Chapter 2 Notes (Nursing Research)
2.1 Research: What Is It?
Nursing integrates art and science. The art of nursing = caring, compassion, communication; the science of nursing = care grounded in rigorous scientific inquiry. The word science appears in a Bachelor of Science in Nursing; nurses generate new knowledge through research and apply it to practice.
Definitions:
science: \text{Knowledge derived from rigorous observation and experimentation to systematically study the physical world to test/develop theories}
research: \text{Systematic study that leads to new knowledge and/or solutions to problems or questions}
Replication and reliability: replication studies are repeated studies to obtain similar results; essential for confidence in findings.
Nursing research focuses on: persons, health, nursing, environment; studies patient outcomes, nurse attitudes, effectiveness of policies, and teaching strategies in nursing education.
Research contributes to theory development and refinement; foundational for evidence-based practice (EBP).
Distinguishing research from EBP:
Research = generate new knowledge or validate existing knowledge.
EBP = apply new knowledge to clinical practice to improve outcomes.
EBP questions arise in clinical care; research questions arise from gaps in literature; both involve data analysis but with different endpoints.
Types of Research (not mutually exclusive): descriptive, explanatory, predictive, causal; basic or applied; quantitative or qualitative.
Box 2-1: Steps of the Research Process (8 steps):
Identify the research question.
Conduct a review of the literature.
Identify a theoretical framework.
Select a research design.
Implement the study.
Analyze data.
Draw conclusions.
Disseminate findings.
Deliberate/systematic approach is essential; many discoveries fail when steps are skipped. Replication helps guard against error.
Four aims and example questions drive how studies are conducted: describe, explain, predict, and causality. Example: pain during chest tube removal (CTR) to illustrate these aims.
Basic vs applied research:
basic (bench) research: gain knowledge for knowledge’s sake; may take years to become practically applicable.
applied research: seeks knowledge to solve a clinical problem; findings have immediate practical application.
Quantitative vs qualitative research:
Quantitative: numbers, precise measurements, often tests hypotheses; designs include randomized controlled trials (RCTs), quasi-experimental, correlational, descriptive surveys; typically larger samples.
Qualitative: words, descriptions of meanings, multiple realities; methods include phenomenology, grounded theory, ethnography, historical; typically smaller samples.
Mixed methods: combine quantitative and qualitative data collection/evaluation in the same study.
Empirical evidence: verifiable by experience/observation/experimentation.
Critical thinking prompts (examples): root words: quantitative (quantity) vs qualitative (quality); deductive vs inductive reasoning.
Key terms to remember: mixed methods, empirical evidence, descriptive/explanatory/predictive aims, basic/applied, quantitative/qualitative.
2.1 Types of Research (deeper): Descriptive, Explanatory, Predictive, Causality; Basic vs Applied; Quantitative vs Qualitative
Descriptive: answers “What is it?”; provides accurate descriptions, often observational in natural settings.
Explanatory: answers “What is the relationship among the variables?”; identifies relationships among phenomena.
Predictive: answers “Is there a difference between groups?”; forecasts relationships or differences between groups; caution: prediction does not imply causation.
Causality: asks “Does A cause B?”; often uses random assignment to study interventions.
Basic vs Applied (revisited): basic focuses on knowledge for knowledge’s sake; applied aims to solve clinical problems with immediate practice implications.
Quantitative vs Qualitative (revisited): quantitative uses numbers; qualitative uses words; many studies use mixed methods.
Example in practice: Table 2-1 illustrates building knowledge about CTR pain across aims (Describe, Explain, Predict, Causal).
Box 2-1: Steps of the Research Process (summary)
1. Identify the research question.
2. Review the literature.
3. Identify a theoretical framework.
4. Select a research design.
5. Implement the study.
6. Analyze data.
7. Draw conclusions.
8. Disseminate findings.
Quantitative vs Qualitative: reasoning and designs (Table 2-2; Fig. 2-1)
Philosophical perspectives:
Quantitative: one reality, objectively viewed by the researcher.
Qualitative: multiple realities, subjective, context-dependent.
Type of reasoning:
Quantitative: primarily deductive (theory -> hunch -> data).
Qualitative: primarily inductive (data -> theory/generalization).
Role of researcher:
Quantitative: controlled, structured.
Qualitative: participative, ongoing engagement.
Strategies:
Quantitative: control/manipulation of variables; structured settings.
Qualitative: naturalistic; allow situations to unfold.
Data analysis:
Quantitative: analysis of numbers with statistical tests.
Qualitative: analysis of words to identify themes.
Sample sizes:
Quantitative: typically larger samples.
Qualitative: smaller numbers of participants.
Designs (examples):
Quantitative: randomized controlled trial (RCT), quasi-experimental, correlational, descriptive survey.
Qualitative: phenomenological, ethnographical, grounded theory, historical, etc.
Mixed methods: combine both approaches.
Note: A given study may be descriptive, applied, qualitative, etc., or combine more than one orientation.
2.1 Key Terms (selected)
abstract: The first section of a research article providing an overview of the study.
introduction: States the problem and purpose.
review of literature: Unbiased, comprehensive synthesis of relevant published studies.
theoretical framework: Links theory concepts to study variables; may be presented as a model/diagram.
methods section: Describes study design, sample, data collection; includes rationale for design choices.
results: Describes data analysis and sample characteristics; includes significant findings (quantitative) or themes (qualitative).
discussion: Interprets results; links to literature and theory; discusses limitations and implications.
references: Full citations for retrieved articles; enables reader to locate original sources.
basic distinction: Research vs EBP (educational/best-practice emphasis): research generates knowledge; EBP applies it to care.
Practical implications and examples
EBP depends on high-quality published research; nurses must read, evaluate, and apply findings in care.
Studies in CTR pain illustrate how descriptive, explanatory, predictive, and causal aims can be pursued within a single research program.
Understanding types of research helps nurses select appropriate designs to answer clinical questions and translate findings into practice.
2.2 How Has Nursing Evolved as a Science?
Central idea: Nursing is a cycle of scientific development—grand theories lead to research, dissemination, application to practice, and refinement of theory.
Cycle components (Figure 2-2): Theory → Research → Dissemination → Application → Refinement; social/political factors influence priorities and dissemination.
Key historical arc: nursing evolved from an art to a science, with the science embedded in evidence and policy to improve patient outcomes.
Box 2-2: Nursing Research Priorities (a sample list emerging in the 21st century):
Bioterrorism, Chronic illness, Cultural/ethnic considerations, End-of-life/palliative care, Genetics, Gerontology, Global warming, Healthcare delivery systems, Health promotion, Immigration, LGBTQ health issues, Management of pandemics/natural disasters, Mental health, Nursing informatics, Opioid epidemic, Patient outcomes/quality of care, Racial health disparities, Safe administration of medications, Symptom management, etc.
Doctor of Nursing Practice (DNP) as the recommended terminal practice degree for advancing leadership in EBP.
Globalization and technology drive nursing research diffusion and collaboration (e.g., expanded Sigma Theta Tau, international journals like IJR).
National databases and outcomes measures (e.g., NDNQI) support benchmarking and quality improvement.
Genetics and the Human Genome Project (completed 2003) integrated into nursing education and research priorities.
Nursing research agendas began focusing on access to care, diversity, patient outcomes, and health policy impacts (Healthy People initiatives).
Shifts in the 1960s–1980s emphasized clinical problems, outcomes, and grand theories (King, Henderson, Orem, Rogers, Roy); later, 1980s–1990s emphasized research utilization and later EBP.
Ethics evolution: Belmont Report (1979) identified core ethical principles; IRBs formalized protections; ethics education and policy matured (Nuremberg Code, Declaration of Helsinki).
Era milestones (highlights by era):
Before 1900: Florence Nightingale as a foundational nurse researcher; environment and infection control; Notes on Nursing (1859/1946).
1900–1929: Education-focused nursing research; Goldmark Report (1923) highlighted education inadequacies; Yale/Nursing program development; first nursing journal (1900); ANA established (1912).
1930–1949: Great Depression and WWII slowed diffusion to practice; hospital-based diploma programs; Brown Report (1948) urged university-based education; more descriptive morbidity/mortality focus.
1950–1969: University-based education expands; funding for nursing research increases; growth of nursing research centers; shift to clinical problems and outcomes; early grand theories (Peplau, Henderson, King, Levine, Orem, Rogers, Roy).
1970–1989: Increased focus on application of research (research utilization) and later evidence-based practice; more doctoral-prepared nurses; ethical oversight grows; IRBs emerge; CINL expands to CINIAL Health Literature; ethics and patient protection emphasis.
1990–1999: Interdisciplinary research grows; NCNR elevated to NIH institute status; electronic databases (CINAHL online from 1995); Iowa and Stetler models for research utilization; EBP emerges from research utilization.
2000–2009: Globalization accelerates knowledge sharing; emphasis on patient safety, NDNQI benchmarking; Human Genome Project influences genetics in nursing; rise of Doctor of Nursing Practice degree; EMR adoption begins; Magnet Recognition linked to evidence-based practice.
2010–2019: EMR widespread; concerns about data security; telehealth expands; focus on patient outcomes, quality improvement, and linkages between EBP and EMRs; national data driving reimbursement decisions; Nurse workforce concerns (shortages, staffing ratios).
2020–present: SARS-CoV-2 pandemic accelerates telehealth, infection prevention, and innovative care delivery; global collaboration; ongoing ethical concerns with digital data; renewed focus on workforce recruitment/retention and disparities; telehealth outcomes and access continue to be studied.
2.2 What Lies Ahead?
Continued drivers: social/political factors, patient safety/outcomes, technology, and globalization.
Priorities likely to persist, with emphasis on replication studies to confirm prior findings and on generating more middle-range and practice-oriented theories.
EBP will remain central to translating research into care, with educators tasked to train nurses in research literacy, evidence retrieval, critical appraisal, and implementation.
Interdisciplinary and international collaboration remains important (e.g., Joanna Briggs Institute).
Key topics for future nursing research (from Box 2-2): Bioterrorism; Chronic illness; Cultural and ethnic considerations; End-of-life/palliative care; Genetics; Gerontology; Global warming; Healthcare delivery systems; Health promotion; Immigration; LGBTQ health; Management of pandemics/natural disasters; Mental health; Nursing informatics; Opioid epidemic; Patient outcomes/quality of care; Racial health disparities; Safe administration of medications; Symptom management.
Practice implications: DNP as essential for leadership in EBP; magnet status linked to evidence-based practice; EMR integration with evidence-based guidelines.
2.3 What Lies Ahead? (Continued)
The Doctor of Nursing Practice (DNP) is the recommended educational requirement for advanced practice nursing; clinically prepared nurses can lead EBP.
Global collaborations (e.g., Joanna Briggs Institute) enable shared best practices across borders.
Emphasis on cultural, social, ethical, and technology-enabled health care delivery in future research agendas.
Test Your Knowledge 2-3 and 2-5 tasks reinforce synthesis of concepts and future-oriented thinking.
2.4 Keeping It Ethical
Objectives:
Identify five unethical studies and discuss international/national initiatives promoting ethical conduct.
Describe the rights of participants and the Belmont/Declaration-based principles guiding ethical research.
Explain the roles of IRBs and the composition/criteria for IRB membership.
Distinguish between vulnerable populations and non-vulnerable groups; differentiate full vs expedited vs exempt reviews.
Provide examples of research exempt from consent under certain conditions.
Differentiate between the research imperative (advancing knowledge) and the therapeutic imperative (patient care).
Nazi experiments (World War II) illustrate extreme violations; led to the Nuremberg Code establishing fundamental ethical rules.
Other historical unethical studies:
Tuskegee syphilis study (1932–1972): lack of informed consent; denial of penicillin when effective; increased harm.
Jewish Chronic Disease Hospital study (1960s): injection of cancer cells into debilitated patients without proper consent/awareness.
Willowbrook hepatitis studies (1960s): coercive participation; parents coerced for admission.
Red wine studies (2000s): data fabrication and falsification by a researcher; public distrust.
International and national guidelines:
Nuremberg Code: 10 key provisions emphasizing voluntary informed consent, minimize harm, scientific validity, and qualified researchers. See Box 2-3 for the complete list.
Declaration of Helsinki (1964, last amended 2013): physician guidelines for biomedical research; emphasizes informed consent and participant welfare.
Belmont Report (1979): three core principles foundational to ethical human participant research: Respect for Persons, Beneficence, Justice.
U.S. federal regulations (45 C.F.R. 46, last updated 2017): establish IRB requirements, protections for human subjects, and review processes.
ANA and Nursing organizations: ethical guidelines for nurses in research, including protecting rights (e.g., right to freedom from harm, privacy/dignity, anonymity).
Belmont Report principles explained:
Respect for Persons: autonomous individuals should be treated as such; those with diminished autonomy require protection; examples of past violations include Nazi experiments, Jewish Chronic Disease Hospital study, Willowbrook.
Beneficence: do no harm; maximize benefits, minimize risks; justify risks by anticipated benefits; Willowbrook and Tuskegee illustrate failures.
Justice: fair distribution of burdens and benefits; avoid exploiting vulnerable groups; ensure equitable selection of participants.
Institutional Review Boards (IRBs):
Primary mechanism for participant protection at organizational level; federal guidelines govern IRB composition and functioning.
IRB membership requirements (min 5 members; diverse expertise; at least one scientist, at least one non-scientist, and at least one unaffiliated member; community representation; avoid conflicts of interest).
Review types: full review (higher risk or vulnerable populations) vs expedited review (minimal risk).
Box 2-4: Key Code of Federal Regulations principles for IRB review (risk minimization, risk-benefit balance, equitable participant selection, informed consent requirements, privacy, monitoring, safeguards for vulnerable populations).
Box 2-5: Examples of exempt research (low-risk activities like educational tests with anonymity, research on existing datasets, certain public health program evaluations); exemptions do not automatically apply and IRB must review.
Exemptions and consent in practice:
Even exempt research requires IRB review; exemptions do not apply to prisoners, pregnant individuals, fetuses, newborns, or many children.
Therapeutic vs research imperatives in nursing:
In practice, patient rights and well-being trump research aims if conflicts arise; ethical decision-making requires balancing care with knowledge advancement.
2.4 Keeping It Ethical (Key Points and Practice Questions)
Examples of ethical questions and scenarios (critical thinking prompts) are provided throughout to reinforce ethical decision-making in research settings.
Sample test prompts include identification of ethical principles violated in hypothetical situations and how to respond as a nurse advocate.
IRB processes, risk/benefit assessment, informed consent documentation, and safeguarding privacy are core competencies for nursing researchers.
Box and Box-Like Content (Key References and Structures)
Box 2-1: Steps of the Research Process (see above).
Box 2-2: Nursing Research Priorities (topic areas for future work).
Box 2-3: Articles of the Nuremberg Code (10 points) – voluntary informed consent, risk-benefit balance, qualified researchers, ability to withdraw, and more.
Box 2-4: Key Points of the Code of Federal Regulations (45 C.F.R. 46) – risk minimization, equitable selection, informed consent, privacy, monitoring, etc.
Box 2-5: Exempt Research Examples – various low-risk scenarios that may be exempt from consent but still require IRB review.
Table 2-1: Example of Building Knowledge in Nursing Science: Pain and CTR – describes descriptive, explanatory, predictive, and causal aims across multiple studies (Gift 1991; Puntillo 1994; Carson 1994; Puntillo & Ley 2004; Friesner et al. 2006; Demir & Khorshid 2010; Aktas & Karabulut 2019; Özcan & Karagözoğlu 2020; etc.). Findings include descriptions of CTR pain, comparisons with suctioning, analgesia regimens, nonpharmacological interventions, and some instances of no significant differences; one study noted a significant reduction with a breathing relaxation technique combined with analgesia.
Table 2-2: Quantitative vs Qualitative Approaches – comparative attributes (philosophical perspective, reasoning style, role of researcher, strategies, data types, sample sizes, designs).
Table 2-3: Comparison of Research and EBP – research generates new knowledge and aims to fill gaps; EBP applies knowledge to patient care and measures outcomes; key distinctions in questions, data, and evaluation focus.
Table 2-4: IRB components and concerns – risk-benefit analysis, informed consent, privacy, monitoring, safeguards, etc.
Table 2-5 (exemptions): Example research exemptions (education, benign behavioral interventions with data anonymity, existing data, public health program evaluations, etc.).
Quick Reference: Key Quotes and Definitions (LaTeX-ready)
Belmont principles: {\text{Respect for Persons},\; \text{Beneficence},\; \text{Justice}}
Minimal risk: \text{The probability and magnitude of harm are not greater than those encountered in daily life}.
Nuremberg Code (summary): voluntary consent is essential; studies must yield fruitful results; avoid unnecessary harm; research must be scientifically valid; investigators must be qualified; participants must be able to withdraw; etc. See Box 2-3 for the full sequence.
Declaration of Helsinki (1964, last amended 2013): emphasizes informed consent and participant welfare in biomedical research.
IRB composition requirements (minimum): at least five members with diverse expertise and no conflicts of interest; at least one scientist, at least one non-scientist, and at least one member unaffiliated with the organization.
Notes: The above notes synthesize the content from the provided transcript, covering definitions, process steps, aims of research, study designs, historical evolution of nursing as a science, ethics, and future directions. Where specific study details were garbled in the transcript (e.g., parts of Table 2-1), the notes retain the intended interpretation and provide a faithful, organized summary suitable for exam preparation.