Chapter 4 NURSING RESEARCH
NURSING RESEARCH
The term ‘research’ refers to a systematic way of studying or examining issues so that the knowledge about that issue is validated. It requires an understanding of the existing knowledge about the issue so that new knowledge can be developed. There are many words and terms specifically related to research referred to in this chapter, which are covered in Table 4.1 (later in the chapter).
Bias | Any influence that may alter the outcomes of a research study |
Clinical nursing research | Nursing research that has a direct impact on nursing interventions with clients |
Data | Measurable bits of information collected for the purpose of analysis |
Data collection | Gathering of information necessary to address the research problem |
Deductive reasoning | Logical system of thinking that starts with the whole and breaks it down into its component parts |
Dependent variable | A variable that is affected by the action of the independent variable |
Ethics committee | Committee responsible for review of research proposals to ensure that human subjects are protected from harm |
Hypothesis | Statement of a predicted relationship or difference between two or more variables. A hypothesis contains at least one independent and one dependent variable |
Independent variable | A variable that causes a change in the dependent variable |
Inductive reasoning | Logical system of thinking that begins with the component parts and builds them into a whole |
Informed consent | An agreement by a research subject to participate voluntarily in a study after being fully informed about the study and the risks and benefits of participation |
Instrument | Device or technique used to collect data in a research study, e.g., questionnaires or interviews |
Literature review | A critical summary of available theoretical and research literature on the selected research topic. It places the research problem for a particular study in the context of what is currently known about the topic |
Nursing research | Research usually conducted by nurses to generate knowledge that informs and develops the discipline and practice of nursing |
Population | All known subjects that possess a common characteristic of interest to a researcher |
Problem statement | A statement that describes the purpose of a research study, identifies key concepts and sets study limits |
Qualitative research | Used to examine subjective human experiences by using non-statistical methods of analysis |
Quantitative research | The systematic process used to gather and statistically analyse information that has been measured by an instrument and converted to numerical data |
Reliability | Characteristic of a good instrument; the assessed degree of consistency and dependability |
Research | A systematic process using both inductive and deductive reasoning to confirm and refine existing knowledge and to build new knowledge |
Research design | The overall plan for collecting data in a research study |
Research process | An orderly series of phrases identifying steps that allow the researcher to move from asking a question to finding an answer |
Research question | Use of an interrogative format to identify the variables to be studied and possible relationships or differences between those variables |
Sample | A subset of a population selected to participate in a research study |
Validity | A characteristic of a good instrument; the extent of an instrument’s ability to measure what it states it will measure |
Variable | A concept, characteristic or trait that varies within an identified population in a research study |
EVIDENCE-BASED PRACTICE
Evidence-based nursing is a clinical activity based on the belief that decisions about the delivery of care to clients should be informed by the best available and current scientific evidence (Beanland et al 2004). Another definition of evidence-based practice is that it is a process within which clinical decisions are made by practitioners using the best available research evidence, their clinical expertise and client preferences, with consideration also of available and finite resources (Schneider et al 2007). The five steps universally accepted as being necessary for evidence-based practice are presented in Clinical Interest Box 4.1. Clinical Interest Box 4.2 explains evidence-based practice.
CLINICAL INTEREST BOX 4.1 Steps in evidence-based practice
(Source: Jackson et al 2006; Sackett et al 2000 as modified in Schneider et al 2007: 305)
CLINICAL INTEREST BOX 4.2 Evidence-Based Practice
What Is Evidence-Based Practice?
Why Do We Need Evidence-Based Practice?
* Descriptions can be found at this website, but access to systematic reviews is by subscription only.
(Brown et al 2008: 13)
THE EVOLUTION OF NURSING RESEARCH
Research was slow to develop in nursing, with little formal research carried out by nurses until the late 1940s. Nursing schools evolved from military and religious roots and stressed order and obedience. Training was viewed as an apprenticeship, with long hours, and nurses had little say in their own training or work. Only when nursing began to move towards advanced education and affiliation with university settings did nursing research begin to emerge. This move began in the USA. In the 1960s and 1970s the number of nurses with advanced degrees and research skills increased and the push for doctoral preparation in nursing began. Nurses began to turn to nursing care and clinical practice to provide questions for research. Nursing theories evolved that attempted to describe and explain the practice of nursing and these theories began to be tested by nurse researchers. Practice-related research flourished and by the end of the 1970s two new research journals were launched in the USA to handle the nursing research explosion (Borbasi et al 2004).
RESEARCH METHODS
The major factor that affects whether a nursing researcher uses systematic, controlled methods for studying events or problems is the extent to which he or she wishes to study the way that characteristics or variables (see Table 4.1) are different, or the way that one variable is predictive of (causally associated with) another. These studies are well organised and follow a specific procedure to enable other researchers to reproduce the study or examine the evidence and achieve the same outcomes. To guide the design of a research study, nurse researchers may create a hypothesis or statement about what they expect to see before conducting the study (Crisp & Taylor 2005).
QUANTITATIVE METHODS
Quantitative research methods involve the use of numbers and statistical analysis. This is a process used to gather and analyse information that has been measured by an ‘instrument’, such as a questionnaire, and converted to numerical data. Quantitative nursing research is the investigation of nursing phenomena that lend themselves to a precise measurement, such as pain severity, rate of wound healing, etc (Crisp & Taylor 2005). Box 4.1 describes different ways of using quantitative methods.
Box 4.1 Types of research that use quantitative methods
QUALITATIVE METHODS
Qualitative research is used to describe information obtained in a non-numerical form, such as data obtained from interviews. Qualitative nursing research is the investigation of phenomena that are not easily quantified or categorised, in which inductive reasoning is used to develop generalisations or theories from specific observations or interviews (Crisp & Taylor 2005). See Box 4.2 for the different ways of using qualitative methods.
Box 4.2 Types of research that use qualitative methods
THE RESEARCH PROCESS
There are several steps in conducting either quantitative or qualitative research.
STEP 3. LITERATURE REVIEW
The literature review provides a way of checking what has already been studied in relation to the proposed study. It can also provide an understanding of the procedures, methods of analysis and variables that can influence the study (see Box 4.3).
Box 4.3 Overall purpose of a literature review
How to search successfully for information
Several electronic indexes are used for nursing journals (Box 4.4), including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Index Medicus (a comprehensive index of peer-reviewed medical journals compiled by the US National Library of Medicine) and its online counterpart, MEDLINE (Medical Literature Analysis and Retrieval System [MEDLARS] online). Each index has a primary area of focus and advantages and limits. Electronic databases operate with a special vocabulary. However, the computer helps the researcher to define the preferred terms to use in a search. It is important to make the search as precise as possible; if there are several key terms, they should be used. Other limits such as gender, age and/or time factors, should also be set. Ask for assistance from the librarian if there is difficulty finding information. Many professional information sources are also available on the internet, where there is access to a wide variety of databases, client and nursing education resources, as well as some nursing journals (see Online Resources at the end of this chapter).