Nursing Research eh

Research into Nursing:Nursing Research Integrated with Evidence-Based Practice

2014 Nurse Licensure Examination

Prepared by: Josel D. Montero, BSN, RN, HAAD-RN

PART I: Foundations of Nursing Research

Definition of Nursing ResearchImportance of Research to NursingNursing Research: Past, Present and FutureParadigm for Nursing ResearchClassification of Nursing Research

PART II: Generating Evidence for Nursing

Key Concepts and Steps in:Qualitative ResearchQuantitative Research

PART III: Translating Research Evidence Into Nursing Practice: Evidence-Based Nursing

Background of Evidence-Based Nursing PracticeEBP in NursingTypes of Evidence and Evidence HierarchiesResources of EBPBarriers to Research UtilizationProcess of Using Research in Nursing Practice

PART IFoundations of Nursing Research

RESEARCH AND NURSING

>Research

>Nursing Research

IMPORTANCE OF NURSING RESEARCH

C A S E

OF IMPORTANCE TO NURSING?

To provide especially strong evidence for informing nurses decisions and actions.

EVIDENCE-BASED NURSING

BOARD CONCEPT: July 2010 NLE

Which of the following is the best reliable source on information for implementing best practice?

a. research journal datab. personal experiencec. expert opiniond. nursing research

Key Concept

Nurse MJ is knowledgeable that research is needed for which of the following purposes? a. to facilitate a more evidence-based practiceb. to find solution to a problemc. to provide answer to questiond. all of the above

NURSING RESEARCH:Past, Present and Future

The Early Years: From Nightingale to the 1960sBegan with FLORENCE NIGHTINGALE.Little research works were conducted.Focused on nursing education.Sigma Theta TauEBP was only in literature.


Nursing Research in the 1970sEBP awareness by nurses of the need for a

scientific bases increased.Utilization of research findings in nursing

practice.


Nursing Research in the 1980sResearch is an integral part of professional

nursing.


Nursing Research in the 1990sIn 1993, the National Institute of Nursing

Research was born.COCHRANE COLLABORATION was

inaugurated.


Trends for the Early 21st CenturyHeightened Focus on EBP.Development of a stronger evidence base

through more rigorous methods and multiple, confirmatory strategies.Greater emphasis on systematic integrative

reviews.Expanded local research in health care

settings.


Trends for the Early 21st CenturyStrengthening of multidisciplinary

collaboration.Expanded dissemination of research findings.Increasing the visibility of nursing research.Increased focus on cultural issues and health

disparities.

PARADIGMS FOR NURSING RESEARCH

PARADIGM: world view; general perspective on the complexities of the real world.

TWO Paradigm in Nursing Research:POSITIVIST ParadigmNATURALISTIC Paradigm

ONTOLOGIC: What is the nature of reality?

EPISTEMOLOGIC: What is the relationship between the inquirer and that being studied?

AXIOLOGIC: What is the role of the values in the inquiry?

METHODOLOGIC: How should the inquirer obtain knowledge?

PHILOSOPHICAL QUESTIONS

CLASSIFICATION OF RESEARCH

According to level of explanation

According to purpose

According to design

ACCORDING TO LEVEL OF EXPLANATION

Identification and DescriptionWhat is this phenomena?; What is its name?

ExplorationWhat is the full nature of the phenomenon?

ExplanationElicits causes and relationships within a phenomenon.

Prediction and ControlUses experimentation or research to predict or to control a

phenomenon.

ACCORDING TO PURPOSE

Basic

Applied

ACCORDING TO DESIGN

Quantitative

Qualitative

QUANTITATVE QUALITATIVE

measurable

deals with numbers

highly objective

may or may not be manipulated

rigid, hard, replicable

deductive

general to specific

not measurable

deals with feelings, emotions and behavior

highly subjective

cannot be manipulated

flexible

inductive

specific to general

Key Concept

Out of curiosity, Glenda conducted a research to generate new knowledge. She wants to know the effect of breast implant in relation with the number of her suitor. This type of research is mainly:a. Quantitativeb. Qualitativec. Appliedd. Pure

PART IIGenerating Evidence for Nursing

QUALITATIVE RESEARCH

DESIGN

QUALITATIVE RESEARCH DESIGN

cannot be measured small sample size field setting/natural environment experiences and feelings never manipulated/control just an observer


Types:

Phenomenological Study Ethnographic Study Case Study Grounded Theory Study Historical Study


Phenomenological Study phenomenon; situation; event people describe experiences researcher looks for themes: saturated

answers looks for common experiences


Ethnographic Study explains and describes culture of groups

Best Method:


Case Study in-depth study of a person or institution one-on-one study


Grounded Theory Study an approach to collecting and analyzing data

that aims to develop new theories grounded in real-world.

Best Method:


Historical Study identifies, evaluates data from the past

Sources of Historical Data: Documents: on paper (e.g. pictures, maps,

diary) Relic/Artifact: items on physical evidence Primary Secondary


Data Sources Evaluation

EXTERNAL CRITICISM:

INTERNAL CRITICISM:

Key Concept

The researcher which will outline the lived experiences of patients is called:

a. Phenomenological Studyb. Correlational Studyc. Ethnographic Studyd. Case Study

QUANTITATIVE RESEARCH

DESIGN

QUANTITATIVE RESEARCH DESIGN

hard, replicable, reliable data may or may not manipulate the independent

variable

QUANTITATIVE RESEARCH DESIGN Steps in Quantitative Research Design1. Identify the problem2. Purpose of the Study3. Review of Related Literature4. Develop a Theoretical or Conceptual

Framework5. Identify Assumptions6. Acknowledge Limitations7. Formulate Hypothesis8. Define the Variables9. Select Research Design/Type of Study

QUANTITATIVE RESEARCH DESIGN Steps in Quantitative Research Design10. Identify the Population11. Select the Sample12. Conduct Plot Study13. Collect Data/Gather Data14. Organize Data for Analysis15. Analyze Data16. Interpret the Findings17. Communicate the Findings

QUANTITATIVE RESEARCH DESIGN 1. Identify the Problem the start of the research process identify a researchable problem

Sources of Research Problem:

Concepts Literature Issues ExperiencesNursing Problems Theories


Problem Statement

A good Problem Statement should have:a. Variablesb. Populationc. Question Mark


Research Variables

Independent Variable:

Dependent Variable:

QUANTITATIVE RESEARCH DESIGN Example:

Is there a difference between the weight gain of infants who are exclusively breastfed and infants who are exclusively formula fed?

a. Variables:IV: DV:

b. Population: c. Question Mark:


Problem Statement Format

Correlational

Comparative Comparative Descriptive Comparative Experimental

Key Concept

The problem statement is as follows: Is there a difference in people who have exercised and those who have not exercised? We can conclude that this research problem:

a. lacks a populationb. lacks an independent variablec. is unethical d. lacks a dependent variable


2. Purpose of the Study why the study is being made?


3. Review of Related Literature

Most important reason: to improve clients quality of care

First reason: to determine what knowledge already exist

in the topic


Literature Sources

Primary: first hand information (e.g. thesis, research paper)

Secondary: e.g. magazine, newspaper

Key Concept

Initially, a review of related literature will serve this important purpose:

a. Clarify a research topicb. Determine existing knowledge on the topic of interestc. Identify a research problemd. Determine available support teams


4. Develop a Theoretical or Conceptual Framework

main idea behind the research

Theoretical Framework:

Conceptual Framework:

Key Concept

Although they have similarities, a theoretical framework is different from conceptual framework in the sense that a theoretical framework:

a. Is less formalb. Is universally acceptedc. Is based on one existing theoryd. Is based on several theories


5. Identify Assumptions


6. Acknowledge Limitations of the Study recognize weakness of the study


7. Formulate the HypothesisHYPOTHESIS: a prediction/guess on the

relationship of variables


HYPOTHESIS according to number of variables: Simple Hypothesis

Complex Hypothesis

HYPOTHESIS according to predicted results: Null

Research


In Research Hypothesis Directional

Non-directional

Key Concept

The hypothesis was formulated, Female post-appendectomy patients request for pain medications more often than male posy-appendectomy patients. According to results, this hypothesis is identified as:

a. Nullb. Complexc. Research directionald. Research non-directional


8. Define the VariablesDICTIONARY Definition: copied from the

dictionary

OPERATIONAL Definition: made by the researcher based on the use in the study

Key Concept

Anxiety is termed as fear of the unknown. This definition used by the researcher in the study is:

a. Theoretical Definitionb. Operational Definitionc. Descriptiond. Webster Definition


9. Select the Research Design/Type of Study overall plan in research

blueprint in research


EXPERIMENTAL

NON-EXPERIMENTAL

NON-EXPERIMENTAL

DESIGN


Types of Non-Experimental Design CORRELATIONAL STUDIES: connect any

changes that happened in the variables; X changes, Y also changes

COMPARATIVE STUDIES:Comparative Studies based on time:Retrospective

Prospective


Types of Non-Experimental Design METHODOLOGICAL STUDIES: testing and

evaluation of researcher instrument

SURVEY STUDIES: merely describes the population

EXPERIMENTAL DESIGN


EXPERIMENTAL DESIGNS True Experimental

Quasi-Experimental


TRUE EXPERIMENTALCriteria:a. Manipulation of IVb. Control Groupc. Randomization


TRUE EXPERIMENTAL DESIGNS

a. Pre-test-post-test Design1. Two Groups2. Randomization3. Pre-test4. Post-test



b. Post-test only Design1. Two Groups2. Randomization3. Post-test



c. Solomon Four-Group Design1. Four Groups2. Randomization3. Pre-test4. Post-test


QUASI-EXPERIMENTAL DESIGNS

a. Non-Equivalent Control Group Before-After Design

1. Two Groups2. Pre-test3. Post-test



b. Time-Series Design: repeated pre-tests and post-tests



c. One-shot case study: no pre-test; single group



d. One-group pre-test-post-test Design1. One Group: always experimental2. Pre-test3. Post-test


10. Identify the Population

POPULATION: the total number of individuals from which the sample is drawn.


11. Select the Sample

SAMPLE: a sub-group to represent the population; any sub-aggregate drawn from the population that is involved in the study

Most Important Characteristic: REPRESENTATIVENESS


REPRESENTATIVENESSThis refers to sufficiency, ability or attribute of the samples to show or give the whole picture and characterist ics of the population even if the totality of the population is not actually involved.


SLOVINs Formula:


SAMPLING TECHNIQUES

Probability Sampling

Non-Probability Sampling


PROBABILITY SAMPLING:


TYPES OF PROBABILITY SAMPLING

Simple Random Sampling:

Stratified Random Sampling:


TYPES OF PROBABILITY SAMPLING

Cluster Sampling:

Systematic Sampling:


NON-PROBABILITY SAMPLING:


TYPES OF NON-PROBABILITY SAMPLING

Convenience Sampling:


TYPES OF NON-PROBABILITY SAMPLIN

Snowball Sampling/Network Sampling:


TYPES OF NON-PROBABILITY SAMPLING

Quota Sampling:

Judgmental Sampling:

Key Concept

Nurse Anthon has chosen to conduct his study among grade 3 students in a private elementary school since his child is also a grade 3 student in the same school and he is the secretary of the PTA with access to the contact numbers of the parents. The type of sampling done by nurse Anthon is one of:

a. Probability Samplingb. Cluster Random Samplingc. Systematic Random Samplingd. Convenience Sampling

ETHICAL PRINCIPLES and GUIDELINES FOR NURSE RESEARCHER: Rights of Subjects

Right to informed consent- full-disclosure- self-determination Right to refuse participation Right to withdraw participation Right to confidentiality and anonymity Right to be protected from harm Right to compensation

CODE OF ETHICS

NUREMBERG CODE

HELSINKI DECLARATION

BELMONT REPORT

Contents[hide]

Key ConceptThe following statement is found in a questionnaire: Return of this questionnaire indicates the subjects consent to the study. Carlo returned the answered questionnaire via mail to the research team. This means that:a. informed consent has been obtainedb. consent can still be invalidatedc. consent is not necessary for the researchd. the statement has no bearing if the questionnaire is returned by mail.


12. Conduct a Pilot Study

PILOT STUDY: miniature, trial version of the study.

Determines: Practicality: ease of use

Validity: degree of CONSISTENCY or DEPENDABILITY with which an instrument measures an attribute. (Tamang tanong Angkop sa pag-aaral) (Susukat sa dapat na sukatin)

Reliability: degree to which inferences made in the study are accurate and well-founded; measures what it is intended to measure. (Tamang resulta sa pag-aaral) (Magbibigay ng tamang resulta)


13. Collect Data/Gather Data

Data Gathering Instruments/Methods:

1. Questionnaire: paper and pencil instrument; self-report instrument; most commonly used instrument in data gathering; anonymity is being provided.


TYPES OF QUESTIONS

a. Closed-ended:

b. Open-ended:

c. Contingency


2. Interviewsa. Structured b. Semi-structuredc. Unstructured

3. Observationa. Participant:b. Non-participant:c. Overt:d. Covert :


4. Physiologic Measurement

5. Delphi Technique

6. Pre-existing Data


14. Organize Data for Analysis involves tabulation and organization of data

Key Concept

Experimental studies that will determine the effects of diet and exercise in weight reduction will require different data collection methods. Which of the following will give the most objective data?

a. Physiologic Measuresb. Interviewc. Questionnaired. Observation


15. Analyze Data

Characteristics of Analysis: Hypothesis action either rejected or

accepted (Step 16) Important finding should be represented by

tables and figures Supported by Statistics


DESCRIPTIVE STATISTICS: presents characteristics of sample population

Levels of Measurement of Data: Nominal:

Ordinal:

Interval:

Ratio:

Subjects Ratio Interval Ordinal NominalAlexander Alaine Derek Amanda Terence Caitlin Danielle James Bob Andrea

180 110 165 130 175 115 125 150 145 120

70 0 55 20 65 5 15 40 35 10

10 1 8 5 9 2 4 7 6 3

2 1 2 1 2 1 1 1 1 1


Frequency Distribution: systematic arrangement of values from lowest to highest, together with a count of the number of times each value was obtained. SHAPES OF DISTRIBUTION

SYMMETRIC

ASYMMETRIC/SKEWED

UNIMODAL

BI-MODAL or MULTI-MODAL

In a sample of 50 patients, if there are 30 men and 20 women in the study; the nurse knows that there are how many percent of the subjects are male and how many percent of female in the said study?

a. 40% and 60% respectivelyb. 60% and 40% respectivelyc. 70% and 30% respectivelyd. 30% and 70% respectively

Key Concept

Consider this scheme for coding a clients ability to perform activities of daily living: (1) completely dependent, (2) needs another persons assistance, (3) needs mechanical assistance, (4) completely independent. In this case, the nurse is using what level of measurement?

a. Nominalb. Ordinalc. Ratiod. Interval

Key Concept


Measures to Central Tendency: Mean: average scores Median: middle score Mode: occurs most often

Measures to Variability: Range: highest - lowest Standard Deviation Variance Percentile

MEDIAN

Example:

Student 1: 23Student 2: 23Student 3: 24Student 4: 25Student 5: 27

Student 6: 26Student 7: 29Student 8: 28Student 9 : 20Student 10: 26

MODE

Example:



MEAN

Example:



RANGE

Example:




BIVARIATE DESCRIPTIVE STATISTICSContingency Tables: two dimensional frequency

distribution in which the frequencies of the two variables are cross-tabulated.

Correlation

GENDER

Women Men Total

Smoking Status n % n % n %

Non-smoker 10 45.4 6 27.3 16 36.4

Light Smoker 8 36.4 8 36.4 16 36.4

Heavy Smoker 4 18.2 8 36.4 12 27.3

TOTAL 22 100.0 22 100.0 44 100.0


INFERENTIAL STATISTICS:

TYPES OF ERRORS: Hypothesis Testing

TYPE 1 ERROR: null was true but it was rejected

TYPE 2 ERROR: null was false but it was accepted


TYPE I ERROR

There is no relationship between the use of placebo and the reduction of cholesterol level among the subjects.

Allows an ineffective drug to come onto the market.

TYPE II ERROR

There is no relationship between the use of placebo and the reduction of cholesterol level among the subjects.

Prevents an effective drug from coming onto the market.

HOW TO AVOID SUCH ERRORS?

Increase the sample size.

LEVEL OF SIGNIFICANCE

Chance of rejecting a null hypothesis when it is actually true.

Probability of incorrectly rejecting a true null hypothesis.

p= 0.05 (.05): acceptable level of significance in nursing research

5x (%) out of 100 possible wrong


STATISTICAL TESTS:

T-Test or Students T (Test for Independent Group)Used when there are two independent groups (e.g.,

experimental versus control), and when the sample is paired or dependent (e.g., pre-treatment and post-treatment for a single group)


Paired T-tests (Test for Dependent Group)Example:Suppose we were studying the effect of a special diet

on the cholesterol level of elderly men. A sample of 50 men is randomly selected, and their cholesterol levels are measured before and again 2 months on the special diet.


Testing Mean Differences With Three or More GroupsANOVA


ANOVAUsed for testing differences between means when

there are three or more groups.


Testing Differences in ProportionsChi-Square Test


Testing CorrelationsPearsons rCorrelation Co-efficientSpearmans rho


If there were two groups of cancer patients assigned to determine their average weight after a single group is subjected to a high protein diet and ordinary diet. The statistical treatment involved is:Chi-squareANOVAANCOVAT-test

In other similar findings, it was stated that male cancer patients responded more to high protein diet to avoid massive losses in body mass than female patients. The analysis used is?Chi-squareANOVAANCOVAT-test

When comparing the actual gathered data on the most common complaints from the expected responses, the best statistical method to use would be:Measure of central tendencyANOVAChi-squarePearson r


16. Interpret the Findings summary, conclusion and recommendation

HYPOTHESIS RESULT ACTION

There is no difference between the weight gain of infants who are exclusively breastfed and infants who are exclusively formula fed.

There is a difference. Reject the null hypothesis.

There is a difference between the weight gain of infants who are exclusively breastfed and infants who are exclusively formula fed.

r= 0.7(Infants who are exclusively formula fed gain more weight than those who are exclusively breastfed)

Research Supported

There is no difference between the weight gain of infants who are exclusively breastfed and infants who are exclusively formula fed.

There is no difference. Retain the null or Research not supported


17. Communicate the Findings last step in research process

PART IIITranslating Research Evidence

Into Nursing Practice: EBP

BACKGROUND OF EBP:

Definition:

Conscientious use of current best evidence in making clinical decisions about patient care.

BACKGROUND OF EBP:

Basic Feature:

It de-emphasizes decisions based on custom, authority, opinion, or ritual.

BACKGROUND OF EBP:

Emphasis:To identify the best available research

evidence and to integrate it with other factors:Clinical expertisePatient preferenceCircumstancesAwareness of the clinical settingResource constraints

BACKGROUND OF EBP:

Key Ingredient:

The effort to personalize the evidence to fit a specific patients needs and a particular clinical situation.

EBP IN NURSING:It offers a situation to improve health care

quality in our current cost-constrained environment.Rational approach is needed to provide the

best possible care to the most people. With the most cost-effective use of resources.Provides an important framework for self-

directed life-long learning that is essential in an era of rapid clinical advances and the information explosion.

TYPES OF EVIDENCE AND EVIDENCE HIERARCHIES

RESOURCES FOR EBP:

Systematic Reviews

Meta-AnalysisMeta-Synthesis

Clinical Practice Guidelines

Other Pre-appraised Evidence

BARRIERS TO RESEARCH UTILIZATION

Quality and Nature of the Research

Characteristics of the Nurses

Organizational Factors

PROCESS OF USING RESEARCH INTO NURSING PRACTICE

Asking clinical questions that are answerable with research evidence

PROCESS OF USING RESEARCH INTO NURSING PRACTIE

Searching for and Collecting Relevant Evidence


Appraising and Synthesizing the Evidence


Integrating the Evidence with your own clinical expertise, patient preferences, and local context.


Assessing the Effectiveness of the decision, intervention, or advice.

TOP THE BOARD!

THANK YOU for Listening, NURSES!

THANK YOU FOR LISTENING!

GOD Bless!

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