Nursing Research: 63-377 Dr. Wally J. Bartfay

1. Nursing Research: 63-377Dr. Wally J. Bartfay “Imagination is more important than knowledge.” (Albert Einstein, 1879-1955)

2. Research Questions • Are specific statements about the query the researcher wants to answer • E.g.1: “What is the effect of a 3 year television community-based heart health program on the CVD mortality rate in Ontario?” • E.g.2: “What is the effect of passive ROM on the prevention of DVT’s during the first 24 hours following stroke?”

3. Research Questions: Quantitative • They often identify key variables (e.g., BP, cholesterol, knowledge), the proposed relationships between (e.g., less, more, higher, lower, etc) them & the target population (e.g., stroke survivors, children with IDDM) {more solid} • E.g., What is the effect of a 10 week walking program on subjects BP, cholesterol profiles and serum ferritin levels in post-menopausal women aged 50 to 60 years?

4. Research Questions: Qualitative • May evolve & change over course of study (fairly broad at onset, narrows overtime) {more fluid B/C researcher is often the instrument & subjectivity is essential for understanding human experiences} • E.g., time 1: What is the lived experience of women who have undergone a C-section? • E.g., time 2: What are the specific negative connotations & images r/t to birth process identified by women who have undergone a C-section?

5. Summary Flow Chart: Formulating A Research Question

6. Research Hypotheses • Specifies the variables to be manipulated or measured • Identifies the target population to be examined • They “predict” the outcomes • May be based on a theory (e.g., behavioral modification) • May be simple (one independent & dependent variable) or complex (multiple variables/ outcomes) • May be directional (e.g., higher, lower) or non-directional (variables related but no direction how) • May be associative versus causal

7. Research Hypothesis: A real example • At least 50% of nursing students enrolled in 63-377 will be able to recall 7+/-2 items on a memory challenge test

8. Research Hypothesis: A real example • Mirror, ray, cat, periscope, system, nucleus • Sand, elephant, pen-knife, gigantic, camera • Jupiter, organic, ice-cream, cow, bladder • Photosynthesis, root, teeth, taxi, snake, x-ray

9. Research Hypothesis: A real example • At least 50% of nursing students enrolled in 63-377 will be able to recall 7+/-2 items on a memory challenge test • Class results? • Accept or reject hypothesis

10. Purposes of Hypotheses • (1) To provide a bridge between theory & reality, in this sense, unifying the 2 domains • (2) To be tools for advancement of knowledge b/c they enable the researcher to objectively enter new areas of discovery • (3) To provide direction for research endeavors by identifying the anticipated outcome

11. Assumptions r/t Hypotheses • Nature of the relationships, either causal or associative, is implied • They are testable, which means variables have to be observable & measurable • Sound hypotheses are consistent with existing body of knowledge, theory & research findings (white horse scenario)

12. Developing Research Hypotheses • Should be a statement about the relationship between 2 or more variables that suggest an answer to the research ? • Should convert the question posed by research problem into a declarative statement that predicts an expected outcome • Should flow from research problem, lit. review & theoretical framework

13. Developing Research Hypotheses Hypotheses Interrelationships of problem statement, lit. review, theoretical framework & hypotheses

14. Review exercise: Examples of hypotheses formulated • (1) There will be a positive relationship between recalled psychological distress & the onset of G.I. symptoms in clients with irritable bowel syndrome • (2) There will be a positive relationship between recalled psychological distress and exacerbation of G.I. symptoms in clients with irritable bowel syndrome

15. Critiquing Criteria for Hypotheses • Does it r/t research problem? • Is it concisely stated in a declarative form? • Are independent & dependent variables clearly identified? • Are variables measurable? • Is it testable? • Is theoretical rationale explicit? • Is it stated objectively, without value-laden words?

16. Review of Literature Review of Literature Proposed relationships between research, education, practice & literature

17. Review of Literature: Major Goal • To develop a sound and strong knowledge base to carry-out research and other scholarly educational and clinical practice activities

18. Critical elements in literature review: Grant proposal development • When the problem/ concept was identified • When was it 1st investigated • How was it previously investigated (specific designs employed, target populations) • By whom was it investigated (individual, multi-site, WHO etc) • Gaps & inconsistencies identified (provides directions for future research)

19. Review of Literature: Objectives • (1) Determines what is known & not known about a problem, subject or concept • (2) Determines gaps, consistencies and inconsistencies • (3) Helps to uncover unanswered ?’s • (4) Helps to identify conceptual frameworks used to examine problems • (5) May uncover new practice interventions and/or provides rationale for current and proposed interventions, protocols & policies

20. Review of Literature: Objectives • (6) Helps generate useful research ?’s & hypotheses of interest to nursing • (7) Helps determine appropriate research design, methodology, & analysis based on earlier reports • (8) Determines need for replication of study or refinement (e.g., other target populations) • (9) Synthesizes strengths & weaknesses of earlier reports in a concise manner • (10) Provides rationale & clinical significance for new research endeavors (research proposals)

21. Steps For Reviewing The Literature: • (1) Determine concept/ issue/ topic/ problem of interest • (2) Identify key words, variables, terms • (3) Conduct print (esp. recent reviews) & computer searches of abstracts (e.g., PUBMED, MEDLINE, CINAHL, ERIC) • (4) Print-out key abstracts & organize sources for retrieval (e.g., organize by journal name, year etc) • (5) Retrieve relevant articles (esp. current reviews as a starting point)

22. Steps For Reviewing The Literature: • (6) Proof articles & weed-out all irrelevant articles • (7) Copy all relevant, classical & ground-breaking articles (hint: who’s quoting who?) • (8) Review articles systematically (abstract, background, research ?s, hypotheses, methods, results, discussion) • (9) Summarize & systematically critique each source • (10) Synthesize critical summaries (e.g., chronologically, according to type etc)

23. Databases: Print & Internet based • CINAHL (1st published in 1956- note: historical research) • Index Medicus {IM} (oldest health related index, 1st published in 1879) • Psychological Abstracts (covers 1927 to present) • International Nursing Index {INI} (started in 1966) • Nursing Studies Index (developed by Virginia Henderson, from 1900 to 1959) • Hospital & Health Administration Index {HHAI} (1945) • Current Index to Journals in Education {CIJE} (1969, now known as ERIC) • Many others, including MEDLINE (since 1966), PUBMED, HealthStar, Psychological Abstracts, Sociological Abstracts, Nursing Abstracts, Dissertation Abstracts, etc

24. Critiquing Criteria for Review of Literature: • (1) What are gaps or inconsistencies? • (2) How does the review reflect critical thinking? • (3) Are all relevant concepts & variables included in the review? • (4) Do summaries reflect essential components of the study (e.g., ?s, study design, results, instruments, validity, reliability issues, etc)? {See page 107 of Polit & Tatano Beck, (2004)} • (5) Does critique include strengths, weaknesses, limitations with design, conflicts, gaps, etc?

25. Critiquing Criteria for Review of Literature: • (6) Are both conceptual & data-based lit. included? • (7) Are primary & current sources used mostly (unless Hx. Research)? • (8) Is there a written synthesis of the reports? • (9) Does organization flow logically (e.g., chronologically, based on design etc)? • (10) Does lit. review fit purpose(s) of the current proposed study (relevant or not)?