EXAM 1 Nursing Research Review

• Known as “Mother of Modern Nursing” + “Lady of the Lamp” 🕯

• First nurse researcher

• Studied effects of cleanliness, ventilation, pure water on patient health

• Analyzed soldier mortality in the Crimean War

• First woman elected to the Royal Statistical Society 📊

• Her research led to improvements in public sanitation, water testing, reducing mortality

Who is Florence Nightingale and why is she important to nursing research?

• Identifies + understands the nature of nursing phenomena

• Helps classify information

• Promotes understanding of real-world situations

• Example: Describing resilience of nurses caring for COVID patients

💡 Mnemonic:
DESCRIBE = “DETAILS ONLY” — descriptive research gives details, not reasons ✨

What is the purpose of descriptive research?

• Focuses on numbers, measurements, statistics

• Objective, structured, controlled

• Examples: surveys, experiments, correlational studies

• Answers: How much? How many? What is the relationship?

📊 Mnemonic:
QUAN = “CUANTO?” (Spanish for “how much”) ➜ Numbers only, bestie

What is quantitative research?

• Explains why events occur

• Clarifies relationships between phenomena

• Example: Examining relationships among environment, socioeconomic status, and health

💕 Mnemonic:
EXPLAIN = “X = WHY?”
If you see an X (relationship), explanatory research wants to know why it exists 💫

What is the purpose of explanatory research?

• Estimates probability of specific outcomes

• Identifies risks + helps with prevention

• Essential for EBP

• Examples:

  • Predicting disease risk

  • Predicting student success with new teaching methods

What is the purpose of predictive research?

• Tests whether interventions produce desired results

• Helps nurses manipulate situations for better outcomes

• Creates EBP guidelines

• Evaluates whether EBP guidelines actually work in the real world 💉📊

💗 Mnemonic:
CONTROL = “CAN CHANGE IT”
If the researcher can change something → it’s control research

What is the purpose of control research?

1. Descriptive — describes what exists 📝

2. Correlational — looks for relationships 🔗

3. Quasi-experimental — tests interventions without randomization

4. Experimental — tests interventions with randomization (gold standard ⭐)

What are the four main quantitative research types?

• Quasi-experimental:

  • NO randomization

  • Researcher assigns groups

  • May influence behavior → affects results

• Experimental:

  • Uses randomized control groups

  • More reliable + strongest evidence

What’s the difference between quasi-experimental and experimental research?

• Focuses on lived experiences, subjective meaning & objective (nonverbal)

• Open-ended questions, interviews

• Looks at feelings, voice tone, descriptions

• Answers: What is it like? How do you experience this?

QUAL “cual fue to experiencia?”

What is qualitative research?

1. phenomenology

2. grounded theory

3. ethnography

4. exploratory descriptive

What are the 4 main types of qualitative research?

• “What is your lived experience?”

• Holistic, inductive

• Example: Experience of adopting a child

• 🎀 Mnemonic: Phenomenology = “Phone me, tell me your story”

explain Phenomenology

• Develops a theory from data

• Inductive, builds concepts from participant input

• Famous researchers: Glaser & Strauss

• 📚 Mnemonic: Grounded = “growing a theory from the ground up”

explain grounded theory

• Study of cultures

• Researcher immerses themselves in the culture

• Example: Migrants adjusting to U.S. culture

• 🌎 Mnemonic: Ethno = ethnicity/culture

explain ethnography

• used to address issue or problem when a topic needs understanding or solutions

• combines multiple qualitative techniques

explain exploratory descriptive

addresses research question combining quantitative + qualitative in one study

• Example:

  • First get numbers (age, gender, income)

  • Then ask about lived experience

💡 Mnemonic:
MIXED = “Math + Meaning” ➜ numbers + feelings together 💖

What is mixed methods research?

bc they generate diff types of knowledge that are useful in nursing practice

• Quant gives facts + patterns

• Qual gives meaning + understanding

• Together they give a full picture for EBP

Why do qualitative + quantitative research complement each other?

🧠 WAYS NURSES ACQUIRE KNOWLEDGE

• “Truths” based on customs, habits

• Often linked to authority

• Can limit new knowledge

• Tradition = “we’ve always done it this way” 🙄💀

What is tradition as a source of knowledge?

• 🧠 WAYS NURSES ACQUIRE KNOWLEDGE

• Gained from someone viewed as an “expert” able to influence opinion & behavior 

• People follow because they’re trusted or powerful

• Knowledge acquired is illustrated when one person credits another as source of info

What is authority as a source of knowledge?

• 🧠 WAYS NURSES ACQUIRE KNOWLEDGE

• appropriating and using knowledge from other fields/disciplines to guide nursing

• practice Identify info from other disciplines that can be used within nursing focus on the whole person

What is borrowing knowledge?

• 🧠 WAYS NURSES ACQUIRE KNOWLEDGE

• Trying things without knowing the outcome

• Not formally documented of what actions worked & which didn’t

• Not ideal for EBP because nurse can gain knowledge from experience but CANNOT share

what is trial and error?

• 🧠 WAYS NURSES ACQUIRE KNOWLEDGE

• gaining knowledge by being involved in events, situations & circumstances

• Builds skill + intuition

what is personal experience?

• 🧠 WAYS NURSES ACQUIRE KNOWLEDGE

• “Gut feeling”

• Deeply internalized knowledge

• Gets stronger with experience

• EX: nurse sixth sense

what is intuition?

• Skillful, holistic care

• Using experience + research + ethical standards. (develop relationships w recipients of their interventions & select interventions consistent w available research evidence and ethical standards)

🌸 Mnemonic:
Pro practice = “the nurse version of adulting”

What is professional practice knowledge?

1. novice

2. advanced beginner

3. competent

4. proficient

5. expert 

what are the 5 levels of Benner’s Novice-to-Expert Model?

novice

• No experience

• Follows rules, relies on authority

• ✨ Mnemonic: New baby nurse

advanced beginner

• has limited experience but can recognize & intervene in recurrent situations

competent

• 2–3 years experience

• Organized, deliberate

• Plans care

• ✨ Mnemonic: “I got this… mostly”

proficient

incorporate interventions from experience, evidence based guidelines & standards of care ✨ Mnemonic: “I can see the bigger picture”

expert

• extensive experience, can supplement facts in situation w intuition

• Their clinical experience inc ability to incorporate EBP w accuracy & speed

• can skillfully seamlessly integrate person experience and research evidence in their responses to pt changing circumstances

✨ Mnemonic: “This is second nature”

• Learning by observing, imitating, and interacting with an expert nurse

• Helps novice nurses learn behaviors, skills, communication

• Often occurs through mentorship
  🌸 Mnemonic: “Role Modeling = Monkey see, monkey DO (but make it evidence-based)”

What is role modeling in nursing knowledge development?

• Processing + organizing ideas to reach a logical conclusion

• Foundation for clinical decision-making

What is reasoning in nursing research?

• Moves from specific → general

• Looks at specific instances and creates a broader conclusion

• Used in qualitative research + synthesizing findings
  💡 Mnemonic: “Inductive = INto a bigger idea”

What is inductive reasoning?

• Moves from general → specific

• Takes a general theory or premise and applies it to cases
  💡 Mnemonic: “DEductive = Down to details”

What is deductive reasoning?

• Structured thinking process

• Uses clear rules of logic to form conclusions

What is logical reasoning?

types of needed evidence

• Identifies & understands the nature of nursing phenomena

• Describes the topic, content, or main idea

• Promotes understanding of a situation

What is descriptive evidence?

• types of needed evidence

• Clarifies relationships among phenomena

• Explains WHY events occur

• Used to analyze factors influencing outcomes
  🌼 Example topics:

• Factors related to caregiving for older adults

• Student hours worked vs academic performance

• “Explanation = exploring WHY 💡”

What is explanation evidence?

• Estimates probability of outcomes

• Predicts risks, behaviors, or results

• Prediction DOES NOT control the outcome
  Example uses: Predict student outcomes, Predict disease risk

types of needed evidence

What is prediction evidence?

• Uses interventions to produce desired results (researchers manipulate study)

• Builds EBP guidelines

• Determines effectiveness of guidelines
  Examples:

• Testing interventions

• Synthesizing research to create protocols

• Checking if guidelines work in practice

what is control evidence?

• Helps researchers explain situations

• Helps identify interacting factors

• Supports better clinical decisions

Why is studying relationships among characteristics important?

Prediction

• Estimates likelihood

• No manipulation

Control

• Researchers manipulate variables

• Creates desired outcomes

What’s the difference between prediction and control?

• Quantitative (#-based CUANTO)

• Qualitative (lived experiences CUAL?)

• Mixed methods (both mix n’match)

What are the main research type categories?

• A comprehensive summary of multiple research articles

• Uses structured methods

• Helps identify the best evidence, Involves identifying, locating, appraising, synthesizing quality research evidence for experts to promote EBP

• Reduces bias

• Often uses the PRISMA diagram (flowchart showing study selection)

What is a systematic review?

• A quantitative summary of multiple studies

• Uses statistics to pool results

• Produces a single combined effect

What is a meta-analysis?

• Overall strength of an intervention

• Best practices

• Consistency across studies

• Whether an effect is clinically meaningful

What does a meta-analysis help determine?

• Combines qualitative studies

• Integrates themes, meanings, experiences

• Produces a deeper understanding of human experiences

what is a meta-synthesis?

• Meaning

• Experience

• Thematic interpretation

What does a meta-synthesis emphasize?

• A ranking system showing the strength & reliability of research

• Higher level = stronger, more trustworthy evidence

What is the level of evidence?

Randomized controlled trials (RCTs)
✨ Mnemonic: “RCT = Really Controlled & Trusted”

what is level II evidence?

• Respect for Persons

  • Autonomy, voluntary participation

• Beneficence

  • Do good, protect from harm

• Justice

  • Fair selection, equal treatment

What are the basic ethical principles in research?

• Fabrication

• Falsification

• Plagiarism

• Mismanagement of data
  💀 Mnemonic: “FFP = Fake, False, Plagiarized”

What is research misconduct?

• Right to Self-Determination

• Right to Privacy

• Right to Anonymity

• Right to Confidentiality

• Right to Fair Treatment

• Right to Protection from Discomfort & Harm

What are the fundamental human rights in research?

• Freedom to choose whether to participate

• Can withdraw at ANY time

• NO coercion, threats, or pressure

“Your choice = your voice 💋”

What is the right to self-determination?

• Exempt Review

• Expedited Review

• Full (Complete) Review

What are the 3 IRB review levels?

• Lowest risk

• Often anonymous surveys, educational research, public data

• Still requires IRB approval (contrary to popular belief)

What is an Exempt Review?

• Minimal risk, only the chairperson or one more IRB

• Collection of hair, saliva

• Noninvasive specimens

• Studies using existing data

What is an Expedited Review?

• More than minimal risk. Allows researchers to describe their study, including how they can minimize risks of study and ensure fair selection of participants Major factor determining if IRB can approve study is if risks to participants are reasonable in reality to anticipated benefits (benefit/risk ratio)

• Involves Vulnerable populations (pregnant women, children, prisoners, mentally disabled, students if coerced)

• Studies using experimental drugs or devices

= Full squad needed

What is a Full Review?

• Conducted during WWII on prisoners

• No consent

• Extreme torture: freezing, high altitude, infections

• Participants were deliberately harmed or killed
  💀 Mnemonic: “Nazi = No consent + Nightmare experiments”

What happened in the Nazi Medical Experiments?

• Black men with syphilis weren’t told their diagnosis

• Treatment (penicillin) was withheld

• Told they were being treated for “bad blood”

• Continued for 40 YEARS

• study was found to be ethically unjustified 

• Bc of experiment, US passed national research act to regulate biomedical and behavioral research, same community who created this act was also responsible for writing Belmont report

What happened in the Tuskegee Syphilis Study (1932–1972)?

• Institution for mentally disabled children

• Children were intentionally infected with hepatitis

• Parents coerced: admission to the school required participating

• Considered unethical research by Beecher

What happened in the Willowbrook Study?

• Elderly, chronically ill patients

• Injected with live cancer cells

• No consent or explanation

• Violated rights: self-determination & protection from harm

What happened in the Jewish Chronic Disease Hospital Study?

True

International standards, US standards, laws were developed due to unethical studies. The Nuremberg code, Declaration of Helsinki, Belmont report; were all responses to a perceived lack of ethical behavior and established to guide experimentation with humans as subjects. Codes are not legally binding but considered guidance for good practice. T/F?

• Health Insurance Portability and Accountability Act

• Law protecting how health info is stored, shared, accessed

• Protect the privacy, period!

What is HIPAA?

• ANY identifiable health info, including:

  • Name

  • Address

  • Birthday

  • SSN

  • Medical record numbers

  • Photos

  • Lab results

  • Insurance info

• Covers oral, written, and electronic info

What is PHI (Protected Health Information)?

• Accessing charts without reason

• Sharing patient details

• Not securing devices

• Leaving screens visible

What is a HIPAA violation?

• Respect for Persons — autonomy, informed voluntary consent

• Beneficence — do good, minimize harm, protect well-being

• Justice — fair treatment/selection, fair distribution of risk & benefits, no exploitation

What are the 3 Belmont Principles?

• Voluntary agreement to participate after receiving FULL information

• MUST include risks, benefits, purpose, procedures

What is informed consent?

• Disclosure — full info shared

• Comprehension — participant understands

• Competence — able to make decision

• Voluntariness — free from coercion

What are the four essential elements of informed consent?

disclosure

element of informed consent

• must share information about study to participant in a way that can be understood

comprehend

• element of informed consent

• participants understand the information. Researchers must discuss benefits and risks of studio in detail

competence

• element of informed consent

• MUST BE A&O x4 if not they can’t consent. Those w/ diminished autonomy bc of legal or mental incompetence or confinement to institution are not legally competent to consent

voluntary agreement

• element of informed consent

• prospective participant has to take part in study of his/her own volition without coercion or any influence

True

Note! Researcher/nurse obtaining consent is guided by principle of beneficence and committed to protection of right to self-determination. Must be knowledgeable of culture or participants - Ex. some cultures may expect participant to consult w family b4 consenting, or a woman is expected to ask her husband for permission. T/F?

• Purpose of study

• Procedures

• Risks

• Benefits

• Voluntary nature

• Right to withdraw anytime

• Contact information

What MUST be included in a consent form?

• Agreement from individuals who cannot legally consent

  • Children

  • Cognitively impaired persons

• Combined with guardian consent

what is assent?

• Emphasized voluntary consent and contains guidelines related to protecting subjects from harm & balancing benefits and risks of study

• was drafted as a set of standards for judging physicians and scientists who had conducted biomedical experiments on concentration camp prisoners

• Crimes against humanity in WWII brought abt this code; advocates for informed consent and voluntary participation involving human subjects, beneficial nature of research, avoidance HARM, REQUIRED scientific justification

What is the Nuremberg Code (1949)?

• the person: understands study, legally consents, no coercion, can voluntarily withdraw anytime

• study must be beneficial & credible, benefits SHOUOLD exceed harm

• researcher should be qualified & ethical must stop if harm is likely

what are the critical components of an ethical study regarding the Nuremberg code of ethics?

• Clarified diff btw therapeutic research (benefit from research tx) and nontherapeutic research (only for knowledge)

• Developed by world medical association in 1964 Cornerstone of ethical behavior for all experimentation involving humans.

• Addresses clinical research

What is the Declaration of Helsinki?

• highlights need to; protect human subjects and participants in clinical trials. Identifies ethical principles to guide participants, informing them of risks and benefits to study & documenting their consent. ALSO Provides strong foundation for conducting ethical research (foundation of common rule)

• Written by national commission for protection of human subjects of biomedical & behavioral research (1978)

• created after Tuskegee & includes the 3 principles (Respect for Persons, Beneficence & Justice)

What is the Belmont Report (1979)?

respect for persons

• Individuals are autonomous

• Extra protection for diminished autonomy

• Must have informed consent

• from Belmont Report

beneficence

from Belmont Report

• Do good

• Minimize harm

• Maximize benefits

justice

• Fair distribution of risks + benefits

• No targeting disadvantaged groups

• Belmont Principle

• U.S. federal policy for protection of human subjects

• Based on the Belmont Report

• Applies to ALL federally funded research

• Defines IRB membership, review, informed consent

what is the common Rule?

• IRB composition & duties

• Additional protections for vulnerable populations

• Informed consent elements

• Documentation rules

• Continuing review requirements

• it protects the rights, safety, welfare of subjects involved in clinical investigations regulated by the FDA

What does the Common Rule regulate?

• Informed consent

• IRB review

• Safety monitoring

• Reporting adverse events

it regulates drug trials, device trials, biologic product trials, and applies to industry-sponsored research

What do FDA regs require?

• Children

• Pregnant women

• Fetuses

• Prisoners

• Mentally/cognitively impaired

• Economically disadvantaged

• Educationally disadvantaged

Who are considered vulnerable populations?

• Increased risk of coercion

• Limited autonomy

• Possible power imbalance

• Ethical need to protect rights & safety

Why are vulnerable populations given extra protections?

• When a person cannot fully make independent decisions
  may be temp. or permanent

• Require additional protection of right to self-determination bc of their decreased ability to give informed consent

• Are vulnerable to coercion and deception

• EX: Children have diminished autonomy (emotionally immature & cognitively)

What is diminished autonomy?

• Intentionally withholding or distorting information

• Use of deception must not cause long lasting harm

• Common rule says; deception can be used ethically in study when researcher informs potential participants, they will be unaware or deliberately misguided abt true purpose of study & agree to participate

what is deception in research?

• Gathering data without the participant’s awareness

• Example: observing behavior secretly

• Allowed ONLY when:

  • In public settings

  • No identifying info

  • Minimal risk

  • NOT LIKE in the Jewish Chronic Disease Study

  • COVERT = “undercover research”

What is covert data collection?

• Excessive reward or pressure

• Too good to refuse

• Example: paying $2,000 to homeless people for a risky study

🌸 Mnemonic: It feels like pressure or bribery

What is undue influence?

• A set of concepts + statements that explain or predict a phenomenon

• Shows how things are connected

• Provides a framework for research and practice

what is theory?

• Not directly measurable

• Intangible ideas
  Examples: Hope, Stress, Coping, Anxiety

• airy-fairy feelings ☁💭

What is an abstract concept?

• Directly measurable bcuz You can observe it or quantify it

• Examples: HR, SpO2, BP

What is a concrete concept?

conceptual definition

• The theoretical meaning of a concept

• Tells you what the concept represents

• It is researcher’s definition

• things you can or cannot control already anticipating it will happen (you know it CAN happen)

Ex. whether or not pt takes medication

What is an extraneous variable?

• A variable that the researcher cannot control

• Interferes with the relationship

• Makes results less valid

What is a confounding variable?

causal relationship

Independent variable causes dependent variable to change, requires manipulation or intervention CAUSE => Effect

associative relationship

• Variables occur together

• Changes in one → changes in the other

• But NO proof of cause

simple relationship

Involves only ONE independent and ONE dependent variable (2)
Example:
Study: Stress → Blood pressure

✨ Mnemonic: “Simple = just the two of us 🎶”

complex relationship

Has 2+ independent OR 2+ dependent variables (2+)
Example:
Exercise + Diet → Weight + Cholesterol