La Salle University Philadelphia, Pennsylvania Becky Christian, PhD, RN lektor; Afdelingsformand University of Utah. DePaul University Chicago, Illinois Valmi Sousa, PhD University of North Carolina Charlotte, North Carolina Amy Spurlock, PhD, RN Lektor Troy State University Troy, Alabama.
KEY FEATURES
The chapter assumes no prior instruction in statistics and focuses primarily on helping readers understand why statistics are necessary, what tests may be appropriate in a given situation, and what statistical information means in a research report. Finally, Chapter 19 describes systematic reviews, including how to understand and assess both meta-analyses and meta-syntheses.
General Features
In addition, many research examples are used to illustrate key points in the text and to stimulate students' thinking about areas of research inquiry. The textbook is filled with practical guidance and "tips" on how to translate the abstract concepts of research methods into more concrete applications.
Features for Student Learning
Research Examples Each chapter concludes with one or two concrete research examples designed to emphasize critical points in the chapter and to sharpen the reader's critical thinking skills. Colorful graphs, in the form of supporting tables, figures and examples, enhance the text and provide visual stimuli.
TEACHING-LEARNING PACKAGE
There are many more opportunities to criticize in the Study Guide, which contains seven studies in their entirety in the appendices and exercises in each chapter that guide students in reading, understanding and critiquing these studies.
ACKNOWLEDGMENTS
OVERVIEW OF NURSING RESEARCH AND ITS ROLE IN EVIDENCE-BASED PRACTICE
PRELIMINARY STEPS IN THE APPRAISAL OF EVIDENCE
DESIGNS FOR NURSING RESEARCH
DATA COLLECTION
DATA ANALYSIS AND INTERPRETATION
APPENDICES: RESEARCH REPORTS
NURSING RESEARCH: PAST, PRESENT AND FUTURE The early years: from Slavac to the 1970s Nursing research since 1980 Directions for nursing research in the new millennium SOURCES OF EVIDENCE FOR NURSING PRACTICE Tradition and authority.
NURSING RESEARCH IN PERSPECTIVE
What Is Nursing Research?
The Importance of Research to Evidence-Based Nursing Practice
In the United States, research has come to play an important role in nursing in terms of qualifications and status. Some of the evidence gathered has been developed in rigorous studies by nursing researchers in the United States, Australia, Canada, Taiwan, Korea and other countries (e.g. Chwo et al., 2002; Ludington-Hoe et al Moore & Anderson, 2007) . .
Roles of Nurses in Research
Kangaroo care," parents' skin-to-skin, chest-to-chest holding of diaper-clad premature infants, is now commonly practiced in neonatal intensive care units (NICUs) in the United States and elsewhere, but this is a new trend. Here's a headline about a health study published in newspapers and major TV networks in the US and Canada in April 2007: "Study does not support abortion-cancer link."
NURSING RESEARCH: PAST, PRESENT, AND FUTURE
Help researchers by recruiting potential study participants or collecting research information (for example, by distributing questionnaires to customers). Could you comment on the credibility of the findings, based on your assessment of how rigorously the research was conducted?
The Early Years: From Nightingale to the 1970s
1936 Sigma Theta Tau awards the first nursing research grant in the United States. 1948 Brown publishes a report on the inadequacy of nursing education. 1965 The American Nurses Association (ANA) begins sponsoring nursing research conferences. 1969 Canadian Journal of Nursing Research begins publication.
Nursing Research Since 1980
Several journals focusing on nursing research were established in the 1970s, including Research in Nursing & Health, Journal of Advanced Nursing, and Western Journal of Nursing Research. Other research-related journals were established in the 1980s, including Applied Nursing Research and in Australia, the Australian Journal of Nursing Research.
Directions for Nursing Research in the New Millennium
In the 1990s, international cooperation on the EBP issue in nursing also started. All the websites mentioned in this chapter, plus additional websites with helpful content related to the foundations of nursing research, are listed in the "Useful Websites for Chapter 1" file on the included CD-ROM.
SOURCES OF EVIDENCE FOR NURSING PRACTICE
(4) development of evidence-based practice and translational research; (5) promoting the health and well-being of older people;. Web pages corresponding to the content of most of the book's chapters are also included in the files on the CD-ROM.
Tradition and Authority
This allows you to simply use the "Control/Click" function to go directly to the website, without having to enter the URL and risk a typographical error. Another common source of knowledge is an authority, a person with specialized expertise and recognition for that expertise.
Clinical Experience, Trial and Error, and Intuition
Reliance on nursing bodies (eg nursing faculty) is to some extent inevitable; but, like tradition, authorities have limitations as a source of information.
Logical Reasoning
Assembled Information
Quality improvement and risk data, such as reports of medication errors, can be used to evaluate practices and determine the need for practice changes. Although these resources provide some information that can be used in practice, they do not provide any mechanism for determining whether their use results in improvements in patient outcomes.
Disciplined Research
PARADIGMS FOR NURSING RESEARCH
The Positivist Paradigm
If a person has a cerebrovascular accident, the scientist in a positivist tradition assumes that there must be one or more potentially identifiable causes. However, they see objectivity as a goal and try to be as neutral as possible.
The Naturalistic Paradigm
Paradigms and Methods: Quantitative and Qualitative Research
Flexible, evolving procedures are used to capitalize on findings that emerge over the course of the study. Naturalistic studies yield rich, in-depth information that can potentially elucidate the divergent dimensions of a complicated phenomenon (for example, the process by which middle-aged women adjust to menopause).
Multiple Paradigms and Nursing Research
On the other hand, if a researcher asks, "What is the process by which parents learn to cope with the death of a child?" the researcher would be hard pressed to quantify such a process. In reading about alternative paradigms for nursing research, you are likely to be more drawn to one of two paradigms—the one that most closely corresponds to your view of the world and reality.
PURPOSES OF NURSING RESEARCH
Research to Achieve Varying Levels of Explanation
HOW-TO-TELL TIP
In some cases, so little is known that the phenomenon has yet to be clearly identified or named or is insufficiently defined or conceptualized. What is the underlying cause of the phenomenon or the causal path through which the phenomenon unfolds.
Research Purposes Linked to EBP
Coughlan and Ward (2007) conducted a study that attempted to explain the meaning of "quality of care". Vellone and colleagues (2008) investigated the importance of quality of life for relatives of patients with Alzheimer's disease.
ASSISTANCE FOR CONSUMERS OF NURSING RESEARCH
What is the underlying goal (or goals) of the research: identification, description, exploration, prediction/control or explanation. Also consider the following focused questions, which can further sharpen your critical thinking skills and help you assess aspects of the merit of the study:.
CHAPTER REVIEW
In the positivist paradigm, it is assumed that there is an objective reality and that natural phenomena are regular and orderly. The positivist paradigm is associated with quantitative research—the collection and analysis of numerical information.
STUDIES CITED IN CHAPTER 1 1
Evidence-based practice (EBP) is the conscientious use of current best evidence in making clinical decisions about patient care (Sackett et al., 2000). Instead, they argue that evidence-based decision-making should combine the best research evidence with clinical expertise, patient preferences and circumstances, and awareness of the clinical environment and resource constraints.
BACKGROUND OF EVIDENCE-BASED NURSING PRACTICE
A fundamental feature of EBP as a clinical problem-solving strategy is that it de-emphasizes decisions based on custom, authority, or ritual; emphasis is placed on identifying the best available research evidence and integrating it with other factors. This book will help you develop the methodological skills you need to assess research evidence for nursing practice.
Research Utilization
During the 1980s, research utilization emerged as an important buzzword, and several changes in nursing education and nursing research were prompted by the desire to develop a knowledge base for nursing practice. These projects were generally institutional attempts to implement changes in nursing practice based on research findings and to evaluate the effects of.
Evidence-Based Practice in Nursing
As we explain in Chapter 9, the strategies used in RCTs are particularly suitable for inferring the effects of health interventions. In particular, this hierarchy is appropriate in relation to questions about causes, especially questions about the effects of clinical interventions.
RESOURCES FOR EVIDENCE-BASED PRACTICE
However, additional barriers are that many nurses do not know how to access research information and do not possess the skills to critically appraise research findings – and even those who do may not know how to effectively incorporate research evidence into clinical decision-making. Although many organizations support the idea of EBP in theory, they do not always provide the necessary support in terms of staff release time and resources.
Systematic Reviews
In particular, the Cochrane Database of Systematic Reviews (CDSR) contains thousands of systematic reviews of health interventions. Another resource for those looking to access systematic reviews is the Agency for Healthcare Research and Quality (AHRQ).
Other Preappraised Evidence
For example, the journal Evidence-Based Nursing, published quarterly, presents critical summaries of studies and systematic reviews published in more than 150 journals. Another journal-based resource is the "evidence digest" feature in each issue of Worldviews on Evidence-Based Nursing.
Models of the Evidence-Based Practice Process
Select outcomes to be achieved Collect baseline data Design evidence-based practice (EBP) guideline(s) Implement EBP in pilot units. Evaluate the process and outcomes Modify the practice guide(s). The Iowa Model of Evidence-Based Practice to Promote Quality Care (Adapted from Titler, et al.
EVIDENCE-BASED PRACTICE IN INDIVIDUAL NURSING PRACTICE
Clinical Scenarios and the Need for Evidence
Some situations may lead to a unit-wide or institution-wide investigation of current practice, but in other situations, individual nurses may personally examine the evidence to help address specific issues. 1. To ask clinical questions that can be answered with research evidence 2. To search for and collect relevant evidence.
Asking Well-Worded Clinical Questions
That is, when looking for evidence about the effectiveness of fish oil supplements, we may want to look for studies that have compared such supplements with melatonin, placebos, other treatments, or no treatments. The Toolkit section of Chapter 2 on the supplied CD-ROM contains Table 2.1 in a Word file that can be modified for your use, making it easy to 'fill in' the template questions.
Finding Research Evidence
For example, we may be specifically interested in learning whether fish oil-fortified supplements are better than melatonin in stabilizing weight in cancer patients. Therefore, when preprocessed evidence is available to answer a clinical question, you may need to look no further—.
Appraising the Evidence
Another consideration, relevant when the evidence is quantitative, is how accurate the estimation of the effect is. If the evidence is considered valid and the magnitude of the effects suggests that further consideration is warranted, there are situations where additional information is important in making decisions.
Integrating Evidence
You may reach this point in your EBP journey and conclude that the evidence base is not robust enough, or that the likely effect is too small or nonexistent, or that the cost of using the evidence is too high to be considered. However, if the initial evaluation of the evidence shows promising clinical activity, you can proceed to the next step.
Implementing the Evidence and Evaluating Outcomes
The questions refer to earlier steps of EBP, such as asking answerable questions (Am I asking any clinical questions at all? Am I asking well-formed questions?) and seeking external evidence (Am I aware of the best sources of current evidence? Am I becoming more effective at search?). Self-assessment may lead to the conclusion that at least some of the clinical questions of interest to you are best addressed as a group effort.
EVIDENCE-BASED PRACTICE IN AN ORGANIZATIONAL CONTEXT
Part of the evaluation process involves following up to determine whether your actions or decisions achieved the desired outcome.
Selecting a Problem for an Institutional Evidence-Based Practice Project
Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus ("triggers") for an EBP effort—(1) problem-focused triggers—the identification of a clinical practice problem in need of resolution, or (2 ) ) knowledge-focused triggers—readings in the research literature. Problem-focused triggers can arise in the normal course of clinical practice (as in the case of the clinical scenarios described earlier) or in the context of quality-assessment or quality-improvement efforts.
Finding and Appraising Evidence: Clinical Practice Guidelines
Worse still, differences in the rigor of guideline development and in the interpretation of evidence lead to different guidelines sometimes offering different or even conflicting recommendations (Lewis, 2001). For example, one dimension in the scope and purpose domain is "The patients to whom the guidelines are intended to apply are specifically described"; and one in the Rigor of Development domain is "The guideline was reviewed by external experts before publication." A team of two to four evaluators should use the AGREE instrument for the guideline they are reviewing.
Actions Based on Evidence Appraisals
A preliminary assessment of the implementation potential (or environmental readiness) of a clinical innovation is often prudent, although there may be situations where there is little need for a formal assessment. If the implementation criteria are met and there is sufficient evidence, the team can develop an action plan for designing and testing the new clinical practice.
Implementing and Evaluating the Innovation
A 12-member Nurse Comfort Therapy Service was formed and trained in the use of the protocols. The team found that in the pilot study there were gains in the patients' knowledge, attitudes and use of the three non-drug interventions for pain management.
STUDIES CITED IN CHAPTER 2
In journals specializing in research (eg the journal Nursing Research), most articles are original research reports, but in specialty journals there is usually a mixture of research and non-research articles. A place is the overall location for the research - it can be an entire community (eg a Haitian neighborhood in Miami) or an institution within a community (eg a clinic in Seattle).
THE BUILDING BLOCKS OF RESEARCH
For example, Fontenot (2007) wrote an article entitled “Transition and adaptation to adoptive motherhood” in the Journal of Obstetric, Gynecologic, & Neonatal Nursing. Some studies take place in a naturalistic setting - in the field; at the other extreme, some studies are conducted in highly controlled laboratory settings.
The Faces and Places of Research
Human studies involve two types of people: those doing the research and those providing the information. In a qualitative study, the people who participate in the research play an active rather than a passive role and are therefore referred to as informants or study participants.
Phenomena, Concepts, and Constructs
The study participants included 1,244 women from two locations: a primary care clinic and a Health Maintenance Organization (HMO). . built) by researchers for a specific purpose.
Theories and Conceptual Models
Variables
For example, researchers examine the extent to which lung cancer (the dependent variable) is dependent on smoking (the independent variable). For example, a study might examine the effect of a nurse-initiated exercise intervention (the independent variable) on osteoporosis (the dependent variable).
Conceptual and Operational Definitions
Several dependent variables could be used to assess treatment effectiveness, such as length of hospital stay, recurrence of respiratory infections, presence of cough, and so on. For researchers who choose to emphasize physiological aspects of anxiety, the operational definition may involve a measure such as the Palmar Sweat Index.
Data
We might ask, "Thinking back over the past week, how depressed would you say you've been on a scale of 0 to 10, where 0 means 'not at all' and 10 means 'the most possible'?" Box 3.1 presents quantitative data from three fictitious respondents. Question: Thinking back over the past week, how depressed would you say you've been on a scale of 0 to 10, where 0 means "not at all" and 10 means "as much as possible?".
Relationships
There is a relationship, for example, between a person's pulmonary artery and tympanic temperatures: People with high readings in one tend to have high readings in the other. Liu and colleagues (2008) examined the relationship between health-related quality of life on the one hand, and gender and age on the other, among adult kidney transplant recipients.
MAJOR CLASSES OF QUANTITATIVE AND QUALITATIVE RESEARCH
Lengacher and colleagues (2008) investigated whether the use of relaxation and guided imagery caused lower stress and better immune function in patients undergoing treatment for breast cancer. However, we cannot say that pulmonary artery temperature caused tympanic temperature, nor that tympanic temperature caused pulmonary artery temperature, despite the relationship that exists between the two variables.
Quantitative Research: Experimental and Nonexperimental Studies
If, on the other hand, a researcher compared the elimination patterns of two groups whose regular eating patterns differed - for example, some normally took foods that stimulated bowel movements and others did not - then there is no intervention. Sweeney, Glaser, and Tedeschi (2007) examined the relationship between physical activity and eating habits of inner-city youth on the one hand, and demographic characteristics of the adolescents (e.g., gender, ethnicity, type of household) on the other.
Qualitative Research: Disciplinary Traditions
Experimental studies are specifically designed to test causal relationships—to test whether an intervention caused changes in the dependent variable. Most grounded theory studies focus on evolving social experiences—the social and psychological stages and phases that characterize a particular event or episode.
MAJOR STEPS IN A QUANTITATIVE STUDY
- The Conceptual Phase
- The Design and Planning Phase
- The Empirical Phase
- The Analytic Phase
- The Dissemination Phase
In the second main phase of a quantitative study, researchers make decisions about the study site and about the methods and procedures to be used to address the research question. A variety of quantitative data collection approaches exist; the primary methods are self-reports (eg interviews), observations (eg observation of children's behaviour) and biophysiological measurements. The task of measuring research variables and developing a data collection plan is a complex and challenging process.
ACTIVITIES IN A QUALITATIVE STUDY
Ideally, the final step of a high-quality study is to plan its use in practice. While nursing researchers may not themselves be able to implement a plan for using research findings, they can contribute to the process by developing recommendations on how to incorporate the evidence into nursing practice, ensuring that adequate information has been provided for a meta-analysis, and by vigorously seeking opportunities to disseminate the findings to practicing nurses.
Conceptualizing and Planning a Qualitative Study
In any case, due to the range of questions they ask, qualitative researchers tend to find a relatively small body of relevant previous work. The process of gaining entry is usually associated with fieldwork in qualitative studies, but quantitative researchers often need to gain entry to data collection sites as well.
Conducting a Qualitative Study
Certain design features are guided by the study's qualitative tradition, but qualitative studies rarely have rigidly structured designs that prohibit changes while in the field. Qualitative researchers, like quantitative researchers, must also develop plans to address ethical issues—and indeed there are special concerns in qualitative studies because of the more intimate nature of the relationship that typically develops between researchers and study participants.
GENERAL QUESTIONS IN REVIEWING A STUDY
Expansion phase: 18 months. The researchers have prepared and submitted their report to the journal Nursing Research for possible publication. Data – information gathered during the course of a study – can be in the form of narrative information (qualitative data) or numerical values (quantitative data).
STUDIES CITED IN CHAPTER 3
Research reports - especially those for quantitative studies - are often intimidating to readers without research training. This chapter is designed to help make research reports more accessible early in your course.
TYPES OF RESEARCH REPORTS
Evidence from nursing studies is communicated through research reports that describe what was studied, how it was studied, and what was found.
Presentations at Professional Conferences
Research Journal Articles
Nevertheless, the publication of an article does not mean that the findings can be accepted uncritically. Research methods courses help nurses evaluate the quality of evidence reported in research journal articles.
THE CONTENT OF RESEARCH JOURNAL ARTICLES
In large journals, the acceptance rate is low - it can be as high as 5% of articles submitted. Thus, consumers have some assurance that journal articles have already been examined for their merit by other nursing researchers.
The Title and Abstract
The Introduction
The purpose of the study reported in this article was to examine reciprocity in caregiving dyads over time and the impact of health changes on the quality of the caregiving relationship (Lyons et al., 2007). In this section, the researchers described the concepts of interest (reciprocity between frail elderly and their relatives), the need for the study (the fact that not much is known about aspects of reciprocity) and the purpose of the study.
The Method Section
Reports on qualitative studies increasingly include descriptions of the researchers' efforts to increase the integrity of the study. In quantitative studies, the method section describes decisions made during the design and planning phase of the study and implemented in the empirical phase (see Chapter 3).
The Results Section
Excerpts from the raw data (the participants' actual words) are presented to support and provide a rich description of the thematic analysis. The results section of qualitative studies may also present the researcher's emerging theory about the phenomenon under study, although this may appear in the concluding section of the report.
The Discussion
The results section of qualitative reports sometimes has several subsections, the headings of which correspond to the researcher's labels for the themes. A biblical allusion from several study participants was the body as the temple of God: “Some of the men and women in this group declared that the body is the temple of God.
In qualitative reports, researchers often organize findings according to major themes, processes, or categories that have been identified in the data.
THE STYLE OF RESEARCH JOURNAL ARTICLES
Why Are Research Articles So Hard to Read?
Tips on Reading Research Articles
A synopsis summarizes the study's purpose, research questions, methods, results, interpretation of the results, and implications. By preparing a synopsis, you become more aware of aspects of the study that you did not understand.
CRITIQUING RESEARCH REPORTS
Try to get the gist of the story without letting the symbols and numbers get you down. When you reach a reasonable level of understanding, a helpful next step is to write a one- to two-page summary of the article.
What Is a Research Critique?
The instruments were administered at entry into the study (when the subjects first came to the clinic) and then 1 year after termination of the pregnancy. There were no significant differences on any of the dependent variables for the two delivery groups.
Critiquing Support in This Textbook
Summarizes the abstract clearly and concisely the main features of the report (problem, methods, results, conclusions). Was the best possible sampling method used to increase the richness of information and meet the needs of the study.
Understanding Key Research Challenges
Credibility is achieved to the extent that the research methods create trust in the truth of the data and in the researchers' interpretations of (and conclusions from) the data. This again means that there are no systematic biases in the composition of the study group.
STUDIES CITED IN CHAPTER 4
Generalizability in a quantitative study concerns the extent to which the results can be applied to other groups and environments. Identify the three primary ethical principles articulated in the Belmont Report and the important dimensions covered by each.
ETHICS AND RESEARCH
Historical Background
Codes of Ethics
Some nurse ethicists have called for an international code of ethics for nursing research, but nurses in most countries have developed their own professional codes or follow codes established by their governments. The International Council of Nurses (ICN), however, has developed the ICN Code of Ethics for Nurses, which was last updated in 2006.
Government Regulations for Protecting Study Participants
For example, guidelines for psychologists have been published by the American Psychological Association (2002) in Ethical Principles of Psychologist and Code of Conduct. The American Medical Association regularly updates its Code of Medical Ethics. ANA also published a revised Code of Ethics for Nurses with Interpretive Statements in 2001, a document that primarily addresses ethical issues for practicing nurses, but also includes principles that apply to nurse researchers.
Ethical Dilemmas in Conducting Research
Another type of dilemma can arise if nurse researchers are faced with conflict of interest situations where their expected behavior as nurses conflicts with the standard behavior of researchers (e.g. It is precisely because of such conflicts and dilemmas that ethical codes have been developed to guide the efforts of the researchers.
ETHICAL PRINCIPLES FOR PROTECTING STUDY PARTICIPANTS
Beneficence
Study participants enter into a special relationship with researchers and it is crucial that this relationship is not exploited. Because nurse researchers may have a nurse-patient relationship (in addition to a researcher-participant), special care must be taken to avoid exploiting that relationship.
Respect for Human Dignity
For example, a generous monetary incentive (or allowance) offered to encourage the participation of an economically disadvantaged group (for example, the homeless) may be considered mildly coercive, as such incentives may place undue pressure on prospective participants. Full disclosure means that the investigator has fully described the nature of the study, the individual's right to decline participation, the investigator's responsibilities, and the likely risks and benefits.
Justice
The question is whether such messages can be used as data without the consent of the authors. Some researchers believe that anything published electronically is in the public domain and can therefore be used for research without official consent.
PROCEDURES FOR PROTECTING STUDY PARTICIPANTS
Researchers should ensure that their research is not more intrusive than it needs to be and that participants' privacy is maintained during the study. The Department of Health and Human Services has issued the Standards for the Privacy of Personally Identifiable Health Information regulations.
Risk–Benefit Assessments
Psychological or emotional distress resulting from self-disclosure, introspection, fear of the unknown, discomfort with strangers, fear of possible consequences, anger or embarrassment at the range of questions asked. In quantitative studies, most of the details of the study are usually defined in advance, so a relatively accurate assessment of risk and benefit can be developed.
Informed Consent
I understand that I may not participate in the survey if I am under the age of 18 or cannot speak English. I understand that my participation in this study is completely voluntary and I can withdraw from the study at any time I wish.
Confidentiality Procedures
In order to increase both individual and institutional privacy, research reports often do not provide explicit information about the location of the study. To avoid the possibility of forced, involuntary disclosure of sensitive research information (for example, via a court order), researchers in the United States can request a certificate of confidentiality from the National Institutes of Health (NIH).
Debriefings and Referrals
Finally, in some situations researchers may need to assist study participants by making referrals to appropriate health, social or psychological services. Sandgren and colleagues (2006) studied the strategies used by palliative cancer nurses to avoid becoming emotionally overwhelmed.
Treatment of Vulnerable Groups
For example, with people who cannot read and write or who have a physical disability that prevents them from writing, alternative procedures should be used to document informed consent (eg, videotaping the consent proceedings). Researchers must also take steps to ensure that if the terminally ill do participate in a study, their health care and comfort are not compromised.
External Reviews and the Protection of Human Rights
Nevertheless, researchers have a responsibility to ensure that their research plans are ethically adequate, and it is good practice for researchers to seek outside opinions, even if they are not required to do so. Taylor and McMullen (2008) examined the process of living kidney donation as experienced by the donors' spouses.
OTHER ETHICAL ISSUES
Before undertaking their study, researchers must submit research plans to the IRB, and must also undergo formal IRB training. The procedures and protocols for the study were approved by the IRB of the researchers' university, and by the IRB of the university hospital where the transplants were performed.
Ethical Issues in Using Animals in Research
They reported that "every effort was made to minimize animal suffering and reduce the number of animals used" (p. 169). The experimental protocols were approved by an institutional animal care committee and were in accordance with federal guidelines for the use of animals in research.
Research Misconduct
And since 2001, NINR and other institutes within NIH have partnered with ORI to offer grants to researchers to conduct "research integrity research"—that is, to study the factors that positively and negatively impact research integrity. In 2004, Sheila Santacroce of Yale University was awarded a 2-year fellowship through NINR under the Research on Research Integrity initiative.
CRITIQUING THE ETHICAL ASPECTS OF A STUDY
Full disclosure means that researchers have fully described to potential participants their rights and the costs and benefits of the study. In a risk-benefit assessment, the potential benefits of the study to individual participants and to society are weighed against the costs to individuals.
STUDIES CITED IN CHAPTER 5
Ethical conduct in research includes not only the protection of human and animal rights, but also efforts to maintain high standards of integrity and prevent forms of research misconduct such as plagiarism, fabrication of results or falsification of data. Describe the function and characteristics of research hypotheses and distinguish between different types of hypotheses (e.g. targeted versus non-targeted, research versus null).
OVERVIEW OF RESEARCH PROBLEMS
Basic Terminology
Research Problems and Paradigms
Research problem Nausea and vomiting are common side effects in (problem definition) patients receiving chemotherapy and interventions to date. Research question What is the relative effectiveness of patient-controlled antiemetic therapy versus nurse-controlled antiemetic therapy with regard to (1) medication use and (2) control of nausea and vomiting in patients undergoing chemotherapy.
Sources of Research Problems
Development and Refinement of Research Problems
COMMUNICATING RESEARCH PROBLEMS AND QUESTIONS
Problem Statements
As this example suggests, the problem statement is usually interspersed with findings from the research literature (for convenience, we have omitted the actual references). Previous findings provide evidence to support the assertions in the problem statement and suggest gaps in knowledge.
Statements of Purpose
A statement that the purpose of the study is to test or evaluate something (eg, an intervention) suggests an experimental design, for example. A statement of purpose indicating that the purpose of the study was to prove, demonstrate, or show something suggests a bias.
Research Questions
In qualitative studies, the statement of purpose indicates the nature of the study, the key concept or phenomenon, and the group, society, or environment being studied. Thus, questions are sometimes formulated in terms of the effects of an independent variable on the dependent variable—but this still involves a relationship between the two.
RESEARCH HYPOTHESES
Researchers begin with a focus that defines the general boundaries of the inquiry, but the boundaries are not set in stone—they "can be changed and, in the typical naturalistic inquiry, will be" (Lincoln & Guba, 1985, p . 228). Researchers usually state their purpose or research questions at the end of the introduction or immediately after the literature review.
Function of Hypotheses in Quantitative Research
Characteristics of Testable Hypotheses
Hypotheses are typically quite easy to identify because researchers make statements such as: “The study tested the hypothesis that.
Wording of Hypotheses
In the six versions of the above hypothesis, versions 1, 3, 5, and 6 are directional because there is an explicit prediction that older patients are at greater risk of falling than younger ones. These hypotheses predict that a patient's age and risk of falling are related, but do not specify whether the researcher believes that older or younger patients are at greater risk.
Hypothesis Testing and Proof
When performing statistical tests, the underlying null hypotheses are assumed without being explicitly stated. If a researcher uses statistical tests (as is the case in most quantitative studies), it means that there are underlying hypotheses - whether or not the researcher explicitly states them - because statistical tests are designed to test hypotheses.
CRITIQUING RESEARCH PROBLEMS, RESEARCH QUESTIONS, AND HYPOTHESES
Does this study appear to have been conducted within one of the three major qualitative traditions? If the results of this study are reliable, what are some of the uses to which the findings can be put in clinical practice.
STUDIES CITED IN CHAPTER 6
Types of information to look for in a research review Main steps and strategies in a literature review FINDING RELEVANT LITERATURE. Many of the activities in conducting a literature review overlap with the early steps in an EBP project, as described in Chapter 2.
BASIC ISSUES RELATING TO LITERATURE REVIEWS
Thus, this chapter describes a number of activities related to conducting a literature review as well as critiquing reviews prepared by others.
Purposes of Research Literature Reviews
Types of Information to Seek for a Research Review
Major Steps and Strategies in Doing a Literature Review
For example, many reviewers must limit their search to reports written in their own language. You may also want to limit your search to studies conducted within a specific time frame (eg, within the past 15 years) or to specific operational definitions of key variables.
LOCATING RELEVANT LITERATURE FOR A RESEARCH REVIEW
Searching Bibliographic Databases
Subject titles for databases can be accessed in the database repository or other reference tools. A text word search will search for your specific word in the text fields of database records (eg, title or abstract).
Screening and Gathering References
You can also search for references using the MeSH database directly by clicking on “MeSH Database” in the left blue panel of the PubMed home page, listed under PubMed Services. A second screen is the relevance of the reference, which you can usually (but not always) surmise by reading the abstract.
Documentation in Literature Retrieval
It is wise to maintain a notebook (or computer database program) to record your search strategies and results. Part of your strategy can be documented by printing your search history from the electronic databases.
Abstracting and Recording Information
You should record information such as databases searched; restrictions on your search; specific keywords, topic headings, and authors used to direct the search; studies used to initiate a search for “Related Articles” or “offspring”; visited websites; and any other information that can help you keep track of what you've been doing. Documenting your actions helps you search more efficiently, that is, you don't accidentally duplicate a strategy you've already followed.
EVALUATING AND ANALYZING THE EVIDENCE
Thus, an important part of a literature search is evaluating the amount of completed studies and integrating the evidence across the different studies.
Evaluating Studies for a Review
Analyzing and Synthesizing Information
Do the findings vary for different types of people (e.g. men vs. women) or environments (e.g. urban vs. rural). It is clear that it is not possible - even in lengthy, detached reviews - to analyze all the themes we have identified.
PREPARING A WRITTEN LITERATURE REVIEW
Organizing the Review
