Chapter 5
Research Problems, Purposes, and Hypotheses
After completing this chapter, you should be able to:
1. Identify research topics, problems, and purposes in published quantitative, qualitative, and outcomes studies.
2. Critically appraise the research problems and purposes in studies.
3. Critically appraise the feasibility of a study problem and purpose by examining the researcher’s expertise, money commitment, availability of subjects, facilities, and equipment, and the study’s ethical considerations.
4. Differentiate among the types of hypotheses (simple versus complex, nondirectional versus directional, associative versus causal, and statistical versus research) in published studies.
5. Critically appraise the quality of objectives, questions, and hypotheses presented in studies.
6. Differentiate the types of variables in studies.
7. Critically appraise the conceptual and operational definitions of variables in published studies.
8. Critically appraise the demographic variables measured and the sample characteristics described in studies.
Associative hypothesis, p. 149
Background for a problem, p. 131
Dependent (outcome) variable, p. 153
Directional hypothesis, p. 150
Environmental variables, p. 154
Feasibility of a study, p. 143
Independent (treatment or intervention) variable, p. 153
Nondirectional hypothesis, p. 150
Operational definition, p. 155
Research objective or aim, p. 145
Sample characteristics, p. 157
Significance of a research problem, p. 131
Statistical hypothesis, p. 151
We are constantly asking questions to gain a better understanding of ourselves and the world around us. This human ability to wonder and ask creative questions is the first step in the research process. By asking questions, clinical nurses and nurse researchers are able to identify significant research topics and problems to direct the generation of research evidence for use in practice. A research topic is a concept or broad issue that is important to nursing, such as acute pain, chronic pain management, coping with illness, or health promotion. Each topic contains numerous research problems that might be investigated through quantitative, qualitative, and outcomes studies. For example, chronic pain management is a research topic that includes research problems such as “What is it like to live with chronic pain?” and “What strategies are useful in coping with chronic pain?” Qualitative studies have been conducted to investigate these problems or areas of concern in nursing (Munhall, 2012). Quantitative studies have been conducted to address problems such as “What is the most accurate way to assess chronic pain?” and “What interventions are effective in managing chronic pain?” Outcomes research methodologies have been used to examine patient outcomes and the cost-effectiveness of care provided in chronic pain management centers (Doran, 2011).
What Are Research Problems and Purposes?
A research problem is an area of concern in which there is a gap in the knowledge needed for nursing practice. Research is required to generate essential knowledge to address the practice concern, with the ultimate goal of providing evidence-based nursing care (Brown, 2014; Craig & Smyth, 2012). In a study, the research problem (1) indicates the significance of the problem, (2) provides a background for the problem, and (3) includes a problem statement. The significance of a research problem indicates the importance of the problem to nursing and health care and to the health of individuals, families, and communities. The background for a problem briefly identifies what we know about the problem area, and the problem statement identifies the specific gap in the knowledge needed for practice. Not all published studies include a clearly expressed problem, but the problem usually can be identified in the first page of the report.
The research problem and purpose from the study of Piamjariyakul, Smith, Russell, Werkowitch, and Elyachar (2013) of the effectiveness of a telephone coaching program on heart failure home management by family caregivers are presented as an example. This example is critically appraised using the following guidelines.
Critical Appraisal Guidelines
Problems and Purposes in Studies
1. Is the problem clearly and concisely expressed early in the study?
2. Does the problem include the significance, background, and problem statement?
3. Does the purpose clearly express the goal or focus of the study?
4. Is the purpose focused on the study problem statement?
5. Are the study variables and population identified in the purpose?
Research Example
Problem and Purpose of a Quantitative Study
“Results of meta-analyses and American Heart Association (AHA) guidelines emphasize the critical importance of family caregivers’ involvement in home management of heart failure (HF). Family caregivers perform daily HF home management and provide essential support for patients in recognizing worsening symptoms (i.e., edema, shortness of breath; Riegel et al., 2009).”
Piamjariyakul et al., 2013, p. 32
“Results of several studies have shown that HF rehospitalization is frequently precipitated by excess dietary sodium, inappropriate changes or reductions in taking prescribed medications, and respiratory infections, most of which family caregivers could help prevent if they were educated to be alert for these problems. . . . One intervention program found that a family partnership program on HF home care was helpful in adherence to diet with significant reductions in patients’ urine sodium (Dunbar et al., 2005).”
Piamjariyakul et al., 2013, p. 32
Piamjariyakul and colleagues (2013) presented a clear, concise research problem that had the relevant areas of (1) significance, (2) background, and (3) problem statement. HF is a significant, costly chronic illness to manage, and family caregivers are essential to the management process. A concise background of the problem was provided by discussing studies of the effects of caregivers on the outcomes of patients with HF. The discussion of the problem concluded with a concise problem statement that indicated the gap in the knowledge needed for practice and provided a basis for the study conducted by these researchers. Each problem provides the basis for generating a variety of research purposes and, in this study, the knowledge gap regarding the effectiveness of interventions on HF home management by family caregivers provides clear direction for the formulation of the research purpose.
In a published study, the purpose frequently is reflected in the title of the study, stated in the study abstract, and restated after the literature review. Piamjariyakul and associates (2013) included the purpose of their study in all three places. The focus of this study was to examine the effectiveness of a telephone coaching program on HF home management (independent variable) on caregiving burden, confidence in providing HF care, preparedness, satisfaction, and program cost (dependent variables) for family caregivers (population). The purpose indicated the type of study conducted (quasi-experimental) and clearly identified the independent variable (telephone coaching program), population (patients with HF and their families), and setting (home). However, the dependent variables are not clearly identified in the study purpose but were discussed in the methods section of the study. The study purpose would have been strengthened by the inclusion of the dependent variables measured in this study.
The findings from the study by Piamjariyakul and co-workers (2013, p. 38) indicated that “The telephone coaching program was shown to reduce the caregiving burden and improve caregiver confidence and preparedness in HF home care management. . . . The cost for the program is considerably less than the cost for home healthcare providers ($120-160 per each visit), a single emergency department visit, or one inpatient hospitalization for HF due to poor HF home management.” This study has potential for use in practice to improve the quality of care provided to patients and families; however, the researchers did recognize the need for additional testing of the coaching program with a larger sample to determine its effectiveness. This type of study supports the Quality and Safety Education for Nurses (QSEN, 2013; Sherwood & Barnsteiner, 2012) prelicensure competency to ensure safe, quality, and cost- effective health care that actively involves patients and families in this care process.
Identifying the Problem and Purpose in Quantitative, Qualitative, and Outcomes Studies
Problems and Purposes in Types of Quantitative Studies
Example research topics, problems, and purposes for the different types of quantitative research (descriptive, correlational, quasi-experimental, and experimental) are presented in Table 5-1. If little is known about a topic, researchers usually start with descriptive and correlational studies and progress to quasi-experimental and experimental studies as knowledge expands in an area. An examination of the problems and purposes in Table 5-1 will reveal the differences and similarities among the types of quantitative research. The research purpose usually reflects the type of study that was conducted (Grove, Burns, & Gray, 2013). The purpose of descriptive research is to identify and describe concepts or variables, identify possible relationships among variables, and delineate differences between or among existing groups, such as males and females or different ethnic groups.
Table 5-1
Quantitative Research
Topics, Problems, and Purposes
| Type of Research | Research Topic | Research Problem and Purpose |
| Descriptive research | Hand hygiene (HH), HH opportunities, HH adherence, infection control, pediatric extended care facilities (ECFs), clinical and nonclinical caregivers | Title of study: “Hand hygiene opportunities in pediatric extended care facilities” (Buet et al., 2013, p. 72). |
| Problem: “The population in pediatric ECFs [extended care facilities] is increasingly complex, and such children are at high risk of healthcare-associated infections (HAIs), which are associated with increased morbidity, mortality, resources use, and cost (Burns et al., 2010) [problem significance]. . . . The Centers for Disease Control and Prevention (CDC) … and the World Health Organization (WHO, 2009) have published evidence-based guidelines confirming the causal relationship between poor infection control practices, particularly hand hygiene (HH), and increased risk of HAIs [problem background]. However, most of the HH research has been focused in adult long term care facilities and acute care settings and findings from such studies are unlikely to be applicable to HH in pediatric ECFs given the different care patterns, including the relative distribution of different devices” [problem statement] (Buet et al., 2013, pp. 72-73). | ||
| Purpose: “The purpose of this observational study was to assess the frequency and type of HH opportunities initiated by clinical (e.g., physicians and nurses) and non-clinical (e.g., parents and teachers) care givers, as well as evaluate HH adherence using the WHO’s ‘5 Moments for HH’ observation tool” (Buet et al., 2013, p. 73). | ||
| Correlational research | Insulin resistance; anthropometric measurements (height, weight, body mass index [BMI], and waist circumference); systolic and diastolic blood pressure; laboratory values of lipids and triglycerides; and inflammatory marker high-sensitivity C-reactive protein (hsCRP) | Title of study: “Biological correlates and predictors of insulin resistance among early adolescents” (Bindler et al., 2013, p. 20). |
| Problem: “Prevalence of obesity is at historic high levels among youth; for example, worldwide, obesity has doubled, and in developed countries, the numbers of youth who are overweight or obese have tripled in the last three decades (WHO, 2011) [problem significance]. . . . Youth with obesity and insulin resistance (IR) are at increased risk of associated chronic conditions in adulthood, such as elevated blood pressure (BP), cardiovascular disease (CVD), type 2 diabetes, and several types of cancer (Li et al., 2009) [problem background]. | ||
| Despite the known relationships between IR and cardiometabolic factors, no study has yet examined the independent effects of these factors on a predictive model of IR among early adolescents” [problem statement] (Bindler et al., 2013, pp. 20-21). | ||
| Purpose: “Therefore, the purposes of this study among a group of early adolescents participating in the Teen Eating and Activity Mentoring in Schools (TEAMS) study were to describe the anthropometric and laboratory markers of the participants and to test the ability of these markers to predict risk of exhibiting IR” (Bindler et al., 2013, p. 21). | ||
| Quasi-experimental research | Nurse-case-managed intervention, hepatitis A and B vaccine completion, sociodemographic factors, risk behaviors, and homeless adults | Title of study: “Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults” (Nyamathi et al., 2009, p. 13). |
| Problem: “Hepatitis B virus (HBV) infection poses a serious threat to public health in the United States. Recent estimates place the true prevalence of chronic HBV in the United States at approximately 1.6 cases per 100,000 persons (CDC, 2008). It is estimated that there were 51,000 new cases of HBV infection in 2005 (Wasley et al., 2007), a financial burden reaching $1 billion annually. . . . Homeless populations are at particularly high risk of HBV infection due to high rates of unprotected sexual behavior and sharing of needles and other IDU [injection drug user] paraphernalia. Previous studies have reported that HBV infection rates among homeless populations range from 17% to 31% (i.e., from 17,000 to 31,000 per 100,000) compared with 2.1 per 100,000 in the general United States population [problem significance]. . . . Vaccination is the most effective way to prevent HBV infection (CDC, 2006). . . . Improving vaccination adherence rates among homeless persons is an important step toward reducing the high prevalence of HBV infection in this population [problem background]. … Thus, little is known about adherence to HBV vaccination among community samples of urban homeless person[s] or about the effect of stronger interventions to incorporate additional strategies, such as nurse case management and targeted HBV education along with client tracking [problem statement]” (Nyamathi et al., 2009, pp. 13-14). | ||
| Purpose: The purpose of this study was to determine the “effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion” (Nyamathi et al., 2009, p. 13). | ||
| Experimental research | Chronic widespread pain, aerobic exercise, analgesia, neurotrophin-3 synthesis, pain management, animal model | Title of study: “Aerobic exercise alters analgesia and neurotrophin-3 [NT-3] synthesis in an animal model of chronic widespread pain” (Sharma et al., 2010, p. 714). |
| Problem: “Chronic widespread pain is complex and poorly understood and affects about 12% of the adult population in developed countries (Rohrbeck et al., 2007) [problem significance]. . . . Management of chronic pain syndromes poses challenges for healthcare practitioners, and pharmacological interventions offer limited efficacy. . . . Exercise training has been long suggested to reduce pain and improve functional outcomes (Whiteside et al., 2004) [problem background]. . . . Surprisingly, the current literature is mainly limited to human studies where the molecular basis for exercise training cannot be easily determined. Relatively few animal studies have addressed the effects and mechanisms of exercise on sensory modulation of chronic pain” [problem statement] (Sharma et al., 2010, p. 715). | ||
| Purpose: “The purpose of the present study was to examine the effects of moderate-intensity aerobic exercise on pain-like behavior and NT-3 in an animal model of widespread pain” (Sharma et al., 2010, p. 714). |
Buet and co-workers (2013) conducted a descriptive study to identify the hand hygiene (HH) opportunities and adherence among clinical and nonclinical caregivers in extended pediatric care facilities. These researchers followed the World Health Organization “5 Moments for Hand Hygiene” (WHO, 2009): before touching a patient, before clean or aseptic procedures, after body fluid exposure or risk, after touching a patient, and after touching patient surroundings. Researchers found that HH opportunities were numerous for clinical and nonclinical caregivers, but adherence to HH was low, especially for nonclinical individuals. This study supports the importance of HH in the delivery of quality, safe care based on current evidence-based guidelines (Melnyk & Fineout-Overholt, 2011; QSEN, 2013).
The purpose of correlational research is to examine the type (positive or negative) and strength of relationships among variables. In their correlational study, Bindler, Bindler, and Daratha (2013) examined the prediction of insulin resistance (IR) in adolescents using anthropometric measurements (height, weight, body mass index [BMI], and waist circumference), systolic and diastolic blood pressure, laboratory values [lipid and triglyceride levels], and the inflammatory marker of high-sensitivity, C-reactive protein (see Table 5-1). The researchers found that waist circumference and triglycerides were the strongest predictors of IR in adolescents. The findings from this study stressed the importance of nurses measuring waist circumference, height, and weight; calculating BMI; and examining lipid levels to identify youths at risk for IR.
Quasi-experimental studies are conducted to determine the effect of a treatment or independent variable on designated dependent or outcome variables (Shadish, Cook, & Campbell, 2002). Nyamathi and colleagues (2009) conducted a quasi-experimental study to examine the effectiveness of a nurse case-managed intervention on hepatitis A and B vaccine completion among homeless adults. The research topics, problem, and purpose for this study are presented in Table 5-1. The findings from this study “revealed that a culturally sensitive comprehensive program, which included nurse case management plus targeted hepatitis education, incentives, and client tracking, performed significantly better than did a usual care program” (Nyamathi et al., 2009, p. 21). Thus the researchers recommended that public health program planners and funders use this type of program to promote increased completion of hepatitis A and B vaccinations for high-risk groups.
Experimental studies are conducted in highly controlled settings, using a highly structured design to determine the effect of one or more independent variables on one or more dependent variables (Grove et al., 2013). Sharma, Ryals, Gajewski, and Wright (2010) conducted an experimental study to determine the effects of an aerobic exercise program on pain like behaviors and neurotrophin-3 synthesis in mice with chronic widespread pain (see Table 5-1). These researchers found that moderate-intensity aerobic exercise had the effect of deep tissue mechanical hyperalgesia on chronic pain in mice. This finding provides a possible molecular basis for aerobic exercise training in reducing muscular pain in fibromyalgia patients.
Problems and Purposes in Types of Qualitative Studies
The problems formulated for qualitative research identify areas of concern that require investigation to gain new insights, expand understanding, and improve comprehension of the whole (Munhall, 2012). The purpose of a qualitative study indicates the focus of the study, which may be a concept such as pain, an event such as loss of a child, or a facet of a culture such as the healing practices of a specific Native American tribe. In addition, the purpose often indicates the qualitative approach used to conduct the study. The basic assumptions for this approach are discussed in the research report (Creswell, 2014). Examples of research topics, problems, and purposes for the types of qualitative research—phenomenological, grounded theory, ethnographic, exploratory-descriptive, and historical—commonly found in nursing are presented in Table 5-2.
Table 5-2
Qualitative Research
Topics, Problems, and Purposes
| Type of Research | Research Topic | Research Problem and Purpose |
| Phenomenological research | Lived experience of children, asthma, health promotion, child health, chronic illness, fears of exacerbations, fears of being ostracized | Title of study: “Children’s experiences of living with asthma: Fear of exacerbations and being ostracized” (Trollvik et al., 2011, p. 295). |
| Problem: “Asthma is the most common childhood disease and long-term medical condition affecting children (Masoli et al., 2004). The prevalence of asthma is increasing, and atopic diseases are considered to be a worldwide health problem and an agent of morbidity in children significance]. . . . Studies show that children with asthma have more emotional/behavioral problems than healthy children… It has also been found that asthma control in children is poor and that healthcare professionals (HCPs) and children focus on different aspects of having asthma (Price et al., 2002) [problem background]. . . . Few studies have considered very young children’s, 7-10 years old, perspectives; this study might contribute to new insights into their lifeworld experiences” [problem statement] (Trollvik et al., 2011, pp. 295-296). | ||
| Purpose: “The aim of this study was to explore and describe children’s everyday experiences of living with asthma to tailor an Asthma Education Program based on their perspectives. . . . In this study, a phenomenological and hermaneutical approach was used to gain an understanding of the children’s lifeworld” (Trollvik et al., 2011, p. 296). | ||
| Grounded theory research | Foster care, pregnancy prevention, prevention of sexually transmitted infections, patient-provider relationship | Title of study: “Where do youth in foster care receive information about preventing unplanned pregnancy and sexually transmitted infections [STIs]” (Hudson, 2012, p. 443). |
| Problem: “Within the United States, approximately 460,000 children live in foster care, and adolescents comprise half of this population. . . . Children enter the foster care system as a result of sexual abuse, physical abuse, or physical neglect and abandonment (Child Welfare League of America, 2007) [problem significance]. . . . With limited access to health promotion information and education about high-risk sexual behavior, it is not surprising that these young people have a high incidence of unplanned pregnancy and STIs compared with youth not in foster care [problem background]. Little research exists on the extent to which foster youth receive information about sexual activity from healthcare providers” [problem statement] (Hudson, 2012, p. 443-444). | ||
| Purpose: A grounded theory study was conducted to “describe how and where foster youth receive reproductive health and risk reduction information to prevent pregnancy and sexually transmitted infections. Participants also were asked to describe their relationship with their primary healthcare provider while they were in foster care” (Hudson, 2012, p. 443). | ||
| Ethnographic research | Critical illness, mechanical ventilation, weaning, family presence, surveillance | Title of study: “Family presence and surveillance during weaning from prolonged mechanical ventilation” (Happ et al., 2007, p. 47). |
| Problem: “During critical illness, mechanical ventilation imposes physical and communication barriers between family members and their critically ill loved ones [problem signicance]. . . . Most studies of family members in the intensive care unit (ICU) have focused on families’ needs for information, access to the patient, and participation in decisions to withdraw or withhold life-sustaining treatment. … Although numerous studies have been conducted of patient experiences with short- and long-term mechanical ventilation (LTMV), research has not focused on family interactions with patients during weaning from mechanical ventilation [problem background]. Moreover, the importance of family members’ bedside presence and clinicians’ interpretation of family behaviors at the bedside have not been critically examined” [problem statement] (Happ et al., 2007, pp. 47-48). | ||
| Purpose: “With the use of data from an ethnographic study of the care and communication processes during weaning from LTMV, we sought to describe how family members interact with the patients and respond to the ventilator and associated ICU bedside equipment during LTMV weaning” (Happ et al., 2007, p. 48). | ||
| Exploratory-descriptive qualitative research | Intimate partner violence, abuse of spouse, supporting mothering, parent-child relationships, family health, providers’ perspective, social support | Title of study: “Supporting mothering: Service providers’ perspectives of mothers and young children affected by intimate partner violence” (Letourneau et al., 2011, p. 192). |
| Problem: “Estimates of the percent of women with exposure to intimate partner violence (IPV) over their lifetimes by husbands, partners, or boyfriends range between 8% and 66%. . . . The high concentration of preschool-age children in households where women experience IPV… is a major concern [problem significance]. . . . Indeed, preschool-age children exposed to IPV may share many of the adjustment difficulties experienced by victims of direct physical and psychological abuse (Litrownik et al., 2003) [problem background]. The degree to which children from birth to 36 months of age are affected by IPV, however, is not well understood. Even less is known of effective services and supports that target mothers and their young children exposed to IPV” [problem statement] (Letourneau et al., 2011, p. 193). | ||
| Purpose: “We conducted a qualitative descriptive study of service providers’ understandings of the impact of IPV on mothers, young children (birth to 36 months), and mother-infant/child relationships, and of the support needs of these mothers and young children” (Letourneau et al., 2011, p. 192). | ||
| Historical research | Health disparities, childhood obesity, historical exemplar, prevention of infant mortality, public health nurses’ role | Title of study: “Nurses’ role in the prevention of infant mortality in 1884-1925: Health disparities then and now (Thompson & Keeling, 2012, p. 471). |
| Problem: “Over the past several years, health policy makers have directed increased attention to issues of health disparities, an issue that has concerned the nursing profession for over a century[problem significance]. . . . Reutter and Kushner (2010) advocate that addressing health inequities are well within the nursing mandate and yet is an underutilized role [problem background]. . . . Nursing historical research lends insight into the complex health issues that nurses face today and may guide policy and nursing practice [problem statement]” (Thompson & Keeling, 2012, p. 471). | ||
| Purpose: The purpose of this historical study “was to evaluate the public health nurses’ (PHNs’) role with infant mortality during 1884-1925, specifically how nursing care impacted on conditions of poverty, poor nutrition, poor living conditions, lack of education, and lack of governmental policies that contributed to the poor health of infants a century ago” (Thompson, & Keeling, 2012, p. 471). |
Phenomenological research is conducted to promote a deeper understanding of complex human experiences as they have been lived by the study participants (Munhall, 2012). Trollvik, Nordbach, Silen, and Ringsberg (2011) conducted a phenomenological study to describe children’s experiences of living with asthma. The research topics, problem, and purpose for this study are presented in Table 5-2. Findings from this study described two themes with five subthemes (identified in parentheses): fear of exacerbation (body sensations, frightening experiences, and loss of control) and fear of being ostracized (experiences of being excluded and dilemma of keeping the asthma secret or being open about it). The findings from this study emphasize that asthma management is not only a major issue for the children involved but also for their parents, teachers, and healthcare providers. Asthma educational programs need to be tailored to the individual child based on her or his perspectives and needs. This type of knowledge provides direction for accomplishing the QSEN (2013) competencies of providing patient-centered care.
In grounded theory research, the problem identifies the area of concern and the purpose indicates the focus of the theory to be developed to account for a pattern of behavior of those involved in the study (Wuest, 2012). For example, Hudson (2012, p. 443) conducted a grounded theory study to “describe how and where foster youth receive reproductive health and risk reduction information to prevent pregnancy and sexually transmitted infections (STIs)” (see Table 5-2). The following three thematic categories emerged from this study: “(a) discomfort visiting and disclosing, (b) receiving and not receiving the bare essentials, and (c) learning from community others” (Hudson, 2012, p. 445). The implications for practice were that primary care providers needed to provide time and confidential space for foster youths to disclose their sexual activities, and they (foster youths) need to receive more reproductive and risk prevention information from their school settings.
In ethnographic research, the problem and purpose identify the culture and specific attributes of the culture that are to be examined, described, analyzed, and interpreted to reveal the social actions, beliefs, values, and norms of the culture (Wolf, 2012). Happ, Swigart, Tate, Arnold, Sereika, and Hoffman (2007) conducted an ethnographic study of family presence and surveillance during weaning of their family member from a ventilator. Table 5-2 includes the research topics, problem, and purpose of this study. They concluded that “this study provided a potentially useful conceptual framework of family behaviors with long-term critically ill patients that could enhance the dialogue about family-centered care and guide future research on family presence in the intensive care unit” (Happ et al., 2007, p. 47).
Exploratory-descriptive qualitative research is being conducted by several qualitative researchers to describe unique issues, health problems, or situations that lack clear description or definition. This type of research often provides the basis for future qualitative and quantitative research (Creswell, 2014; Grove et al., 2013). Letourneau, Young, Secco, Stewart, Hughes, and Critchley (2011) conducted an exploratory-descriptive qualitative study of service providers’ understandings of the impact of intimate partner violence (IPV) on mothers and their young children to determine their needs for support (see Table 5-2). They found that these mothers and their children require more support than is currently available. In addition, the service providers had difficulty identifying interventions to promote and protect them and their children.
The problem and purpose in historical research focus on a specific individual, characteristic of society, event, or situation in the past and usually identify the time period in the past that was examined by the study (Lundy, 2012). For example, Thompson and Keeling (2012) examined the role of the public health nurse (PHN) in the prevention of infant mortality from 1884 to 1925 (see Table 5-2). They emphasized that studying the past role of PHNs and the health disparities then and now would increase our understanding of current nursing practice with regard to childhood health issues. They provided the following suggestions for nursing practice: “focus on health disparities in childhood obesity, in areas of environmental and policy change, and the development of social programs and education for families to support healthier living” (Thompson & Keeling, 2012, p. 471).
Problems and Purposes in Outcomes Research
Outcomes research is conducted to examine the end results of care (Doran, 2011). This is a growing area of research in nursing to examine the relationships between the nursing process of care and patient outcomes. Table 5-3 includes the topics, problem, and purpose from an outcomes study by Ausserhofer and associates (2013), who explored the relationship between patient safety climate (PSC) and selected patient outcomes in Swiss acute care hospitals. The adverse events or outcomes examined were medication errors, patient falls, pressure ulcers, and healthcare-associated infections that are common problems in U.S. hospitals (Institute of Medicine, 2004). This study was guided by a common outcomes framework that focused on structure or work system, process of care, and patient outcomes (see Chapter 14). These researchers did not find a significant relationship of PSC to the selected patient outcomes. However, they stressed the need for additional research in this area and for selecting more reliable outcome measures.
Table 5-3
Outcomes Research
Topics, Problem, and Purpose
| Type of Research | Research Topic | Research Problem and Purpose |
| Outcomes research | Work system of patient safety climate (PSC) Process of care of nurses, workload work, and patient needs Outcomes of adverse events and patient satisfaction | Title of study: “The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey” Ausserhofer et al., 2013, p. 240). |
| Problem: “Today’s patient care in healthcare organizations is anything but safe, as between 2.9% and 16.6% of hospitalized patients are affected by adverse events such as medication errors, healthcare-associated infection, or patient falls. More than one-third of adverse events lead to temporary (34%) or permanent disability (6-9%) and between 3% and 20.8% of the patients experiencing an adverse event die [problem significance]. . . . As 37-70% of all adverse events are considered preventable, . . . harmful impacts on patients, such as psychological trauma, impaired functionality or loss of trust in the healthcare system as well as socio-economic costs, could be avoided (Institute of Medicine, 2004). . . . Patient safety climate (PSC) is an important work environment factor determining patient safety and quality of care in healthcare organizations [problem background]. Few studies have investigated the relationship between PSC and patient outcomes, considering possible confounding effects of other nurse-related organizational factors [problem statement]” (Ausserhofer et al., 2013, pp. 240-241). | ||
| Purpose: “The purpose of this study was to explore the relationship between PSC and selected patients outcomes in Swiss acute care hospitals” (Ausserhofer et al., 2013, p. 242). |
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