La Salle University Philadelphia, Pennsylvania Becky Christian, PhD, Associate Professor RN; Division Chair University of Utah. DePaul University Chicago, Illinois Valmi Sousa, PhD University of North Carolina Charlotte, North Carolina Amy Spurlock, PhD, RN Associate Professor 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 needed, what tests may be appropriate in a particular situation, and what statistical information in a research report means. 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 full of 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 real-life research examples designed to highlight critical points made in the chapter and to sharpen the reader's critical thinking skills. Colorful graphics, in the form of supporting tables, figures and examples, reinforce the text and provide visual stimulation.
TEACHING-LEARNING PACKAGE
Many more critique options are available in the Study Guide, which includes 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 played an important role in nursing in terms of credibility and status. Some of the accumulated evidence has been developed in rigorous studies by nursing researchers in the United States, Australia, Canada, Taiwan, Korea and other countries (eg Chwo et al., 2002; Ludington-Hoe et al. Moore & Anderson, 2007).
Roles of Nurses in Research
Kangaroo care," the holding of diaper-clad premature infants skin-to-skin, chest-to-chest by parents, is now commonly practiced in neonatal intensive care units (NICUs) in the United States and elsewhere, but it is a new tendency. Here is a headline about a health study published in newspapers and major television networks in the United States and Canada in April 2007: "Study Does Not Support Abortion-Cancer Link."
NURSING RESEARCH: PAST, PRESENT, AND FUTURE
Assist researchers by recruiting potential study participants or collecting research information (eg distributing questionnaires to clients). Will you be able to comment on the credibility of the findings based on your assessment of how rigorously the study 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 the report on the inadequacies of nursing education. 1965 American Nurses Association (ANA) begins sponsoring nursing research conferences 1969 Canadian Journal of Nursing Research begins publication.
Nursing Research Since 1980
In the 1970s, several journals focused on nursing research were established, including Research in Nursing & Health, the Journal of Advanced Nursing, and the Western Journal of Nursing Research. Further 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
International collaboration around the issue of EBP in nursing also began to develop in the 1990s. All of the Web sites cited in this chapter, plus additional Web sites with useful content related to the foundations of nursing research, are in the "Websites of useful for Chapter 1" on the accompanying 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 sites corresponding to the content of most chapters in the book are also in files on the CD-ROM.
Tradition and Authority
This will allow you to simply use the Control/Click feature to go directly to the website without having to type in the URL and risk a typo. 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 authorities (eg, nursing faculty) is to some extent inevitable; however, as tradition, authorities as a source of information have limitations.
Logical Reasoning
Assembled Information
Quality improvement and risk data, such as medication error reports, can be used to assess practices and determine the need for practice changes. Such resources, while providing some information that can be used in practice, do not provide a mechanism for determining whether improvements in patient outcomes result from their use.
Disciplined Research
PARADIGMS FOR NURSING RESEARCH
The Positivist Paradigm
When someone suffers a cerebrovascular accident, the scientist in the positivist tradition assumes that there must be one or more reasons that can possibly be identified. However, they do see objectivity as a goal and strive to be as neutral as possible.
The Naturalistic Paradigm
Paradigms and Methods: Quantitative and Qualitative Research
Flexible and evolving procedures are used to take advantage of the findings that emerge during the study. Naturalistic studies provide rich and in-depth information that can clarify the various dimensions of a complex phenomenon (eg, 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. When you read about the alternative paradigms for nursing research, you were probably more attracted to one of the two paradigms – the one that most closely matches 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 not yet been clearly identified or named, or has been inadequately defined or conceptualized. What is the underlying cause of the phenomenon or the causal pathway 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 primary purpose (or purposes) of the study – to identify, describe, explore, predict/control, or explain. Also consider the following targeted questions, which can further sharpen your critical thinking skills and help you evaluate aspects of the study's merit:
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). Rather, they argue that evidence-based decision making should integrate the best research evidence with clinical expertise, patient preferences and circumstances, and awareness of the clinical setting and resource limitations.
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 evaluate 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 drawing conclusions about the effects of healthcare interventions. This hierarchy is especially suitable when it comes to investigating the cause, especially when asking 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 have the skills to critically evaluate research findings – and even those who do may not know how to effectively integrate research data into clinical decision making. Although many organizations support the idea of EBP in theory, they do not always provide the necessary support in the form of freeing up staff time and resources.
Systematic Reviews
In particular, the Cochrane Database of Systematic Reviews (CDSR) contains thousands of systematic reviews about health care interventions. Another resource for those wishing 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) guidelines Implement EBP on pilot units Evaluate process and outcomes Change the practice guidelines. 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 or facility-wide review of current practices, while in other cases, individual nurses may personally investigate the evidence to help address specific issues. 1. Asking clinical questions that can be answered with research evidence 2. Finding and gathering 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 customized for your use, making it easy to 'fill in' the template questions.
Finding Research Evidence
For example, we might be specifically interested in whether fish oil-fortified supplements are better than melatonin in stabilizing weight in cancer patients. So when pre-processed evidence is available to answer a clinical question, you may not need to look any further.
Appraising the Evidence
Another consideration, relevant when the evidence is quantitative, is how precise the estimate of effect is. If the evidence is judged to be valid and the extent of the effects suggests that further consideration is warranted, there are situations in which supplementary information is important to guide 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 relate to the earlier EBP steps, such as asking answerable questions (Am I asking any clinical questions at all? Am I asking well-formulated questions?) and finding external evidence (Do I know the best sources of current evidence? Am I becoming more effective in my search?). A 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 produced the desired results.
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, because of variation in the rigor of guideline development and interpretation of evidence, different guidelines sometimes provide different or even conflicting recommendations (Lewis, 2001). As examples, one dimension in the domain of scope and purpose is "Patients for whom the guideline is intended to apply are specifically described"; and one in the field of development rigor is "The guide has been externally reviewed by experts before its publication." The AGREE instrument should be applied to the guideline under review by a team of two to four raters.
Actions Based on Evidence Appraisals
A preliminary assessment of the implementation potential (or, environmental readiness) of a clinical innovation is often sensible, although there may be situations with little need for a formal assessment. If the implementation criteria are met and the evidence base is sufficient, the team can prepare an action plan for designing and piloting 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 that specialize in research (eg Nursing Research), most articles are original research reports, but in specialist journals there is usually a mix of research and non-research articles. A site is the general 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 titled "Transition and Adjustment to Adoptive Motherhood" in the Journal of Obstetric, Gynecological, & Neonatal Nursing. Some studies take place in naturalistic settings - in the field; at the other extreme, some studies are done in highly controlled laboratory settings.
The Faces and Places of Research
Human studies involve two groups of people: those who do the research and those who provide the information. In a qualitative study, the individuals who cooperate in the study play an active rather than a passive role, and are therefore called informants or study participants.
Phenomena, Concepts, and Constructs
Study participants included 1,244 women from two sites: general practice clinics and health maintenance organizations (HMOs). . constructed) 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 ourselves, “If you think about the past week, how depressed would you say you have 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 for three fictitious respondents. Question: Thinking back on the past week, how depressed would you say you have been on a scale of 0 to 10, where 0 means "not at all" and 10 means "the most possible."
Relationships
For example, there is a connection between a person's pulmonary artery and eardrum temperature: people with high readings on one tend to have high readings on 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, in adult kidney transplant recipients.
MAJOR CLASSES OF QUANTITATIVE AND QUALITATIVE RESEARCH
Lengacher and colleagues (2008) examined whether the use of relaxation and guided imagery resulted in less stress and better immune system function in patients undergoing breast cancer treatment. However, we cannot say that the temperature of the tympanic membrane caused the temperature of the pulmonary artery, nor that the temperature of the tympanic membrane caused the temperature of the pulmonary artery, despite the relationship that exists between the two variables.
Quantitative Research: Experimental and Nonexperimental Studies
If, on the other hand, a researcher compares elimination patterns of two groups whose regular eating patterns differed—for example, some habitually took foods that stimulated intestinal elimination and others did not—there is no intervention. Sweeney, Glaser and Tedeschi (2007) studied the relationship between inner-city adolescents' physical activity and eating habits on the one hand and demographic characteristics of the adolescents (eg gender, ethnicity, household type) on the other.
Qualitative Research: Disciplinary Traditions
Experimental studies are explicitly designed to test causal relationships – to test whether the intervention caused changes in the dependent variable. Most grounded theory studies focus on an evolving social experience: 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 major phase of a quantitative study, researchers make decisions about the study site and the methods and procedures to be used to address the research question. There are a variety of methods for collecting quantitative data; the main 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 for its use in practice settings. Although nurse researchers are not themselves in a position to implement a plan for the use of research findings, they can contribute to the process by developing recommendations on how the evidence can be incorporated into nursing practice, by ensuring that sufficient information is provided is for a meta-analysis, and by vigorously pursuing opportunities to disseminate the findings to practicing nurses.
Conceptualizing and Planning a Qualitative Study
In any case, qualitative researchers typically find a relatively small amount of relevant prior work because of the type of questions they ask. The process of gaining entry is usually associated with doing fieldwork in qualitative studies, but quantitative researchers often need to also gain access to sites to collect data.
Conducting a Qualitative Study
Certain design features are guided by the qualitative tradition of the study, but qualitative studies rarely have rigidly structured designs that prohibit changes in the field. Qualitative researchers, like quantitative researchers, must also develop plans to address ethical issues—and indeed there are particular 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 they were studied, and what they found.
Presentations at Professional Conferences
Research Journal Articles
Nevertheless, the publication of an article does not mean that the results can be uncritically accepted. Research methods courses help nurses evaluate the quality of evidence reported in research journal articles.
THE CONTENT OF RESEARCH JOURNAL ARTICLES
In major journals, the acceptance rate is low - it can be as low as 5% of submitted articles. Thus, consumers have some assurance that journal articles have already been reviewed for their value by other nurse 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 paragraph, the researchers describe the concepts of interest (reciprocity between frail elders and their caregivers), the need for the study (the fact that little is known about aspects of reciprocity), and the purpose of the study.
The Method Section
Increasingly, reports of qualitative studies include descriptions of the researchers' efforts to enhance the integrity of the research. In quantitative studies, the methods section describes the decisions made during the design and planning phase of the study and implemented during 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 whose headings correspond to the researcher's topic labels. One biblical allusion made by several study participants was the body as the temple of God: “Some of the men and women in this group stated 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
The synopsis summarizes the purpose of the study, research questions, methods, findings, interpretation of findings, and implications. By preparing a synopsis, you will be 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 symbols and numbers frustrate you. When you reach a reasonable level of understanding, a useful next step is to write a one- to two-page summary of the article.
What Is a Research Critique?
Instruments were administered at study entry (when subjects first came to the clinic) and then 1 year after termination of pregnancy. There were no significant differences in any of the dependent variables for the two birth groups.
Critiquing Support in This Textbook
Does the abstract clearly and concisely summarize the main features of the report (problem, methods, results, conclusions). Was the best possible sampling method used to increase the richness of the information and address the needs of the study.
Understanding Key Research Challenges
Credibility is achieved to the extent that the research methods inspire confidence in the truth of the data and in the researchers' interpretations of (and inferences from) the data. This in turn means that there are no systematic biases in the composition of the research group.
STUDIES CITED IN CHAPTER 4
Generalizability in a quantitative study concerns the extent to which the findings can be applied to other groups and settings. Identify the three primary ethical principles expressed in the Belmont Report and the important dimensions covered by each.
ETHICS AND RESEARCH
Historical Background
Codes of Ethics
Some nurses 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. However, the International Council of Nurses (ICN) has developed the ICN Code of Ethics for Nurses, which was most recently 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 contains principles applicable to nurse researchers.
Ethical Dilemmas in Conducting Research
Another type of dilemma may arise when nurse researchers are faced with conflict-of-interest situations in which their expected behavior as nurses conflicts with standard researcher behavior (eg, deviating from standard research protocol to provide necessary assistance to a patient). . It is precisely because of these kinds of conflicts and dilemmas that ethical codes have been developed to guide the efforts of 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 (in addition to a researcher-participant) relationship, special care may need to be taken to avoid exploiting this bond.
Respect for Human Dignity
For example, a generous monetary incentive (or grant) offered to encourage the participation of an economically disadvantaged group (eg, the homeless) may be considered slightly coercive because such incentives may place undue pressure on prospective participants. Full disclosure means that the researcher has fully described the nature of the study, the person's right to refuse participation, the researcher's responsibilities and likely risks and benefits.
Justice
The issue is whether such messages can be used as data without the authors' permission. Some researchers believe that anything posted electronically is in the public domain and can therefore be used for research without formal permission.
PROCEDURES FOR PROTECTING STUDY PARTICIPANTS
Researchers must ensure that their research is not more intrusive than it needs to be and that participants' privacy is maintained throughout the study. Department of Health and Human Services issued the regulations Standards for Privacy of Individually Identifiable Health Information.
Risk–Benefit Assessments
Psychological or emotional distress due to self-disclosure, introspection, fear of the unknown, discomfort with strangers, fear of eventual repercussions, anger or embarrassment at the type of questions being asked. In quantitative studies, most of the details of the study are usually spelled out in advance, and therefore a fairly accurate risk-benefit assessment can be developed.
Informed Consent
I realize that I may not participate in the study if I am under 18 years of age or do not speak English. I realize that my participation in this study is completely voluntary and that I may withdraw from the study at any time.
Confidentiality Procedures
As a means of enhancing both individual and institutional privacy, research reports often avoid providing explicit information about the study site. To avoid the possibility of forced, involuntary disclosure of sensitive research information (eg, through a court order), researchers in the United States can apply for 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) investigated 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 donors' spouses.
OTHER ETHICAL ISSUES
Before undertaking their study, investigators must submit research plans to the IRB, and must also undergo formal IRB training. 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 on Research Integrity"—that is, to study the factors that influence, both positively and negatively, integrity in research. In 2004, Sheila Santacroce of Yale University was awarded a 2-year grant through NINR under the Research on Research Integrity initiative.
CRITIQUING THE ETHICAL ASPECTS OF A STUDY
Full disclosure means that researchers have fully described their rights and the costs and benefits of the study to potential participants. In a risk-benefit assessment, the potential benefits of the study for the individual participant and for society are weighed against the costs for the individual.
STUDIES CITED IN CHAPTER 5
Ethical conduct in research involves not only the protection of human and animal rights, but also efforts to maintain high standards of integrity and avoid such forms of research misconduct as plagiarism, fabrication of results or falsification of data. Describe the function and characteristics of research hypotheses and distinguish between different types of hypotheses (eg, directional versus nondirectional, research versus null).
OVERVIEW OF RESEARCH PROBLEMS
Basic Terminology
Research Problems and Paradigms
Research Problem Nausea and vomiting are common side effects in (Problem Statement) chemotherapy patients, and current interventions are. Research Question What is the relative effectiveness of patient-controlled versus nurse-controlled antiemetic therapy in terms of (1) medication consumption and (2) control of nausea and vomiting in chemotherapy patients.
Sources of Research Problems
Development and Refinement of Research Problems
COMMUNICATING RESEARCH PROBLEMS AND QUESTIONS
Problem Statements
As this example indicates, the problem statement is usually intertwined with findings from the research literature (for convenience we have omitted the actual references). Previous findings provide the evidence that supports claims in the problem statement and suggest gaps in information.
Statements of Purpose
For example, a statement indicating that the purpose of the study is to test or evaluate something (e.g., an intervention) suggests an experimental design. A statement of purpose that indicates that the purpose of the research was to prove, demonstrate, or show something indicates a bias.
Research Questions
In qualitative studies, the statement of purpose indicates the nature of the inquiry, the key concept or phenomenon, and the group, community, or setting being studied. Thus, questions are sometimes framed in terms of the effects of the independent variable on the dependent variable, but this still involves the 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 usually quite easy to identify, because researchers make statements like: “The study tested the hypothesis.
Wording of Hypotheses
In the six versions of the hypothesis above, versions 1, 3, 5 and 6 are driven because there is a clear prediction that older patients are at greater risk of falling than younger ones. These hypotheses state the prediction that patient age and fall risk are related, but they do not specify whether the researcher thinks older or younger patients are at greater risk.
Hypothesis Testing and Proof
When statistical tests are performed, 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 – regardless of whether the researcher has explicitly stated them – because statistical tests are designed to test hypotheses.
CRITIQUING RESEARCH PROBLEMS, RESEARCH QUESTIONS, AND HYPOTHESES
Does it appear that this research was conducted within one of the three major qualitative traditions? If the results of this study are reliable, what are some of the applications to which the findings could be put in clinical practice?
STUDIES CITED IN CHAPTER 6
Types of information to look for for a research review Important steps and strategies for conducting a literature review. Many of the activities in conducting a literature review overlap with early steps in an EBP project, as described in Chapter 2.
BASIC ISSUES RELATING TO LITERATURE REVIEWS
Therefore, this chapter describes the range of activities involved in conducting a literature review as well as critical appraisals 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 certain time frame (eg within the last 15 years) or to certain operational definitions of key variables.
LOCATING RELEVANT LITERATURE FOR A RESEARCH REVIEW
Searching Bibliographic Databases
Subject headings for databases can be found in the database's thesaurus or other reference tools. A text word search will search for your specific keyword in the text fields of the records in the database (eg the title or the summary).
Screening and Gathering References
You can also search references directly using the MeSH database by clicking on "MeSH Database" in the left blue pane of the PubMed home page, listed under PubMed Services. The second screen is the relevance of the reference, which you can usually (but not always) guess 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 electronic databases.
Abstracting and Recording Information
You should note information such as databases you have searched; limitations on your search; specific keywords, subject headings and authors used to guide the search; studies used to initiate a search for "related articles" or "descendants". websites visited; and any other information that may help you keep track of what you have done. By documenting your actions, you'll be able to perform a more efficient search—that is, you won't inadvertently duplicate a strategy you've already followed.
EVALUATING AND ANALYZING THE EVIDENCE
Thus, an important part of a literature review is to evaluate the body of completed studies and integrate the evidence across studies.
Evaluating Studies for a Review
Analyzing and Synthesizing Information
Do the findings differ for different types of people (eg, men vs. women) or settings (eg, urban vs. rural). Clearly, it is not possible – even in long independent reviews – to analyze all the themes we have identified.
PREPARING A WRITTEN LITERATURE REVIEW
Organizing the Review
