3515 midterm

What is research?

What is research?

→ to search again, to examine carefully
→ diligent and systematic inquiry
→ GOAL: to develop an empirical body of knowledge

Output of research: develop new knowledge

Research definition

Systematic, rigorous, logical investigation with the aim of answering questions about nursing phenomena.

phenomena

Occurrences, shuations, facts that are perceptible by the senses. (Situation)

Role of Research in Nursing

→ expands the disciplines unique body of scientific knowledge
→ forms the foundation of evidence-informed nursing practice
→ allows practices to change with work environments and the most common health issues.
→ allows efective outcomes for pts
→ use of evidence-based practice: procedure that already show something is effective

Evidence informed decision making

a continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care

evidence-based practice

→ systematically finding, appraising, and using research findings as the basis for clinical practice for making decisions about patient care
→ process where nurses make clinical decisions based on the best available research evidence, clinical practice and pt preference in the context of available resources
→ provides support and quality and cost effectiveness of nursing intervention

EBP within nursing

→ problem-solving approach to the delivery of health care that integrates the best evidence from well designed studies and pt. Care data and combines it with clinical expertise and pt preferences and values.

Trends that influence nursing research.

→ An emphasis on health disparities amongst indigenous people
→ An emphasis on underserviced communities and vulnerable populations
→ A focus on palliative care and MAID
→ increased prevalence of life threatening illnesses due to life-sustaining technologies
→ increase in mental health illness
→ expanding population of older people
→ expanding population with chronic illnesses
→ impact of Covid
→ A focus on maternal-neonatal mortality occurrences

nurses role in research

- Consumer: follow guidelines and protocols. nurses consume research
- Generator of clinical questions: if no evidence nurses consume and generate evidence
- Investigator/participant in research: prof job.
- Protector of research participants: make sure research is safe

19th century history key events (3)

→ nursing becomes a formal discipline
→ Florence publishes "notes on nursing" in 1859. Introduces the systematic collection and exploration of data to support health promotion and disease prevention
→ schools of nursing are getting established but research is in early stages.

20th century key events

1900-1940
→ emphasis not on research but on preparation of nurses for practice
1950-1999
→ first masters program in Canada
→ 1st federally funded grant for nursing research
→ doctoral programs U OF A, UBC, McGill U Of T
→ nursing research fund established (25 million dollars for nursing research)

21st century history key events

2000-2012
→ growth of university based registered psychiatric nursing programs
→ first masters degree at U of B for registered psychiatric nurses

Covid 19 impact on research

→ projects and funding got delayed
→ generated a lot of research ideas and topics

International perspectives

→ global research community
→ cross cultural and cross national studies could be implemented
→ requires networks, databases, website funding, respect for cultural perspectives
→ international organizations create valuable and accessible partnerships

Knowledge Development in Research

1. Knowledge gap: Abscence of theoretical/empirical knowledge
2. Knowledge generation: research questions are devised, qualitative and quantitative methods are used to answer all the questions
3. Knowledge distribution: evidence is shared. Formal: presentation, journal reports, publications. Informal: media, internet, social networks
4. Knowledge adoption: new practice is used to alter ad practice
5. Knowledge review and revision: new health issues leading to asking of new questions. Old knowledge is revised or excluded. New questions prompt the need for new research.

6 knowledges of nursing

1. Personal: comes from inner experiences and maturation of the nurse. Encompasses becoming a whole, aware, genuine authentic self. Occurs with deep reflection, allows for interpersonal relationships
2. Experiential: comes from related exposure to situations that leads to refining earlier ideas and thoughts
3. Ethical: moral component of nursing knowledge
4. Aesthetic: expressive, intuitive and creative aspect.
5. Sociopolitical: contextual knowledge that moves beyond nurse pt relationship. understanding of culture, society and politics
6. Theoretical/empirical: scientific knowledge

Paradigm

→ a set of beliefs and practices shared by communities of researchers that guide the knowledge development process
→ every researcher has their own paradigm (assumption about reality)

Ontology

the study of being

Epistemology

addressess the issue of "truth"

Methodology

Disupline-specific rules, principles and procedures that guide the research process

Methods

the specific ways that scholars collect and analyze data

context

Personal, social and political environment in which a Phenomenon of interest occurs

Aim of inquiry

goals or specific objectives of the research

2 key paradigms for nursing research

Positivist:
• reality exists. Ex water boils @100
• researcher is independent from those researched

Constructivist:
• reality is multiple and subjective
• researcher interacts with those being researched
• subjectivity And values are inevitable And desirable

Research Methods

Quantitative research: positivist tradition. numbers, Charts, figures
Qualitative: associated with the constructivist tradition

Quantitative Research

a formal, objective, systematic process in which numerical data are used to obtain information about the world.

Measurement, hypothesis testing, data analysis
Traditional approaches, such as experiments, Questionnaires and surveys

Qualitative Research

systematic, subjective approach used to describe life experiences and give them meaning

→ Evaluate subjective life experiences and give meaning to them
→ focus on understanding phenomena from an individuals perspective
→ approaches: observation, in depth interviews, case studies, narrative analyses
→ often conducted in natural settings
→ qualitative researchers believe reality is socially constructed and context-dependent. The meaning of an observation is defined by it's circumstance or the environment.

Quantitative research steps

6 steps:
1. Identify research purpose and question
2. Review literature to see what is known about concepts
3. Identify a framework that best explains how concepts relate
4. Decide on most suitable and rigorous study design
5. Select sample and measure concepts of interest
6. Analyze data § whether hypothesis is true or false

Qualitative research steps

1. Identify the research purpose and question
2. Select a group of people who have experienced the phenomenon of interest
3. Conduct interviews about phenomenon of interest or observe the group experiencing the phenomenon
4. Analyze data for themes
5. Conduct further interviews and observations until no new themes occur (saturation)
6 summarize findings and describe the human experience

1. Review literature
2. Study design
3. Sample
4. Setting
5. Data collection
6. Data analysis
7. Findings
8. Conclusions

inductive reasoning

specific to general
Start with details and move to general picture. Used by qualitative researchers

deductive reasoning

general to specific
2 or more concepts
Followed by quantitative researchers

Variable

→ property that is being studied
→ something that changes or varies. Height weight, religion, health etc.
→ studies often conducted based on how changes in one variable relate to changes in another.

Concept

Image or symbolic representation of an abstract idea
Concepts are the major components of theory and convey the abstract ideas within a theory.

• The theoretical framework is the theory on which the study is based, the conceptual framework is the opertionalzation of the theory.

Theory

Set of interrelated concepts that serve as the purpose of explaining or predicting phenomena.
A blue print or a written or diagrammatic depiction of both the concepts that compose a theory and h they are related

Hypothesis

→ best guess or prediction about what a researcher expects to find with regard to the relationship between 2 or more variables
→ test hypothesis in quantitative not qualitative

Conceptual framework

A structure of concepts theories, or both that is used to construct a map for the study

Presents a theory that explains why the phenomenon being studied exists

Constructed from a review of the literature or is developed as part of a qualitative research project.

Theoretical frameworks

Same as conceptual but based on a philosophical or theorem belief or understanding Of why the phenomenon under study exists

function of a framework

-clarifies concepts
-identifies and states underlying assumptions of a study
-Specifies relationship among and between concepts
-A conceptual or theoretical model is a visual symbolic representation of the concepts in a framework

critical thinking

Rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, beliefs, statements And actions.

→ disciplined self-directed thinking

critical thinker

1. Consciously thinking about their own thoughts: what they say, write read, or do
2. Questioning the appropriateness of the content, applying standards or criteria
3. Evaluating the arguments or overall position of the author

Critically reading

→ An active intellectually engaging process in which the reader participates in an inner dialogue with the writer
→ a critical reader can enter the point of view of writer
→ both critical thinking & critical reading are developed by learning the research process

Critical Reading Process

1) Preliminary understanding
• familiarize with content, identify concepts, clarify unfamiliar terms, skim article

2) Comprehensive understanding
• understand researchers purpose, identify main theme/identify steps of research design, continue to clarify unfamiliar terms.

3) Analysis understanding.
• Begin developing a critique, assess the study's value for your needs, critically evaluate the validity and applicability to practice

4) Synthesis understanding
• understand the whole article and step in the research process, use your own words to describe, identify articles strengths and weaknesses

Levels of Evidence

Level I: Randomized controlled trials
Level II: Cohort Studies
Level III: Case control studies
Level IV: Case report
Level V: Other
Level vi: single descriptive or qualitative study
Level VII: evidence from the opinion of authorities or reports of expert committees

Components Of a research report

Title
Abstract
Intro.
Literature review:purpose, question or hypothesis, theoretical/conceptual framework
Methods: design, sample, procedures, instruments, ethics
Results: data analysis
Discussion
Complications and implications
References

title

A good title tells you everything you need to know about the content of the paper in as few words as possible
A title should:
1.Describe the content of the paper;
2.Distinguish the paper from others on a similar topic;
3. Catch the reader's attention and interest;
4. Match search queries so people will find your paper (and cite it)-keywords

Critique the title

Criteria:
−Tell what the article is about
−Be as brief as possible; 10-12 words
−Be concise yet complete (convey the topic) Concise statement of the main topic
−Be interesting
−Identify the actual variables or theoretical issues under investigation −Relationship between variables

critique of abstract

Criteria:
− A brief, comprehensive summary of the contents of the article
− 100-120 words; maximal 250 words (50-250); 960 characters; six short sentences
− Usually a single paragraph (traditional)

Background/introduction: importance or purpose of the study − Objectives: − Methods: setting; study population; selection of subjects for the study; research design; period of time; data collection procedure; analytical techniques & statistical tests if possible − Results: summarize the key findings with significant level precision in data − Conclusion/implication: state whether the hypothesis was proven

A good abstract is self contained, accurate, concise and specific, non evaluative, just report, coherent and readable

2 formats of abstract

1. unstructured (without text)
2. structured (use of subheadings such as "objective", "method", "outcomes" and "conclusion". Bolded

The research problem (problem statement)

Usually stated in the introduction section
• Refined by the researcher from an idea to something that can be studied; the question that is to be answered by the research
• Arises from practice, theory, or gaps in the literature and from previous research
• In the first part of the paper, but may not be well defined

Research problem cont'd

A concise, interrogative statement written in the present tense and including one or more variables/concepts
• A research problem statement is a short (a paragraph or two) description of a specific research area or issue that you intend to address, with an explanation of
why that area/issue needs to be addressed,
why addressing this area/issue is of importance,
and what overall benefit (i.e, to society as a whole or to other researchers) addressing the issue may provide

research question

A concise, interrogative statement written in the present tense and including one or more variables/concepts.

• Research questions focus on
▪ describing variables/concepts.
▪ specifying the population being studied.
▪ examining testable relationships among variables

PICO model

Four components
P-Patient/Population/Problem; among____ (for persons entering a hospital)
I-Intervention; does _____ (is hand rubbing with a waterless, alcohol based solution)
C-Comparison; versus____ (as effective as standard hand washing with antiseptic soap)
O-Outcome: affect____ (for reducing hand contamination)

Spider model for qualitative

S. Sample (young parents)
P/I: Phenomenon of interest ( antenatal education)
D: design ( questionnaire, survey, interview , focus group)
E: evaluation (experiences)
R: research type (qualitative)

Concepts and constructs

Concepts: abstractions of particular aspects of human behavior or characteristics (pain, weight)
Constructs: slightly more complex abstractions (self-care)

Types of Variables

Continuous (height)
Discrete (number of children)
Categorical (marital status)
Dichotomous (gender)
Attribute versus active variable
Independent: cause of a dependent variable
Dependent: The presumed effect

Definitions of concepts and variables

Conceptual definition: the abstract or theoretical meaning of a concept being studied

Operational definition: the operations (measurements) a researcher must perform to collect the desired information

Data(singular = datum): the pieces of information researchers collect in a study • Quantitative: researchers collect numeric (quantitative) data.
• Qualitative: researchers collect narrative (verbal) data

types of hypothesis: simple and complex

Simple: predicts the relationship between a single IV and Dv
Complex: predicts the relationship between 2 or more IV and DV

Directional and non-directional hypothesis

Directional hypothesis
• Specifies the expected direction of the relationship between variables
• X is negatively (or positively) related to Y

Nondirectional hypothesis
• Predicts the existence of a relationship, not its direction
• X is related to Y

null hypothesis

the hypothesis that there is no significant difference between specified populations, any observed difference being due to sampling or experimental error.

hypothesis testing

→ tested through statistical analysis
→ never proved! Accepted or supported only
→ increasingly supported with more evidence

Literature review

•Is the documentation of a comprehensive review of the published and unpublished work from primary and secondary sources of data in the areas of specific interest to the researcher.
• The literature review is an integral part of the entire research process and makes a valuable contribution to almost every operational step

Literature review helps with

Relevant literature helps with:
- Broaden your knowledge base in your research area
- Research problem identification, development or refinement of RQs
- Orientation to what is "known" and "not known"
- Identify gaps or inconsistencies in a body of research
- Identification of relevant theoretical/conceptual frameworks for a research problem

Improve your methodology:
-Identification of designs & data collection methods for a study
- Development of a hypotheses to be tested

Contextualise your findings
- Identify how your findings compare with the existing body of knowledge.

Main stages of literature review

Planning the review: identifying the need for a review and documenting the methodology

Conducting the review: finding, selecting, appraising, extracting and synthesizing primary research studies

Reporting and dissemination: writing up and disseminating the results of the review

2 types of literature

Data - based = reports of original research studies by the researchers who conducted them. Ex: research literature, studies in journals, empirical, scientific

Conceptual-based: articles that comprise an authors theory or that discuss a particular concept, theory or topic (non research articles)

Steps of conducting a literature review

1 formulate review questions
2. Searching and selecting studs
3. Study quality assessment
4. Extracting data from studies
5. Data synthesis

Formulating review questions

• Question may be broad or narrow
• well formulated questions Will guide many aspects of the review process
1. Searching strategy
2. Inclusion/exclusion criteria
3. Data extraction
4. Choice of synthesis method
5. Presentation/dissemination of findings

Searching and selecting studies

→ search databases and look for grey literature

→ Types of search:
-subject search: search for topics or keywords
- textword search: search for specific words
-Author search: search for prominent researchers

Tools for Searching: Wildcard Characters

Can use a truncation symbol
- nurs* would include nurse, nurses, nursing

Searching for information

MESH terms: medical subject heading: controlled vocabulary thesaurus used for indexing articles.

Tools for Searching: Boolean Operators

Boolean operators
can be used to combine, restrict, or
broaden searches

AND
- instructs computer to retrieve references in
which two or more terms are present (e.g., obesity
AND diabetes).

OR
- instructs computer to retrieve references
containing
any of 2+ terms separated by "OR" (e.g., obesity OR diabetes).

NOT
- narrows a search by retrieving information for
one term, not the other

Tools for Searching: Quotation Marks

Yields citations in which the exact phrase appears in text
fields

The use of quotation marks around a phrase can change
the search results.
- For example, a search for
"high blood pressure" would yield overlapping but nonidentical results to
high blood pressure

Key Databases for Nurse Researchers

CINAHL (Cumulative Index to Nursing and Allied Health Literature)
→ covers references to hundreds of nursing and allied health journals as well as to books and dissertations
→ 1982 - present.

MEDLINE® (Medical Literature on-Line)
→ premier source for bibliographic coverage of the biomedical literature.
→ developed by the US national library of medicine
→ covers 5600 nursing, biomedical, and health journals and has more than 24 million records.
→ can be accessed via PUBMED.
→ uses MESH.

Google scholar
→ launched in 2004. Includes articles in journals from scholarly publishers in all disciplines
→ one advantage of GS is that it is free

Screening, documenting and abstracting

After identifying potentially relevant citations the references must be;
1. screened and gathered
2. Documented:note search actions and results
3. Abstracted and recorded: notes are made of key pieces of information

study quality assessment: quality assessment and critical appraisal

Not all published and unpublished Itterature is rigorous
• quality may be used as an explanation for differences in study results or to guide interpretation of findings, strength of inferences.

quality assessment and critical appraisal quantitative studies

Quantitative studies
→ internal validity
- bias
→ external validity
→ move away from checklists/numerical scores to domain based assessment.

quality assessment and critical appraisal qualitative studies

• 3 broad categories
Rigour: has a thorough and appropriate approach been applied?
Credibility: are the findings well presented and meaningful?
Relevance: how useful are the findings to you?

Data Extraction

Be clear what information you want.
→ study detail
→ data for your analysis

Information will need to be collected relating to:
→ methodology
→ population
→ interventions being compared
→ outcomes evaluated

Identify important themes

data synthesis: analyze the evidence

Find themes
Substantive themes:
→ pattern of evidence?
→what findings predominate?
→ how much evidence is there?

Methodologies themes:
→ what methods have been used to address the question?
→ major methoddlogic deficiencies and strengths

Generalizability themes:
→ to what population does the evidence apply?
→ do the findings vary for different types of plods

data synthesis

Building up, putting together, making a whole out of parts
→ results from different studies need to be synthesized
→ are studies and results similar enough to be combined into a single numerical result? No: qualitative descriptive/narrative summary.
YES: quantitative meta-analysis
→ heterogeneity: difference in results can arise due to differences in study design population, selection, intervention delivery
→ how similar is similar? Results from heterogenous studies should not be pooled

Purpose of qualitative research methods

1. description and understanding
2. instrument development
3. Theory building
4. guide practice

guide practice

Example: qualitative study of pain of patients with chronic obstructive pulmonary disease
Objective: evaluate pain experiences of pts with CCOPD
Sample: 16
Design: semi-structured interview
Results: 3 man themes merged
Conclusion: unrelieved pain appears to be significant problem in pts wit COPD . Research is warranted to determine if pain is clustered with other symptoms and how these symptoms affect denial management in COPD.

Bracketing

a strategy used by qualitative researchers to set aside personal interpretations to avoid bias
→ researcher sets aside personal biases (brackets them)

purposive sampling

a biased sampling technique in which only certain kinds of people are included in a sample
Participants are "purposefully" chosen.

Snowballing

A method which involves starting the process with one individual or group and then using these contacts to develop more contacts to increase the sample.

theoretical sampling

The researcher decides what data to collect
. Can use purposive sampling to collect data at the beginning of the study
. Can use theoretical sampling to collect data second time based on the theory they develop from the first data

Theoretical sampling cont'd

Participants are selected in order to inform the researchers developing understanding of the area of investigation
Idea that researchers collect data from any individual or any group of people who can provide appropriate and relevant data

Theoretical sampling process

The researchers identify a small group of people to interview based on a set of criteria (much like in purposeful sampling).
• Then, they interview those people.
• The researcher will analyze these data.
• Based on the results from this round of data analysis, the researcher will identify more people to interview.
• These might be people who will confirm what the researcher has already found, but the researcher will also purposefully look for participants who can disconfirm the previous findings.
• The researcher will conduct interviews with those newly selected participants and then analyze them.
• The process stops until the researcher reaches data saturation, or the point at which the researcher fails to collect new information with subsequent interviews

data saturation

in qualitative research, the time when no new information is being obtained and repetition of information is consistently heard

Key informants

individuals who have intimate knowledge of a subject and are willing to share it with the researcher

Recruiting sample

Inclusion and exclusion criteria

maximum variation

seeking individuals who have extremely different experiences of the phenomenon being studied

Triangulation

Bringing more than one source of data to bear on a single point
Enhances diversity
Enrich understanding
Accomplish certain goals

Types of Triangulation

Data: a variety of data sources
Investigator: use of diff researchers
Theory: use of multiple perspectives during data interpretation
Methodological. Multimethods used to study a single topic
Interdisciplinary: more than one discipline to study the topic

mixed methods

A research approach that combines quantitative and qualitative elements;
it involves the description of the measurable state of a phenomenon and the individual's subjective response to it.

Meta-synthesis

A systematic review that contains only qualitative studies.

Qualitative research cont'd

Is flexible and capable of adjusting to what is learned during data collection
• Often involves triangulating various data collection strategies
• Tends to be holistic, striving for an understanding of the whole
• Requires researchers to become intensely involved and reflexive and can
require a lot of time
• Benefits from ongoing data analysis to guide subsequent strategies

• Emergent: evolves as researchers make ongoing decisions about their data
needs based on what they have already learned

Assumptions underlying qualitative methodology

Constructivist perspective
Inductive
Interaction between researcher and informants

Design features of qualitative research

• No control of the Independent Variable
• Group comparisons are NOT planned in advance
• Number of data collection points
• Researcher may look back retrospectively, and/or study the evolution prospectively
• Research setting (real world, natural setting)
• Researcher-participant interaction
Relationship developed between the researcher and the participant may
blur the focus of the interaction
• Researcher as instrument
The researcher may misinterpret the participants' reality

Commonalities of qualitative research methods

• Interview, direct observation artifacts, documents, cultural records
• Data saturation
• Artful, progressive analysis
• Ethical principles of respect, non-coercion, non-manipulation, accountability, and sharing of emotionality

Constructivist lens

• Is applied in qualitative research
• Humans uniquely attribute meaning to their experiences.
• Experience evolves from life context.
• Life context is the matrix of human-health-environment
relationships emerging over the course of day-to-day living.