HNI/HNC 440HNI/HNC 440Research in NursingResearch in Nursing

Marie Ann Marino, EdD, RN, PNPMarie Ann Marino, EdD, RN, PNP

Clinical Associate ProfessorClinical Associate Professor

Course OverviewCourse Overview

Course OutlineCourse Outline Texts and ReadingsTexts and Readings Course RequirementsCourse Requirements Late SubmissionsLate Submissions AttendanceAttendance Group FormationGroup Formation

The Role of Research in NursingThe Role of Research in Nursing

How Do Nurses Know What How Do Nurses Know What They Know?They Know?

TraditionTradition AuthorityAuthority Clinical experience and intuitionClinical experience and intuition Logical reasoningLogical reasoning Disciplined researchDisciplined research

What is Nursing Research?What is Nursing Research?

A systematic inquiry designed to develop A systematic inquiry designed to develop knowledge about issues important to the knowledge about issues important to the nursing professionnursing profession

Nursing Research: An Historical Nursing Research: An Historical PerspectivePerspective

Nineteenth Century – After 1850Nineteenth Century – After 1850

Beginning of nursing as a formal Beginning of nursing as a formal disciplinediscipline

Concepts are congruent with current Concepts are congruent with current priorities of nursing researchpriorities of nursing research

Believed systematic collection and Believed systematic collection and exploration of data were necessary exploration of data were necessary for nursingfor nursing

Her research led to a variety of health Her research led to a variety of health reforms during the Crimean Warreforms during the Crimean War

Twentieth Century – Before 1950Twentieth Century – Before 1950

Focus was mainly on nursing educationFocus was mainly on nursing education Leaders: Lavinia Dock, Anne Leaders: Lavinia Dock, Anne

Goodrich, Adelaide Nutting, Isabel Goodrich, Adelaide Nutting, Isabel Hampton Robb and Lillian WaldHampton Robb and Lillian Wald

Gathered documentation to establish Gathered documentation to establish nursing as a profession and reform nursing as a profession and reform nursing educationnursing education

Clinically-oriented research centered Clinically-oriented research centered mainly on morbidity and mortality ratesmainly on morbidity and mortality rates

1920: First nursing research course1920: First nursing research course

Twentieth Century – After 1950Twentieth Century – After 1950

Groundwork is laid for nursing’s current Groundwork is laid for nursing’s current level of research skilllevel of research skill

Expansion of nursing programs; Expansion of nursing programs; graduate programs including research graduate programs including research coursescourses

Research priority: Practice-oriented Research priority: Practice-oriented researchresearch

1986: National Center for Nursing 1986: National Center for Nursing Formed (later became NINR)Formed (later became NINR)

Expansion of master’s and doctoral Expansion of master’s and doctoral programsprograms

Future DirectionsFuture Directions

Continued expansion of nursing Continued expansion of nursing knowledgeknowledge

Numerous opportunities to study Numerous opportunities to study important research questionsimportant research questions

Focus is on promoting health and Focus is on promoting health and ameliorating the side effects of illness ameliorating the side effects of illness and the consequences of treatmentand the consequences of treatment

Goal is to provide the foundation for Goal is to provide the foundation for evidence-based practiceevidence-based practice

Expansion of doctoral programsExpansion of doctoral programs

NINR: Research ThemesNINR: Research Themes

Changing lifestyle behavior for better health Changing lifestyle behavior for better health (starting healthy behaviors)(starting healthy behaviors)

Managing the effects of chronic illness to improve Managing the effects of chronic illness to improve quality of lifequality of life

Identifying effective strategies to reduce health Identifying effective strategies to reduce health disparitiesdisparities

Harnessing advanced technologies to serve human Harnessing advanced technologies to serve human needsneeds

Enhancing end-of-life experience for patients and Enhancing end-of-life experience for patients and familiesfamilies

Purposes of Nursing ResearchPurposes of Nursing Research

Basic researchBasic research Applied researchApplied research

Methods for Nursing ResearchMethods for Nursing Research

Scientific Method and Quantitative Scientific Method and Quantitative ResearchResearch

Naturalistic Method and Qualitative Naturalistic Method and Qualitative ResearchResearch

Importance of Nursing ResearchImportance of Nursing Research

Evidence-Based Nursing PracticeEvidence-Based Nursing Practice Credibility of the Nursing ProfessionCredibility of the Nursing Profession Accountability for Nursing PracticeAccountability for Nursing Practice Documentation of Cost-Effectiveness of Documentation of Cost-Effectiveness of

Nursing CareNursing Care

Research UtilityResearch Utility

General consensus that the research role of General consensus that the research role of the baccalaureate graduate calls for the skill the baccalaureate graduate calls for the skill of critical appraisalof critical appraisal

The nurse must be a knowledgeable The nurse must be a knowledgeable consumerconsumer of research of research

Also, to be able to Also, to be able to critiquecritique research and use research and use existing standards to determine the existing standards to determine the readiness and merit of that research for use readiness and merit of that research for use in clinical practicein clinical practice

Consuming Nursing Research: Consuming Nursing Research: Be Informed Be Informed

Use critical thinkingUse critical thinking Understand the steps in the research processUnderstand the steps in the research process

Evidence-Based PracticeEvidence-Based Practice

Integrates individual clinical expertise and Integrates individual clinical expertise and the best evidence to guide (mutual) decision the best evidence to guide (mutual) decision making and patient preference.making and patient preference.– Sackett, 2000Sackett, 2000

Steps to Develop Evidence-Based Steps to Develop Evidence-Based InterventionsInterventions

First step:First step: Be able to critically read the Be able to critically read the literatureliterature

– Research articlesResearch articles

– Clinical articlesClinical articles

– Clinical guidelinesClinical guidelines

Research Article vs. Clinical ArticleResearch Article vs. Clinical Article

Research ArticleResearch Article Follows the steps of the research processFollows the steps of the research process Not a “how to,” but answers a question with Not a “how to,” but answers a question with

all the components of research clearly all the components of research clearly presentedpresented

Assess Strength of EvidenceAssess Strength of Evidence

Level ILevel I Meta-analysis or systematic Meta-analysis or systematic review of RCTs/experimental studiesreview of RCTs/experimental studies

Level IILevel II RCTs or experimental studies RCTs or experimental studies Level IIILevel III Quasi-experimental studies Quasi-experimental studies Level IVLevel IV Nonexperimental studies Nonexperimental studies Level VLevel V Case reports, program evaluation, Case reports, program evaluation,

qualitative researchqualitative research Level VILevel VI Opinion of respected authorities Opinion of respected authorities

Assessing StrengthAssessing Strength

Quality: Quality: Extent to which a study’s design, Extent to which a study’s design, implementation, and analysis minimizes biasimplementation, and analysis minimizes bias

Quantity: Quantity: Number of studies that have evaluated Number of studies that have evaluated the research question, including sample size across the research question, including sample size across studiesstudies

Consistency: Consistency: Degree to which studies have Degree to which studies have similar and different designs yet the same research similar and different designs yet the same research question and similar findingsquestion and similar findings

The Research Process: The Sum of The Research Process: The Sum of It’s PartsIt’s Parts

AbstractAbstract

Short comprehensive synopsis or summary Short comprehensive synopsis or summary of a studyof a study

Located at the beginning of a studyLocated at the beginning of a study Quickly focuses the reader on the main Quickly focuses the reader on the main

points of the studypoints of the study 50 to 250 words50 to 250 words Should accurately represent the study’s Should accurately represent the study’s

methods and resultsmethods and results

VariableVariable

A characteristic or quality that takes on A characteristic or quality that takes on different values, i.e., that varies from one different values, i.e., that varies from one person to the nextperson to the next

– Blood typeBlood type

– WeightWeight

– Length of stay in hospitalLength of stay in hospital

Types of VariablesTypes of Variables

Continuous (age, height)Continuous (age, height) Discrete (number of children)Discrete (number of children) Categorical (blood type)Categorical (blood type) Dichotomous (gender)Dichotomous (gender)

Attribute variable vs. Active variableAttribute variable vs. Active variable

Types of Variables (cont’d)Types of Variables (cont’d)

Independent variable—the presumed Independent variable—the presumed cause (of a dependent variable)cause (of a dependent variable)Dependent variable—the presumed Dependent variable—the presumed effect (of an independent variable)effect (of an independent variable)

Example: Smoking (IV) Example: Smoking (IV) Lung cancer (DV) Lung cancer (DV)

Definitions of Concepts and Definitions of Concepts and VariablesVariables

Conceptual definitionConceptual definition – the abstract or theoretical meaning of the abstract or theoretical meaning of

a concept being studieda concept being studied Operational definitionOperational definition

– the operations (measurements) a the operations (measurements) a researcher must perform to collect researcher must perform to collect the desired informationthe desired information

Identification of a Research Identification of a Research Purpose/QuestionPurpose/Question

ResearchResearch problemproblem

An unexplained, perplexing, or troubling An unexplained, perplexing, or troubling conditioncondition

Problem statementProblem statement

A statement describing the research A statement describing the research problem and indicating the need for a problem and indicating the need for a studystudy

Research Question/HypothesesResearch Question/Hypotheses

Research questionsResearch questions The specific questions the researcher The specific questions the researcher wants to answer in addressing the wants to answer in addressing the research problemresearch problem

HypothesesHypotheses

The researcher’s predictions about The researcher’s predictions about relationships among variablesrelationships among variables

Research Design and DataResearch Design and Data

– Quantitative Studies—Researchers Quantitative Studies—Researchers identify variables of interest, develop identify variables of interest, develop operational definitions, then collect operational definitions, then collect relevant data from subjects. The actual relevant data from subjects. The actual values of the study variables constitute values of the study variables constitute data for the projectdata for the project

– Qualitative Studies—Researcher primarily Qualitative Studies—Researcher primarily collects narrative datacollects narrative data

Example of Quantitative DataExample of Quantitative Data

Example of Qualitative DataExample of Qualitative Data

Major Methodologic ChallengeMajor Methodologic Challenge

Designing studies that are:Designing studies that are: Reliable and valid (quantitative Reliable and valid (quantitative

studies)studies) Trustworthy (qualitative studies)Trustworthy (qualitative studies)

Criteria for Evaluating Quantitative Criteria for Evaluating Quantitative ResearchResearch

ReliabilityReliabilityThe accuracy & consistency of obtained The accuracy & consistency of obtained informationinformation

ValidityValidityThe soundness of the evidence—whether The soundness of the evidence—whether findings are convincing, well-groundedfindings are convincing, well-grounded

Dimensions of Trustworthiness Dimensions of Trustworthiness in Qualitative Studiesin Qualitative Studies

CredibilityCredibility ConfirmabilityConfirmability DependabilityDependability

ResultsResults

AnalysisAnalysis DiscussionDiscussion Recommendations/ImplicationsRecommendations/Implications CommunicationCommunication

Generalizability and Generalizability and TransferabilityTransferability

GeneralizabilityGeneralizability (Quantitative research): (Quantitative research): The extent to which study findings are The extent to which study findings are valid for other groups not in the studyvalid for other groups not in the study

TransferabilityTransferability (Qualitative research): (Qualitative research): The extent to which qualitative findings The extent to which qualitative findings can be transferred to other settingscan be transferred to other settings

Questions??Questions??