PPt Used in class

1. Nursing Research :
An Introduction

2. Trust in the LORD with all your heart; and lean not
to your own understanding. In all your ways
acknowledge him, and he shall direct your paths.
- Proverbs 3:5-6
2

3. Definition of Research and
Nursing Research
Nelia S. Bañaga – Perez, RN, PhD, DNS
3

4. BASICTERMINOLOGIESIN
RESEARCH

5. ▹ Research
▹ Nursing Research
▹ Hypothesis
▹ Theory
▹ Assumption
▹ Paradigm
▹ Variable
▹ Instrument/tool
▹ Conceptual and
Operational Definition
▹ Quantitative and
Qualitative data
▹ Database Access
5

6. Nursing research
• A systematic, objective, process of analyzing
phenomena of importance to nursing.
Theory
• A set of related statements that describes or
explains phenomena in a systematic way.

7. Concept:
"A general idea referring to a behavior or
characteristic of an individual, group, or nation".
For example, pain, patient care, coping,
happiness, cleanliness, dignity…etc.

8. Construct:
• "A concept specified in such a way that it is
observable in the real world, in order to
facilitate testing of the idea".
• For example, position, in real world has many
different meanings in gynecology, in surgery and
in management.

9. Example of the relationship between
"concept" and "construct":
• Weight
• Weight By electronic scale.
In the morning.
Before breakfast.
Without clothes.
A
construct
A concept

10. Conceptual definition:
"The definition or description of the study variables that is
drawn from the theoretical or conceptual framework“
Conceptual framework
A background or foundation for a study; a less well-
developed structure than a theoretical framework; concepts
are related in a logical manner by the researcher.

11. Conceptual model
• Symbolic presentation of concepts and the
relationships between these concepts.
Operational definition
• The definition of a variable that identifies how
the variable will be observed or measured.

12. Assumption:
"A statement of principles whose correctness
has not been proven, but is taken for granted
on the basis of logical reasoning".
"health is a priority for all people"

13. Hypothesis:
"A statement of predicted or expected
relationships between the variables of the
research (dep. & indep. variables)".
Hypothesis lead to empirical studies that are
seeking to confirm or disconfirm these
predictions.

14. Research design
• The overall plan for gathering data in a research
study.
Pilot study:
"A small scale trial done in preparation of a major
research".

15. Validity:
▹“Degree or extent to which the tool or
instrument measures what it is
supposed to measure".
▹For example, a ruler measures the
height not the weight, while the scale
measures the weight not the height.

16. Reliability:
• Degree or extent of consistency or dependability
with which a study tool measures the variable
over time, by different persons".

17. Population:
• “Group of people who are going to be studied, and to whom
should the study result apply".
• It is the complete set of persons or objects that possess some
common characteristics of interest to the researcher.
For example, in a research studying the factors affecting the
nurse's workload , bed-side nurses are the population .

18. Target population
• The entire group of people or objects to which the
researcher wishes to generalize the findings of a
study.
Accessible population
• The group of people or objects that is available to
the researcher for a particular study.

19. Sample:
• "Are those persons – in the population- from whom
data will be actually collected, and from whom
generalizations about the population will be
made".
• A subset of the population that is selected to
represent the population.

20. Variable:
"A concept that is observable, measurable, and
has a dimension that can vary".
For example, temperature is a variable that is
observable, measurable, and varies from high
to low.

21. Types of Variables
1. Dichotomous variables
2. Attribute variable
3. Active variables.
4. Dependent and independent variables .
5. Extraneous variable

22. 1. Dichotomous variables.
Variables that vary in only two values.
For example:
Male Vs female.
Alive Vs dead.
Day Vs night.

23. 2. Attribute variable / demographic
variables:
A pre-existing characteristic or attribute such as
age, sex …etc. which the researcher simply
observes and measures.

24. 4. Dependent and independent variables
Independent variable: “Variable that is believed to
cause or influence the dependent variable".
Dependent variable: “Variable that is
influenced by the independent variable".

25. Does Smoking Cause Lung cancer ?
Does Nursing care Cause Rapid recovery?
Does Drug (a) Cause Improvement ?
Cause Effect
Independent variable Dependent variable

26. Extraneous variable/ intervening variable
• Variable that confound the relationship between the
dependent and independent variables, thus it needs to be
controlled.
• E.g., "air pollution" is an extraneous variable interferes with
studying the relationship between smoking "independent
variable" and lung cancer "dependent variable".

27. Data:
Pieces of information that are collected as they pertain to
the study".
Limitations:
• "Weaknesses in a research“
• Uncontrolled extraneous variables, that limit the
generalizability of the findings.

28. Measurement
• A process in scientific research that uses rules to assign numbers
to objects.
Abstract
A brief summary of a completed research or a proposal. It contains
purpose, method and major findings of the study, located at the
beginning of a report or a proposal.

30. Sources of evidence for nursing practice
• Unstructured methods
▫ Tradition
▫ Authority
▫ Clinical experience
▫ Trial & error
▫ Intuition

31. • Structured methods
▫ Logical reasoning
Inductive reasoning - generalization from specific
Deductive reasoning -developing specific
prediction from generalization
▫ Assembled information
▫ Disciplined research
▫ Problem solving

32. Problem solving
Definition
The process of analyzing & solving a problem.

33. Problem solving process
Problem
definition
Problem
analysis
Generating
possible
solutions
Analyzing
the
solutions
Selecting
the best
solutions
Implementing
the solutions
Evaluation
and revision

34. Scientific methods
Defined as controlled systematic investigations routed
in a objective reality aiming to develop general
knowledge about natural phenomenon.
Characteristics
Orderly & systematic
Attempt to control extraneous variable thatare not
under direct investigation
Findings are based onempirical evidence
Findings can be generalized
Based on assumptions or hypothesis
Conducted to develop or test theories

35. Purposes
• Description
• Exploration
• Explanation
• Prediction
• Control
• Prescription
• Identification of relationship of facts

36. Steps of scientific process
Selecting the
topic &
identifyingthe
problem
Define
objectives
ROL
Defining
conceptsand
variables
Stating
hypothesis
Identifying
assumptions
and
implications
Determine
ethical
implication
Describe r/s
design &
methods for d/c
Define study
population&
sample
Plan for data
analysis &
discussion
Collecting data
from subjects
Analysing &
interpreting
Communicating
study findings

37. Limitations
• Moral or ethical problem
• Human complexity
• Measurement problems
• Extraneous variable

38. Definition - nursing research
• Research is a systematic inquiry that uses disciplined
methods to answer questions or solve problems
• Goal - to develop, refine & expand knowledge
• Acc to Polit & Beck : - Nsg research is a systematic inquiry
which develop trustworthy evidence issues of importance
to nsg prof.
Nsg .prac, edu., admin, informatics.

39. Purposes
Identification & description
Studying a phenomenon that is little known (quant.)
Indepth probing nature (qual.)
Eg of identification --- X (2009) studied the experiences of women after
breast cancer treatment. She identified through indepth conversation
with 13 women, a unique description of intense loneliness that she called
as survivor loneliness
Eg of description ----- X (2009) undertook a indepth study to describe
how women coped with breast cancer in the period between
diagnosis & surgery.

40. Exploration
▫ The researcher investigates the full nature of the
phenomenon , the manner in which it is
manifested and related factors.
 Explanation
▫ Explanatory r/s understands the underpinnings of the natural
phenomenon and explain the
systematic relationship among them.

41. Prediction & Control
• The researcher makes prediction and control a phenomenon
based on research finding.
▫ Eg: a research has shown that the incidence of Down’s syndrome in
infants increase with age of the mother.
We can predict that a women aged 40 yrs is at risk of bearing a child
with Down’s syndrome than a women aged 26 yrs.
▫ We can partially control the outcome by educating the women about
the risk.

42. Purposes linked to EBP
• Treatment , therapy or intervention
▫ Studies are designed to develop evidence based
treatment decision ---- how to prevent a d/s , decide on
a therapy, or compare b/w two therapies.
• Diagnosis & assessment
For development and evaluation of formal instruments to
screen , diagnose and assess pt. conditions.

43. Prognosis
• These type of studies examine the outcome
associated with a disease or health problem , estimate
the probability that they will occur , and indicate when
the outcomes are most likely.
Prevention of harm
• Providing information to patients as how to
avoid potentially harmful exposures.

44. Etiology or causation
▫ To know the cause of a d/s so as to prevent it
▫ To identify the factors that affect or cause illness,
mortality or morbidity
Meaning and processes
▫ r/s provide evidences about what health & illness mean to clients,
what barriers they face to practice positive healthy life style, what
processes they
experience in transisition through a health care crisis.

45. Need of nursing research
Develop, refine & extend the scientific base of knowledge
Enhance the body of knowledge
Provide foundation for EBN
For growth of the profession
Define parameters of the nursing profession
Refine & eliminate the old knowledge
Identify cost effective nursing practices
Develop & refine nursing theories & principles
Solve problems to answer questions related to nursing practice, education
and administration

46. Significance of nursing research
• ALL needs + purposes & to:-
• Build and expand the body of knowledge
• Validate and refine the existing nursing practice
• Make health care efficient and cost effective

47. Characteristics of good research
• Orderly & systematic process
• Based on current professional issue
• Begin with clearly defined objectives
• Emphasize to develop , refine & expand the body of knowledge
• Directed towards developing or testing theories
• Finding solution to a problem
• Dedicated to develop empirical evidence

48. Strive to collect first hand information
Logical process
Generate findings to refine and improve professional practices
Use of appropriate methodology
Conduct on representative sample
Conducted through appropriate use of methods and tools for data collection
Carefully recorded and reported
Adequately & appropriately analyzed research
Patiently carried out
Researcher’s expertise , interest and motivation
Adequately communicated

49. Qualities of a good researcher
R - research oriented
E - efficient
S - scientific
E - effective
A - active
R - resourceful
C - creative
H - honest
E - economical
R - religious

51. Types of research
Based on approach
Quantitative
r/s
Experimental r/s
Quasi experimental
r/s
Non experimental
r/s
Qualitative r/s
Phenomenological
Ethnographic
Grounded theory
Case study
Historical
Based on purpose
Basic r/s
Applied r/s

52. • Comparison of quantitative & qualitative r/s
Parameters Quantitative r/s Qualitative r/s
General nature Obj. approach --numerical form Subj. approach -- narrative form
Knowl. Of
study
variables
Clear understanding in advance Rough understanding in advance
Aims Test / refine the theories & hypo. To develop theories / hyp.
r/s problem Deductively reasoned Inductively reasoned
Planning Designed before data collection Designed as the study emerges
r/s design Exp, quasi, non exp Phen. , g.t , eth., c.s, hist. r/s
Sample Large sample size Small sample size
Data Easier to collect Time consuming
Tools Structured or semi structured Less formally structured tools
Methods r/ser remain separated from
the subj. matter
r/s er become immersed in
the subject matter
Analysis Descriptive and /or
inferential statistics
Descriptive coding,
indexing, narration,
thematic analysis

53. Scope of nursing research
• r/s in clinical nsg. practices
• r/s in nsg. Education
• r/s in nsg administration
• r/s in health systems and outcomes of care

54. r/s in clinical nsg. practice
Areas :
Health promotion, maintenance and disease prevention
Patient safety and quality of health care
Promotion and risk reduction interventions of health of
vulnerable , minority gps and marginalized community
Patient centered care and care co-ordination
Promotion of health and well being of older people
Palliative and end of life care

55. • Care implication of genetic testing and
therapeutics
• Nurse’s working envt.
• Home care and community health care practices
• Treatment compliance and adherence to
treatment

56. r/s in nursing education
Testing effectivity & efficiency of old teaching methods and generating new
methods
Curriculum taught and learning exp. Of nsg. Students at UG &PG level
Extent of strict discipline required for nsg students to improve
learning
Promoting clinical and class room learning among students
Refining & generating evaluation methods
Identifying and managing problems of absenteeism and lack of motivation

57. r/s in nursing administration
• Assessing existing organizational structure , span of
control, communication, staffing pattern, wages,
benefits, performance evaluation practice.
• Refining old know. Regarding nsg administrative
phenomenon
• Developing and testing different administrative methods
to enhance swift administration , employee & customer
satisfaction

58. • Recruitment , deployment, retention, and
effective use of nursing personnel in providing
the quality of nursing care
• Any phenomenon related to nsg administrative
issue.

59. r/s in health systems and outcome of care
• Developing models of health care
• Developing cost effective health care model for
rural and deprived communities
• Effective use of information and technology
from tertiary care centers to remote areas
• Evaluating the effectiveness of existing policies
and programmes

60. Problems & challenges in nursing, health and social
research
Lack of disciplined research
Handling multiple variables
Difficulty in controlling external variable
minimal possibility of laboratory r/s
Lack of standardized tools
Measuring qualitative phenomenon throu’ quantitative means
Lack of interest among researchers
Ethical constraints
Lack of qualitative research expertise

61. Overview of research process

62. Phase 1
The conceptual
phase
• Formulating &
delimiting the
problem
• Reviewing the
related literature
• Undertaking the
clinical field work
• Defining the
framework
• Formulating the
hypothesis
Phase 2
The design and planning
phase
• Selecting the
r/s design
• Developing
intervention
protocols
• Identifying the
population
• Designing the
sampling plan
• Specifying
methods to
measure r/s
variables
• Developing
methods to
safeguard
subjects
• Finalizing the
r/s plan
Phase 3
The empirical
phase
• Collecting
the data
• Preparing
the data
for
analysis
Phase 4
The analyticphase
• Analyzing
the data
• Interpreti
ng the
results
Phase5
The
dissemination
phase
• Communic
ating the
findings
• Utilizing
the findings
in practice

63. Qualitative r/s process
PLANNING THE STUDY
1. Identifying the r/s pblm
2. Doing a ROL
3. Developing an overallapproach
4. Selecting and gaining entry into
r/s site
5.Developing methodsto
safeguard participants
DEVELOPING D/C
STRATEGIES
1. Deciding what type of data to
gather and how to gather
2. Deciding from whom to
collect the data
3. Deciding how to enhance
trustworthiness
DISSEMINATINGTHE
FINDINGS
1. Communicating he
findings
2. Utilizing findings
in practice
GATHERING & ANALYZING THE DATA
1. Collecting the data
2. Organizing and analyzing the data
3.Evaluating the data : making
modifications to d/c strategies
4. Evaluating the data: determining if
saturation has been achieved

64. Future trends in nsg. r/s
Continued focus on EBP
Development of a stronger base throu multiple, confirmatory
strategies
Greater emphasis on systematic reviews
Expanded local r/s in health care settings
Strengthening interdisciplinary collaboration
Expanded dissemination of research findings
Increasing the visibility of nursing research
Increased focus on cultural issues and health disparities
Shared decision making

66. • Acc to David Sackett : EBP is the integration of
best research evidence with clinical expertise
and patient values.

67. Purposes - EBP
• Specify the way in which a decision has to be
made based on evidence
• Eliminate unsound or excessively risky practices
• Provide highest quality and most cost efficient
nursing care possible

68. Steps of EBP
Formulating a
clear question
based on a
clinical problem
Literature review
to search beat
available
evidence
Analysis of
strengths and
weaknesses of
evidences
Use of best
evidences in
clinical practice
Evaluating the
efficacy of
empirical
evidences

69. Barriers in EBP
Overwhelming amt of information available and contradictory
findings
lack of professional ability to critically appraise r/s
Lack of time, workload pressure, competing priorities of pt care can impede
use of EBP
Lack of knowledge of r/s methods
Lack of support from prof. colleagues and org.
Shortage of r/s in some areas of nsg.
Resistance to change
Lack of CE programs
Lack of interest to create the envt of EBP
Physician’s dominance in clinical practices

71. Effects of Pre Operative
Nursing Care Rendered by
Nurses to Patients
Undergoing Surgery
71

72. Definition
• It is the act of moral principles that the
researcher has to follow while conducting
nursing research to ensure the rights and welfare
of individuals, groups or community under
study.

73. Development of ethical codes
• The ten commandments in bible are the best
example of a code of conduct
• Ethical principles frequently change with time
and the development of new knowledge
• The 1947 Nuremberg Code resulted from the
revelations of unethical human behaviour from
World War II

74. • The criteria's of Nuremberg Code:
▫ The researcher must :
Inform subjects about the study
Be based on animal experiments if possible
Try to avoid injury to research subjects
Be qualified to conduct research
Stop the study if problems arise
• In 1978 The National Commission for Protection of
Human Subjects of Biomedical and Behavioural
Research was formed
• The report by this Commision submitted in 1979- titled
as the Belmont report is now being utilized in the
research ethics.

75. Importance of ethics
• Protect the vulnerable gp - harmful effects of the
experimental interventions
• Safeguard the participants from exploitation by
r/sers
• Establish risk - benefit ratio for study subjects
• Ensure fullest respect, dignity, privacy, disclose
of information and fair treatment for stud
subjects
• Build the capability of the subjects to accept or
reject participation in study

76. Ethical principles for protecting study
participants
Acc to Belmont Report :-
1.Principle of beneficence – research subjects
should be protected from harm
2.Principle of justice – research subjects should get
fair treatment
3.Principle of respect for human dignity - research
subjects must have the autonomy and self
determination

77. 1.Principle of beneficence
• Beneficence - imposes a duty on r/sers to
minimize harm and maximize benefits.
• covers multiple dimension :-
Rt. To freedom from ham & discomfort
Rt to protection from exploitation

78. Rt to freedom from harm &discomfort
r/sers have an obligation to prevent , avoid or minimize harm
to subjects
Harm or discomfort can be physical, emotional, social,
financial.
Establish risk - benefit ratio
Rt. To protection fromexploitation
Involvement in a study must not expose the samples to
damage.
Assure the samples that the information they provide will
not be used against them.

79. 3.Principle of respect for human dignity
• Include the rt to self determination and the right to full
disclosure.
• Rt to self determination
▫ means that the participants can voluntarily decide whether to
take part in the study
▫ People have the rt to ask questions, refuse to give information
and to withdraw from the study.
▫ Also include freedom from coercion - threat of penalty if failing
to participate in the study/ excessive rewards for agreeing to
participate in the study

80. • Rt to full disclosure
▫ Means that the r/ser has fully described the nature of the
study, the persons right to refuse participation , the r/sers
responsibility and the likely risk and benefits.
▫ Full disclosure + self determination = informed consent
▫ Covert data collection (concealment) - collection of data
without the participants knowledge & consent
▫ Deception - deliberately withholding information about the
study / providing false information

81. 3.Rt to justice
• Includes participant’s right to fair treatment and
their right to privacy.
• Rt .to fair treatment
▫ Equitable distribution of benefits and burdens of
research
▫ Distributive justice

82. • Rt to privacy
▫ anonymity of participants & confidentiality of
information must be maintained
▫ No information collected from study participants
can be used for other than r/s purpose

83. Informed consent
• Adequate information about the r/s is given in a
simple & easily understandable unambiguous
language in a document - informed consent
form

84. Content / elements of informed consent form
▹ Participant status
▹ Study goals
▹ Type of data
▹ Procedures
▹ Nature of commitment
▹ Sponsorship
▹ Participant selection
▹ Potential risks
▹ Potential benefits
▹ Alternatives
▹ Compensation
▹ Confidentiality pledge
▹ Voluntary consent
▹ Rt to withdraw & withhold information
▹ Contact information

85. ICMR ethical guidelines for biomedical research
Principles of:
 Essentiality
 Voluntariness, IC, community agreement
 Non exploitation
 Privacy and confidentiality
 Precaution & risk minimization
 Professional competence
 Accountability & transparency
 Maximization of public interest & distributive justice
 Institutional agreements
 Public domain
 Totality of responsibility
 Compliance

86. Code of ethics for nurses in India
• The nurse respects the uniqueness of an
individual in provision of care
• The nurse respects the rights of the individuals
as partners in care and helps in making
informed choices
• The nurse respects individuals’ rt to privacy,
maintains confidentiality and shares
information judiciously
• The nurse maintains competence in order to
render quality nursing care

87. • The nurse is obliged to practice within the frame
work of ethical, professional and legal
boundaries
• The nurse is obliged to work harmoniously with
the members of the health team
• The nurse commits to reciprocate the trust
invested in nursing profession by the society

88. Ethical responsibilities of a nurse
researcher
• Ensures the respect of individuals autonomy in
consenting to participate in r/s
• Adequate protection of the vulnerable group
• Ensure optimum balance b/w benefit risk ratio
• Privacy, confidentiality, anonymity must be
promised
• Maintain competence in identified r/s area