Research and Research ProcessCHAPTER 1

Research, in common parlance, refers to a search for knowledge. One can also define research as a scientific and systematic search for pertinent information on a specific topic. In fact, research is an art of scientific investigation. Some people consider research as a movement, a movement from the known to the unknown. It is actually a voyage of discovery.

The Advanced Learner's Dictionary of Current English lays down the meaning of research as “a careful investigation or inquiry specially through search for new facts in any branch of knowledge.” Redman and More define research as a “systematized effort to gain new knowledge.”

Research is an academic activity and as such the term should be used in a technical sense. According to Clifford Woody, “research comprises defining and redefining problems, formulating hypothesis or suggested solutions; collecting, organizing and evaluating data; making deductions and reaching conclusions; and, at last, carefully testing the conclusions to determine whether they fit the formulating hypothesis”

The purpose of research is to discover answers to questions through the application of scientific procedures. The main aim of research is to find out the truth which is hidden and which has not been discovered as yet. Though each research study has its own specific purpose, we may think of research objectives as falling into a number of following broad groupings:

The possible motives for doing research may be either one or more of the following:

The basic types of research are as follows:

The above description of the types of research brings to light the fact that there are two basic approaches to research, viz quantitative approach and the qualitative approach.

It involves the generation of data in quantitative form which can be subjected to rigorous quantitative analysis in a formal and rigid fashion. This approach can be further subclassified into inferential, experimental, and simulation approaches to research. The purpose of inferential approach to research is to form a data base from which to infer characteristics or relationships of population. This usually means survey research where a sample of population is studied (questioned or observed) to determine its characteristics, and it is then inferred that the population has the same characteristics. Experimental approach is characterized by much greater control over the research environment and in this case some variables arc manipulated to observe their effect on other variables. Simulation approach involves the construction of an artificial environment within which relevant information and data can be generated. This permits an observation of the dynamic behavior of a system (or its subsystem) under controlled conditions. The term ‘simulation’ in the context of sciences applications refers to “the operation of a numerical model that 6represents the structure of a dynamic process. Given the values of initial conditions, parameters and exogenous variables, a simulation is run to represent the behavior of the process over time.” Simulation approach can also be useful in building models for understanding future conditions.

Qualitative approach to research is concerned with subjective assessment of attitudes, opinions, and behavior. Research in such a situation is a function of researcher's insights and impressions. Such an approach to research generates results either in non-quantitative form or in the form which are not subjected to rigorous quantitative analysis. Generally, the techniques of focus group interviews, projective techniques and depth interviews are used in this approach.

“All progress is born of inquiry. Doubt is often better than overconfidence, for it leads to inquiry, and inquiry leads to invention.” Increased amounts of research make progress possible. Research inculcates scientific and inductive thinking and it promotes the development of logical habits of thinking and organization.

It seems appropriate at this juncture to explain the difference between research methods and research methodology. Research methods may 8be understood as all those methods/techniques that are used for conduction of research.

Thus, when we talk of research methodology we not only talk of the research methods but also consider the logic behind the methods we use in the context of the research study and explain why we are using a particular method or technique and why we are not using others so that research results are capable of being evaluated either by the researcher himself or by others. Why a research study has been undertaken, how the research problem has been defined, in what way and why the hypothesis has been formulated, what data have been collected and what particular method has been adopted, why particular technique of analyzing data has been used and a host of similar other questions are usually answered when we talk of research methodology concerning a research problem or study.

For a clear perception of the term research, one should know the meaning of scientific method. The two terms, research and scientific method, are closely related. Research, as we have already stated, can be termed an inquiry into the nature of, the reasons for, and the consequences of any particular set of circumstances, whether these circumstances are experimentally controlled or recorded just as they occur. On the other hand, the philosophy common to all research methods and techniques, although they may vary considerably from one science to another, is usually given the name of scientific method.

In this context, Karl Pearson writes, “The scientific method is one and same in the branches (of science) and that method is the method of all logically trained minds… Scientific method is the pursuit of truth as determined by logical considerations. The ideal of science is to achieve a systematic interrelation of facts. Scientific method attempts to achieve “this ideal by experimentation, observation, logical arguments from accepted postulates and a combination of these three in varying proportions.” In scientific method, logic aids in formulating propositions explicitly and accurately so that their possible alternatives become clear. All this is done through experimentation and investigations, which constitute the integral parts of scientific method.

Whatever may be the types of research works and studies, one thing that is important is that they all meet on the common ground of scientific method employed by a researcher. One expects scientific research to satisfy the following criteria:

In other words, we can state the qualities of a good research as under:

Each nurse was using a different approach for looking at the situation, but both were systematically evaluating what was observed. This is the essence of science systematic collection, analysis, and interpretation of data. Using inductive reasoning, a process of starting with details of experience and moving to a general picture. Inductive reasoning involves the observation of a particular set of instances that belong to and can be identified as part of a larger set. Using deductive reasoning, a process of starting with the general picture, in this case the theory of attentively embracing story, and moving to a specific direction for practice and research. Deductive reasoning uses two or more related concepts that when combined enable suggestion of relationships between the concepts. Inductive reasoning and deductive reasoning are basic to frameworks for research. Inductive reasoning is the pattern of “figuring out what's there” 13from the details of the nursing practice experience. Inductive reasoning is the foundation for most qualitative inquire. Research questions relaxed to the issue of the meaning of experience for the patient can be addressed with the inductive reasoning of qualitative inquiry. Deductive reasoning begins with a structure that guides searching for “what's there”.

The ladder of abstraction is a way for the reader to gain perspective when reading and thinking about frameworks for research. When critiquing the framework of a study, imagine a ladder. The highest level on the ladder includes beliefs and assumptions, what is sometimes called the worldview of the researcher. Although the worldview is not always explicitly stated in a manuscript, it is there. In the study on individualized information for men and their partners to facilitate treatment decision making in prostate cancer the researchers note a commonly held belief that “patients with cancer should be involved; in making informed treatment choices”. The study was planned because there is evidence that men who present for treatment of prostate cancer know little about the disease or treatment options. Davison and colleagues (2004) cite the Lazarus Transaction Model of Stress and Coping as a guide for their study, noting that the developers of this model identify information seeking “as the most frequent method individuals use to cope with and maintain control over a stressful life event”. Information is conceptualized as an approach to gain cognitive control from the perspective of the Lazarus model. The study hypotheses addressed how desired information affected stress for patients and their partners dealing with prostate cancer. The researchers used the Lazarus model to logically structure their study, and they provided detail linking this model to the interventions and outcome measures selected for their research. This linking of the Lazarus model to interventions an comes is an example of how theory guides research.

It is important to consider the middle of the ladder of abstraction where concepts, theories, and frameworks are located. Pretend to look at the middle section through a magnifying glass so that what is located there can be distinguished and clarified.

Concepts, theories, and frameworks can be compared to each other from the perspective of abstraction, with concepts being the lowest on the ladder and frameworks the highest. However, some concepts are closer to the ground than others. The same is true for theories and frameworks. For instance, the concept of pain relief is closer to the ground than the concept of caring. The idea of varying levels-of abstraction within the middle of the ladder is emphasized in the section addressing theories, but it has relevance for concepts and frameworks as well.

A concept is an image or symbolic representation of an abstract idea. Chinn and Kramer (1999) define a concept as a “complex mental formulation of experience.” Concepts are the major components of theory and convey the abstract ideas within a theory. In this chapter, readers have been introduced to several concepts, such as cognitive control, female social roles, and symptom management. Each concept creates a mental image that is explained further through the conceptual definition. For instance, pain is a concept whose mental image means something based on experience. The experiential meaning of the concept of pain is different for the child who has just fallen off a bike, for the elderly person with rheumatoid arthritis, and for the doctorally prepared nurse who is studying pain mechanisms using an animal model. These definitions and associated images of the concept of pain incorporate different experiential and knowledge components, all with the same label pain. Therefore, it is important to know the meaning of the concept for the person. In the case of the reader, it is important to know the meaning that the researcher gives to the concepts in a research study.

Theory is a set of interrelated concepts that provides a systematic view of a phenomenon. Theory guides practice and research; practice enables testing of theory and generates questions for research; research contributes to theory building and establishing practice guidelines. Therefore, what is learned through practice, theory, and research interweaves to create the knowledge fabric of the discipline of nursing. From this perspective, each reader is in the process of contributing to the knowledge base of the discipline.

A theory is a set of interrelated concepts that structure a systematic view of phenomena for the purpose of explaining or predicting. A theory is like a blueprint, a guide for modeling a structure. A blueprint depicts the elements of a structure and the relation of each element to the other, just as a theory depicts both the concepts that compose it and how they are related. Chinn and Kramer (1999) define a theory as an “expression of knowledge … a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena.”

Theories are located on the ladder of abstraction relative to their scope. An often used label in nursing is “grand theory,” which suggests a broad scope, covering major areas of importance to the discipline. Grand theories arose at a time when nursing was addressing its nature, mission, and goals (Im and Meleis, 1999), so it is historically important. However, its significance extends beyond history to have implications for guiding the discipline today and in the future. For the purpose of introducing the reader to theory as a framework for nursing research, grand theory, midrange theory, and micro range theory are discussed. As is suggested by the names of these theory categories, grand theories are highest and micro range theories are lowest in the level of abstraction.

Importance of midrange theories: “Midrange theories address the experiences of particular patient populations or a cohort of people who are dealing with a particular health or illness issue…Because midrange theories are more specific in what they explain, practitioners often find them more directly applicable….”

The critical thinking decision path takes reader through the thinking of a researcher who is about to begin doing research. It is reasonable for the reader to expect to find some but not of the phases of decision making addressed' a research manuscript. Beginning with the view of the world, the highest rung on the ladder of abstraction and the researcher is inclined to approach research problem from a perspective of inductive or deductive reasoning. If the researcher pursues an inductive reasoning approach, he or she generally will not present a framework before beginning discussion of the methods. This is not say that literature will not be reviewed before introducing methods. Authors may provide overview of a literature base documenting the need to do the study, but they will not provide a framework for the study because an inductive approach demands that they begin where their participants are rather than beginning with a framework. Their intent is to be free of the structures that may limit what they learn and to be open to the experience of the person who is living through the experience they are studying.

The framework for Research provides guidance for the researcher as study questions are fine-tuned, methods for measuring variables are collected and analyzed. The framework it used as a comparison.

In all parts of the world, nursing has experienced a profound culture change over the past few decades. Nurses are increasingly expected to understand and conduct research, and to base their professional practice on emerging evidence from research that is, to adopt an evidence-based practice (EBP). EBP is broadly defined as the use of the best clinical evidence in making patient care decisions, and such evidence typically comes from research conducted by nurses and other health care professionals.

Research is systematic inquiry that uses disciplined methods to answer questions or solve problems. The ultimate goal of research is to develop, refine, and expand a body of knowledge.

There is general agreement that research findings from rigorous studies provide especially strong evidence for informing nurses decisions and actions. Nurses are accepting the need to base specific nursing actions and decisions on evidence indicating that the actions are clinically appropriate, cost-effective, and result in positive outcomes for clients.

With the current emphasis on EBP, it has become every nurse's responsibility to engage in one or more roles along a continuum of research participation. At one end of the continuum are those nurses whose involvement in research is indirect. Consumers of nursing research read research reports to develop new skills and to search for relevant findings that may affect their practice. Nurses are now expected to maintain this level of involvement with research, at a minimum. EBP depends on well-informed nursing research consumers.

Although nursing research has not always had the prominence and importance it enjoys today, its long and interesting history portends a distinguished future.

Most people would agree that research in nursing began with Florence Nightingale. Her landmark publication, Notes on nursing (1859), describes her early interest in environmental factors that promote physical and emotional well-being an interest that continues among nurses nearly 150 years later. Based on her skillful analyses and presentations, she was successful in effecting some changes in nursing care and more generally, in public health.

By the 1970s, the growing number of nurses conducting research studies and the discussions of theoretical and contextual issues surrounding nursing research created the need for additional communication outlets. Several journals that focus on nursing research were established in the United States in the 1970s, including “Advances in Nursing Science, Research in Nursing and Health, and the Western Journal of Nursing Research.”

The 1980s brought nursing research to a new level of development. An increase in the number of qualified nurse researchers, the widespread availability of computers for the collection and analysis of information, and an ever-growing recognition that research is an integral part of professional nursing led nursing leaders to raise new issues and concerns. More attention was paid to the types of questions being asked, the methods of collecting and analyzing information being used, the linking of research to theory, and the utilization of research findings in practice.

Nursing science came into its maturity in the United States during the 1990s. As but one example, nursing research was strengthened and given more national visibility when NCNR was promoted to full institute status within the NIH: in 1993, the National Institute of Nursing Research (NINR) was born. The birth of NINR helped put nursing research more into the mainstream of research activities enjoyed by other health disciplines. Funding for nursing research has also grown.

Nursing research continues to develop at a rapid pace and will undoubtedly flourish in the 21st century. Broadly speaking, the priority for nursing research in the future will be the promotion of excellence in nursing science. Toward this end, nurse researchers and practicing nurses will be sharpening their research skills, and using those skills to address emerging issues of importance to the profession and its clientele.

Research in India has its roots with philosophy of Florence Nightingale that a profession is committed to the task of enlarging body of knowledge through systematic approach to solve problems in nursing. The statistics on the insanitary conditions of the Army in India prepared by F Nightingale may be called a starting point of research in India.30

Afterwards so many developments have taken place in India, through the emergence of Associations, educational institutions and efforts of prominent educators and administrators though directly or indirectly adopting the scientific approach as shown below.

Nurses make clinical decisions based on a large repertoire of knowledge and information (Estabrooks et al., 2005). Nursing students are taught by faculty and textbooks how to practice nursing. Nurses also learn from each other and from interactions with other healthcare professional. In fact, Millenson (1997) estimated that 85% of healthcare practice has not been scientifically validated. Although the percentage of validated practices may have increased since 1997, there is widespread support for the notion that nursing practice should rely more heavily on evidence from research.

Many questions are answered and decisions made based on customs or tradition. Within each culture, certain “truths” are accepted as given. For example, as citizens of democratic societies, most of us accept 34without proof that democracy is the highest form of government. This type of knowledge often is so much a part of our heritage that few of us seek verification. Tradition is efficient as an information source: each individual is not required to begin anew in an attempt to understand the world or certain aspects of it. Tradition or custom also facilitates communication by providing a common foundation of accepted truth. Nevertheless, tradition poses some problems because many traditions have never been evaluated for their validity. There is growing concern that many nursing interventions are based on tradition, customs, and “unit culture” rather than on sound evidence.

Clinical experience is a familiar and functional source of knowledge. The ability to generalize, to recognize regularities, and to make predictions based on observations is an important characteristic of the human mind.

Solutions to many problems are developed by logical thought processes. Logical reasoning as a problem solving method combines experience, intellectual faculties, and formal systems of thought. Inductive reasoning 35is the process of developing generalizations from specific observations. For example, a nurse may observe the anxious behavior of (specific) hospitalized children and conclude that (in general) children's separation from their parents is stressful. Deductive reasoning is the process of developing specific predictions from general principles. For example, if we assume that separation anxiety occurs in hospitalized children (in general), then we might predict that (specific) children in a local hospital whose parents do not room in will manifest symptoms of stress.

In making clinical decisions, healthcare professionals also rely on information that has been assembled for a variety of purposes. For example, local, national, and international bench-marking data provide information on such issues as the rates of using various procedures (e.g. rates of cesarean deliveries) or rates of infection (e.g. nosocomial pneumonia rates), and can serve as a guide in evaluating clinical practices. Cost data, that is, information on the costs associated with certain procedures, policies, or practices are sometimes used as a factor in clinical decision making. Quality improvement and risk data, such as medication error reports and evidence on the incidence and prevalence of skin breakdown, can be used to assess practices and determine the need for practice charges.

Research conducted within a disciplined format is ‘the most sophisticated method of acquiring knowledge that humans have developed. Nursing research combines aspects of logical reasoning with other features to create evidence that, although fallible, tends to be more reliable than other methods of knowledge acquisition. Cumulative findings from rigorous, systematically appraised research is at the pinnacle of most evidence hierarchies. The current emphasis on evidence based health care requires nurses to base their clinical practice to the greatest extent possible on research based findings rather than on tradition, authority, intuition, or personal experience although nursing will always remain a rich blend of art and science.

The general purpose of nursing research is to answer questions or solve problems of relevance to the nursing profession. Specific purposes can be classified in a number of different ways.36

The specific purposes of nursing research include identification, description, exploration, explanation, prediction, and control. For each purpose, various types of question are addressed by nurse researchers some more amenable to qualitative than to quantitative inquiry, and vice versa.

Qualitative researchers sometimes study phenomena about which little is known. In some cases, so little is known that the phenomenon has yet to be clearly identified or named or has been inadequately defined or conceptualized. The in depth, probing nature of qualitative research is well suited to the task of answering such questions as, “What is this phenomenon?” and “What is its name?” In quantitative research, by contrast, the researcher begins with a phenomenon that has been previously studied or defined sometimes in a qualitative study. Thus, in quantitative research, identification typically precedes the inquiry.

Marcinkowski, Wong, and Dignam (2005) studied the experiences of nine adults with osteoarthritis who had undergone a total knee joint arthroplasty. They identified a basic process of adjustment that they called getting back to the future

Like descriptive research, exploratory research begins with a phenomenon of interest; but rather than simply observing and describing it, 37exploratory research investigates the full nature of the phenomenon, the manner in which it is manifested, and the other factors to which it is related. For example, a descriptive quantitative study of patients' preoperative stress might seek to document the degree of stress patients experience before surgery and the percentage of patients who actually experience it. An exploratory study might ask: What factor diminish or increase a patient's stress? Is a patient's stress related to behaviors of the nursing staff? Is stress related to the patient's cultural background? Qualitative methods are especially useful for exploring the full nature of a little understood phenomenon. Exploratory qualitative research is designed to shed light on the various ways in which a phenomenon is manifested and on underlying processes.

The goals of explanatory research are to understand the underpinnings of specific natural phenomena, and to explain systematic relationships among phenomena. Explanatory research is often linked to theories, which represent a method of organizing and integrating ideas about phenomena and their interrelationships. Whereas descriptive research provides new information, and exploratory research provides promising insights, explanatory research attempts to offer understanding of the underlying causes or full nature of a phenomenon. In quantitative research, theories or prior findings are used deductively to generate hypothesized explanations that are then tested empirically. In qualitative studies, researchers may search for explanations about how or why a phenomenon exists or what a phenomenon means as a basis for developing a theory that is grounded in rich, in-depth, experiential evidence.

Many phenomena defy explanation. Yet, it is frequently possible to make predictions and to control phenomena based on research findings, even in the absence of complete understanding. For example, research has shown that the incidence of Down syndrome in infants increases with the age of the mother. We can predict that a woman aged 40 years is at higher risk for bearing a child with Down syndrome than is a woman aged 25 years. We can partially control the outcome by educating women about the risks and offering amniocentesis to women older than 35 years of age. In many nursing and health related studies typically, quantitative ones prediction and control are key objectives. For example, studies designed to test the effectiveness of nurseled smoking cessation interventions are ultimately concerned with controlling (improving) patient outcomes and 38health care costs. Although explanatory studies are powerful in an EBP environment, studies whose purpose is prediction and control are also critical in helping clinicians make decisions.

Nurse researchers are increasingly undertaking studies designed to help nurses make evidence based treatment decisions. Such studies range from evaluations of highly specific treatments of therapies (e.g. comparing two types of cooling blankets for febrile patients) to complex multi session or multicomponent interventions designed to effect major behavioral changes (e.g. nurse led smoking cessation interventions). Such intervention research plays a critical role in EBP. Before intervening with patients, nurses have a responsibility to determine the benefits and risks of the intervention, and also whether the expenditure of resources for the intervention is justifiable.

A burgeoning number of studies published in the nursing literature concern the rigorous development and evaluation of formal instruments to screen, diagnose, and assess patients and to measure important clinical outcomes. High quality instruments with documented accuracy are essential both for clinical practice and for further research.

Studies of prognosis examine the outcomes of a disease or health problem, estimate the probability they will occur, and indicate when (and for which types of people) the outcomes are most likely. Such studies facilitate the development of long-term care plans for patients. They also provide valuable information that can guide patients to make important lifestyle choices or to be vigilant for key symptoms. Prognostic studies can also play a role in resource allocation decisions.

Nurse frequently encounter patients who face potentially harmful exposures some as a result of health care factors, others because of environmental agents, and still others because of personal behaviors or characteristics. Providing useful information to patients about such harms and how best to avoid them, and taking appropriate prophylactic measures with patients in care, depend on the availability of accurate evidence.

It is difficult, and sometimes impossible, to prevent harms or treat problems if we do not know what causes them. For example, there would be no smoking cessation programs if research had not provided firm evidence that smoking cigarettes causes or contributes to a wide range of health problems. Thus, determining the factors that affect or cause illness, mortality, or morbidity is an important purpose of many nursing studies.