Nursing experiences a remarkable change in all parts of the world over the period of time. The demands on the nursing practice are ever increasing due to advancements in medical technology, the legal implications of nursing practice and cultural migration for variety of reasons. Nursing research has gained momentum in last few decades owing to these demands to meet the ever-changing demands of the nursing practice. Nursing research provides answers to these challenges in the most scientific manner.
RESEARCH
Research is defined as a systematic inquiry that uses disciplined methods to answer questions or solve problems.
GOALS OF RESEARCH
- To develop the body of knowledge.
- To refine the existing body of knowledge.
- To expand the body of knowledge in any given field.
RESEARCH TERMINOLOGY
Subjects: People being studies = study participants = respondents of questionnaire = sample = informants = key informants.
Researcher: Person who conducts the research—investigator
Collaborative research: Research conducted by a research team where the team consists of more than one researcher. The team members may be from the same field or from different disciplines.
Reviewer: An expert who critiques various aspects of a study and offers feedback.
Naturalistic setting (in the field): Homes, places of work etc. These are locations of data collection from the subjects or areas of work at the time of data collection.
Laboratory setting: Highly controlled setting.
Site: Overall location for the research.
Abstractions: In quantitative research it means concepts and in qualitative research it means phenomenon.
Construct: Refers to an abstraction or mental representation inferred from situations or behaviors. Constructs are abstractions deliberately and systematically invented for specific purpose.
Theory: A theory is a systematic, abstract explanation of some aspects of reality. In a theory concepts are knitted together into a coherent system to describe or explain some aspects of the world.
Heterogeneous group: When an attribute is extremely varied in the group under study.
Homogeneous group: The amount of variability is limited in a group under study.
VARIABLES
Variable—Concepts are called variables in quantitative studies. A variable is something that varies.
Nearly all aspects of human being are variables. People and conditions vary and hence research is conducted. Researchers seek to understand how or why things vary and to learn how differences in one variable are related to differences in another. The degree of variability or heterogeneity of a group of subjects has implications for study design.
Variables are inherent characteristics of research subjects, e.g. age, blood group, weight, height, are attribute variables.
Many a times the researcher creates a variable.
TYPES OF VARIABLES
Continuous variable: Continuous variables have values along a continuum. It can assume an infinite number of values between two points, e.g. weight.3
Discrete variable: It has finite number of values between any two points, representing discrete quantities, e.g. Number of children.
Categorical variables: These variables take on a small range of values that do not represent quantity, e.g. Blood Groups - 4 types.
Dichotomous variable: These are categorical variables that take on only two values, e.g. gender —male/female.
Dependent variable: It is the presumed effect. Also called outcome variable.
Independent variable— Presumed cause
- Variability in the dependent variable is presumed to depend on variability in the independent variable.
- Independent variable and dependent variable are the terms used to indicate direction of influence at times.
- Many dependent variables have multiple causes or antecedents.
- Variables are not inherently dependent or independent.
- A dependent variable in one study could be an independent variable in another.
CONCEPTUAL DEFINITION
A conceptual definition presents the abstract or theoretical meaning of the concepts being studied.
- In qualitative studies, conceptual definitions of key phenomena may be the major end product of the endeavor, reflecting an intent to have the meaning of concepts defined by those being studied.
- In quantitative studies, researchers must clarify and define concepts at the beginning.
OPERATIONAL DEFINITION
An operational definition of a concept specifies the operations that researchers must perform to collect and measure the required information.
- Definitional precision has the advantage of communicating exactly what terms mean within the context of the study.
DATA
Research data are the pieces of information obtained during a study.
The actual values of the study variables constitute the data.
Quantitative data: Information in numeric form.
Qualitative data: Narrative descriptions.
RELATIONSHIPS
Researchers explore or test relationships between the concepts.
A relationship is a bond or a connection between the concepts of the phenomena under study.
In Quantitative Studies
- Researchers are primarily interested in the relationship between the independent and dependent variables.
- Variation in the dependent variable is systematically related to variation in the independent variable and focused in the research question.
- Relationships are expressed in quantitative terms like less than, more than etc.
- Most of the quantitative studies are undertaken:
- To determine whether relationships exist among variables.
- To study the direction of the relationships.
- To know the strength of the relationship.
- To understand the nature of the relationship.
- Not all the relationships between variables can be interpreted as cause and effect relationships.
- There can be functional relationship or associative relationship between the variables.
In Qualitative Studies
- There is no quantifying of relationships, nor is there testing causal relationships.
- Researchers in qualitative studies seek patterns of association.
- Patterns of interconnected themes and processes are identified as a means of understanding the whole.
NURSING RESEARCH
Nursing research is defined as systematic inquiry designed to develop trustworthy evidence about issues of importance to the nursing profession, including nursing practice, education, administration and informatics.
IMPORTANCE OF RESEARCH IN NURSING
- There is broad support for evidence-based nursing practice.
- There is general understanding that research findings from rigorous studies provide strong evidence for informing nurse's decision and actions.
- Nursing actions and decisions based on evidence indicate that the actions are clinically appropriate, cost-effective and result in positive outcomes for clients.
- Nurses can provide very high quality nursing care and elevate the standard and reputation of the nursing profession with the help of nursing research findings.
- Integration of nursing research with evidence-based practice into the delivery of nursing care and the framework for nursing administration decision-making may help nursing achieve a ‘Magnet’ status.
- Changes to nursing practice are regularly occurring due to evidence-based practice.
- Clinical changes in large scale are occurring due to accumulation of research evidence about beneficial practice innovations.
SCOPE OF NURSING RESEARCH
The scope of nursing research may be studied as the consumer-producer continuum in nursing research. With current emphasis on EBP, every nurse must engage in one or more roles along a continuum of research participation.6
Consumers of Nursing Research
At one end of this continuum are the nurses whose involvement in research is indirect. They are the users or consumers of nursing research. These consumers read research reports to develop new skills and to search for relevant findings that may affect their practice. This minimum involvement in nursing research must be maintained by all nurses.
EBP depends on well-informed nursing research consumers.
Producers of Nursing Research
At the other end of the continuum are the producers of the nursing research. These are nurses actively participating in designing and implementing studies in nursing practice, administration, and profession at large.
Earlier nursing educators were more involved in nursing research. Now a days research in nursing is increasingly conducted by practicing nurses who want to find out what works best for their patients.
Other Activities on the Continuum
A rich variety of research activities lie in between these two end points on the consumer–producer continuum (Fig. 1.1). The activities include:
- Participating in a journal club.
- Solving clinical problems and making clinical decisions based on rigorous research.
- Collaborating in the development of an idea for a clinical research project.
- Reviewing a proposed research plan.
- Offering clinical expertise to improve the research plan.
- Recruit the study participants.
- Assist in collecting research information.
- Guiding participants in studies.
- Discussing the implications and relevance of research findings with clients.
Nurses with some research skills are better than those without them, to make a contribution to nursing and to evidence-based practice. 7Understanding of nursing research can improve the depth and breadth of every nurse's professional practice.
HISTORICAL EVOLUTION OF RESEARCH IN NURSING
Research in nursing began with Florence Nightingale. Her ‘Note on Nursing’ in 1859 is the landmark publication. It describes environmental factors that promote physical and emotional wellbeing. She presented analysis of factors affecting soldier mortality and morbidity during Crimian war. Those were the findings that made her bring about changes in nursing care and public health.
Most of the studies in 1900s were concerned with nursing education. These identified many inadequacies in the educational background of the groups and concluded that advanced educational preparation was essential.
A number of forces combined during 1950s to put nursing research on a rapidly accelerating upswing in the United States. These included.
- Increase in the number of nurses with advanced educational degrees.
- Establishment of nursing research center at Walter Reed Army Institute of Research.
- Increase in the availability of funds for Nursing Research.
- The inception of American Nurses Foundation which is devoted exclusively to nursing research.
- The first journal “Nursing Research” published in 1952.
Nursing leaders began to express concern about the lack of research in nursing practice. Practice-oriented research on various clinical 8topics began to emerge in the literature. In the year 1963, International Journal of Nursing studies was published for the first time. By 1970, growing number of nurses conducting research studies created need for additional communication outlets. Hence, many research journals came into being.
During 1970s, a decided change in nursing research from areas of teaching, curriculum and nurses themselves to the improvement of client-care took place. This is considered as the modern foundation of scientific base for nursing practice.
By 1980, nursing research came to a new level of development. This decade is marked by:
- Increase in the qualified nurse researchers.
- Widespread availability of computers for the collection and analysis of information
- Ever-growing recognition of research being integral part of professional nursing.
- More attention to the types of questions, the methods of collecting and analyzing information being used, linking of research to theory and utilization of research findings in practice.
- The year 1986 is marked by establishment of National Center for Nursing Research in US.
NCNR–National Center for Nursing Research
The purpose of NCNR is to promote and financially support research projects and training relating to patient care. Clinical learning strategy called Evidence Based Practice was designed. EBP proved that research findings were far superior as a basis for clinical decisions and has had a significant effect on all health care professions including nursing.
Research specifically designed to improve the quality of health care, reduce health costs and enhance patient safety; were supported and promoted. In the year 1993, the NCNR became the National Institute of Nursing Research. This was important step towards strengthening the nursing research. Later in 1990s, there was emerging importance of in-depth studies using different methodologies. International cooperation about EBP in Nursing enhanced. The focus changed to research utilization.9
FUTURE DIRECTIONS FOR NURSING RESEARCH
Nursing research continues to develop at a rapid pace. Funding for nursing research continues to grow. The priority for nursing research in the future will be the promotion of excellence in nursing science. Certain trends that have moulds been prepared are:
Heightened Focus on EBP
Efforts to use research findings in practice are sure to continue in coming era. Nurses are encouraged for EBP. Emerging interest is in translational research meaning research on how findings from studies can best be translated into nursing practice.
Development of a Stronger evidence-base through more Rigorous Methods and Multiple, Confirmatory Strategies
Strong research designs are essential for strong evidence. Confirmation of the evidence is required through replication of studies with different clients, in different clinical settings and at different times, to ensure that findings are robust. Multiple studies pose confirmatory strategy status.
Greater Emphasis on Systematic Integrative Review
Systematic reviews are cornerstone of EBP. Amassing comprehensive research information on the topic, weighing pieces of evidence and integrating information to draw conclusions about the state of evidence, is gaining importance in 21st century in the field of nursing practice.
Expanded Local Research in Health Care Setting
Increase in the small, localized research designed to solve immediate problems of the local clients. The local problems are influenced by a variety of factors including intrinsic, racial, social, cultural and constitutional in addition to external factors such as climate, geographical location etc. Mechanisms to ensure that evidence from these small projects, becomes available to others facing similar problems; need to be developed.10
Strengthening of Multidisciplinary Collaboration
Interdisciplinary collaboration of nurses with researchers in related fields is must. Researchers address fundamental problems at the bio-behavioral and psychologic interface. Collaborative efforts could lead to nurse researcher playing a more prominent role in national and international health care policies.
Expanded Dissemination of Research Findings
The internet and other means of electronic communication have a large impact on the dissemination of research information, which in turn helps to promote EBP. Wide and quick access to the research information makes nurses well versed with the latest trends in nursing practice and the recent developments in the knowledge of nursing profession.
Increasing Visibility of Nursing Research
There are increased efforts to increase the visibility of nursing research. Most people do not know that nurses are scholars and researchers. Nurses must market their knowledge and their research to professional organizations in order to improve their social scholarly status.
Increasing Focus on Cultural Issues and Health Disparities
The issue of health disparities has emerged as a central concern in nursing and other health disciplines. This has raised consciousness about ecological validity and cultural sensitivity of health interventions.
Ecological validity refers to the extent to which study designs and findings have relevance and meaning in a variety of real world contexts.
Nursing research must be sensitive to the health beliefs, behaviors, epidemiology and values of culturally and linguistically diverse populations. Meeting the health care needs of an increasingly diverse society and a more globalized world has become an international concern.11
PARADIGMS FOR NURSING RESEARCH
Paradigms | World view, General perspective |
Ontologic | What is the nature of reality? |
Epistemologic | What is the relationship between the inquirer and that being studied? |
Axiologic | What is the role of values in the inquiry? |
Methodologic | How should the inquirer obtain knowledge? |
There are two paradigms for nursing research
- Positivist
- Naturalistic
Positivist Paradigm
- Dominated nursing research for decades.
- Also called logical positivism.
- Guided by philosophers like Comte, Newton, Mill and Locke.
- Scientific and modernism is the focus.
Definition: Positivism is a reflection of a broader cultural phenomenon that is referred to as modernism, which emphasizes the national and the scientific.
Major Concepts
- There exists reality.
- Reality in the world can be studied and known.
- Nature is basically ordered and regular.
- Objective reality exists independent of human observations.
- Phenomena have antecedent causes.
- Research is directed at understanding the underlying causes of natural phenomena.
- Positivists believe in objective reality and attempt to hold their personal belief and biases in check.
- Research involves the use of orderly, disciplined procedures with tight controls over the research situations.
- Study the nature of phenomena and the relationship among its concepts.
- Believe in reality and have a desire to understand it.
- But objectivity is their goal and they strive to be as neutral as possible.
- Appreciate the impediments to know reality.
- Hence also seek probabilistic evidence, i.e. probable true state of the phenomena under study.
- Quantitative research is most closely associated with positivism.
Definition: Scientific Method — Positivist scientific method refers to a general set of orderly, disciplined procedures used to acquire information.
- In a systematic study, the investigator progress logically through a series of steps, according to a pre-specified plan of action.
- Control involves imposing conditions on the research situation so that biases are minimized and precision and validity are maximized.
- Quantitative researcher gather empirical evidence, i.e. the evidence rooted in objective reality and gathered directly or indirectly through the senses – sight, hearing, taste, touch or smell.
- Information gathered is quantitative – numeric information that is analyzed with statistical procedures.
- The degree to which research findings can be generalized to individuals other than those who participated in the study (referred to as the generalizability of the research) is the criteria for assessing the quality of quantitative studies.
- Reflects the cultural phenomenon of modernism in the wake of the industrial revolution.
- It is a reductionist model as it reduces human experiences to only the few concepts under investigation.
The Naturalistic Paradigm
- Also called constructivist paradigm
- Promoted by writers – Weber and Kant
Definition: Naturalism is an outgrowth of the pervasive cultural transformation called postmodernism.
- Emphasizes deconstruction — taking apart old ideas and structures and reconstruction — putting ideas and structures together in new ways.
- Reality is not a fixed entity.
- Reality exists within a context and many constructions are possible.
- There are multiple interpretations of reality.
- There is no process by which the ultimate truth or falsity of the construction can be determined.
- Knowledge is maximized when the distance between the inquirer and the participants in the study is minimized.
- Voices and interpretations of those under study are crucial to understanding the phenomenon of interest.
- The findings are the products or interactions between the inquirer and the participants. The naturalistic methods deal with the human complexity by exploring it directly. The truth is composite of realities.
- It believes in and attempts to understand the human experience as it is lived.
- Careful collection and analysis of qualitative materials that are narrative and subjective is must.
- Naturalistic researchers emphasize the dynamic, holistic and individual aspects of human experiences.
- They capture the entire experience within the context of those who are experiencing them.
- Flexible, evolving procedures and findings that emerge in the course of investigations.
- Inquiry takes place in the field over an extended period of time.
- Collection of information and its analysis typically progress concurrently.
- Through inductive process, researchers integrate information to develop a theory or description that helps to explain the phenomena under observation.
- Studies yield rich, in-depth information.
- Findings are grounded in the real-life experiences of people with first hand knowledge of the phenomenon.
- Human beings are used directly as the instrument.
- Subjective nature of naturalistic inquiry.
- Idiosyncratic nature of conclusions.
- Relatively small group of people under study.
- Generalizability of findings may be limited.
IMPORTANT POINTS TO BE NOTED
Both, qualitative and quantitative research methods cannot be used to answer moral or ethical questions, e.g. Euthanasia to be practiced or not.
Since many moral issues are linked to health care, it is inevitable that nursing process cannot rely exclusively on scientific information.
Accurate measures of psychological phenomena like hope, self- esteem are not yet developed.
Human beings are inherently complex and diverse, extremely intelligent, sensitive but fallible tools.
Quantitative research is accused of narrowness and inflexibility of vision, i.e. a sedimented view of the world that does not fully capture the reality of human experience.
GLOBAL NURSING PRIORITIES
Nursing is an important pillar of health care delivery system in all parts of the world. With the changing medical technology, the priorities in the nursing practice also change. The change in the nursing practice is so great that it influences the actual health care delivery by all the health team members. Some of the global nursing priorities are:
- Health promotion and disease prevention through health education and health awareness of masses.
- Promotion of health of vulnerable and marginalized communities.
- Patient safety and quality of health care.
- Development of EBP and translational research.
- Promotion of the health and well-being of older people.
- Patient centered care and care coordination.
- Palliative and end of life care.
- Care implications of genetic testing and genetic therapeutics.
- Capacity development of nurse researchers.
- Nurses’ working environment.
PURPOSES OF NURSING RESEARCH
General purpose of nursing research is to answer the questions or solve problems of relevance to the nursing profession.
Specific purposes: Specific purposes of nursing research include:
- Basic research to extend the base of knowledge in nursing.
- To formulate or refine a nursing theory.
- Applied research to find solutions to existing problems.
- To enhance the immediate utility of EBP.
- To study the effectiveness of a nursing interventions.
- To discover general principles of human behavior to solve problems in nursing practice.
- To achieve varying levels of explanation.
- To identify, describe, explore, explain and predict and to exert control over the existing health problem situation.
- To link research findings with EBP.
- To develop and rigorously test a new method of measuring patient outcomes.
- To help nurses make evidence-based treatment decisions.
- To determine the benefits and risks of the newly developed or existing interventions.
- To assess the cost-effectiveness of nursing interventions
- To diagnose, assess patients and to measure important clinical outcomes.
- To facilitate the development of long-term care plans for patients.
- To provide guidance to patients to make important lifestyle choices and to be vigilant for key symptoms.
- To decide resource allocation.
- To prevent harm to the patients.
- To determine the factors that, influence the health or cause illness, mortality, morbidity.
- To design effective interventions.
- To motivate people to comply with the treatment.
- To engage in health promotion activities.
- To study the barriers to positive health practices.
- To understand the processes clients experience in a transition through health care crisis.
The purpose of research can be further studied depending on the nature of the study, i.e. the quantitative study or qualitative study.
PURPOSES OF QUANTITATIVE RESEARCH
- To assess the prevalence of phenomenon. (How much?)
- To study the frequency of the phenomenon. (How often?)
- To understand the nature of phenomenon. (What is?)
- To study the factors related to the phenomenon. (What influences?)
- To know the antecedents of the phenomenon. (What leads to?)
- To identify the causal pathway of the phenomenon.
- To apply theory to explain the phenomenon.
- To understand the alterations in the phenomenon with modification or introduction of an intervention.
- To predict the occurrence of cause and effect.
- To make the phenomenon occur or to alter its prevalence.
PURPOSES OF QUALITATIVE RESEARCH
- To define the phenomenon.
- To label the phenomenon.
- To understand the dimensions of the phenomenon.
- To know the important aspects of the phenomenon.
- To understand the nature of the phenomenon in depth.
- To study the events/outcomes to which the phenomenon leads.
- To illustrate the process by which the phenomenon evolves or is experienced.
- To identify what makes the phenomenon occur/exist.
- To study the working of the phenomenon.
- To learn the meaning of the phenomenon.
- To evaluate the occurrence of the phenomenon.
The nursing research, though a recently developed dimension of nursing profession; had existed ever since the nursing existed. From its most primitive trial and error form, it has evolved to today's most modern and scientific study. It is only three decades back it got momentum with the rapid inventions and technological advances in the health care delivery. From the transition of family doctor to family nurse, research literacy is vital for nurses to provide cost-effective managed care.