Applied Healthcare Research

What is Theory?

They are an organization of ideas indented to explain something and aid in guiding how people practice.

Research is important to healthcare because it provides.

• Knowledge

• Treatment

• Advancements

• Improved safety and efficacy

• Quality

• Improved public health

• Understand patient perspectives

• New collaborative knowledge

• Funding

What is Maslow’s Hierarchy of Needs?

Says that human needs are organized in a pyramid from most basic to most advanced. Lower-level needs to be met before a person is motivated to pursue higher-level needs. They are Psychologal Needs, Saftey and Security, Love and Belonging, Self-Esteem, Self-Actualization

Progressivley Lowered Threshold Model (Buckwalter, 1987)

As dimentia progresses, the brain;s ability to handle stress decreases and smaller triggers cause bigger reactions. The caregiver must lower enviornmental stressors to match the patient’s shrinking tolerance.

Theory of Personhood (Kitwood 1997)

Kitwood defined personhood as a status that others giv eyou through relationship dynamics. His point was that dimentia doesn’t erase someone’s personhood, but how caregivers treat them care either protect it or damage it.

Declining Respect for the Person leads to diminishing personhood status and can lead to…

healthcare provider impacts and patient impacts

What is Buron’s level of Personhood (2008)

A 3 level pyramid used to guide dimentia care.

How does Burons Level of Personhood (2008) work?

As dementia progresses, the person loses access to the higher levels first (sociologic → individual) and relies more on biologic personhood — but nursing care should work in the opposite direction, still working to support and promote the higher levels (relationships, individuality) for as long as possible, not just treat the body. The three are Sociologic Personhood (base), Individual Personhood (middle), and Biologic Personhood (top).

Evidence Based Practice - How do you know what to do?

It requires best available research evidence, clinical expertise, patient values and prefrences, and clinical context and available resources. Research evidence INFORMS the decision it does NOT make the decision alone.

Where do we find evidence?

You can look through systematic reviews, research databases, clinical guidlines, and clinical trial registries. A general web search can find informaiton, but a research database helps you systematically find evidence.

What is human research?

A systematic process of asking and answering questions to generate new knowledge. There are 3 approaches to improve healthcare through research (Discover [what should we know], Apply [ what should we do for this patient or population], and Improve[ how can we improve the care we’re giving']).

What is Quantitative Research?

This is numerical data that describes variables, relationships, differences, or effects. It is structured measurement and statistical analysis.

What is Qualitative Research?

These are experiences, meanings, perceptions, and processes. Things such as interviews, observations, and narratives, and often conducted in natural settings.

What is a mixed method research?

It integrated quantitative and qualitative approaches.

What are the two approaches to inquiry.

Inductive and Deductive

What is the Inductive appraoch to inquiry?

This is the “bottom up”. You start with an observation or data and identify patters or themes. You then develop a broader explaination or theory. This is often associated with QUALitative research.

What is the Deductive approach to inquiry?

You start with a theory or prior knowledge and develop a prediction or hypothesis. Then you collect data and determine whether evidence supports the prediction. This is common with QUANTitative research.

What are the 7 strength levels of evidence?

• 1.) Sysmatic Review/ Meta Analysis of RCT (strongest / combines many randomized trials)

• 2.) Individual RCT (one well designed RCT)

• 3.) Controlled trial without randomization (quasi-experimental/ tests cause and effect without random assignment)

• 4.) Cohort or case control study (observational, compares groups over time)

• 5.) Cross-sectional study (systematic review of descriptive/ qualitative studies)

• 6.) Case Report or Single Qualitaitve Study (one person studied intensivley)

• 7.) Expert opnion / expert consensus (weakest, based on professional judement, not data)

Where do research problems arise?

• Clinical practice and the healthcare environment

• Personal interest or professional experience

• Finding and recommendations from prior studies

• Literature reviews and identified gaps

• Curiosity; observations that lead to questions

What are the 9 Essentials of Research?

1. Identify a philosophical foundation 

2. Frame a research problem 

3. Determine supporting knowledge 

4. Develop a specific question/query 

5. Select a design strategy 

6. Set study boundaries 

7. Obtain information 

8. Analyze information & draw conclusions 

9. Share and use research knowledge 

What is Axiology?

What do you value and what is considered “good”

What is ontology?

What is real and what does “exitence” mean. Is pain shaped by physical only or also culture and beliefs?

What is Epistemology?

How do we know what we know? Where does it come from? Is knowledge only real if it is measured with numbers or can personal experience count as knowledge too?

What is Positivism/ Postpositivism?

belief that truth is found through objective observation and testing → leads to quantitative research (numbers, measurements, statistics)

What is Interpretivism/ Constructivism?

belief that truth/meaning is shaped by personal experience and context, not one fixed objective fact → leads to qualitative research (interviews, stories, themes)

Pragmatism

doesn't commit to one "truth" belief — instead just picks whatever method best answers the specific question, even mixing quantitative and qualitative approaches

What does a research problem do?

It defines what is wrong, missing, uncertain, or not understood.

3. Determine Supporting Knowledge (9 Essentials of Research)

This is about figuring out what's already known before you start your own study. You ask yourself: what's already known, how strong is the evidence, where do studies agree or disagree, what's still unknown, and whether there's a gap that justifies doing another study. You go from finding existing studies, checking whether you can trust the eidence, pulling it togehter to see bigger picture, and then spotting what is still missing to become the reason for your research.

4. Develop a PICOT Question (9 Essentials of Research)

• P - patient/ population

• I - intervention

• C - Comparison

• O - Outcome

• T - Time (when applicable)

5. Select a Design Study (9 Essentials of Research)

This is about choosing the overall plan for how you'll actually answer your research question. This decision depends on several things: what the question is asking, the purpose of the study, what kind of data you need, how much control or intervention is involved, whether it's feasible, and ethical considerations.

You can choose either quantitative, qualitative, or mixed methods.

6. Set Study Boundaries (9 Essentials of Research)

This is about clearly defining the scope of your study so it's specific and manageable. You need to identify the population (who you're studying), the setting (where the study takes place), the timeframe (when it happens and how long it lasts), and the variables or intervention (what exactly you're measuring or testing). On top of that, you set inclusion criteria — the specific characteristics a person must have to be allowed into the study — and exclusion criteria — characteristics that disqualify someone even if they'd otherwise fit, like having a conflicting health condition or being on a certain medication.

7. Obtain Information (9 Essentials of Research)

This is about actually collecting the data needed to answer your research question — and the type of data depends on whether you're doing quantitative or qualitative research. Quantitative data is numerical and measurable: things like physiologic measurements (vitals, lab values), survey or scale results, medical record data, counts/frequencies, and structured observations.

Qualitative data is more descriptive and experience-based: individual interviews, focus groups, open-ended responses, observations or field notes, and documents or other textual/visual material. The key principle tying it together is that whatever data you collect should directly answer the research question — you're not just gathering information for its own sake, it has to serve the purpose of the study.

8. Analyze Information and Draw Conclusions (9 Essentials of Research)

This is is where you actually make sense of the data you collected. Quantitative analysis involves describing the data, comparing groups, examining relationships between variables, and testing hypotheses — and importantly, this analysis plan is typically decided before you even collect the data, since you already know what statistical tests you'll run.

Qualitative analysis is different — it involves identifying patterns, themes, meanings, or processes within the data, and it often happens alongside data collection rather than strictly afterward, since new insights can shape what you look for next. It's also interpreted through the lens of whatever qualitative approach you chose (like grounded theory or phenomenology). The overarching rule for both types: the analysis method has to match the research question, the study design, and the type of data you collected — you can't just pick any analysis approach randomly.

9. Share and Use Research Knowledge (9 Essentials of Research)

This is is the final step, where researchers make sure their findings actually reach others instead of just sitting unused. This means disseminating results appropriately and transparently — and importantly, even null, nonsignificant, or unexpected findings are still valuable and worth reporting, since knowing what doesn't work (or what didn't show an effect) helps guide future research and prevents other researchers from wasting time repeating the same study. Reporting findings this way also reduces unnecessary duplication of effort and helps build a more accurate, complete evidence base overall. Common ways to share findings include journals, conferences, professional media, websites, and other appropriate outlets.

What are the 3 Belmont Principles

• Respect for Persons (participants choose freely and give real informed consent, with extra protection for those who can't fully decide for themselves.)

• Beneficence: minimize harm, maximize benefit, and make sure the risks are actually worth it.

• Justice: fairly choose who's involved so no single group carries all the risk while others get all the benefit.

What are the 3 Levels of IRB?

• Excempt: applies when a study meets a specific federally defined exemption category, usually involving lower-risk research activities — but "exempt" doesn't mean there's zero ethical oversight, it just means it qualifies for a lighter review process)

• Expedited: applies to research that involves no more than minimal risk, and instead of going through the full committee, it gets reviewed through a faster, streamlined procedure

• Full Board: review means the entire IRB committee convenes to review the study — this is generally required when the research involves more than minimal risk, or when specific regulations or institutional policy require the full review process regardless of risk level.

What are Institutional Review Boards (IRBs)

These are commites that oversee any human subject research that generally require insitutional review or determination before recruitment or data collection.

IRBs evaluate participant protections, risks, consent, recruitment, privary, confidentiality, and regulatory requirements.

Researchers must follow the approved protocol and obtain approval for changes when required  

What are the 3 Main ways to protect research participants?

Informed Consent: You make the participate known of all the foreseeable risks and discomforts and how they have the right to not participate or to withdraw. You can also offer alternatives when applicable.

Voluntary Participation: You must avoid coercion and make it known that participants can leave at any time without penalty.

Privacy & Confidentiality: You must protect the participants privacy and hide any identifiable information. Also explain how the data will be used, stored, and shared.

Privacy is about the _____. Confidentiality is abou the ______.

Person; Information

Difference between Confidentiality and Anonymity.

Confidential: This means that researchers DO know who participated, but they protect the identifying information from aunauthorized people.

Anonymous: This means the participants identity is either never known or cant be linked back to them via their responses or data.

Never promise more _____ than the study can actual provide.

confidentiality

Potential Benefits and Risks

This covers what participants might gain or lose by being in the study.

Benefits: direct benefit from the intervention itself, gaining personal insight or knowldege, or process experiences. Payment is compensation or insentive. It is NOT a benefit used to justify research risk.

Risks: physical harm or discomfort, psychological or emotional distress, socioal or economic or legal consequences, or loss of privacy and confidentiality

What was the Nuremberg Code (1947)

This was created after american judged tried Nazi doctor for their horrific human experiments in concentration camps. The principles was that consent must be voluntary and research must be scientifically justifed and expected to benefit society.

What was the Tuskegee Study?

This was an unethical research study where Black men with syphilis were promised free medical treatment — but not one of them actually received proper treatment for the disease. The real goal of the study was to observe how syphilis progressed in the body without treatment, so researchers deliberately withheld the cure (even after penicillin became available) while letting the men believe they were being cared for. This deception continued for 40 years before the study was finally exposed and shut down. Its legacy caused lasting distrust between Black communities and the medical system, and it became a major driving force behind modern research ethics protections, like informed consent requirements.

What was the National Research Act 1974

This was a law passed in response to research ethics scandals, especially the Tuskegee Syphilis Study. It didn't lay out the ethical principles itself — instead, its main job was to create a commission (the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research) made up of physicians, lawyers, scientists, and ethicists. Their task was to figure out proper ethical guidelines for research on human subjects.

The National Research Act was the law that created the commission, and the Belmont Report was the document that commission produced.

What was the Belmont Report (1978)?

This was the actual output of that commission's work — after several years of study (1974-1978), they published this report laying out the ethical principles researchers should follow: Respect for Persons, Beneficence, and Justice. It also translated those principles into practical protections like informed consent and risk-benefit assessments. The Belmont Report is the document people actually reference today when talking about research ethics — it's still the foundation of federal research regulations.

The National Research Act was the law that created the commission, and the Belmont Report was the document that commission produced.

What is Philosphy of Logical Positivism?

This underlies quantitative research and describes a linear, systematic process for how research is supposed to unfold: you start with a theory, use it to form a hypothesis (a specific, testable prediction), then move to testing that hypothesis through observation and measurement, and finally reach conclusions.

What is Epistemology?

Asks how do we know what we know?

What is Phenomenology?

Asks what is the lived experience

What is Interactionism?

Asks how is meaning created through interaction?

What are the 4 Quantitative Research Designs?

• Nonexperimental: designs simply observe variables as they naturally occur — there's no manipulation or intervention at all

• Pre-experimental:designs involve some kind of intervention, but with very limited controls — think of it as a quick, preliminary test to get an early sense of whether something might work, not a rigorous study.

• Quasi-experimental:designs involve an actual intervention, but without random assignment of participants to groups

• True experiment: designs are the gold standard: they involve manipulation of a variable (an intervention), random assignment of participants to groups, and a comparison group to measure against

What is Participatory Action Research in selected appraoched in qualitative research?

This is an approach where researchers and participants work together as collaborators, not just researcher-and-subject — the goal isn't just to study a problem, but to actually create change alongside the people affected by it.

What is Critical Theory in selected appraoched in qualitative research?

This is an approach focused on examining power, inequity, and social structures — it looks at how systems of power and social arrangements shape people's experiences, often with an eye toward exposing and challenging injustice.

What are the 4 Qualitative Research Designs?

• Phenomenology: studies lived experience — it's about understanding what it's actually like for someone to go through a particular experience, from their own perspective

• Ethnography: studies culture and group behavior — researchers immerse themselves in a group or community to understand their shared practices, beliefs, and way of life.

• Narrative Inquiry: focuses on stories and meaning — it looks at how people make sense of their lives through the stories they tell.

• Grounded Theory: is about developing a theory about a process — rather than testing an existing theory, researchers build a new theory from the data itself, often to explain how people go through a particular experience or process.

What are the 3 Mixed Method Research Designs?

• Convergent: collects quantitative and qualitative data around the same time, then combines the findings together to get a fuller, more complete picture.

• Explanatory: starts with quantitative data first, then follows up with qualitative data to explain those numerical findings in more depth — basically, "here's what happened (numbers), now let's understand why (interviews/stories)."

• Exploratory: flips that order — it starts with qualitative data first to explore a topic, then follows up with quantitative data to measure or test what was found — basically, "let's first understand the experience, then see if it holds up on a larger scale with numbers."

What is Theory?

It is an organized explanation of some phenomenon, built by connecting concepts together and describing how they relate to one another.

What are the 3 Structural Components that build into a theory?

• Concepts/Constructs: they key ideas or building blocks

• Relationships: how the concepts connect to or influence one another

• Propositions:actual statements that spell out those relationships

What is the relationship between research and theory?

Theory helps GUIDE research questions and study design. Research TESTS and CLARIFIES theoretical relationships.

What are the 3 levels of Generality for Theories?

• Grand Theory: are broad, abstract, and overarching — they try to explain large, sweeping aspects of a discipline (like all of nursing or all of human behavior) but aren't very specific or directly testable. Examples (Roy Adaptation Model)

• Middle Range: are more focused and testable — they zoom in on a specific phenomenon or population (like Buckwalter's Progressively Lowered Stress Threshold Model for dementia patients) and can actually be applied and studied in practice.(Example Theory of Uncertainty in Illness)

• Practice / Situation Specific: are the most narrow — highly focused on a specific clinical situation or problem, guiding very concrete, immediate action. (Personhood Model for Dimentia Care)

What are the 5 ways theories appear?

• Clinical Practice: recurring observations and problems that clinicians notice repeatedly in real-world care can spark the development of a theory to explain them.

• Research: patterns and relationships discovered through studies can be organized into theoretical explanations.

• Existing Theories: being adapted, refined, or built upon rather than created from scratch.

• Other Diciplines: ideas get borrowed and shared across fields (like psychology influencing nursing theory). And theories aren't static

• New Evidence: continues to shape them over time, either supporting the theory as-is, challenging parts of it, or driving actual changes to it.

What does appraising a theoretical framework do?

Evaluates whether a theory is actually solid and worth using.

What are the 5 criteria for Appraising Theoretical Frameworks?

• Clarity: asks: is the framework clearly and understandably defined, or is it vague and confusing?

• Relevance: asks: does it actually fit the specific problem and population being studied, or is it a poor match?

• Consistency: asks: do the study's methods actually align with and follow the framework being used, or is there a mismatch?

• Evidence: asks: is the framework supported by solid evidence, and is it genuinely useful in practice?

• Contribution: asks: does using this framework actually advance understanding of the topic, or does it add nothing new?