or specfic procedures

Theoretical knowledge

Focuses on formulating/evaluating theories, potential explanations or concepts that nurse researchers propose to understand how the world functions

Guided by empirical knowledge which is based on observations of phenomena

Scientific observation includes:

Speaking to people with lived experiences of a phenomena

Direct observation of cultural or social interactions as they naturally occur

Administration of an intervention

Using data collection tools (ensure theyre valid and reliable)

Critical social theories

Proposes that reality and our perception of reality are shaped by those who hold the greatest power

Reality is influenced by social, political, economic and cultural determinants (race, gender, socioeconomic statuts etc). Researchers examine disparities iof power

Examples of critical social theories

Feminist theory

Critical race theory

Queer theory

Disability theory

Intersectionality

Empirical Knowing

Creating evidence or knowledge through the scientific process (results are tested and justified knowledge for practice)

Ways of knowing

Personal knowledge

Experiential knowledge

Ethical knowledge

Aesthetic knowledge

Sociopolitical knowledge

Theoretical/empirical knowledge

Ways of knowing: Personal knowledge

Comes from inner experiences and maturation of the nurse

Encompasses becoming a whole, aware, authentic self

Continual life process that occurs with deep reflection

Allows for interpersonal relationships

Ways of knowing: Experiential knowledge

Comes from repeated exposure to situations that lead to the refining of earlier ideas and thoughts

Expert pracitioner is fully enaged and attuned to each situation and responds on the basis of past learning

Ways of knowing: Aesthetic knowledge

The art of nursing

Expressive, intuitive and creative aspect of nursing

Practice that incorporates poetrym art, music and stories

Allows for a deep understanding of the human experience

Ways of knowing: Sociopolitical Knowledge

Contextual knowledge that moves beyond nurse-patient relationship and the profession

Undertsanding of culture, society and politics

Awareness of how society is organized and its implications for health

Ways of knowing: Theoretical/empirical knowledge

Scientific knowledge

Development and testing of theories/theoretical models

Observation and measurement of case specific issues and phenomena

Quantitative and qualitative research

Indigenous knowledge

A learned way of looking at the world that may have very different forms of acquisitions, transmission and manifestations for indigenous peoples

Indigenous ways of knowing emphasize:

Storytelling, traditions, spirituality and lived experiences

Quantitative Research

Testing relationships and group differences

Clarifying cause and effect interactions

Explaining the effectiveness of an intervention

Controlled measures to collect data, such as surveys

Data is analyzied and summarized statistically

Steps for quantitative research

1. Identify the research purpose and question 

2. Review the literature to see what is already known 

3. Identify a framework that best explains how the concepts relate to one another 

4. Decide on the most suitable and rigorous study design 

5. Select a sample and measure the concepts of interest 

6. Analyze the data and report whether the hypotheses are supported

Qualitative research

Systematic

Interactive 

Describes and interprets life experiences 

Data from personal perceptions of study participants 

The goal is to understand human experiences/phenomena 

Steps of qualitative research

1. Identify research purpose and question

2. Review literature and select a group of people who have experienced that phenomenon of interest

3. Conduct interviews and/or gather textual data or artifacts about phenomena of interest or observe the people experiencing the phenomenon

4. Review the literature and conduct further interviews and observations until new themes occur (saturation)

5. Review of the literature and summarize findings and describe the human experience 

Conceptual definition

Like a dictionary definition, it describes the meaning of the concept. 

For research: goes beyond the general dictionary meaning and is defined as it is rooted in the theoretical literature 

Operational definition

How is this done in the research?

Specifies how the concept will be measured within a research study or theoretical paper 

The researchers specify what will be used to capture the features of the variable 

Inductive reasoning

Bottom up “figuring out what is there”

Foundation of most qualitative inquiry 

Starting with the details of the expereince and building towards a general picture (theory)

Clinical observation —> Theory

Deductive reasoning

Top down

Theory —> Practice 

Starts with the general picture/theory and moves towards the specifics 

Researchers measure concepts that when combined can help them suggest relationships between the concepts 

Constructs

Broad ideas that are abstract in nature

Cant be easily measured 

Ex: pain or stress 

Variables

Factors that can be measured/given values

Ex: temperature, job satisfaction, pain, heart rate