Understanding the Research Process Cynthia A. Logan, PhD, RN

Research is… Systematic process of Purpose Collecting Analyzing Interpreting Purpose Understand a phenomenon of interest Communicate findings to the nursing community

Typical Characteristics of Research Originates with a question or problem Requires clear articulation of a goal Requires a specific plan for proceeding May divide initial problem into subproblems Guided by problem, question, or hypothesis Accepts certain assumptions Requires data collection and interpretation Cyclical or helical Several steps to research process—do not always follow same sequence Systematic, rigorous, planned.

Research is not……. Reading for personal learning Transporting facts from one place to another Rummaging for information Information gathering

Why Research?????? Practical Application Reading Consider the source Expert review Sufficient details Logical organization Utilizing Agree/disagree with findings Implementation in clinical setting Conducting Significance Researchability Feasibility Reading – Utilizing Evaluation of the applicability of research requires some knowledge of the process. One way of looking at research is to check out the journal the research report appears in. Ask yourself: What does the journal require of its authors? Can usually be found in the journal or on the website. Are the manuscripts submitted reviewed by others or does one person control publication? Are sufficient details about the process included in the article? Enough to allow you to make a judgment about the value of the findings? Does the journal have the respect of the profession? Do you think that the article is logically organized, written so that you can understand the findings, even if you don’t really understand the choice of statistical techniques, etc. Does it make sense to you? Don’t underestimate your knowledge. Conducting Research Time and money are often in short supply where research is concerned, even when it is an expectation. Some questions should be discussed in the early stages in order to use wisely everyone’s investment of time and money. Is the problem important? Will the findings be of interest to many or to few? How costly will it be? Are people available to conduct the study who are interested, motivated, and qualified? Will other employees be affected and how? Will all who are affected given the opportunity to have input on some level or to opt out?

What to Research? Finding a researchable problem General Categories: People, Things, Records, Thoughts, Dynamics, and Energy Observations & Experience “GRIPES” Identifying needs & problems Your own interests Nursing literature Ideas from others Why???? What??? How?? Curiosity is a natural accompaniment to finding a researchable problem. Questioning mind asks Why? What happened here? What caused that? Sources of research problems usually fall into one of these categories, regardless of discipline: People – (lots of application to nursing) individuals, groups, families, students, workers, management, disadvantaged, wealthy, poor, etc. Things – biological and vegetable life, e.g. rocks, space, pharmacological problems, machines, food, and clothing, etc. Thoughts – opinions, reactions, concepts, theories, viewpoints, perceptions, observations, issues, language, semanticss, etc. Dynamics & energy – Metabolism, bionics, quantum mechanics, nuclear energy, black holes, and extragalactic radiation. Griping, though it has lots of negatives, has an upside too and can help us to identify needs and difficulties that may result in a researchable problem. Does a problem recur, can you discern a pattern in a situation? The answer may reveal more to you about the problem. Explore….Take some time to read articles in your field. Bring interesting articles to your unit to share. What do you do with down time? Don’t have any? Go to the gift shop? Gripe or gossip? Think about -- What irks you, frustrates you, affects patient care in unintended ways, or affects your job performance? We all have opinions about patient care and job performance, but we are not always provoked to act on the problem. Research is one way of acting on a problem and giving ourselves another dimension to make work life more meaningful. Requires critical examination of what we do and why we do it? Including the decisions that we make. What are your decisions based on? Tradition Evidence of effectiveness Custom Is the basis on which you make decisions in need of challenge?

Problem Statement: A Matter of Words Briefly describes the dilemma or situation in need of investigation Describes the scope of the problem Identifies the nature of the problem , its context, and significance States what the researcher intends to do Focus of the study written in 4 sentences or less, usually Delimitation – states what the researcher does not intend to do. Definitions of terms – the reader cannot evaluate the research or determine whether the researcher has carried out what was proposed in the problem statement, unless the researcher clearly defines the terms important to the study.

Literature Review Identifies: What is known and what is not known Gaps and inconsistencies in body of knowledge New interventions to test Available instruments with established reliability and validity Theoretical or conceptual frameworks Types of research designs already used Problems you may encounter Not only helps to identify problems, but also can help you explore the area to find out what has been done and what suggestions for future research exist. If a problem has been fully researched, there may be no point in developing another study unless you have a fresh perspective. Primary vs. secondary sources Locating literature—print resources, internet resources, online search of electronic databases, references lists attached to research reports Limiting your search, so that you don’t get thousands of articles Seeing the same references or authors again and again may give you a clue to something important that you may want to include in your review.

Clinical Fieldwork Talk informally with others in your field Collect expert opinions Think about the situation who affects the situation who is affected by the situation Begin to plan your next steps Expands your knowledge of the factors involved and may give you ideas about the significance to nursing. Who’s an expert?

Defining the Framework Theory: “an abstract generalization that offers a systematic explanation abut how phenomena are interrelated.” Polit & Beck Set of propositions that explain a relationship among concepts Conceptual Models, Conceptual Frameworks, Conceptual Schemes (terms often used interchangeably): views about the nursing process and the nature of nurse-client relationships Less formal but also deal with abstractions Concepts that are relevant to a common theme Research findings become a part of the body of knowledge that is nursing. Having an appropriate theoretical or conceptual framework assists with this process by linking new research to existing knowledge

Hypothesis: It’s Worth a Guess Speculation about the answer to a question Essential to experimental research A position from which the researcher can explore Serves as a “reality check” for the findings that the data reveal Findings support the hypothesis? Accept! Or not? Reject! Not necessarily proof. If not supported, no fault in this outcome. Setting out to “prove” a hypothesis may bias your research. Null hypothesis Research Question – identifies the concepts under investigation and asks how the concepts might be related. Example: RQ -- Is preeclamptic toxemia in pregnant women associated with stress factors present during pregnancy? Hypothesis – Pregnant women with a higher incidence of stressful events during pregnancy will be more likely than women with a lower incidence of stress to experience preeclamptic toxemia.

Research Designs General strategy for solving a research problem Guides the planning needed for implementing a study Resources Procedures Data Experimental vs. Nonexperimental Research designs vary according to: Degree of structure -- Quantitative research designs tend to be more structured than qualitative designs and are very specific re: interventions, comparisons made, methods to control extraneous variables, data collection, types of participants, etc. All specified in advance of the start of data collection. Qualitative designs are more fluid/flexible and some modifications may be made along the way. Type of group comparisons Time frame Control over IV Measurement of IV & DV

Research Methodology & Intervention Protocols Specific to the discipline Addresses practical issues precisely and realistically: Type of data Data availability Data collection Data interpretation Intervention protocol “You cannot study chromosomes with a questionnaire and you cannot study attitudes with a chemical analysis.” How will you get to where you want to go? The details should be planned in advance not haphazardly along the way. Sometimes something comes up unexpectedly that must be dealt with, but planning is essential. Feasibility Time & cost Intervention protocol

Population & Sample Population – those who conform to a certain set of characteristics which will be studied. Those to whom findings can be generalized. Sample – participants in the study, a subset of the population. Representative of the population Generalizability—to whom will your finding apply Example—a nurse researcher may want to study labor and delivery nurses, so the population may be defined as all L & D nurses in the U. S. Probably will not have the time or the money to conduct a study including the entire population, so you select a sample of nurses from this population, which could include your L & D friends, a convenience sample 2. your L & D friends and their L & D friends, snowball or network sample, also a convenience sample 3. Selection according to some existing characteristic, such as the percentage of males (20%) and females (80%) in nursing, quota sample Urban/rural, older/younger, etc 4. Hand picking nurses who are judged by the researcher to be typical of a certain population of nurses, purposive sampling Frequently used by qualitative researchers Used when testing and evaluating new instruments often All of the above—non-probability sampling Problem with non-probability sampling is that they are rarely representative of the population. They are used chiefly because of convenience and low cost. Probability sampling involves the random selection of elements from a population If I listed every L & D nurse here (sampling frame) and selected 10% by drawing out of a hat, then I have a better chance of getting an unbiased sample, representative of the population, but not a guarantee. There are other methods of obtaining a sample, also based on random selection but more complicated.

Research Variables Definition: “an attribute or a person or object that varies, that is, takes on different values…” Polit & Beck Weight, temperature, anxiety level, income… Hypothesis is a predicted relationship between two or more variables. Independent variable Dependent variable In cause-effect studies IV is the presumed cause and the presumed effect is the dependent variable Smoking causes lung cancer “Nursing intervention” causes more rapid recovery. Not always written so clearly– more often talking about associations or relationships, not cause/effect which is the most difficult to find. = DV Italics=IV The incidence of decubitus ulcers is related to the frequency of turning patients. Nurses administer the same amount of narcotic analgesics to male and female patients.

Participants’ Rights Ethical dilemmas result of: Ethics Principles Not aware of participation Dealing with sensitive information Revelation of information Denial of benefits Ethics Principles Codes of Ethics Ethical Guidelines Dilemmas – Participants must be made aware that they are in a study. Studies dealing with sensitive information or interventions that may be uncomfortable, physically or emotionally. Denial of benefits of treatment. Revelation of information by participants about immoral or illegal behavior.   Principles – Beneficence – not just freedom from harm but must do good. What can be built into a study to minimize or reduce the potential risks. If there are any potential benefits to participants, should be spelled out. Freedom from exploitation – need to assure that information collected will not be used against them, e.g. informing health insurance carrier, affecting grade in course or standing in university. Risk/benefit ratio Respect – Self-determination – right to ask questions, to terminate participation, no coercion to participate, use of money as incentive, etc. Right to disclosure – essential for informed consent Justice – Right to fair treatment – Selection unbiased, honoring all agreements made, access to assistance if risk present, debriefing, courtesy Right to privacy – Informed Consent – Comprehension – readability Consent and assent (affirmative agreement to participate) Vulnerable groups – children, terminally ill, “captive audiences,” disabled Anonymity & Confidentiality – difference When anonymity impossible, steps must be taken to ensure confidentiality. Usually, these steps are spelled out in the information that goes to IRB, the participants, and described in the research report. Codes – Nuremberg Code – international standard developed after WWII atrocities. Declaration of Helsinki, adopted in 1964 by World Medical Association and revised 2000. Unethical actions have led to greater visibility and increased oversight of human rights. Tuskegee Syphilis Study—treatment withheld Radiation experiments on prisoners and others in 1940’s ANA Code of Ethics—Provision 7 states: “The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.” Interpretative statement re: research -- excerpts “…Ongoing scholarly activities are essential to fulfilling a profession’s obligations to society. All nurses working alone or in collaboration with others can participate in the advancement of the profession through the development, evaluation, dissemination, and application of knowledge in practice… an organizational climate and infrastructure conducive to scholarly inquiry must be valued and implemented for this to occur.” In addition ANA put out a document in 1995 titled Ethical Guidelines in the Conduct, Dissemeination, and Implementation of Nursing Research which gives additional direction re: research in nursing. Belmont Report—serves as the basis for regulations affecting research sponsored by the federal government. Articulated 3 primary ethical principles on which standards of ethical conduct in research are based: beneficence, respect for human dignity, and justice. Institutional Review Boards (IRB)—formal committee for reviewing proposals with set protocols before they are implemented. May go by other names but all have responsibility for unbiased review of proposals to protect the rights of human participants.

Pretesting/Pilot Study Allows researcher to try out protocols, instruments, participant response, etc. Allows researcher to make adjustment before investing major time and energy Pretest vs. Pilot Study Instrument pretesting Small scale trial run—pilot study Proposal review

Data Collection Answers the following questions: What data are necessary? What are their characteristics? Where is the data located? How will data be secured? How will data be interpreted?

Data Analysis Varies according to the type of design Preparing data Determining if usable Assigning identification codes, if not already done Statistical analysis Quantitative vs. qualitative Experimental vs. Nonexperimental Identification codes Coding data—translating verbal into numeric

Interpreting Results Process of making sense of the data Were hypotheses supported? Yes! If not, why not? Critical evaluation needed Critical evaluation needed of all decisions made

Communicating Findings Dissemination of study results contributes evidence to nursing practice through: Research reports Presentations Articles

Utilizing Research Findings Researcher should: include recommendations for using the findings in nursing Pursue opportunities to disseminate findings to practicing nurses Practicing nurses have the final word!

Example: Topic vs. Problem Statement “Side effects of chemotherapy” Polit & Beck “N & V are common SE’s among pts on chemotx, and interventions to date have been only moderately successful in  these effects. New interventions that can  or prevent these side effects need to be identified.” Sets up the problem and focuses the reader on the need for this research. Immediately tells the reader what is important and what direction this study will take.

Example: 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 chemotx?” Polit & Beck More specific Requires definition of terms Antiemetic therapy Patient-controlled antiemetic therapy Nurse-controlled antiemetic therapy Medication consumption Control of N & V

Example: Hypotheses “Subjects receiving antiemetic therapy by a patient-controlled pump will report less nausea than subjects receiving the therapy by nurse administration. Subjects receiving antiemetic therapy by a patient-controlled pump will vomit less than subjects receiving the therapy by nurse administration.” Polit & Beck Definition of terms—is retching nausea or vomiting?

The End