THE RESEARCH PROCESS

PHASES OF NURSING RESEARCH CONCEPTUAL PHASE THE DESIGN AND PLANNING PHASE THE EMPIRICAL PHASE THE ANALYTIC PHASE THE DISSEMINATION PHASE

CONCEPTUAL PHASE FORMULATING AND DELIMITING THE PROBLEM Topic Research Problem Problem statement – articulates the problem to be addressed and indicates the need for a study Research Questions – are the specific queries researchers want to answer in addressing the research problem Research Hypothesis – predictions that are tested empirically Null hypothesis Research or alternative hypothesis

Side effects of Chemotherapy Term Example Topic Side effects of Chemotherapy Research Problem Nausea and vomiting are common side effects among patients on chemo; interventions have been moderately successful. New interventions that can reduce or prevent these side effects need to be identified Statement of purpose Purpose is to test an intervention to reduce chemotherapy-induced side effects – specifically to compare the effectiveness of patient-controlled and nurse-administered antiemetic therapy Research question What is the relative effectiveness of patient-controlled antiemetic therapy versus nurse-controlled antiemetic therapy with regard to (a) medication consumption, and (b) control of nausea and vomiting in patients on chemotherapy? Hypothesis There is no difference on the effectiveness between patient-controlled and nurse-controlled antiemetic therapy with regard to medication consumption and control of nausea and vomiting of patients on chemotherapy.

CONCEPTUAL PHASE FORMULATING AND DELIMITING THE PROBLEM Evaluating research problems Significance of the problem – research problem should have the potential of contributing meaningfully to the nursing knowledge Research ability of the Problem Time and timing Availability of study participants Facilities and equipment Money Experience and interest of the researcher

CONCEPTUAL PHASE 2. REVIEWING THE LITERATURE Done to familiarize researchers with the knowledge base PURPOSES: Orient of what is known and not known regarding the topic Replication of study Identifications of relevant theoretical and conceptual framework Assistance in interpreting study findings and developing implications and recommendations

SOURCES OF LITERATURE PRIMARY SOURCES SECONDARY SOURCES Research reports/studies SECONDARY SOURCES Books Literature review summaries

THE DESIGN AND PLANNING PHASE Selecting a research design Identifying the population to be studied Sampling plan Methods to measure research variables Finalizing the research study

RESEARCH DESIGN Based on: Time Frame Control over independent variable Measurement of independent and dependent variables RESEARCH DESIGN

TIME FRAME DESIGN FEATURES EXAMPLE CROSS-SECTIONAL Data are collected at one point in time Practical, easy to do, economical Mindell and Jacobson (2000) assessed sleep patterns and the prevalence of sleep disorders during pregnancy. They compared women who were at 4 points in pregnancy: 8-12wks, 18-22wks, 25-28wks, 35-38wks. They concluded that sleep disturbance is common in late pregnancy.

Design of cohort study START WITH: EXPOSED NOT EXPOSED AND THEN FOLLOW TO SEE IF DISEASE DEVELOPS DISEASE DOES NOT DEVELOP DISEASE DEVELOPS DISEASE DOES NOT DEVELP Design of cohort study

Design of a case-control study THEN DETERMINE EXPOSURE HISTORY Were not exposed Were not exposed Were exposed Were exposed HAVE THE DISEASE DO NOT HAVE THE DISEASE START WITH Design of a case-control study

In A COHORT STUDY IN A CASE-CONTROL STUDY GROUPS COMPARED EXPOSED PEOPLE NON-EXPOSED PEOPLE AND IN A CASE-CONTROL STUDY GROUPS COMPARED PEOPLE WITH THE DISEASE PEOPLE WITHOUT THE DISEASE AND ‘CASES ‘ ‘CONTROLS’

In A COHORT STUDY IN A CASE-CONTROL STUDY DETERMINE INCIDENCE RATES OF DISEASE IN: EXPOSED PEOPLE NON-EXPOSED PEOPLE AND IN A CASE-CONTROL STUDY DETERMINE THE PROPORTIONS EXPOSED IN: PEOPLE WITH THE DISEASE PEOPLE WITHOUT THE DISEASE AND CASES CONTROLS

Cohort study Case-control study Measure of risk Relative risk Odds ratio Temporal sequence Easy to establish Sometimes hard Multiple association Possible to study associations of an exposure with several disease Possible to study associations of a disease with several exposures or factors Time and cost required Long and expensive Relatively short and inexpensive Population size Relatively large Relatively small Potential bias Assessment of outcome Assessment of exposure Best when Exposure is rare, and disease is frequent among exposed Disease is rare, exposure is frequent among the diseased

Changes over time in criteria and methods Cohort study Case-control study Problems Selection of non-exposed comparison group often difficult; Changes over time in criteria and methods Selection of appropriate controls often difficult; Incomplete information on exposure

Not Exposed Exposed B C B B C B C C Develop Disease A Develop Disease Do not Develop Disease A B C Do not Develop Disease A B B C B C C

Not Exposed To A Not Exposed To A No Disease Disease C C C C B B B B Exposed to A Not Exposed To A Exposed to A Not Exposed To A No Disease Disease cases Controls

TIME FRAME DESIGN FEATURES LONGITUDINAL Data are collected at two or more points in time over an extended period TREND STUDIES Investigations in which samples from a population are studied over time Different samples are selected but drawn from the same population Based on surveys TIME FRAME

CONTROL OVER INDEPENDENT VARIABLE DESIGN FEATURES EXPERIMENTAL Manipulation of independent variable Control group randomization QUASI -EXPERIMENTAL No control group No randomization NONEXPERIMENTAL No manipulation of independent variable

Is there an intervention? No Yes NONEXPERIMENTAL Is there randomization? No Yes QUASI-EXPERIMENTAL EXPERIMENTAL

MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES DESIGN FEATURES EXAMPLE RETROSPECTIVE Study begins with dependent variable and looks backward for cause Heitkemper, et. al. (2001), used a Retrospective design in their study of factors contributing to the onset of irritable bowel syndrome. They compared samples of women with and without IBS in terms of their history of sexual and physical abuse and found that abusive experiences were more prevalent among women with IBS.

MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES DESIGN FEATURE EXAMPLE PROSPECTIVE Study begins with independent variable and looks forward for the effect Brook, et. al. (2000) conducted a prospective study to examine clinical and cost outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. Early tracheostomy was found to be associated with shorter lengths of hospital stay and lower cost.

IDENTIFYING THE POPULATION TO BE STUDIED POPULATION – aggregate or totality of those conforming to a set of specifications. Nurses Students Children Etc.

DESIGNING THE SAMPLING PLAN SAMPLE – subset of a population Sampling techniques: Probability sampling Systematic sampling Fish bowl method Nonprobability sampling Purposive/Judgmental sampling Snow ball technique Convenience/accidental sampling

METHODS TO MEASURE RESEARCH VARIABLES Different methods of data collection Biophysiologic measurements Self-reports Observation Use of a research instrument Questionnaires Survey forms

FINALIZING THE RESEARCH PLAN Pretesting of questionnaires Conducting a Pilot study

Observational Experimental Cross sectional Case control study Study Design General categories Observational Experimental Cross sectional Case control study Cohort study Community trials Clinical Trials

Cross sectional Retrospective Descriptive Studies Future Past Today Cross sectional (Prevalence) Retrospective (Case Control) Prospective (Incidence) Historical Prospective

Descriptive Study: Advantages Cross sectional Retrospective Prospective Quick Cheap Large sample Attributes Prevalence Public health Rare disease Cheap Uses records Small sample Quick Risk factors Complete Risk factors Quality data Natural history Incidence Etiology

Cross-Sectional Study It is also called prevalence study. It is conduct at one point of time and try to concurrently evaluate exposure (risk factors ) and outcome (diseases) in a population. Cross-Sectional Study

Questionnaire (include every information of interest) Risk factors Investigators Collection of data

Cross-sectional Study Design Selection of study population -target appropriate population -acquire a “representative” sample -Sampling definitions -sampling unit: person, patient, household -Sampling frame: list of all sampling units -Sample: all sampling units chosen rule: each unit has the same probability of being chosen

Sampling Simple random sampling Systematic sampling Stratified sampling Cluster sampling Multistage sampling Sampling

Prevalence of Metabolic Syndrome:8814 US Adults Age 20+ NHANES 1988-94, JAMA 2002 287

Prevalence of Cardiovascular Disease in Women with Diabetes NHIS 1997-9 MMWR 2001 50:948-54

Cross-sectional Studies Analysis: Study sample Cross-sectional collection of data Exposed w/disease “a” Exposed w/o disease “b” No exposure w/disease “c” No exposure w/o disease “d”

Cross-sectional Studies Analysis: Study sample Cross-sectional collection of data Exposed w/disease “a” Exposed w/o disease “b” No exposure w/disease “c” No exposure w/o disease “d” Dis no dis Compare prevalence in exposed to prevalence in non-exposed Exp no exp a b Prevalence ratio = a / a+b c / c+d c d

Cross-sectional Studies Common methods of Analysis: -t-tests -rate comparisons -categorical data analysis descriptive analysis comparisons can be by age, sex, or date, year

3ed stage – working up of material The stages of statistic investigation 1st stage – composition of the program and plan of investigation 5th stage – putting into practice 4th stage – analysis of material, conclusions, proposals 2nd stage – collection of material 3ed stage – working up of material

DATA COLLECTION DATA ENCODING EMPIRICAL PHASE

THE ANALYTIC PHASE DATA ANALYSIS Statistical analysis DATA INTERPRETATION – is the process of making sense of the results and examining their implications CONCLUSION AND RECOMMENDATION THE ANALYTIC PHASE

DISSEMINATION PHASE RESEARCH REPORT UTILIZATION OF FINDINGS Research Abstract Research published in journals Term papers, theses, dissertations UTILIZATION OF FINDINGS Application to nursing practice and nursing education DISSEMINATION PHASE