differences in the approaches used by grounded theory researchers, phenomenologists, and ethnographers are noted throughout.
•Better “how to” assistance.There are even more
“how to” tips in this edition than in previous ones, with many new ones aimed at qualitative re- searchers. Moreover, these tips are interspersed throughout the text rather than clustered at the end, which not only places them in more relevant loca- tions, but also makes for a livelier presentation.
•Improved readability.This textbook has been widely hailed for its clear, concise, and “user- friendly” presentation. In this edition, however, we have gone to great lengths to write in an even simpler, more straightforward fashion, in recognition of the fact that research methods are an inherently complex topic. Additionally, the readability of the text is enhanced by several visual features, such as the use of a new, full- color design.
•Greater acknowledgment of international efforts.This edition gives better recognition to the contributions of nurse researchers from around the globe.
Organization of the Text
The content of this edition is organized into seven main parts.
•Part I—Foundations of Nursing Research introduces fundamental concepts in nursing re- search. Chapter 1 summarizes the history and vii
T
his seventh edition of Nursing Research:Principles and Methods presents many im- portant changes to this textbook. This edition retains the features that have made this an award-winning textbook, while introducing revisions that will make it more relevant in an environment that is increas- ingly focused on evidence-based nursing practice.
New to This Edition
•Emphasis on producing and evaluating research evidence. This edition focuses more squarely on the fact that research is an evidence- building enterprise. We stress throughout that the decisions researchers make in designing and implementing a study have implications for the quality of evidence the study yields—and that the quality of evidence affects the utility of study findings for nursing practice. We have also expanded the final chapter on using re- search in an evidence-based nursing practice.
•Expanded coverage of qualitative research methods.As in the sixth edition, this textbook discusses the methods associated with naturalis- tic inquiries (qualitative studies) in a manner roughly parallel to the description of methods more typically used in traditional scientific research (quantitative studies). This edition, which is coauthored by a prominent qualitative nurse researcher, goes even further than previous ones in offering assistance to those embarking on a qualitative research project. For example,
•Part V—The Analysis of Research Datadis- cusses methods of analyzing qualitative and quantitative data. Chapters 19, 20, and 21 pre- sent an overview of univariate, inferential, and multivariate statistical analyses, respectively.
Chapter 22 describes the development of an overall analytic strategy for quantitative studies.
Chapter 23 discusses methods of doing qualita- tive analyses, with specific information about grounded theory, phenomenologic, and ethno- graphic analyses.
•Part VI—Communicating Research focuses on two types of research communication.
Chapter 24 discusses how to write about re- search and, greatly expanded in this edition, how to publish a research report and prepare a thesis or dissertation. Chapter 25 offers suggestions and guidelines on preparing research proposals.
•Part VII—Using Research Resultsis intended to sharpen the critical awareness of nurses with regard to the use of research findings by practic- ing nurses. Chapter 26 discusses the interpretation and appraisal of research reports. The conclud- ing chapter (Chapter 27) offers suggestions on utilizing research to build an evidence-based practice, and includes guidance on performing integrative reviews.
Key Features
This textbook was designed to be helpful to those who are learning how to do research, as well as to the growing number of nurses who are learning to ap- praise research reports critically and to use research findings in practice. Many of the features success- fully used in previous editions have been retained in this seventh edition. Among the basic principles that helped to shape this and earlier editions of this book are (1) an unswerving conviction that the develop- ment of research skills is critical to the nursing pro- fession; (2) a fundamental belief that research is an intellectually and professionally rewarding enter- prise; and (3) a judgment that learning about research methods need be neither intimidating nor dull.
Consistent with these principles, we have tried to pre- sent the fundamentals of research methods in a way future of nursing research, introduces the topic
of using research evidence for nursing practice, discusses the philosophical underpinnings of qualitative research versus quantitative research, and describes the major purposes of nursing research. Chapter 2 introduces readers to key terms, with new emphasis on terms related to the quality of research evidence. Chapter 3 presents an overview of steps in the research process for both qualitative and quantitative studies.
•Part II—Conceptualizing a Research Study further sets the stage for learning about the research process by discussing issues relating to a study’s conceptualization: the formulation of research questions and hypotheses (Chapter 4);
the review of relevant research (Chapter 5); and the development of theoretical and conceptual contexts (Chapter 6).
•Part III—Designs for Nursing Researchpre- sents material on the design of qualitative and quantitative nursing research studies. Chapter 7 discusses issues important to the design of research that is ethically sound. Chapter 8 describes fundamental principles and applica- tions of quantitative research design, while Chapter 9 describes mechanisms of research control for quantitative studies. Chapter 10 ex- amines quantitative research with different pur- poses. Chapter 11 is devoted to research designs for qualitative studies, with new material added on critical theory, feminist, and participatory action research. Chapter 12 discusses mixed method research designs in which methods for qualitative and quantitative inquiry are blended.
Chapter 13 presents designs and strategies for selecting samples of study participants.
•Part IV—Measurement and Data Collection deals with the gathering of information in a study. Chapter 14 discusses the overall data collection plan, and the subsequent three chap- ters present materials on specific data collection methods such as self-reports (Chapter 15), observation (Chapter 16), and biophysiologic and other methods (Chapter 17). Chapter 18 dis- cusses the concept of measurement, and then focuses on methods of assessing data quality.
•The Study Guide augments the textbook and provides students with exercises that correspond to each text chapter. Answers to selected exer- cises are included at the end of the Study Guide.
The Study Guide also includes two actual re- search reports that students can read, analyze, and critique.
• Free CD-ROM: The Study Guide also includes a CD-ROM providing hundreds of review ques- tions to assist students in self-testing. This review program provides a rationale for both correct and incorrect answers, helping students to identify areas of strength and areas needing further study.
•The Instructor’s Resource CD-ROMincludes a chapter corresponding to every chapter in the textbook. Each chapter of the Instructor’s Manual contains a statement of intent, student objectives, new terms in the chapter, comments on selected research examples in the textbook, answers to certain Study Guide exercises, and test questions (true/false and multiple choice) and answers. New to this edition are PowerPoint slides summarizing key points in each chapter, and test questions have been placed into a pro- gram that allows instructors to automatically generate a test complete with instructions and an answer key. A gradebook is also included in this program.
It is our hope that the content, style, and organization of this book continue to meet the needs of a broad spectrum of nursing students and nurse researchers.
We also hope that the book will help to foster enthu- siasm for the kinds of discoveries that research can produce, and for the knowledge that will help sup- port an evidence-based nursing practice.
DENISE F.POLIT,PHD
CHERYL TATANO BECK,DNSC,CNM,FAAN
that both facilitates understanding and arouses curiosity and interest. Key features of our approach include the following:
•Research Examples. Each chapter concludes with one or two actual research examples (usu- ally one quantitative and one qualitative study) designed to highlight critical points made in the chapter and to sharpen the reader’s critical thinking skills. In addition, many research examples are used to illustrate key points in the text and to stimulate students’ thinking about a research project.
•Clear, “user friendly” style.Our writing style is designed to be easily digestible and nonin- timidating. Concepts are introduced carefully and systematically, difficult ideas are presented clearly and from several vantage points, and readers are assumed to have no prior exposure to technical terms.
•Specific practical tips on doing research.The textbook is filled with practical guidance on how to translate the abstract notions of research methods into realistic strategies for conducting research. Every chapter includes several tips for applying the chapter’s lessons to real-life situa- tions. The inclusion of these suggestions acknowledges the fact that there is often a large gap between what gets taught in research meth- ods textbooks and what a researcher needs to know in conducting a study.
•Aids to student learning. Several features are used to enhance and reinforce learning and to help focus the student’s attention on specific areas of text content, including the following:
succinct, bulleted summaries at the end of each chapter; tables and figures that provide exam- ples and graphic materials in support of the text discussion; study suggestions at the end of each chapter; and suggested methodologic and sub- stantive readings for each chapter.
Teaching-Learning Package
Nursing Research: Principles and Methods, sev- enth edition, has an ancillary package designed with both students and instructors in mind.
Major Steps in a Quantitative Study 47 Activities in a Qualitative Study 55 Research Examples 58
Summary Points 60
P a r t 2
Conceptualizing a Research Study 63
Chapter 4
Research Problems, Research Questions, and Hypotheses 65
Overview of Research Problems 65 Sources of Research Problems 67 Development and Refinement of
Research Problems 69
Communicating the Research Problem 73 Research Hypotheses 77
Research Examples 84 Summary Points 85 Chapter 5
Reviewing the Literature 88 Purposes of a Literature Review 88 Scope of a Literature Search 89 Locating Relevant Literature for a
Research Review 91 Reading Research Reports 96
Preparing a Written Literature Review 103
P a r t 1
Foundations of
Nursing Research 1
Chapter 1
Introduction to Nursing Research 3 Nursing Research in Perspective 3
Nursing Research: Past, Present, and Future 5 Sources of Evidence for Nursing Practice 11 Paradigms for Nursing Research 13
The Purposes of Nursing Research 18 Research Examples 21
Summary Points 22 Chapter 2
Key Concepts and Terms in Qualitative and Quantitative Research 26
The Faces and Places of Research 26 The Building Blocks of a Study 29
Key Challenges of Conducting Research 35 Research Examples 41
Summary Points 42 Chapter 3
Overview of the Research Process in Qualitative and Quantitative Studies 46
Major Classes of Quantitative and Qualitative Research 46
xiii
Research Examples of Research Literature Reviews 109
Summary points 111 Chapter 6
Developing a Conceptual Context 114 Theories, Models, and Frameworks 114 The Nature of Theories and Conceptual
Models 119
Conceptual Models Used in Nursing Research 120
Testing, Using, and Developing a Theory or Framework 125
Research Examples 133 Summary Points 134
P a r t 3
Designs for
Nursing Research 139
Chapter 7
Designing Ethical Research 141 The Need for Ethical Guidelines 141 The Principle of Beneficence 143 The Principle of Respect for
Human Dignity 147 The Principle of Justice 149 Informed Consent 150 Vulnerable Subjects 154
External Reviews and the Protection of Human Rights 156
Building Ethics into the Design of the Study 157
Research Examples 158 Summary Points 159 Chapter 8
Designing Quantitative Studies 162 Aspects of Quantitative
Research Design 162
Overview of Research Design Types 164 Experiments 168
Quasi-Experiments 181 Nonexperimental Research 188 Designs and Research Evidence 195 Summary Points 196
Chapter 9
Enhancing Rigor in Quantitative Research 201
Controlling the Research Situation 201 Controlling Intrinsic Subject Factors 203 Characteristics of Good Design 209 Research Example 219
Summary Points 220 Chapter 10
Quantitative Research for Various Purposes 223
Studies That Are Typically Experimental or Quasi-Experimental 223
Studies That Can Be Either Experimental or Nonexperimental 230
Studies That Are Typically Nonexperimental 234 Research Examples of Various Types of
Quantitative Studies 239 Summary Points 240 Chapter 11
Qualitative Research Design and Approaches 245
The Design of Qualitative Studies 245 Qualitative Research Traditions 248 Other Types of Qualitative Research 259 Research With Ideological Perspectives 263 Research Examples 266
Summary Points 268 Chapter 12
Integration of Qualitative and Quantitative Designs 273
Rationale for Multimethod Research 273 Applications of Multimethod Research 275 Multimethod Research Designs 279 Strategies for Multimethod Research 280
Using and Preparing Structured Self-Report Instruments 352
Administering Structured Self-Report Instruments 365
Research Examples 368 Summary Points 369 Chapter 16
Collecting Observational Data 375 Observational Issues 375
Qualitative Observational Methods:
Participant Observation 378 Observational Methods: Structured
Observations 385
Mechanical Aids in Observations 390 Observer Biases 391
Research Examples 392 Summary Points 393 Chapter 17
Collecting Biophysiologic and Other Data 398
Biophysiologic Measures 398
Records, Documents, and Available Data 402 Q Methodology 403
Projective Techniques 405 Vignettes 407
Cognitive and Neuropsychological Tests 408 Examples of Studies Using Alternative Data
Collection Methods 409 Summary Points 410 Chapter 18
Assessing Data Quality 413 Measurement 413
Reliability of Measuring Instruments 416 Validity 422
Other Criteria for Assessing Quantitative Measures 428
Assessment of Qualitative Data and Their Interpretation 430 Research Examples 437 Summary Points 443 Obstacles to Multimethod Research 283
Research Examples 284 Summary Points 286 Chapter 13
Sampling Designs 289 Basic Sampling Concepts in
Quantitative Studies 289 Nonprobability Sampling 292 Probability Sampling 295
Sample Size in Quantitative Studies 300 Implementing a Sampling Plan in
Quantitative Studies 303
Sampling in Qualitative Research 305 Research Examples 310
Summary Points 311
P a r t 4
Measurement and
Data Collection 315
Chapter 14
Designing and Implementing a Data Collection Plan 317
Existing Data Versus Original Data 317 Dimensions of Data Collection
Approaches 318
Major Types of Data Collection Methods 319 Converting Quantitative and
Qualitative Data 322
Developing a Data Collection Plan in a Quantitative Study 323
Implementing a Data Collection Plan in a Quantitative Study 330
Data Collection Issues in Qualitative Studies 332 Research Examples 336 Summary Points 337 Chapter 15
Collecting Self-Report Data 340 Qualitative Self-Report Techniques 340 Quantitative Self-Report Instruments 349
P a r t 5
The Analysis of
Research Data 449
Chapter 19
Analyzing Quantitative Data:
Descriptive Statistics 451 Levels of Measurement 451 Frequency Distributions 455 Central Tendency 459 Variability 460
Bivariate Descriptive Statistics: Contingency Tables and Correlation 465
The Computer and Descriptive Statistics 469 Research Example 473
Summary Points 475 Chapter 20
Analyzing Quantitative Data: Inferential Statistics 477
Sampling Distributions 477 Estimation of Parameters 479 Hypothesis Testing 480 Testing Differences Between Two
Group Means 486
Testing Differences Between Three or More Group Means 489
Testing Differences in Proportions 493 Testing Relationships Between
Two Variables 494 Power Analysis 495
The Computer and Inferential Statistics 502 Guide to Bivariate Statistical Tests 505 Research Example 507
Summary Points 507 Chapter 21
Analyzing Quantitative Data: Multivariate Statistics 511
Simple Linear Regression 511 Multiple Linear Regression 514 Analysis of Covariance 521 Factor Analysis 526
Other Least-Squares Multivariate Techniques 530
Causal Modeling 532
Other Multivariate Statistical Procedures 536 The Computer and Multivariate Statistics 538 Guide to Multivariate Statistical Tests 540 Research Example 543
Summary Points 543 Chapter 22
Designing and Implementing a Quantitative Analysis Strategy 547
Phases in the Analysis of Quantitative Data 547 Preanalysis Phase 547
Preliminary Assessments and Actions 553 Principal Analyses 560
Interpretation of Results 562 Research Example 566 Summary Points 568 Chapter 23
Analyzing Qualitative Data 570 Introduction to Qualitative Analysis 570 Qualitative Data Management and
Organization 572 Analytic Procedures 578
Interpretation of Qualitative Findings 591 Research Examples 592
Summary Points 594
P a r t 6
Communicating Research 599
Chapter 24
Summarizing and Sharing Research Findings 601
Getting Started on Dissemination 601 Content of Research Reports 604 The Style of Research Reports 617 Types of Research Reports 618 Summary Points 626
Conclusion 666 Research Examples 667 Summary Points 669 Chapter 27
Utilizing Research: Putting Research Evidence Into Nursing Practice 671
Research Utilization Versus Evidence-Based Practice 671
Barriers to Using Research in Nursing Practice 677 The Process of Using Research in
Nursing Practice 681
Research Integration and Synthesis 690 Research Example 696
Summary Points 697 Appendix
Glossary Index Chapter 25
Writing a Research Proposal 629 Overview of Research Proposals 629 Proposals for Theses and Dissertations 635 Funding for Research Proposals 637 Grant Applications to the National
Institutes of Health 639 Research Examples 647 Summary Points 648
P a r t 7
Using Research Results 651
Chapter 26
Evaluating Research Reports 653 The Research Critique 653
Elements of a Research Critique 654
xi
Eileen Chasens,
DSN, RN Assistant ProfessorWayne State University Detroit, Michigan
Celia R. Colon-Rivera,
RN, PhD ProfessorUniversity of Puerto Rico-Mayaguez Campus Mayaguez, Puerto Rico
Carol Cornwell,
PhD, MS, CS Director of Nursing Research andAssistant Professor of Nursing
Georgia Southern University School of Nursing Statesboro, Georgia
Linda Goodfellow,
RN, MNEd Assistant Professor of Nursing Duquesne UniversityPittsburgh, Pennsylvania
Janice S. Hayes,
PhD, RN Associate ProfessorFlorida Atlantic University College of Nursing Davie, Florida
Joan R. S. McDowell,
MN LecturerUniversity of Glaston Nursing & Midwifery School Glasgow, Scotland
Virginia Nehring,
PhD, RN Associate ProfessorWright State University Dayton, Ohio
Marlene Reimer,
RN, PhD, CNN(C) Associate ProfessorFaculty of Nursing University of Calgary Calgary, Alberta, Canada
Beth L. Rodgers,
PhD, RN Professor and Chair, Foundations ofNursing Department
University of Wisconsin-Milwaukee School of Nursing
Milwaukee, Wisconsin
Janet S. Secrest,
PhD, RN Assistant ProfessorUniversity of Tennessee at Chattanooga School of Nursing
Chattanooga, Tennessee
Gloria Weber,
PhD, RN, CNAA Associate ProfessorThe University of Texas at Tyler College of Nursing
Tyler, Texas
A Statistical Tables
LEVEL OF SIGNIFICANCE FOR ONE-TAILED TEST
.10 .05 .025 .01 .005 .0005
LEVEL OF SIGNIFICANCE FOR TWO-TAILED TEST
df .20 .10 .05 .02 .01 .001
1 3.078 6.314 12.706 31.821 63.657 636.619
2 1.886 2.920 4.303 6.965 9.925 31.598
3 1.638 2.353 3.182 4.541 5.841 12.941
4 1.533 2.132 2.776 3.747 4.604 8.610
5 1.476 2.015 2.571 3.376 4.032 6.859
6 1.440 1.953 2.447 3.143 3.707 5.959
7 1.415 1.895 2.365 2.998 3.449 5.405
8 1.397 1.860 2.306 2.896 3.355 5.041
9 1.383 1.833 2.262 2.821 3.250 4.781
10 1.372 1.812 2.228 2.765 3.169 4.587
11 1.363 1.796 2.201 2.718 3.106 4.437
12 1.356 1.782 2.179 2.681 3.055 4.318
13 1.350 1.771 2.160 2.650 3.012 4.221
14 1.345 1.761 2.145 2.624 2.977 4.140
15 1.341 1.753 2.131 2.602 2.947 4.073
16 1.337 1.746 2.120 2.583 2.921 4.015
17 1.333 1.740 2.110 2.567 2.898 3.965
18 1.330 1.734 2.101 2.552 2.878 3.922
19 1.328 1.729 2.093 2.539 2.861 3.883
20 1.325 1.725 2.086 2.528 2.845 3.850
21 1.323 1.721 2.080 2.518 2.831 3.819
22 1.321 1.717 2.074 2.508 2.819 3.792
23 1.319 1.714 2.069 2.500 2.807 3.767
24 1.318 1.711 2.064 2.492 2.797 3.745
25 1.316 1.708 2.060 2.485 2.787 3.725
26 1.315 1.706 2.056 2.479 2.779 3.707
27 1.314 1.703 2.052 2.473 2.771 3.690
28 1.313 1.701 2.048 2.467 2.763 3.674
29 1.311 1.699 2.045 2.462 2.756 3.659
30 1.310 1.697 2.042 2.457 2.750 3.646
40 1.303 1.684 2.021 2.423 2.704 3.551
60 1.296 1.671 2.000 2.390 2.660 3.460
120 1.289 1.658 1.980 2.358 2.617 3.373
∞ 1.282 1.645 1.960 2.326 2.576 3.291
TABLE A-1 Distribution of t Probability
1 2 3 4 5 6 8 12 24 ∞
1 161.4 199.5 215.7 224.6 230.2 234.0 238.9 243.9 249.0 254.3
2 18.51 19.00 19.16 19.25 19.30 19.33 19.37 19.41 19.45 19.50
3 10.13 9.55 9.28 9.12 9.01 8.94 8.84 8.74 8.64 8.53
4 7.71 6.94 6.59 6.39 6.26 6.16 6.04 5.91 5.77 5.63
5 6.61 5.79 5.41 5.19 5.05 4.95 4.82 4.68 4.53 4.36
6 5.99 5.14 4.76 4.53 4.39 4.28 4.15 4.00 3.84 3.67
7 5.59 4.74 4.35 4.12 3.97 3.87 3.73 3.57 3.41 3.23
8 5.32 4.46 4.07 3.84 3.69 3.58 3.44 3.28 3.12 2.93
9 5.12 4.26 3.86 3.63 3.48 3.37 3.23 3.07 2.90 2.71
10 4.96 4.10 3.71 3.48 3.33 3.22 3.07 2.91 2.74 2.54
11 4.84 3.98 3.59 3.36 3.20 3.09 2.95 2.79 2.61 2.40
12 4.75 3.88 3.49 3.26 3.11 3.00 2.85 2.69 2.50 2.30
13 4.67 3.80 3.41 3.18 3.02 2.92 2.77 2.60 2.42 2.21
14 4.60 3.74 3.34 3.11 2.96 2.85 2.70 2.53 2.35 2.13
15 4.54 3.68 3.29 3.06 2.90 2.79 2.64 2.48 2.29 2.07
16 4.49 3.63 3.24 3.01 2.85 2.74 2.59 2.42 2.24 2.01
17 4.45 3.59 3.20 2.96 2.81 2.70 2.55 2.38 2.19 1.96
18 4.41 3.55 3.16 2.93 2.77 2.66 2.51 2.34 2.15 1.92
19 4.38 3.52 3.13 2.90 2.74 2.63 2.48 2.31 2.11 1.88
20 4.35 3.49 3.10 2.87 2.71 2.60 2.45 2.28 2.08 1.84
21 4.32 3.47 3.07 2.84 2.68 2.57 2.42 2.25 2.05 1.81
22 4.30 3.44 3.05 2.82 2.66 2.55 2.40 2.23 2.03 1.78
23 4.28 3.42 3.03 2.80 2.64 2.53 2.38 2.20 2.00 1.76
24 4.26 3.40 3.01 2.78 2.62 2.51 2.36 2.18 1.98 1.73
25 4.24 3.38 2.99 2.76 2.60 2.49 2.34 2.16 1.96 1.71
26 4.22 3.37 2.98 2.74 2.59 2.47 2.32 2.15 1.95 1.69
27 4.21 3.35 2.96 2.73 2.57 2.46 2.30 2.13 1.93 1.67
28 4.20 3.34 2.95 2.71 2.56 2.44 2.29 2.12 1.91 1.65
29 4.18 3.33 2.93 2.70 2.54 2.43 2.28 2.10 1.90 1.64
30 4.17 3.32 2.92 2.69 2.53 2.42 2.27 2.09 1.89 1.62
40 4.08 3.23 2.84 2.61 2.45 2.34 2.18 2.00 1.79 1.51
60 4.00 3.15 2.76 2.52 2.37 2.25 2.10 1.92 1.70 1.39
120 3.92 3.07 2.68 2.45 2.29 2.17 2.02 1.83 1.61 1.25
∞ 3.84 2.99 2.60 2.37 2.21 2.09 1.94 1.75 1.52 1.00
(continued)
dfB
dfW
TABLE A-2 Significant Values of F
= .05 (Two-Tailed) = .025 (one-tailed)
1 2 3 4 5 6 8 12 24 ∞
1 4052 4999 5403 5625 5764 5859 5981 6106 6234 6366
2 98.49 99.00 99.17 99.25 99.30 99.33 99.36 99.42 99.46 99.50
3 34.12 30.81 29.46 28.71 28.24 27.91 27.49 27.05 26.60 26.12
4 21.20 18.00 16.69 15.98 15.52 15.21 14.80 14.37 13.93 13.46
5 16.26 13.27 12.06 11.39 10.97 10.67 10.29 9.89 9.47 9.02
6 13.74 10.92 9.78 9.15 8.75 8.47 8.10 7.72 7.31 6.88
7 12.25 9.55 8.45 7.85 7.46 7.19 6.84 6.47 6.07 5.65
8 11.26 8.65 7.59 7.01 6.63 6.37 6.03 5.67 5.28 4.86
9 10.56 8.02 6.99 6.42 6.06 5.80 5.47 5.11 4.73 4.31
10 10.04 7.56 6.55 5.99 5.64 5.39 5.06 4.71 4.33 3.91
11 9.65 7.20 6.22 5.67 5.32 5.07 4.74 4.40 4.02 3.60
12 9.33 6.93 5.95 5.41 5.06 4.82 4.50 4.16 3.78 3.36
13 9.07 6.70 5.74 5.20 4.86 4.62 4.30 3.96 3.59 3.16
14 8.86 6.51 5.56 5.03 4.69 4.46 4.14 3.80 3.43 3.00
15 8.68 6.36 5.42 4.89 4.56 4.32 4.00 3.67 3.29 2.87
16 8.53 6.23 5.29 4.77 4.44 4.20 3.89 3.55 3.18 2.75
17 8.40 6.11 5.18 4.67 4.34 4.10 3.78 3.45 3.08 2.65
18 8.28 6.01 5.09 4.58 4.29 4.01 3.71 3.37 3.00 2.57
19 8.18 5.93 5.01 4.50 4.17 3.94 3.63 3.30 2.92 2.49
20 8.10 5.85 4.94 4.43 4.10 3.87 3.56 3.23 2.86 2.42
21 8.02 5.78 4.87 4.37 4.04 3.81 3.51 3.17 2.80 2.36
22 7.94 5.72 4.82 4.31 3.99 3.76 3.45 3.12 2.75 2.31
23 7.88 5.66 4.76 4.26 3.94 3.71 3.41 3.07 2.70 2.26
24 7.82 5.61 4.72 4.22 3.90 3.67 3.36 3.03 2.66 2.21
25 7.77 5.57 4.68 4.18 3.86 3.63 3.32 2.99 2.62 2.17
26 7.72 5.53 4.64 4.14 3.82 3.59 3.29 2.96 2.58 2.13
27 7.68 5.49 4.60 4.11 3.78 3.56 3.26 2.93 2.55 2.10
28 7.64 5.45 4.57 4.07 3.75 3.53 3.23 2.90 2.52 2.06
29 7.60 5.42 4.54 4.04 3.73 3.50 3.20 2.87 2.49 2.03
30 7.56 5.39 4.51 4.02 3.70 3.47 3.17 2.84 2.47 2.01
40 7.31 5.18 4.31 3.83 3.51 3.29 2.99 2.66 2.29 1.80
60 7.08 4.98 4.13 3.65 3.34 3.12 2.82 2.50 2.12 1.60
120 6.85 4.79 3.95 3.48 3.17 2.96 2.66 2.34 1.95 1.38
∞ 6.64 4.60 3.78 3.32 3.02 2.80 2.51 2.18 1.79 1.00
(continued)
dfB
dfW
TABLE A-2 Significant Values of F(continued)
=.01 (Two-Tailed) = .005(one-tailed)
1 2 3 4 5 6 8 12 24 ∞ 1 405284 500000 540379 562500 576405 585937 598144 610667 623497 636619
2 998.5 999.0 999.2 999.2 999.3 999.3 999.4 999.4 999.5 999.5
3 167.5 148.5 141.1 137.1 134.6 132.8 130.6 128.3 125.9 123.5
4 74.14 61.25 56.18 53.44 51.71 50.53 49.00 47.41 45.77 44.05
5 47.04 36.61 33.20 31.09 29.75 28.84 27.64 26.42 25.14 23.78
6 35.51 27.00 23.70 21.90 20.81 20.03 19.03 17.99 16.89 15.75
7 29.22 21.69 18.77 17.19 16.21 15.52 14.63 13.71 12.73 11.69
8 25.42 18.49 15.83 14.39 13.49 12.86 17.04 11.19 10.30 9.34
9 22.86 16.39 13.90 12.56 11.71 11.13 10.37 9.57 8.72 7.81
10 21.04 14.91 12.55 11.28 10.48 9.92 9.20 8.45 7.64 6.76
11 19.69 13.81 11.56 10.35 9.58 9.05 8.35 7.63 6.85 6.00
12 18.64 12.97 10.80 9.63 8.89 8.38 7.71 7.00 6.25 5.42
13 17.81 12.31 10.21 9.07 8.35 7.86 7.21 6.52 5.78 4.97
14 17.14 11.78 9.73 8.62 7.92 7.43 6.80 6.13 5.41 4.60
15 16.59 11.34 9.34 8.25 7.57 7.09 6.47 5.81 5.10 4.31
16 16.12 10.97 9.00 7.94 7.27 6.81 6.19 5.55 4.85 4.06
17 15.72 10.66 8.73 7.68 7.02 6.56 5.96 5.32 4.63 3.85
18 15.38 10.39 8.49 7.46 6.81 6.35 5.76 5.13 4.45 3.67
19 15.08 10.16 8.28 7.26 6.61 6.18 5.59 4.97 4.29 3.52
20 14.82 9.95 8.10 7.10 6.46 6.02 5.44 4.82 4.15 3.38
21 14.59 9.77 7.94 6.95 6.32 5.88 5.31 4.70 4.03 3.26
22 14.38 9.61 7.80 6.81 6.19 5.76 5.19 4.58 3.92 3.15
23 14.19 9.47 7.67 6.69 6.08 5.65 5.09 4.48 3.82 3.05
24 14.03 9.34 7.55 6.59 5.98 5.55 4.99 4.39 3.74 2.97
25 13.88 9.22 7.45 6.49 5.88 5.46 4.91 4.31 3.66 2.89
26 13.74 9.12 7.36 6.41 5.80 5.38 4.83 4.24 3.59 2.82
27 13.61 9.02 7.27 6.33 5.73 5.31 4.76 4.17 3.52 2.75
28 13.50 8.93 7.19 6.25 5.66 5.24 4.69 4.11 3.46 2.70
29 13.39 8.85 7.12 6.19 5.59 5.18 4.64 4.05 3.41 2.64
30 13.29 8.77 7.05 6.12 5.53 5.12 4.58 4.00 3.36 2.59
40 12.61 8.25 6.60 5.70 5.13 4.73 4.21 3.64 3.01 2.23
60 11.97 7.76 6.17 5.31 4.76 4.37 3.87 3.31 2.69 1.90
120 11.38 7.31 5.79 4.95 4.42 4.04 3.55 3.02 2.40 1.56
∞ 10.83 6.91 5.42 4.62 4.10 3.74 3.27 2.74 2.13 1.00
dfB
dfW
TABLE A-2 Significant Values of F(continued)
= .001 (Two-Tailed) = .0005 (one-tailed)
LEVEL OF SIGNIFICANCE
df .10 .05 .02 .01 .001
1 2.71 3.84 5.41 6.63 10.83
2 4.61 5.99 7.82 9.21 13.82
3 6.25 7.82 9.84 11.34 16.27
4 7.78 9.49 11.67 13.28 18.46
5 9.24 11.07 13.39 15.09 20.52
6 10.64 12.59 15.03 16.81 22.46
7 12.02 14.07 16.62 18.48 24.32
8 13.36 15.51 18.17 20.09 26.12
9 14.68 16.92 19.68 21.67 27.88
10 15.99 18.31 21.16 23.21 29.59
11 17.28 19.68 22.62 24.72 31.26
12 18.55 21.03 24.05 26.22 32.91
13 19.81 22.36 25.47 27.69 34.53
14 21.06 23.68 26.87 29.14 36.12
15 22.31 25.00 28.26 30.58 37.70
16 23.54 26.30 29.63 32.00 39.25
17 24.77 27.59 31.00 33.41 40.79
18 25.99 28.87 32.35 34.81 42.31
19 27.20 30.14 33.69 36.19 43.82
20 28.41 31.41 35.02 37.57 45.32
21 29.62 32.67 36.34 38.93 46.80
22 30.81 33.92 37.66 40.29 48.27
23 32.01 35.17 38.97 41.64 49.73
24 33.20 36.42 40.27 42.98 51.18
25 34.38 37.65 41.57 44.31 52.62
26 35.56 38.89 42.86 45.64 54.05
27 36.74 40.11 44.14 46.96 55.48
28 37.92 41.34 45.42 48.28 56.89
29 39.09 42.56 46.69 49.59 58.30
30 40.26 43.77 47.96 50.89 59.70
TABLE A-3 Distribution of 2Probability
LEVEL OF SIGNIFICANCE FOR ONE-TAILED TEST
.05 .025 .01 .005 .0005
LEVEL OF SIGNIFICANCE FOR TWO-TAILED TEST
df .10 .05 .02 .01 .001
1 .98769 .99692 .999507 .999877 .9999988
2 .90000 .95000 .98000 .990000 .99900
3 .8054 .8783 .93433 .95873 .99116
4 .7293 .8114 .8822 .91720 .97406
5 .6694 .7545 .8329 .8745 .95074
6 .6215 .7067 .7887 .8343 .92493
7 .5822 .6664 .7498 .7977 .8982
8 .5494 .6319 .7155 .7646 .8721
9 .5214 .6021 .6851 .7348 .8471
10 .4973 .5760 .6581 .7079 .8233
11 .4762 .5529 .6339 .6835 .8010
12 .4575 .5324 .6120 .6614 .7800
13 .4409 .5139 .5923 .5411 .7603
14 .4259 .4973 .5742 .6226 .7420
15 .4124 .4821 .5577 .6055 .7246
16 .4000 .4683 .5425 .5897 .7084
17 .3887 .4555 .5285 .5751 .6932
18 .3783 .4438 .5155 .5614 .5687
19 .3687 .4329 .5034 .5487 .6652
20 .3598 .4227 .4921 .5368 .6524
25 .3233 .3809 .4451 .5869 .5974
30 .2960 .3494 .4093 .4487 .5541
35 .2746 .3246 .3810 .4182 .5189
40 .2573 .3044 .3578 .3932 .4896
45 .2428 .2875 .3384 .3721 .4648
50 .2306 .2732 .3218 .3541 .4433
60 .2108 .2500 .2948 .3248 .4078
70 .1954 .2319 .2737 .3017 .3799
80 .1829 .2172 .2565 .2830 .3568
90 .1726 .2050 .2422 .2673 .3375
100 .1638 .1946 .2301 .2540 .3211
TABLE A-4 Significant Values of the Correlation Coefficient
Foundations of Nursing Research
1
1
N U R S I N G R E S E A R C H I N P E R S P E C T I V E
It is an exciting—and challenging—time to be a nurse. Nurses are managing their clinical responsi- bilities at a time when the nursing profession and the larger health care system require an extraordinary range of skills and talents of them. Nurses are expected to deliver the highest possible quality of care in a compassionate manner, while also being mindful of costs. To accomplish these diverse (and sometimes conflicting) goals, nurses must access and evaluate extensive clinical information, and incorporate it into their clinical decision-making. In today’s world, nurses must become lifelong learners, capable of reflecting on, evaluating, and modifying their clinical practice based on new knowledge. And, nurses are increasingly expected to become producers of new knowledge through nursing research.
What Is Nursing Research?
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.
Nurses are increasingly engaged in disciplined studies that benefit the profession and its patients,
Introduction to Nursing Research
and that contribute to improvements in the entire health care system. Nursing research is systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administra- tion, and informatics. In this book, we emphasize clinical nursing research, that is, research designed to generate knowledge to guide nursing practice and to improve the health and quality of life of nurses’ clients.
Nursing research has experienced remarkable growth in the past three decades, providing nurses with an increasingly sound base of knowledge from which to practice. Yet as we proceed into the 21st century, many questions endure and much remains to be done to incorporate research-based knowl- edge into nursing practice.
Examples of nursing research questions:
• What are the factors that determine the length of stay of patients in the intensive care unit undergoing coronary artery bypass graft surgery (Doering, Esmailian, Imperial-Perez,
& Monsein, 2001)?
• How do adults with acquired brain injury per- ceive their social interactions and relationships (Paterson & Stewart, 2002)?
The Importance of Research in Nursing
Nurses increasingly are expected to adopt an evidence-based practice (EBP), which is broadly defined as the use of the best clinical evidence in making patient care decisions. Although there is not a consensus about what types of “evidence”
are appropriate for EBP (Goode, 2000), there is general agreement that research findings from rigorous studies constitute the best type of evi- dence for informing nurses’ decisions, actions, and interactions with clients. Nurses are accept- ing 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. Nurses who incorporate high-quality research evidence into their clinical decisions and advice are being professionally accountable to their clients. They are also reinforcing the identity of nursing as a profession.
Another reason for nurses to engage in and use research involves the spiraling costs of health care and the cost-containment practices being instituted in health care facilities. Now, more than ever, nurses need to document the social relevance and effectiveness of their practice, not only to the profession but to nursing care consumers, health care administrators, third-party payers (e.g., insur- ance companies), and government agencies. Some research findings will help eliminate nursing actions that do not achieve desired outcomes.
Other findings will help nurses identify practices that improve health care outcomes and contain costs as well.
Nursing research is essential if nurses are to understand the varied dimensions of their profes- sion. Research enables nurses to describe the char- acteristics of a particular nursing situation about which little is known; to explain phenomena that must be considered in planning nursing care; to predict the probable outcomes of certain nursing decisions; to control the occurrence of undesired outcomes; and to initiate activities to promote desired client behavior.
Example of an EBP project:
• The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) is one nursing organization that has demonstrated a strong commitment to evidence-based nursing practice. For example, AWHONN undertook a project that developed and tested an evidence- based protocol for urinary incontinence in women, and then designed procedures to facilitate the protocol’s implementation into clinical practice (Samselle et al., 2000a, 2000b).
More recently, AWHONN and the National Association of Neonatal Nurses designed and tested an evidence-based protocol for neonatal skin care, and also instituted procedures for implementing it (Lund, Kuller, Lane, Lott, Raines, & Thomas, 2001; Lund, Osborne, Kuller, Lane, Lott, & Raines, 2001).
The Consumer–Producer Continuum in Nursing Research
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 keep up to date on relevant findings that may affect their practice. Nurses increasingly are expected to maintain this level of involvement with research, at a minimum. Research utilization—the use of research findings in a practice setting—
depends on intelligent nursing research consumers.
At the other end of the continuum are the pro- ducers of nursing research: nurses who actively participate in designing and implementing research studies. At one time, most nurse researchers were academics who taught in schools of nursing, but research is increasingly being conducted by prac- ticing nurses who want to find what works best for their patients.
Between these two end points on the continuum lie a rich variety of research activities in which nurses engage as a way of improving their effec-
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.
Nightingale’s most widely known research contri- bution involved her data collection and analysis relating to factors affecting soldier mortality and morbidity during the Crimean War. Based on her skillful analyses and presentations, she was suc- cessful in effecting some changes in nursing care—
and, more generally, in public health.
For many years after Nightingale’s work, the nursing literature contained little research. Some attribute this absence to the apprenticeship nature of nursing. The pattern of nursing research that even- tually emerged at the turn of the century was closely aligned to the problems confronting nurses. Most studies conducted between 1900 and 1940 con- cerned nurses’ education. For example, in 1923, a group called the Committee for the Study of Nursing Education studied the educational prepara- tion of nurse teachers, administrators, and public health nurses and the clinical experiences of nursing students. The committee issued what has become known as the Goldmark Report, which identified many inadequacies in the educational backgrounds of the groups studied and concluded that advanced educational preparation was essential. As more nurses received university-based education, studies concerning nursing students—their differential characteristics, problems, and satisfactions—
became more numerous.
During the 1940s, studies concerning nursing education continued, spurred on by the unprece- dented demand for nursing personnel that resulted from World War II. For example, Brown (1948) reassessed nursing education in a study initiated at the request of the National Nursing Council for War Service. The findings from the study, like those of the Goldmark Report, revealed numerous inadequa- cies in nursing education. Brown recommended that the education of nurses occur in collegiate settings.
Many subsequent research investigations concerning the functions performed by nurses, nurses’ roles and attitudes, hospital environments, and nurse—patient interactions stemmed from the Brown report.
tiveness and enhancing their professional lives.
These activities include the following:
• Participating in a journal club in a practice set- ting, which involves regular meetings among nurses to discuss and critique research articles
• Attending research presentations at professional conferences
• Discussing the implications and relevance of research findings with clients
• Giving clients information and advice about participation in studies
• Assisting in the collection of research informa- tion (e.g., distributing questionnaires to patients)
• Reviewing a proposed research plan with respect to its feasibility in a clinical setting and offering clinical expertise to improve the plan
• Collaborating in the development of an idea for a clinical research project
• Participating on an institutional committee that reviews the ethical aspects of proposed research before it is undertaken
• Evaluating completed research for its possible use in practice, and using it when appropriate
In all these activities, nurses with some research skills are in a better position than those without them to make a contribution to nursing knowledge. An understanding of nursing research can improve the depth and breadth of every nurse’s professional practice.
N U R S I N G R E S E A R C H : PA S T, P R E S E N T, A N D F U T U R E
Although nursing research has not always had the prominence and importance it enjoys today, its long and interesting history portends a distinguished future. Table 1-1 summarizes some of the key events in the historical evolution of nursing research.
The Early Years: From Nightingale to the 1950s
Most people would agree that research in nursing began with Florence Nightingale. Her landmark