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Nursing Research

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Nursing Research

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Nursing Research

  1. 1. RESEARCHJOFRED M. MARTINEZ, RN, MAN • ST. ANTHONY’S COLLEGE INTRODUCTION TO NURSING
  2. 2. • having the capacity for critical thought • possessing analytical skills • having the skills to gain access to relevant research and evidence • having a critical understanding of research processes • being able to read and critically appraise research and other types of evidence • having an awareness of ethical issues related to research.
  3. 3. RE – SEARCH The word was derived from the old French word cerchier, meaning to“seek or search”. The prefix re means “again” and signifies replication of the search. One seeks new knowledge or to directly utilize knowledge specific to life situations.
  4. 4. Webster (1971), “research is a studious inquiry or examination, investigation, or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts or practical applications of such new or revised theories or laws.”
  5. 5. Treece and Treece (1973) stated: “Research is an attempt to gain solutions to problems. It is the collection of data in a rigorously controlled situation for the purpose of prediction or explanation.” Best (1968) stated: “Research is a formal systematic and intensive process of carrying on a specific analysis for the purpose of discovery and development of an organized body of knowledge.”
  6. 6. Polit and Beck (2004) - systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administration and informatics. Burns and Grove (2005) - defined nursing research as a “scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences clinical nursing practice.
  7. 7. Vreeland (1973), stated that “Nursing research is concerned with the systematic study and assessment of nursing problems or phenomena; finding ways to improve nursing practice and patient care through creative studies; initiating and evaluating change; and taking action to make new knowledge useful in nursing.”
  8. 8. Treece and Treece (1973), stated: “Nursing research includes the breadth and depth of the discipline of nursing and the rehabilitative, therapeutic, and preventive aspects of nursing as well as the preparation of practitioners and personnel involved in the total nursing sphere.”
  9. 9. According to the National Center for Nursing Research (NCNR) (1998), “Nursing research is the testing of knowledge that can be used to guide nursing practice. It is concerned with examining questions and verifying interventions based on human experiences.”
  10. 10. Committee on research of the PNA - Research is an honest scientific investigation undertaken for the purpose of discovering new facts or establishing new relationships among facts already known which will contribute to the present body of knowledge and can lead to effective solution of the present problem. It involves careful or critical thinking to revise or to revalidate accepted conclusions and previously held concepts or established generations or principles. (PNA, 1995)
  11. 11. Nieswiadomy – systematic objective process of analyzing phenomena of importance to nursing. Clinical nursing research indicates nursing research involving clients or studies that have the potential for affecting the care of clients, such as with the studies of animals or the so-called normal subjects.
  12. 12. Customs and tradition - “we’ve always done it that way”. Assembled information (e.g., quality improvement data) Scientific research – the most objective and the source of nursing knowledge. Trial and error – “if it works, we’ll use it”. Logical reasoning (inductive & deductive) Experts or authorities
  13. 13. Reliability/Generalizations - findings can be applied to situation or population larger than the one studied Order Control- minimize bias and maximize the precision and validity of data gathered. Empiricism-objective methods of seeking information Systematic- systematic fashion from identifying a problem to conclusions and recommendations
  14. 14. Identification Description Exploration Explanation Prediction Control
  15. 15. RA 9173 Section 28 (e )states that: It shall be the duty of the nurse to: (e) Undertake nursing and health human resource development training and research which shall include, but not limited to the development of advance nursing practice.
  16. 16. ANA-1989 BSN Degree 1. Critiquing & synthesizing research findings from nursing profession and other discipline for use in practice. 2. Provide valuable assistance in identifying research problems and collecting data for studies.
  17. 17. ANA-1989 Master's Degree 1. To lead health care teams • Making essential changes in nursing practice • Health care system based on research 2. Conduct investigations 3. Initial studies in collaboration with other investigators 4. Facilitate research and provide consultation
  18. 18. ANA-1989 Doctoral Degree 1. Assume a major role in the conduct of research. 2. Generation of nursing knowledge in a selected area of interest. • Extend scientific basis • Develop methods to measure nursing phenomena
  19. 19. ANA-1989 Post Doctoral Degree 1. Assumed a full researcher role and has a funded program of research 2. Develop and coordinate funded research programs
  20. 20. Kristhoff, 1991) 1. Intellectual curiosity 2. Creative thinking 3. Critical thinking 4. Ability to relate study to a known theory 5. Patience and discipline to push the study through 6. Intellectual honesty 7. Sense of humor
  21. 21. The NURSING PROCESS is an orderly and systematic manner of determining the client’s problems, making plans to solve them, initiating plans or assigning others to implement them, and evaluating the effectiveness of those plans.
  22. 22. NURSING RESEARCH NURSING PROCESS 1. Problem Identification • Conceptualize topic • Curiosity about the topic • Brainstorm with peers • Review related literature • Develop conceptual framework • State specific problem 1. Assessment Phase • Collect data from various sources using appropriate techniques 2. Methodological Development 2. Diagnosis Phase • Identify variables • Formulate hypothesis • Develop sampling size • Develop instruments needed and validate • Balance validity with reliability • Validate/organize data • Analyze and interpret actual and potential health problems • Formulate nursing diagnosis
  23. 23. NURSING RESEARCH NURSING PROCESS 3. Data Management • Collect and organize data • Analyze data • Interpret results of study 3. Planning Phase • Prioritize health problems • Identify components of care/resources needed • Set goals, formulate plan of care • Select nursing actions • Set evaluation parameters • Update/modify as needed 4. Disseminate Findings 4. Implementation Phase • Publish findings • Review findings • Critique findings • Implement plan of care • Collaborate with other members • Modify plan as needed
  24. 24. YEAR EVENT 1859 Nightingale’s Notes on Nursing is published 1900 American Journal of Nursing begins publication 1923 Columbia University establishes first doctoral program for nurses Goldmark Report with recommendations for nursing education is published 1936 Sigma Theta Tau awards first nursing research grant in the United States 1948 Brown publishes report on inadequacies of nursing education 1952 The journal Nursing Research begins publication
  25. 25. YEAR EVENT 1955 Inception of the American Nurses’ Foundation to sponsor nursing research 1957 Establishment of nursing research center at Walter Reed Army Institute of Research 1963 International Journal of Nursing Studies begins publication 1965 American Nurses’ Association (ANA) sponsors nursing research conferences 1969 Canadian Journal of Nursing Research begins publication 1972 ANA establishes a Commission on Research and Council of Nurse Researchers
  26. 26. YEAR EVENT 1976 Stetler and Marram publish guidelines on assessing research for use in practice Journal of Advanced Nursing begins publication 1978 Research in Nursing & Health and Advances in Nursing Science begin publication 1979 Western Journal of Nursing Research begins publication 1982 Conduct and Utilization of Research in Nursing (CURN) project publishes report 1983 Annual Review of Nursing Research begins publication 1985 ANA Cabinet on Nursing Research establishes research priorities
  27. 27. YEAR EVENT 1988 Applied Nursing Research and Nursing Science Quarterly begin publication; Conference on Research Priorities is convened by NCNR 1989 U.S. Agency for Health Care Policy and Research (AHCPR) is established 1993 NCNR becomes a full institute, the National Institute of Nursing Research (NINR) The Cochrane Collaboration is established Magnet Recognition Program® makes first awards 1994 Qualitative Health Research begins publication
  28. 28. YEAR EVENT 1995 Joanna Briggs Institute, an international EBP collaborative, is established in Australia 1997 Canadian Health Services Research Foundation is established with federal funding 1999 AHCPR is renamed Agency for Healthcare Research and Quality (AHRQ) 2000 NINR’s annual funding exceeds $100 million The Canadian Institute of Health Research is launched Council for the Advancement of Nursing Science (CANS) is established
  29. 29. YEAR EVENT 2004 Worldviews on Evidence-Based Nursing begins publication 2006 NINR issues strategic plan for 2006–2010 2010 NINR budget exceeds $140 million 2004 Worldviews on Evidence-Based Nursing begins publication Polit, D. F. & Beck, C. T. (2012). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia: Lippincott Williams & Wilkins. pp. 5-8
  30. 30. In the Philippines, nursing research prior to and during the 60’s was mostly on nursing administration (51%), and nursing education (33%), while patient care and related studies received minimal attention, with only 13% and 3% respectively. Teaching of research was integrated in the nursing curriculum in the mid-sixties.
  31. 31. An analysis of nursing studies done from 1935 to 1980 shows that of the 305 studies, 123 or 40% were on nursing service administration, 112 or 37% were on nursing education, 47 or 15.5% were on patient care, and 23 or 7.5% were on related studies (Williams, 1998). In the Philippines today, nursing educators agreed that skill in research should be one of the core competencies of Bachelor of Science in Nursing.
  32. 32. Polit and Beck, 2008 • Heightened focus on evidence-based practice. • Development of stronger evidence-base through rigorous methods and multiple confirmatory strategies. • Greater emphasis on systematic integration of reviews. • Expanded local research in healthcare settings. • Strengthening of multidisciplinary collaboration among nurse researchers.
  33. 33. Polit and Beck, 2008 • Expanded dissemination of research findings. • Increasing the visibility of nursing researchers. • Increased focus on cultural issues and health disparities.
  34. 34. Sigma Theta Tau, 2005 HEALTH PROMOTION AND DISEASE PREVENTION
  35. 35. Sigma Theta Tau, 2005 PROMOTION OF HEALTH OF VULNERABLE AND MARGINALIZED COMMUNITIES
  36. 36. Sigma Theta Tau, 2005 PATIENT SAFETY AND QUALITY OF HEALTHCARE
  37. 37. Sigma Theta Tau, 2005 DEVELOPMENT OF EBP AND TRANSLATIONAL RESEARCH
  38. 38. Sigma Theta Tau, 2005 PROMOTION OF HEALTH AND WELL-BEING OF OLDER PEOPLE
  39. 39. Sigma Theta Tau, 2005 PATIENT-CENTERED CARE AND CARE COORDINATION
  40. 40. Sigma Theta Tau, 2005 PALLIATIVE AND END OF LIFE CARE
  41. 41. Sigma Theta Tau, 2005 CARE IMPLICATION OF GENETIC TESTING AND THERAPEUTICS
  42. 42. Sigma Theta Tau, 2005 CAPACITY DEVELOPMENT OF NURSE RESEARCHERS
  43. 43. Sigma Theta Tau, 2005 WORKING ENVIRONMENTS FOR NURSES
  44. 44. NURSINGJOFRED M. MARTINEZ, RN, MAN • ST. ANTHONY’S COLLEGE EVIDENCE-BASED PRACTICE IN
  45. 45. The ultimate goal of nursing is to provide evidence- based care that provides quality outcomes for patients and their families, healthcare providers, and the healthcare system (Craig & Smith, 2007; Pearson et. Al., 2007)
  46. 46. Evidence-based practice is the conscientious use of current best evidence of making clinical decisions about patient care (Sacheet et. Al., 2000). Evidence-based practice evolves from the integration of the best research evidence with clinical expertise and patient needs and values (Institute of Medicine, 2001; Sachett, et. Al., 2000).
  47. 47. Evidence from research Evidence-based theories Opinion leaders/expert panels Evidence from assessment of patient’s history and physical exam and availability of healthcare resources Clinical expertise Information about patient’s preferences and values Evidence-based clinical decision
  48. 48. The Stetler Model of research utilization to promote evidence-based practice. Five sequential phases of settler model: Phase I: Preparation Phase II: Validation Phase III: Comparative Evaluation and Decision Making Phase IV: Translation/Application Phase V: Evaluation
  49. 49. The Iowa Model of evidence-based practice to promote quality care. Steps of individual EBP: 1. Framing an answerable clinical question 2. Searching for relevant research-based evidence 3. Appraising and synthesizing the evidence 4. Integrating evidence with other factors 5. Assessing effectiveness
  50. 50. Validity of study findings Clinical importance of findings Precision of estimates of effects Associated costs and risks Utility in a particular clinical situation
  51. 51. 1. Identify a problem from practice and turn it into a specific question. 2. Find the best available evidence that relates to the specific question. 3. Critically appraise the evidence for its validity, usefulness and methodological rigor. 4. Identify and use the current best evidence, and together with the patient or client’s preferences and the practitioner’s expertise and experience, apply it to the situation. 5. Evaluate the effect on the patient or client, and reflect on the nurse’s own performance.
  52. 52. A paradigm is a world view, a general perspective on the complexities of the world. POSITIVIST PARADIGM Positivism is rooted in 19th century thought, guided by such philosophers as Mill, Newton, and Locke. Fundamental assumption of positivists is that there is a reality out there that can be studied and known. Research activity is directed at understanding the underlying causes of phenomena.
  53. 53. CONSTRUCTIVIST PARADIGM Constructivism began as a countermovement to positivism with writers such as Weber and Kant. Postmodern thinking emphasizes the value of deconstruction—taking apart old ideas and structures—and reconstruction—putting ideas and structures together in new ways.
  54. 54. POSITIVIST CONSTRUCTIVIST Fixed design Flexible design Discrete, specific concepts Holistic Deductive processes Inductive processes Control over context Context-bound Verification of hunches Emerging interpretations Quantitative information Qualitative information Seeks generalizations Seeks patterns
  55. 55. RESEARCHJOFRED M. MARTINEZ, RN, MAN • ST. ANTHONY’S COLLEGE CLASSIFICATIONS OF
  56. 56. 1. BASIC / PURE RESEARCH • It is done for the intellectual pleasure of learning to search for knowledge for its own sake and eventually filter down the result into real life situation. 2. APPLIED RESEARCH • It results from present problems or from socially disorganized situations. It frequently raises theoretical questions that must be answered by basic/ pure research.
  57. 57. 1. BASIC / PURE RESEARCH • It is done for the intellectual pleasure of learning to search for knowledge for its own sake and eventually filter down the result into real life situation. 2. APPLIED RESEARCH • It results from present problems or from socially disorganized situations. It frequently raises theoretical questions that must be answered by basic/ pure research.
  58. 58.  To solve a problem  To make a decision  To develop a new program, product, and methods  To evaluate program and methods.
  59. 59. 3. ACTION RESEARCH • The process involves the study of certain problem and from that experience, decisions, actions and conclusion are drawn. • Findings are limited to settings actually studied.
  60. 60. QUANTITATIVE RESEARCH Quantitative research is a formal, objective and systematic process in which the numerical data are used to obtain information. It is used to describe variables, examine relationships among variables. Quantitative research requires the use of: structured interviews, questionnaires , or observations; scales; and physiological instruments that generate numerical data.
  61. 61. QUANTITATIVE RESEARCH The types of quantitative research are: Descriptive Correlational Quasi-experimental Experimental
  62. 62. QUALITATIVE RESEARCH Qualitative research is a systematic, interactive and subjective approach used to describe life experiences and give them meaning (Marshall & Rossman, 2006; Munhall, 2001). It is conducted to describe and promote understanding of human experience such as pain, caring and comfort. It is an interpretative methodological approach to produce more of a subjective science than quantitative research.
  63. 63. QUALITATIVE RESEARCH The types of qualitative research are: Phenomenological research Grounded theory Ethnographic research Historical case study
  64. 64. QUANTITATIVE QUALITATIVE Objective data Subjective data Explanation Discovery Parts are equal to the whole Whole is greater than the parts One truth Multiple truths Large sample sizes Small sample sizes Subjects Participants/respondents Results presented as statistics Results presented as narrative data Researcher separate from the study Researcher part of the study
  65. 65. DESCRIPTIVE RESEARCH METHODS Descriptive research provides accurate portrayal or account of characteristics of particular individuals, situations or groups. The types of descriptive research methods: Surveys Analytical studies Causal comparative research
  66. 66. SURVEYS Data are gathered from a relatively large number of cases at a particular time. 1. COMMUNITY SURVEYS Conducted in communities defines by territorial boundaries, interests, social and economic conditions, and a common bond of solidarity.
  67. 67. SURVEYS 2. NORMATIVE SURVEYS Conducted to determine the normal or typical condition of situations or people. 3. SOCIAL SURVEYS Social surveys aim to study and diagnose a current social problem, situation or population within a definite place so as to formulate a constructive program of social reform and amelioration.
  68. 68. SURVEYS 4. SCHOOL SURVEYS Investigations conducted in schools. Types of school surveys: a. Outside expert surveys b. Self-surveys c. Combined surveys
  69. 69. SURVEYS Topics that may be used for school surveys: a. Comprehensive survey b. Educational survey c. Building survey
  70. 70. ANALYTICAL STUDIES Studies involving analysis. 1. JOB AND ACTIVITY ANALYSIS Describes activities of persons who are observed, classified and analyzed. The questions raised in the study are who, what, where, and when. It employs a sampling of observations rather than continuous observation.
  71. 71. ANALYTICAL STUDIES 2. DOCUMENT ANALYSIS Critical analysis of the content written and printed materials as sources of data. CAUSAL COMPARATIVE RESEARCH Discover the antecedents or factors that contribute to some observable facts.
  72. 72. CAUSAL COMPARATIVE RESEARCH Discover the antecedents or factors that contribute to some observable facts. 1. JOB AND ACTIVITY ANALYSIS Describes activities of persons who are observed, classified and analyzed. The questions raised in the study are who, what, where, and when. It employs a sampling of observations rather than continuous observation.
  73. 73. CORRELATIONAL RESEARCH METHODS Examines relationships between two or more variables and determines the type (positive or negative) or degree (strength) of relationship. QUASI EXPERIMENTAL RESEARCH METHODS Identify causal relationships, to determine the significance of causal relationship, and to clarify why certain events happen, or a combination of these.
  74. 74. EXPERIMENTAL RESEARCH METHODS The researcher structures the situation so there will be a sound basis for determining the effect of the dependent variable in relation to the independent variable and how much is due to chance. The study subjects belong either to the control group or the experimental group. Twiss and colleagues (2009) tested the effect of an exercise intervention for breast cancer survivors with bone loss on the women’s muscle strength, balance, and fall frequency. Some women received the 24-month intervention, and others did not.
  75. 75. EXPERIMENTAL RESEARCH METHODS Four strategies: a. Manipulation of the independent variables; b. Use of an experimental group that is exposed to the independent variable or experimental factor and another group that is not exposed to the independent variable or experimental factor.
  76. 76. EXPERIMENTAL RESEARCH METHODS Four strategies: c. Random selection of sample members of the control or experimental groups; and d. Measurement of the effects of the independent variable on the dependent variable before and after the manipulation of the independent variable.
  77. 77. AFTER-ONLY EXPERIMENTAL TECHNIQUE Investigator assigns the subjects to an experimental group and a control group but collects the data only at the end of the treatment or exposure to the independent variable.
  78. 78. BEFORE AND AFTER EXPERIMENTAL TECHNIQUE SINGLE GROUP OR ONE-GROUP DESIGN Steps: 1. pre-testing of the dependent variable 2. exposure of the subjects to the experimental variable 3. post-testing of the subjects; and 4. Comparison of the results of the two tests to determine the effect of the independent variable
  79. 79. BEFORE AND AFTER EXPERIMENTAL TECHNIQUE TWO-GROUP BEFORE AND AFTER TECHNIQUE Steps: 1. matching subjects on the basis of a matching variable; 2. exposing the experimental group to the experimental factor and the control group to the ordinary treatment; 3. Testing both groups on the dependent variable; and 4. Comparing the results to determine the effect of the experimental factor.
  80. 80. TWO GROUPS WITH CONTROL GROUP TECHNIQUE Study subjects are selected from the target population and are further subdivided into the experimental and control groups by the process of random assignment. The experimental group is subjected to different experimental factors while the control group is tested with the ordinary treatment. The results are compared to determine the effects of the experimental factors.
  81. 81. Concepts relevant to quantitative research: PURE OR BASIC RESEARCH The search for new knowledge includes establishment of fundamental theories or relationships among facts not intended for immediate use in real life-situations. APPLIED RESEARCH Scientific investigations conducted to generate knowledge that will directly influence or improve a clinical situation, make a decision, develop or evaluate a procedure, program or product.
  82. 82. Concepts relevant to quantitative research: RIGOR IN QUANTITATIVE RESEARCH Rigor involves discipline, scrupulous adherence to details and strict accuracy. CONTROL Imposing conditions on the research situations so that biases are minimized and precision and validity are maximized.
  83. 83. PHENOMENOLOGICAL RESEARCH METHODS Humanistic study of phenomenon that is conducted in a variety of ways according to the philosophy of the researcher. Participant’s lived experiences are expressed through the researcher’s interpretation and underlying philosophy of the phenomenological study. Schachman (2010) conducted in-depth interviews to explore the lived experience of first-time fatherhood from the perspective of military men deployed to combat regions during birth.
  84. 84. GROUNDED THEORY RESEARCH METHODS Useful for discovering what problems exist in a social setting and the process people use to handle them. Grounded theory methodology emphasizes observation and the development of practice-based intuitive to formulate, test, and redevelop prepositions until a theory evolves. Propp and colleagues (2010) conducted a grounded theory study to examine critical healthcare team processes. They identified specific nurse–team communication practices that were perceived by team members to enhance patient outcomes.
  85. 85. ETHNOGRAPHIC RESEARCH METHODS Provides mechanisms for studying one’s own culture and that of others. Ethnography describes and analyzes aspects of the way of life of a particular culture or subculture group. Hessler (2009) conducted ethnographic fieldwork to investigate physical activity and active play among rural preschool children.
  86. 86. HISTORICAL RESEARCH METHODS Used if the researcher believes that the answer to his research lies in the past. This approach can shed light on current conditions and problems through a deeper and fuller understanding of what has already been done.
  87. 87. SOURCES OF DATA PRIMARY SOURCES Provides first-hand information that serves as clear evidence about the past. Consists of: 1. Remains or relics which are associated with a person or group or period such as fossils, skeletons, tools, clothing, etc.
  88. 88. SOURCES OF DATA PRIMARY SOURCES 2. Oral or written testimony are records kept and written by actual participants or witnesses of an event. Such sources are transmitted as valuable information in the future.
  89. 89. SOURCES OF DATA SECONDARY SOURCES Second-hand or third-hand accounts used in the absence of primary data. They are reports of a person who relates the testimony of an actual witness to or participant in an event.
  90. 90. EXTERNAL CRITICISM OR AUTHENTICITY Used to determine the genuineness of the document, evidence or remains. INTERNAL CRITICISM OR CREDIBILITY Data are appraised of their internal contents. Internal criticism weighs statements as to validity.
  91. 91. Involves an in-depth investigation of a single unit of study, such as a person, family, group, community or institution or a small number of subjects who are examined intensively. Researchers attempt to analyze and understand issues that are important to the history, development or circumstances under study.

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