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Nursing Fundamentals Focus XII
The Role of Research in the Development of
Nursing Theory and Practice
Module for Chapter 2-Berman
30-35; 41-42
Objectives:
• Compare and contrast the seven ways of acquiring
knowledge
• Discuss the advantages and disadvantages of each
• Examine 5 characteristics of the scientific method of
acquiring knowledge and explain why it is important in
nursing.
• List the different types of research and describe the
differences
• Explain the importance of nursing research in the
development of nursing theory
• Identify some of the limitations of the scientific research
process.
Acquiring Knowledge
• What is knowledge?
• How is it acquired?
• Is it based on research?
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Acquiring Knowledge
• Knowledge
– Essential information acquired in a variety of
ways
– Accurate reflection of reality
– Incorporated and used to direct a person’s
actions (Kaplan, 1964).
Acquiring Knowledge
• Quality of knowledge
– Question the quality and credibility
– Sources of knowledge
– Nursing interventions:
• Tradition
• Research
• Borrowed
• Trial and error
• Personal experience
• Role modeling
• Intuition
• Reasoning
Acquiring Knowledge
• Traditions
– “truths” or beliefs based on customs and trends
– Transferred by:
• written and oral communication
• role modeling
– Narrow and limit knowledge
– Not tested for accuracy or efficiency
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Acquiring Knowledge
• Authority
– Person with power and expertise
– Influences opinion and behavior
– Given to a person because they are perceived to
know more in a given area
• Quoting someone – authors
• Instructors
• Clinical nursing experts
– Maintain traditional ways of knowing
Acquiring Knowledge
• Borrowing
– Appropriation and use of knowledge from other
fields or disciplines to guide nursing practice.
– Using medical model to guide their nursing
practice
• Diagnosis and treatment of the disease
– Integrating information from other disciplines
within the focus of nursing.
• Blurred boundaries
• May not answer the question generated in nursing
Acquiring Knowledge
• Trial and Error
– Used in situations of uncertainty
– Other sources of knowledge are not available
– Knowledge is gained from experience
– Documentation of effective and ineffective
practices does not exist
– May be detrimental to patient’s health
– Time consuming
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Acquiring Knowledge
• Personal Experience
– Being personally involved in an event, a
situation, or a circumstance
– Gain skills and expertise by providing care
– Nurse can cluster ideas into a meaningful whole
• Read about it, told about it, observed it and now do
it repeatedly
• Novice to expert –Benner
Acquiring Knowledge
• Benner’s Novice to Expert
– Novice
• No experience
• Preconceptions and expectations
– Challenged, refined, confirmed, or refuted by clinical
experiences
– Advanced beginner
• Just enough experience to recognize and intervene
in recurrent situations
– Competent Nurses
• Generate and achieve long-range goals and plans
• Conscious, deliberate actions that are efficient and
organized
Acquiring Knowledge
• Benner’s Novice to Expert
– Proficient nurse
• Views patient as a whole and member of the family
• Recognizes each patient and family responds
differently to illness and health
– Expert Nurse
• Extensive background of experience
• Able to identify accurately and intervene skillfully
in a situation
• Grasps a situation with intuition, speed and accuracy
– Benner, 1984 – Qualitative Research
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Acquiring Knowledge
Role Modeling
• Role Modeling
– Imitating behaviors of an expert
– Admired teachers
– Expert clinicians
– Researchers
– Inspirational people
• Mentorship
– Expert nurse serves as teacher, sponsor, guide,
counselor
Acquiring Knowledge
• Intuition
– Insight into or understanding of a situation or
event as a whole that usually cannot be
explained logically.
– “gut feeling” “hunch”
– Result of deep knowing
Acquiring Knowledge
• Reasoning
– Processing and organizing of ideas in order to
reach conclusions
– Make sense of both their thoughts and
experiences.
• Logical thinking
– Inductive reasoning – specific to general
• Particular instances are observed and then combined
into a larger whole or general statement
– Deductive reasoning – general to specific
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Acquiring Knowledge
Inductive Reasoning Deductive Reasoning
• Particular Instances • Premise – statement of
– A headache is an altered level proposed relationship between
of health that is stressful two or more concepts
– A terminal illness is an altered • Premises:
level of health that is stressful. – All human beings experience
• General Statement loss
– Therefore it can be induced – All adolescents are human
that all altered levels of health beings
are stressful • Conclusion
– Therefore it can be deduced
that all adolescents experience
loss.
Benefits of Nursing Research
• Improve client care
• Expand the body of knowledge
• Explore and describe new phenomena to enhance
understanding
• To generate a theory development
• To provide sound rationales for nursing interventions
• Clients who are subjects in a study
– may receive care they would not have received
– some receive stipends
– enhanced self esteem from being apart of something
that may help society
Pages 307-308-Harkreader
Risk of Nursing Research
Physiological Factors Physical factors
• fatigue and anxiety • Physical harm
• related to: • Discomfort
• self disclosure • Adverse effects
• loss of privacy
• time
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Risk of Nursing Research
• Sociological factors
– loss of time
– financial costs
– transportation expenditures that may not
be reimbursed
Page 308 - Harkreader
Ethics of Nursing Research
Risk/Benefit Ratio –
• Competent investigator to conduct the research
• Safeguards the subjects
• Risk:
• Probability harm may occur
• Weigh severity and magnitude of harm
• Benefit:
• Positive value related to health and welfare of subject and
others
Page 308-309 - Harkreader
Ethics of Nursing Research
• Review Board -
– Institutional Review Board (IRB)
• committee whose duties include making sure that
proposed research meets the federal guidelines for
ethical research.
• the committee is mandatory in institutions receiving
federal funds for research
• Page 308-309 - Harkreader
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Ethics of Nursing Research
• Informed Consent
– Subjects must be competent, informed, freely
able give consent.
– Primary Ethical Principles of the Belmont
Report (the National Research Act) 1978.
• Respect for persons, beneficence and justice
Page 308-309 - Harkreader
Protecting Rights of Human Subjects
• Right Not to Be Harmed
– Nurse acts as advocate for
client
• Right to Full Disclosure
– Informed and aware of
consequences
• Right of Self-
Determination
• Right of Privacy and
Confidentiality
Page 33 - Berman
Ethics of Nursing Research
Ethical Dilemmas:
•Use of vulnerable participants:
• infants, children, pregnant women,
• terminally ill, prisoners, mentally ill……
•Knowledge gained from research is more important and
beneficial than the rights of subjects or ethical
principles.
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EthicalEthical Dilemmas
Dilemmas in Nursing
Research
• Research Question:
– Do maternity clients discharged 24 hours after
childbirth experience less complications if
visited by a home health nurse?
• Ethical Dilemma
– Some clients are visited and others not for a
control group
– Is the group not being visited at risk?
– How can this be prevented?
• Research Question:
– How do clients cope with the new diagnosis of
an impending terminal illness?
• Ethical Dilemma
– Clients diagnosed with a terminal illness are very
vulnerable.
– Intrusive questions may need to be asked causing
increased anxiety and psychological trauma
– The insights gained will help other patients with a
terminal illness
– Is it fair to ask such questions?
Pg 309 - Harkreader
Types of Research
Types of Research
• Exploratory
• Evaluation
• Descriptive
• Experimental
• Historical
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Experimental
• A study in which the researcher manipulates a
treatment or interventions
• Subjects are randomly assigned to either a control or an
experimental group
• The researcher has control over the research situation.
• Quasi-experimental
– Type of study in which the researcher manipulates a treatment
or intervention
– unable to randomize subjects or lacks a control group
• Nonexperimental
– researcher collects data without the introduction of a treatment
or intervention.
Types of Nonexperimental Research
•Correlational
• examines relationships between variables to see if when one
changes, if the other changes without active intervention
•Descriptive
• is used to obtain information concerning the current status of the
phenomena
• describes "what exists" with respect to variables or conditions in a
situation.
•Case study
• detailed investigation on group, institution or individual to
understand which variables are important to the subjects,
history, care or development
Types of Nonexperimental Research
• Historical
– Reporting events and/or conditions that
occurred in the past
• Needs assessment
– collect data to estimate needs of community
• Survey
– studies to examine opinion, attitudes, behavior
• Page 311-Harkreader
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Anatomy of a Research Study
•Abstract
• A snapshot or a short summary that contains succinct information
about the purpose of the study, the number of subjects and
methodology used to select subjects, the type of study and the major
results.
•Review of the literature
• Reviews the current literature and theoretical background that brought
the investigator to identify or refine the research problem,
substantiate a rationale and develop their study
•Development of the theoretical construct
• A structure that aids in developing relationships among the variables in the study.
• It helps in the explanation of all the information included in the study.
• The framework allows the research to tie the research to the body of nursing
knowledge .
• See fig 15.2. Theoretical framework in study is Roy Model. Pg. 315/316-
Harkreader.
Anatomy of a Research Study
• Identification of the variables
• The concepts under investigation
• Table 15.3 – pg. 313
• Clarification of operational definitions: precise meanings of
the concepts being used in study, defined in a manner that specifies
how the concept will be used in the study
• Formulation of the research question: the hypothesis the
prediction of the relationship of the variables being studied
Anatomy of a Research Study
•Research design
• researchers strategy for testing a hypothesis.
• Quantitative
• uses variables analyzed as numbers
• Qualitative
• type that uses ideas that are analyzed as words
•Collection of data
• investigator collects information needed to answer the research
question.
•Methods
• describes how the researcher sought to answer the research
questions, sample size, how the sample was collected and
instruments used to collect data.
Page 311-314
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Anatomy of a Research Study
• Data analysis
– what statistical tests were used to analyze data?
• Results
– describes results of study
– addresses research question/s
• Interpretation of the findings
– researchers interpretation of the study
– the relationship of the findings to the theoretical
framework
– implications for further study
Nursing Research Journals
Evidence Based Nursing
Journal of Nursing Measurement
Clinical Nursing Research
Western Journal of Nursing
Research Nurse Researcher
Scholarly Inquiry for Nursing Applied Nursing Research
Practice
Research in Nursing and Health
Advances in Nursing Science
Nursing Science Quarterly
Oncology Nursing Forum
Journal of Nursing Scholarship
Nursing Research
Annual Review of Nursing Research
Nursing Computer Search Databases
• Computer search databases identify databases of
interests of nurses.
• Computer Index to Nursing and Allied Health
Literature CINAHL
• MEDICUS INTERNATIONAL NURSING INDEX
MEDLINE
• Many of the helpful nursing literature can be
accessed at
http://www.nursingcenter.com/home/index.asp
Table 15.2, page 312
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Evidence Based Nursing
What's Evidence Based Nursing (EBN)?
• Evidence Based Nursing is the process by which nurses
make clinical decisions using the best available
research evidence, their clinical expertise and patient
preferences.
Three areas of research competence are:
• interpreting and using research
• evaluating practice
• conducting research
319-320
Evidence-based Nursing
Evidence-based Nursing Practice (EBP)
• Use of some form of substantiation in making clinical
decisions.
• Solves problems encountered by nurses by carrying
out four steps:
I. Clearly identify the issue or problem based on
accurate analysis of current nursing knowledge
and practice
II. Search the literature for relevant research
III. Evaluate the research evidence using
established criteria regarding scientific merit
IV. Choose interventions and justify the selection
with the most valid evidence
Evidenced Based Nursing
To carry out EBP the following factors must be considered:
• sufficient research must have been published on the
specific topic
• the nurse must have skill in accessing and critically
analyzing research
• the nurse's practice must allow her/him to implement
changes based on EBN
319-320
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Evidenced Based Nursing
• Agency for Healthcare Research and
Quality’s Effective Health Care Program
– 3 approaches to publishing research on the
comparative effectiveness of different
treatments and clinical practices
– 1. Review and synthesize knowledge
– 2. Promote and generate knowledge
– 3. Compile findings in practice and translate
knowledge
Nursing Research
• Use of research finding in practice
• AACN – 2006
– Position statement on nursing research that
delineates expectations of graduates at each
level of nursing education
• ANA Standard’s of Professional
Performance – 2004
– Standard 13: Research
• The registered nurse integrates research findings
into practice. (Pg 30- Berman)
Nursing Research
• Use of research finding in practice
• AACN – 2006
– Position statement on nursing research that
delineates expectations of graduates at each
level of nursing education
• ANA Standard’s of Professional
Performance – 2004
– Standard 13: Research
• The registered nurse integrates research findings
into practice. (Pg 30- Berman)
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Nursing Research Critique
• Evaluates the scientific merit of the study
• Decides how the results may be useful in
practice.
• Intensive scrutiny
– Strengths and weaknesses
– Statistical and clinical significance
– Generalizability of the results
Nursing Research Critique
• Evaluates the scientific merit of the study
• Decides how the results may be useful in
practice.
• Intensive scrutiny
– Strengths and weaknesses
– Statistical and clinical significance
– Generalizability of the results
Nursing Research Critique
• Polit and Beck – 2005
– Elements to be considered in a critique of
quantitative research
• Substantive and theoretical dimensions
– Significance of problem
– Appropriateness of conceptualizations
– Theoretical framework of the study
– Congruence of research question and methods used
• Methodologic dimensions
– Appropriateness of design
– Size and sampling validity and reliability of the
instruments
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Nursing Research Critique
• Ethical dimensions
– Human rights protected
– Any ethical compromise occurred
• Interpretive dimensions
– Accuracy of the discussion, conclusions, and
implication of the results
– Implication and limitations reviewed
– Replication or generalizability of findings
• Presentation and stylistic dimensions
– Manner in which results are communicated
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