CH 01 PDF

PA R T
Foundations
of Nursing
Research
1
Introduction to
Nursing Research
NURSING RESEARCH IN and that contribute to improvements in the entire

PERSPECTIVE health care system. Nursing research is systematic
inquiry designed to develop knowledge about
It is an exciting—and challenging—time to be a issues of importance to the nursing profession,
nurse. Nurses are managing their clinical responsi- including nursing practice, education, administra-
bilities at a time when the nursing profession and the tion, and informatics. In this book, we emphasize
larger health care system require an extraordinary clinical nursing research, that is, research
range of skills and talents of them. Nurses are designed to generate knowledge to guide nursing
expected to deliver the highest possible quality of practice and to improve the health and quality of
care in a compassionate manner, while also being life of nurses’ clients.
mindful of costs. To accomplish these diverse (and Nursing research has experienced remarkable
sometimes conflicting) goals, nurses must access growth in the past three decades, providing nurses
and evaluate extensive clinical information, and with an increasingly sound base of knowledge from
incorporate it into their clinical decision-making. In which to practice. Yet as we proceed into the 21st
today’s world, nurses must become lifelong learners, century, many questions endure and much remains
capable of reflecting on, evaluating, and modifying to be done to incorporate research-based knowl-
their clinical practice based on new knowledge. And, edge into nursing practice.
nurses are increasingly expected to become producers
of new knowledge through nursing research. Examples of nursing research
questions:
• What are the factors that determine the length
What Is Nursing Research?
of stay of patients in the intensive care unit
Research is systematic inquiry that uses disciplined undergoing coronary artery bypass graft
methods to answer questions or solve problems. surgery (Doering, Esmailian, Imperial-Perez,
The ultimate goal of research is to develop, refine, & Monsein, 2001)?
and expand a body of knowledge. • How do adults with acquired brain injury per-
Nurses are increasingly engaged in disciplined ceive their social interactions and relationships
studies that benefit the profession and its patients, (Paterson & Stewart, 2002)?
4 ■ PART 1 Foundations of Nursing Research
The Importance of Research Example of an EBP project:

in Nursing
• The Association of Women’s Health, Obstetric,
Nurses increasingly are expected to adopt an and Neonatal Nurses (AWHONN) is one
evidence-based practice (EBP), which is broadly nursing organization that has demonstrated a
defined as the use of the best clinical evidence in strong commitment to evidence-based nursing
making patient care decisions. Although there is practice. For example, AWHONN undertook a
not a consensus about what types of “evidence” project that developed and tested an evidence-
are appropriate for EBP (Goode, 2000), there is based protocol for urinary incontinence in
general agreement that research findings from women, and then designed procedures to
rigorous studies constitute the best type of evi- facilitate the protocol’s implementation into
dence for informing nurses’ decisions, actions, clinical practice (Samselle et al., 2000a, 2000b).
and interactions with clients. Nurses are accept- More recently, AWHONN and the National
ing the need to base specific nursing actions and Association of Neonatal Nurses designed and
decisions on evidence indicating that the actions tested an evidence-based protocol for neonatal
are clinically appropriate, cost-effective, and skin care, and also instituted procedures for
result in positive outcomes for clients. Nurses implementing it (Lund, Kuller, Lane, Lott,
who incorporate high-quality research evidence Raines, & Thomas, 2001; Lund, Osborne,
into their clinical decisions and advice are being Kuller, Lane, Lott, & Raines, 2001).
professionally accountable to their clients. They
are also reinforcing the identity of nursing as a
The Consumer–Producer Continuum
profession.
in Nursing Research
Another reason for nurses to engage in and
use research involves the spiraling costs of health With the current emphasis on EBP, it has become
care and the cost-containment practices being every nurse’s responsibility to engage in one or more
instituted in health care facilities. Now, more than roles along a continuum of research participation. At
ever, nurses need to document the social relevance one end of the continuum are those nurses whose
and effectiveness of their practice, not only to the involvement in research is indirect. Consumers of
profession but to nursing care consumers, health nursing research read research reports to develop
care administrators, third-party payers (e.g., insur- new skills and to keep up to date on relevant findings
ance companies), and government agencies. Some that may affect their practice. Nurses increasingly are
research findings will help eliminate nursing expected to maintain this level of involvement with
actions that do not achieve desired outcomes. research, at a minimum. Research utilization—the
Other findings will help nurses identify practices use of research findings in a practice setting—
that improve health care outcomes and contain depends on intelligent nursing research consumers.
costs as well. At the other end of the continuum are the pro-
Nursing research is essential if nurses are to ducers of nursing research: nurses who actively
understand the varied dimensions of their profes- participate in designing and implementing research
sion. Research enables nurses to describe the char- studies. At one time, most nurse researchers were
acteristics of a particular nursing situation about academics who taught in schools of nursing, but
which little is known; to explain phenomena that research is increasingly being conducted by prac-
must be considered in planning nursing care; to ticing nurses who want to find what works best for
predict the probable outcomes of certain nursing their patients.
decisions; to control the occurrence of undesired Between these two end points on the continuum
outcomes; and to initiate activities to promote lie a rich variety of research activities in which
desired client behavior. nurses engage as a way of improving their effec-
CHAPTER 1 Introduction to Nursing Research ■ 5
tiveness and enhancing their professional lives. publication, Notes on Nursing (1859), describes her
These activities include the following: early interest in environmental factors that promote
physical and emotional well-being—an interest that
• Participating in a journal club in a practice set-
continues among nurses nearly 150 years later.
ting, which involves regular meetings among
Nightingale’s most widely known research contri-
nurses to discuss and critique research articles
bution involved her data collection and analysis
• Attending research presentations at professional
relating to factors affecting soldier mortality and
conferences
morbidity during the Crimean War. Based on her
• Discussing the implications and relevance of
skillful analyses and presentations, she was suc-
research findings with clients
cessful in effecting some changes in nursing care—
• Giving clients information and advice about
and, more generally, in public health.
participation in studies
For many years after Nightingale’s work, the
• Assisting in the collection of research informa-
nursing literature contained little research. Some
tion (e.g., distributing questionnaires to patients)
attribute this absence to the apprenticeship nature of
• Reviewing a proposed research plan with
nursing. The pattern of nursing research that even-
respect to its feasibility in a clinical setting and
tually emerged at the turn of the century was closely
offering clinical expertise to improve the plan
aligned to the problems confronting nurses. Most
• Collaborating in the development of an idea for
studies conducted between 1900 and 1940 con-
a clinical research project
cerned nurses’ education. For example, in 1923, a
• Participating on an institutional committee that
group called the Committee for the Study of
reviews the ethical aspects of proposed research
Nursing Education studied the educational prepara-
before it is undertaken
tion of nurse teachers, administrators, and public
• Evaluating completed research for its possible
health nurses and the clinical experiences of nursing
use in practice, and using it when appropriate
students. The committee issued what has become
In all these activities, nurses with some known as the Goldmark Report, which identified
research skills are in a better position than those many inadequacies in the educational backgrounds
without them to make a contribution to nursing of the groups studied and concluded that advanced
knowledge. An understanding of nursing research educational preparation was essential. As more
can improve the depth and breadth of every nurse’s nurses received university-based education, studies
professional practice. concerning nursing students—their differential
characteristics, problems, and satisfactions—
became more numerous.
NURSING RESEARCH:
During the 1940s, studies concerning nursing
PA S T, P R E S E N T, A N D
education continued, spurred on by the unprece-
FUTURE
dented demand for nursing personnel that resulted
Although nursing research has not always had the from World War II. For example, Brown (1948)
prominence and importance it enjoys today, its long reassessed nursing education in a study initiated at
and interesting history portends a distinguished the request of the National Nursing Council for War
future. Table 1-1 summarizes some of the key events Service. The findings from the study, like those of
in the historical evolution of nursing research. the Goldmark Report, revealed numerous inadequa-
cies in nursing education. Brown recommended that
the education of nurses occur in collegiate settings.
The Early Years: From Nightingale to
Many subsequent research investigations concerning
the 1950s
the functions performed by nurses, nurses’ roles and
Most people would agree that research in nursing attitudes, hospital environments, and nurse—patient
began with Florence Nightingale. Her landmark interactions stemmed from the Brown report.
TABLE 1.1 Historical Landmarks Affecting Nursing Research
YEAR EVENT
1859 Nightingale’s Notes on Nursing published

1900 American Nursing Journal begins publication
1923 Columbia University establishes first doctoral program for nurses
Goldmark Report with recommendations for nursing education published
1930s American Journal of Nursing publishes clinical cases studies
1948 Brown publishes report on inadequacies of nursing education
1952 The journal Nursing Research begins publication
1955 Inception of the American Nurses’ Foundation to sponsor nursing research
1957 Establishment of nursing research center at Walter Reed Army Institute of Research
1963 International Journal of Nursing Studies begins publication
1965 American Nurses’ Association (ANA) begins sponsoring nursing research conferences
1966 Nursing history archive established at Mugar Library, Boston University
1968 Canadian Journal of Nursing Research begins publication
1971 ANA establishes a Commission on Research
1972 ANA establishes its Council of Nurse Researchers
1976 Stetler and Marram publish guidelines on assessing research for use in practice
1978 The journals Research in Nursing & Health and Advances in Nursing Science begin publication
1979 Western Journal of Nursing Research begins publication
1982 The Conduct and Utilization of Research in Nursing (CURN) project publishes report
1983 Annual Review of Nursing Research begins publication
1985 ANA Cabinet on Nursing Research establishes research priorities
1986 National Center for Nursing Research (NCNR) established within U.S. National Institutes of Health
1987 The journal Scholarly Inquiry for Nursing Practice begins publication
1988 The journals Applied Nursing Research and Nursing Science Quarterly begin publication
Conference on Research Priorities (CORP #1) in convened by NCNR
1989 U.S. Agency for Health Care Policy and Research (AHCPR) is established
1992 The journal Clinical Nursing Research begins publication
1993 NCNR becomes a full institute, the National Institute of Nursing Research (NINR)
CORP #2 is convened to establish priorities for 1995–1999
The Cochrane Collaboration is established
The journal Journal of Nursing Measurement begins publication
1994 The journal Qualitative Health Research begins publication
1997 Canadian Health Services Research Foundation is established with federal funding
1999 AHCPR is renamed Agency for Healthcare Research and Quality (AHRQ)
2000 NINR issues funding priorities for 2000–2004; annual funding exceeds $100 million
The Canadian Institute of Health Research is launched
The journal Biological Research for Nursing begins publication
6
A number of forces combined during the 1950s for the educational preparation of nurses and,
to put nursing research on a rapidly accelerating increasingly, for nursing research.
upswing. An increase in the number of nurses with Nursing research began to advance worldwide
advanced educational degrees, the establishment of in the 1960s. The International Journal of Nursing
a nursing research center at the Walter Reed Army Studies began publication in 1963, and the
Institute of Research, an increase in the availability Canadian Journal of Nursing Research was first
of funds from the government and private founda- published in 1968.
tions, and the inception of the American Nurses’
Example of nursing research break-
Foundation—which is devoted exclusively to the
throughs in the 1960s:
promotion of nursing research—were forces provid-
ing impetus to nursing research during this period. • Jeanne Quint Benoliel began a program of
Until the 1950s, nurse researchers had few research that had a major impact on medicine,
outlets for reporting their studies to the nursing medical sociology, and nursing. Quint explored
community. The American Journal of Nursing, first the subjective experiences of patients after diag-
published in 1900, began on a limited basis to nosis with a life-threatening illness (1967). Of
publish some studies in the 1930s. The increasing particular note, physicians in the early 1960s
number of studies being conducted during the usually did not advise women that they had
1950s, however, created the need for a journal in breast cancer, even after a mastectomy. Quint’s
which findings could be published; thus, Nursing (1962, 1963) seminal study of the personal
Research came into being in 1952. experiences of women after radical mastectomy
Nursing research took a twist in the 1950s not contributed to changes in communication and
experienced by research in other professions, at information control by physicians and nurses.
least not to the same extent as in nursing. Nurses
studied themselves: Who is the nurse? What does
Nursing Research in the 1970s
the nurse do? Why do individuals choose to enter
nursing? What are the characteristics of the ideal By the 1970s, the growing number of nurses con-
nurse? How do other groups perceive the nurse? ducting research studies and the discussions of the-
oretical and contextual issues surrounding nursing
research created the need for additional communi-
cation outlets. Several additional journals that focus
Knowledge development through research in nurs- on nursing research were established in the 1970s,
ing began in earnest only about 40 years ago, in the including Advances in Nursing Science, Research in
1960s. Nursing leaders began to express concern Nursing & Health, the Western Journal of Nursing
about the lack of research in nursing practice. Research, and the Journal of Advanced Nursing.
Several professional nursing organizations, such as In the 1970s, there was a decided change in
the Western Interstate Council for Higher Education emphasis in nursing research from areas such as
in Nursing, established priorities for research inves- teaching, curriculum, and nurses themselves to the
tigations during this period. Practice-oriented improvement of client care—signifying a growing
research on various clinical topics began to emerge awareness by nurses of the need for a scientific base
in the literature. from which to practice. Nursing leaders strongly
The 1960s was the period during which terms endorsed this direction for nursing studies.
such as conceptual framework, conceptual model, Lindeman (1975), for example, conducted a study to
nursing process, and theoretical base of nursing ascertain the views of nursing leaders concerning the
practice began to appear in the literature and to focus of nursing studies; clinical problems were
influence views about the role of theory in nursing identified as the highest priorities. Nurses also began
research. Funding continued to be available both to pay attention to the utilization of research findings
in nursing practice. A seminal article by Stetler and Of particular importance in the United States
Marram (1976) offered guidance on assessing was the establishment in 1986 of the National
research for application in practice settings. Center for Nursing Research (NCNR) at the
In the United States, research skills among National Institutes of Health (NIH) by congres-
nurses continued to improve in the 1970s. The sional mandate, despite a presidential veto that was
cadre of nurses with earned doctorates steadily overridden largely as a result of nurse-scientists’
increased, especially during the later 1970s. The successful lobbying efforts. The purpose of NCNR
availability of both predoctoral and postdoctoral was to promote—and financially support—
research fellowships facilitated the development of research training and research projects relating to
advanced research skills. patient care. In addition, the Center for Research
for Nursing was created in 1983 by the American
Nurses’ Association. The Center’s mission is to
develop and coordinate a research program to serve
• Kathryn Barnard’s research led to break- as the source of national information for the profes-
throughs in the area of neonatal and young child sion. Meanwhile, funding for nursing research
development. Her research program focused on became available in Canada in the 1980s through the
the identification and assessment of children at National Health Research Development Program
risk of developmental and health problems, (NHRDP).
such as abused and neglected children and Several nursing groups developed priorities for
failure-to-thrive children (Barnard, 1973, 1976; nursing research during the 1980s. For example, in
Barnard & Collar, 1973; Barnard, Wenner, 1985, the American Nurses’ Association Cabinet
Weber, Gray, & Peterson, 1977). Her research on Nursing Research established priorities that
contributed to work on early interventions for helped focus research more precisely on aspects of
children with disabilities, and also to the field of nursing practice. Also in the 1980s, nurses began to
developmental psychology. conduct formal projects designed to increase
research utilization. Finally, specialty journals such
as Heart & Lung and Cancer Nursing began to
expand their coverage of research reports, and sev-
The 1980s brought nursing research to a new level of eral new research-related journals were estab-
development. An increase in the number of qualified lished: Applied Nursing Research, Scholarly
nurse researchers, the widespread availability of Inquiry for Nursing Practice, and Nursing Science
computers for the collection and analysis of informa- Quarterly. The journal Applied Nursing Research
tion, and an ever-growing recognition that research is is notable for its intended audience: it includes
an integral part of professional nursing led nursing research reports on studies of special relevance to
leaders to raise new issues and concerns. More atten- practicing nurses.
tion was paid to the types of questions being asked, Several forces outside of the nursing profes-
the methods of collecting and analyzing information sion in the late 1980s helped to shape today’s nurs-
being used, the linking of research to theory, and the ing research landscape. A group from the
utilization of research findings in practice. McMaster Medical School in Canada designed a
Several events provided impetus for nursing clinical learning strategy that was called evidence-
research in this decade. For example, the first based medicine (EBM). EBM, which promulgated
volume of the Annual Review of Nursing Research the view that scientific research findings were far
was published in 1983. These annual reviews superior to the opinions of authorities as a basis for
include summaries of current research knowledge clinical decisions, constituted a profound shift for
on selected areas of research practice and encourage medical education and practice, and has had a
utilization of research findings. major effect on all health care professions.
In 1989, the U.S. government established the the Canadian Health Services Research Foundation
Agency for Health Care Policy and Research was established in 1997 with an endowment from
(AHCPR). AHCPR (which was renamed the Agency federal funds, and plans for the Canadian Institute
for Healthcare Research and Quality, or AHRQ, in for Health Research were underway.
1999) is the federal agency that has been charged Several research journals were established
with supporting research specifically designed to during the 1990s, including Qualitative Health
improve the quality of health care, reduce health Research, Clinical Nursing Research, Clinical
costs, and enhance patient safety, and thus plays a Effectiveness, and Outcomes Management for
pivotal role in the promulgation of EBP. Nursing Practice. These journals emerged in
response to the growth in clinically oriented and in-
depth research among nurses, and interest in EBP.
Another major contribution to EBP was inaugurated
• A team of researchers headed by Dorothy in 1993: the Cochrane Collaboration, an interna-
Brooten engaged in studies that led to the devel- tional network of institutions and individuals,
opment and testing of a model of site transitional maintains and updates systematic reviews of hun-
care. Brooten and her colleagues (1986, 1988, dreds of clinical interventions to facilitate EBP.
1989), for example, conducted studies of nurse Some current nursing research is guided by pri-
specialist–managed home follow-up services orities established by prominent nurse researchers
for very-low-birth-weight infants who were dis- in the 1990s, who were brought together by NCNR
charged early from the hospital, and later for two Conferences on Research Priorities
expanded to other high-risk patients (1994). The (CORP). The priorities established by the first
site transitional care model, which was devel- CORP for research through 1994 included low birth
oped in anticipation of government cost-cutting weight, human immunodeficiency virus (HIV)
measures of the 1980s, has been used as a infection, long-term care, symptom management,
framework for patients who are at health risk as nursing informatics, health promotion, and techno-
a result of early discharge from hospitals, and logy dependence.
has been recognized by numerous health care In 1993, the second CORP established the
disciplines. following research emphases for a portion of
NINR’s funding from 1995 through 1999: develop-
ing and testing community-based nursing models;
assessing the effectiveness of nursing interventions
Nursing science came into its maturity during the in HIV/AIDS; developing and testing approaches to
1990s. As but one example, nursing research was remediating cognitive impairment; testing interven-
strengthened and given more national visibility in tions for coping with chronic illness; and identifying
the United States when NCNR was promoted to full biobehavioral factors and testing interventions to
institute status within the NIH: in 1993, the promote immunocompetence.
National Institute of Nursing Research (NINR)
was born. The birth of NINR helps put nursing
research more into the mainstream of research
activities enjoyed by other health disciplines. • Many studies that Donaldson (2000) identified
Funding for nursing research has also grown. In as breakthroughs in nursing research were con-
1986, the NCNR had a budget of $16.2 million, ducted in the 1990s. This reflects, in part, the
whereas 16 years later in fiscal year 2002, the bud- growth of research programs in which teams of
get for NINR was over $120 million. Funding researchers engage in a series of related research
opportunities for nursing research expanded in other on important topics, rather than discrete and
countries as well during the 1990s. For example, unconnected studies. As but one example,
several nurse researchers had breakthroughs into practice will continue and nurses at all
during the 1990s in the area of psychoneuroim- levels will be encouraged to engage in evidence-
munology, which has been adopted as the model based patient care. In turn, improvements will
of mind—body interactions. Barbara Swanson be needed both in the quality of nursing studies
and Janice Zeller, for example, conducted several and in nurses’ skills in understanding, critiquing,
studies relating to HIV infection and neuropsy- and using study results.
chological function (Swanson, Cronin-Stubbs, • Development of a stronger knowledge base
Zeller, Kessler, & Bielauskas, 1993; Swanson, through multiple, confirmatory strategies.
Zeller, & Spear, 1998) that have led to discoveries Practicing nurses cannot be expected to change
in environmental management as a means of a procedure or adopt an innovation on the basis
improving immune system status. of a single, isolated study. Confirmation is usu-
ally needed through the deliberate replication
(i.e., the repeating) of studies with different
Future Directions for Nursing Research clients, in different clinical settings, and at dif-
Nursing research continues to develop at a rapid ferent times to ensure that the findings are
pace and will undoubtedly flourish in the 21st cen- robust. Replication in different settings is espe-
tury. Broadly speaking, the priority for nursing cially important now because the primary set-
research in the future will be the promotion of ting for health care delivery is shifting from
excellence in nursing science. Toward this end, inpatient hospitals to ambulatory settings, the
nurse researchers and practicing nurses will be community, and homes. Another confirmatory
sharpening their research skills, and using those strategy is the conduct of multiple-site investi-
skills to address emerging issues of importance to gations by researchers in several locations.
the profession and its clientele. • Strengthening of multidisciplinary collabora-
Certain trends for the beginning of the 21st tion. Interdisciplinary collaboration of nurses
century are evident from developments taking with researchers in related fields (as well as
shape in the 1990s: intradisciplinary collaboration among nurse
researchers) is likely to continue to expand in
• Increased focus on outcomes research. the 21st century as researchers address funda-
Outcomes research is designed to assess and mental problems at the biobehavioral and psy-
document the effectiveness of health care ser- chobiologic interface. As one example, there are
vices. The increasing number of studies that can likely to be vast opportunities for nurses and
be characterized as outcomes research has been other health care researchers to integrate break-
stimulated by the need for cost-effective care throughs in human genetics into lifestyle and
that achieves positive outcomes without com- health care interventions. In turn, such collabo-
promising quality. Nurses are increasingly rative efforts could lead to nurse researchers
engaging in outcomes research focused both on playing a more prominent role in national and
patients and on the overall delivery system. international health care policies.
• Increased focus on biophysiologic research. • Expanded dissemination of research findings. The
Nurse researchers have begun increasingly to Internet and other electronic communication have
study biologic and physiologic phenomena as a big impact on the dissemination of research
part of the effort to develop better clinical evi- information, which in turn may help to promote
dence. Consistent with this trend, a new journal EBP. Through such technological advances as on-
called Biological Research for Nursing was line publishing (e.g., the Online Journal of
launched in 2000. Knowledge Synthesis for Nursing, the Online
• Promotion of evidence-based practice. Journal of Clinical Innovation); on-line resources
Concerted efforts to translate research findings such as Lippincott’s NursingCenter.com; elec-
tronic document retrieval and delivery; • Responding to compelling public health con-
e-mail; and electronic mailing lists, information cerns (e.g., reducing health disparities in cancer
about innovations can be communicated more screening; end-of-life/palliative care)
widely and more quickly than ever before.
• Increasing the visibility of nursing research.
SOURCES OF EVIDENCE
The 21st century is likely to witness efforts to
FOR NURSING PRACTICE
increase the visibility of nursing research, the
onus for which will fall on the shoulders of Nursing students are taught how best to practice
nurse researchers themselves. Most people are nursing, and best-practice learning continues
unaware that nurses are scholars and throughout nurses’ careers. Some of what students
researchers. Nurse researchers must market and nurses learn is based on systematic research,
themselves and their research to professional but much of it is not. In fact, Millenson (1997) esti-
organizations, consumer organizations, and the mated that 85% of health care practice has not been
corporate world to increase support for their scientifically validated.
research. They also need to educate upper-level Clinical nursing practice relies on a collage of
managers and corporate executives about the information sources that vary in dependability and
importance of clinical outcomes research. As validity. Increasingly there are discussions of evi-
Baldwin and Nail (2000) have noted, nurse dence hierarchies that acknowledge that certain
researchers are one of the best-qualified groups types of evidence and knowledge are superior to
to meet the need in today’s world for clinical others. A brief discussion of some alternative
outcomes research, but they are not recognized sources of evidence shows how research-based
for their expertise. information is different.
Priorities and goals for the future are also under
discussion. NINR has established scientific goals Tradition
and objectives for the 5-year period of 2000 to
Many questions are answered and problems solved
2004. The four broad goals are: (1) to identify and
based on inherited customs or tradition. Within
support research opportunities that will achieve sci-
each culture, certain “truths” are accepted as given.
entific distinction and produce significant contribu-
For example, as citizens of democratic societies,
tions to health; (2) to identify and support future
most of us accept, without proof, that democracy is
areas of opportunity to advance research on high
the highest form of government. This type of
quality, cost-effective care and to contribute to the
knowledge often is so much a part of our heritage
scientific base for nursing practice; (3) to communi-
that few of us seek verification.
cate and disseminate research findings resulting
Tradition offers some advantages. It is efficient
from NINR-funded research; and (4) to enhance the
as an information source: each individual is not
development of nurse researchers through training
required to begin anew in an attempt to understand
and career development opportunities. For the years
the world or certain aspects of it. Tradition or custom
2000, 2001, and 2002, topics identified by NINR as
also facilitates communication by providing a com-
special areas of research opportunity included:
mon foundation of accepted truth. Nevertheless, tra-
• Chronic illnesses or conditions (e.g., management dition poses some problems because many traditions
of chronic pain; care of children with asthma; have never been evaluated for their validity. Indeed,
adherence to diabetes self-management) by their nature, traditions may interfere with the
• Behavioral changes and interventions (e.g., ability to perceive alternatives. Walker’s (1967)
research in informal caregiving; disparities of research on ritualistic practices in nursing suggests
infant mortality; effective sleep in health and that some traditional nursing practices, such as the
illness) routine taking of a patient’s temperature, pulse, and
respirations, may be dysfunctional. The Walker that the same objective event is usually experienced
study illustrates the potential value of critical or perceived differently by two individuals.
appraisal of custom and tradition before accepting Related to clinical experience is the method of
them as truth. There is growing concern that many trial and error. In this approach, alternatives are
nursing interventions are based on tradition, cus- tried successively until a solution to a problem is
toms, and “unit culture” rather than on sound evi- found. We likely have all used trial and error in our
dence (e.g., French, 1999). lives, including in our professional work. For exam-
ple, many patients dislike the taste of potassium chlo-
ride solution. Nurses try to disguise the taste of the
Authority
medication in various ways until one method meets
In our complex society, there are authorities—people with the approval of the patient. Trial and error may
with specialized expertise—in every field. We are offer a practical means of securing knowledge, but
constantly faced with making decisions about mat- it is fallible. This method is haphazard, and the
ters with which we have had no direct experience; knowledge obtained is often unrecorded and, hence,
therefore, it seems natural to place our trust in the inaccessible in subsequent clinical situations.
judgment of people who are authoritative on an issue Finally, intuition is a type of knowledge that
by virtue of specialized training or experience. As a cannot be explained on the basis of reasoning or prior
source of understanding, however, authority has instruction. Although intuition and hunches undoubt-
shortcomings. Authorities are not infallible, particu- edly play a role in nursing practice—as they do in the
larly if their expertise is based primarily on personal conduct of research—it is difficult to develop policies
experience; yet, like tradition, their knowledge often and practices for nurses on the basis of intuition.
goes unchallenged. Although nursing practice would
flounder if every piece of advice from nursing
Logical Reasoning
educators were challenged by students, nursing edu-
cation would be incomplete if students never had Solutions to many perplexing problems are devel-
occasion to pose such questions as: How does the oped by logical thought processes. Logical reason-
authority (the instructor) know? What evidence is ing as a method of knowing combines experience,
there that what I am learning is valid? intellectual faculties, and formal systems of
thought. Inductive reasoning is the process of
developing generalizations from specific observa-
Clinical Experience, Trial and Error,
tions. For example, a nurse may observe the anxious
and Intuition
behavior of (specific) hospitalized children and con-
Our own clinical experiences represent a familiar clude that (in general) children’s separation from
and functional source of knowledge. The ability to their parents is stressful. Deductive reasoning is
generalize, to recognize regularities, and to make the process of developing specific predictions from
predictions based on observations is an important general principles. For example, if we assume that
characteristic of the human mind. Despite the obvi- separation anxiety occurs in hospitalized children
ous value of clinical expertise, it has limitations as (in general), then we might predict that (specific)
a type of evidence. First, each individual’s experi- children in Memorial Hospital whose parents do not
ence is fairly restricted. A nurse may notice, for room-in will manifest symptoms of stress.
example, that two or three cardiac patients follow Both systems of reasoning are useful as a means
similar postoperative sleep patterns. This observa- of understanding and organizing phenomena, and
tion may lead to some interesting discoveries with both play a role in nursing research. However, rea-
implications for nursing interventions, but does one soning in and of itself is limited because the validity
nurse’s observations justify broad changes in of reasoning depends on the accuracy of the infor-
nursing care? A second limitation of experience is mation (or premises) with which one starts, and
reasoning may be an insufficient basis for evaluating PA R A D I G M S F O R

accuracy. NURSING RESEARCH
A paradigm is a world view, a general perspective
Assembled Information on the complexities of the real world. Paradigms
for human inquiry are often characterized in terms
In making clinical decisions, health care profes-
of the ways in which they respond to basic philo-
sionals also rely on information that has been
sophical questions:
assembled for a variety of purposes. For example,
local, national, and international bench-marking • Ontologic: What is the nature of reality?
data provide information on such issues as the • Epistemologic: What is the relationship between
rates of using various procedures (e.g., rates of the inquirer and that being studied?
cesarean deliveries) or rates of infection (e.g., • Axiologic: What is the role of values in the inquiry?
nosocomial pneumonia rates), and can serve as a • Methodologic: How should the inquirer obtain
guide in evaluating clinical practices. Cost data— knowledge?
that is, information on the costs associated with Disciplined inquiry in the field of nursing is
certain procedures, policies, or practices—are being conducted mainly within two broad paradigms,
sometimes used as a factor in clinical decision- both of which have legitimacy for nursing research.
making. Quality improvement and risk data, This section describes the two alternative paradigms
such as medication error reports and evidence on and outlines their associated methodologies.
the incidence and prevalence of skin breakdown,
can be used to assess practices and determine the
The Positivist Paradigm
need for practice changes.
Such sources, although offering some infor- One paradigm for nursing research is known as pos-
mation that can be used in practice, provide no itivism. Positivism is rooted in 19th century
mechanism for determining whether improvements thought, guided by such philosophers as Comte,
in patient outcomes result from their use. Mill, Newton, and Locke. Positivism is a reflection
of a broader cultural phenomenon that, in the
humanities, is referred to as modernism, which
Disciplined Research
emphasizes the rational and the scientific. Although
Research conducted within a disciplined format is strict positivist thinking—sometimes referred to as
the most sophisticated method of acquiring evi- logical positivism—has been challenged and
dence that humans have developed. Nursing undermined, a modified positivist position remains
research combines aspects of logical reasoning a dominant force in scientific research.
with other features to create evidence that, The fundamental ontologic assumption of pos-
although fallible, tends to be more reliable than itivists is that there is a reality out there that can be
other methods of knowledge acquisition. studied and known (an assumption refers to a
The current emphasis on evidence-based health basic principle that is believed to be true without
care requires nurses to base their clinical practice to proof or verification). Adherents of the positivist
the greatest extent possible on research-based find- approach assume that nature is basically ordered
ings rather than on tradition, authority, intuition, or and regular and that an objective reality exists inde-
personal experience. Findings from rigorous pendent of human observation. In other words, the
research investigations are considered to be at the world is assumed not to be merely a creation of the
pinnacle of the evidence hierarchy for establishing human mind. The related assumption of determin-
an EBP. As we discuss next, disciplined research in ism refers to the belief that phenomena are not hap-
nursing is richly diverse with regard to questions hazard or random events but rather have antecedent
asked and methods used. causes. If a person has a cerebrovascular accident,
the scientist in a positivist tradition assumes that The Naturalistic Paradigm

there must be one or more reasons that can be
The naturalistic paradigm began as a counter-
potentially identified and understood. Much of the
movement to positivism with writers such as Weber
activity in which a researcher in a positivist para-
and Kant. Just as positivism reflects the cultural
digm is engaged is directed at understanding the
phenomenon of modernism that burgeoned in the
underlying causes of natural phenomena. wake of the industrial revolution, naturalism is an
Because of their fundamental belief in an objec- outgrowth of the pervasive cultural transformation
tive reality, positivists seek to be as objective as pos- that is usually referred to as postmodernism.
sible in their pursuit of knowledge. Positivists attempt Postmodern thinking emphasizes the value of
to hold their personal beliefs and biases in check deconstruction—that is, of taking apart old ideas
insofar as possible during their research to avoid con- and structures—and reconstruction—that is,
taminating the phenomena under investigation. The putting ideas and structures together in new ways.
positivists’ scientific approach involves the use of The naturalistic paradigm represents a major alter-
orderly, disciplined procedures that are designed to native system for conducting disciplined research
test researchers’ hunches about the nature of phenom- in nursing. Table 1-2 compares the major assump-
ena being studied and relationships among them. tions of the positivist and naturalistic paradigms.
TABLE 1.2 Major Assumptions of the Positivist and Naturalistic Paradigms
ASSUMPTION POSITIVIST PARADIGM NATURALISTIC PARADIGM
Ontologic (What is Reality exists; there is a real Reality is multiple and subjective,
the nature of reality?) world driven by real natural mentally constructed by individuals.
causes.
Epistemologic (How is The inquirer is independent The inquirer interacts with those
the inquirer related to from those being researched; being researched; findings are
those being researched?) findings are not influenced by the creation of the interactive
the researcher. process.
Axiologic (What is the role Values and biases are to be Subjectivity and values are
of values in the inquiry?) held in check; objectivity inevitable and desirable.
is sought.
Methodologic (How is Deductive processes Inductive processes

knowledge obtained?) Emphasis on discrete, specific Emphasis on entirety of some
concepts phenomenon, holistic
Verification of researchers’ Emerging interpretations grounded
hunches in participants’ experiences
Fixed design Flexible design
Tight controls over context Context-bound
Emphasis on measured, Emphasis on narrative information;
quantitative information; qualitative analysis
statistical analysis
Seeks generalizations Seeks patterns
For the naturalistic inquirer, reality is not a researchers use deductive reasoning to generate
fixed entity but rather a construction of the individ- hunches that are tested in the real world. They typ-
uals participating in the research; reality exists ically move in an orderly and systematic fashion
within a context, and many constructions are possi- from the definition of a problem and the selection
ble. Naturalists thus take the position of relativism: of concepts on which to focus, through the design
if there are always multiple interpretations of real- of the study and collection of information, to the
ity that exist in people’s minds, then there is no solution of the problem. By systematic, we mean
process by which the ultimate truth or falsity of the that the investigator progresses logically through a
constructions can be determined. series of steps, according to a prespecified plan of
Epistemologically, the naturalistic paradigm action.
assumes that knowledge is maximized when the Quantitative researchers use mechanisms
distance between the inquirer and the participants designed to control the study. Control involves
in the study is minimized. The voices and interpre- imposing conditions on the research situation so
tations of those under study are crucial to under- that biases are minimized and precision and validity
standing the phenomenon of interest, and subjective are maximized. The problems that are of interest to
interactions are the primary way to access them. nurse researchers—for example, obesity, compli-
The findings from a naturalistic inquiry are the ance with a regimen, or pain—are highly complicated
product of the interaction between the inquirer and phenomena, often representing the effects of vari-
the participants. ous forces. In trying to isolate relationships
between phenomena, quantitative researchers
attempt to control factors that are not under direct
Paradigms and Methods: Quantitative
investigation. For example, if a scientist is interested
and Qualitative Research
in exploring the relationship between diet and heart
Broadly speaking, research methods are the tech- disease, steps are usually taken to control other
niques used by researchers to structure a study and to potential contributors to coronary disorders, such
gather and analyze information relevant to the as stress and cigarette smoking, as well as addi-
research question. The two alternative paradigms tional factors that might be relevant, such as a
have strong implications for the research methods to person’s age and gender. Control mechanisms are
be used. The methodologic distinction typically discussed at length in this book.
focuses on differences between quantitative Quantitative researchers gather empirical
research, which is most closely allied with the posi- evidence—evidence that is rooted in objective
tivist tradition, and qualitative research, which is reality and gathered directly or indirectly through
most often associated with naturalistic inquiry— the senses. Empirical evidence, then, consists of
although positivists sometimes engage in qualitative observations gathered through sight, hearing,
studies, and naturalistic researchers sometimes col- taste, touch, or smell. Observations of the pres-
lect quantitative information. This section provides ence or absence of skin inflammation, the heart
an overview of the methods associated with the two rate of a patient, or the weight of a newborn infant
alternative paradigms. Note that this discussion are all examples of empirical observations. The
accentuates differences in methods as a heuristic requirement to use empirical evidence as the basis
device; in reality, there is often greater overlap of for knowledge means that findings are grounded
methods than this introductory discussion implies. in reality rather than in researchers’ personal
beliefs.
The “Scientific Method” and Evidence for a study in the positivist paradigm
Quantitative Research is gathered according to a specified plan, using for-
The traditional, positivist “scientific method” mal instruments to collect needed information.
refers to a general set of orderly, disciplined proce- Usually (but not always) the information gathered
dures used to acquire information. Quantitative in such a study is quantitative—that is, numeric
information that results from some type of formal Another issue is that nursing research tends
measurement and that is analyzed with statistical to focus on human beings, who are inherently
procedures. complex and diverse. Traditional quantitative
An important goal of a traditional scientific methods typically focus on a relatively small por-
study is to understand phenomena, not in isolated tion of the human experience (e.g., weight gain,
circumstances, but in a broad, general sense. For depression, chemical dependency) in a single
example, quantitative researchers are typically not study. Complexities tend to be controlled and, if
as interested in understanding why Ann Jones has possible, eliminated, rather than studied directly,
cervical cancer as in understanding what general and this narrowness of focus can sometimes
factors lead to this carcinoma in Ann and others. obscure insights.
The desire to go beyond the specifics of the situa- Finally and relatedly, quantitative research con-
tion is an important feature of the traditional scien- ducted in the positivist paradigm has sometimes
tific approach. In fact, the degree to which research been accused of a narrowness and inflexibility of
findings can be generalized to individuals other vision, a problem that has been called a sedimented
than those who participated in the study (referred view of the world that does not fully capture the
to as the generalizability of the research) is a reality of human experience.
widely used criterion for assessing the quality of
quantitative studies. Naturalistic Methods and Qualitative Research
The traditional scientific approach used by Naturalistic methods of inquiry attempt to deal with
quantitative researchers has enjoyed considerable the issue of human complexity by exploring it
stature as a method of inquiry, and it has been used directly. Researchers in the naturalistic tradition
productively by nurse researchers studying a wide emphasize the inherent complexity of humans, their
range of nursing problems. This is not to say, how- ability to shape and create their own experiences,
ever, that this approach can solve all nursing prob- and the idea that truth is a composite of realities.
lems. One important limitation—common to both Consequently, naturalistic investigations place a
quantitative and qualitative research—is that heavy emphasis on understanding the human expe-
research methods cannot be used to answer moral or rience as it is lived, usually through the careful col-
ethical questions. Many of our most persistent and lection and analysis of qualitative materials that are
intriguing questions about the human experience fall narrative and subjective.
into this area—questions such as whether euthanasia Researchers who reject the traditional “scien-
should be practiced or abortion should be legal. tific method” believe that a major limitation of the
Given the many moral issues that are linked to health classical model is that it is reductionist—that is, it
care, it is inevitable that the nursing process will reduces human experience to only the few concepts
never rely exclusively on scientific information. under investigation, and those concepts are defined
The traditional research approach also must in advance by the researcher rather than emerging
contend with problems of measurement. To study a from the experiences of those under study.
phenomenon, quantitative researchers attempt to Naturalistic researchers tend to emphasize the
measure it. For example, if the phenomenon of dynamic, holistic, and individual aspects of human
interest is patient morale, researchers might want to experience and attempt to capture those aspects in
assess if morale is high or low, or higher under cer- their entirety, within the context of those who are
tain conditions than under others. Although there experiencing them.
are reasonably accurate measures of physiologic Flexible, evolving procedures are used to capi-
phenomena, such as blood pressure and body tem- talize on findings that emerge in the course of the
perature, comparably accurate measures of such study. Naturalistic inquiry always takes place in the
psychological phenomena as patient morale, pain, field (i.e., in naturalistic settings), often over an
or self-image have not been developed. extended period of time, while quantitative research
takes place both in natural as well as in contrived desirable trend in the pursuit of new evidence for
laboratory settings. In naturalistic research, the col- practice. Although researchers’ world view may be
lection of information and its analysis typically paradigmatic, knowledge itself is not. Nursing
progress concurrently; as researchers sift through knowledge would be thin, indeed, if there were not
information, insights are gained, new questions a rich array of methods available within the two
emerge, and further evidence is sought to amplify or paradigms—methods that are often complementary
confirm the insights. Through an inductive process, in their strengths and limitations. We believe that
researchers integrate information to develop a theory intellectual pluralism should be encouraged and
or description that helps explicate processes under fostered.
observation. Thus far, we have emphasized differences
Naturalistic studies result in rich, in-depth between the two paradigms and their associated
information that has the potential to elucidate varied methods so that their distinctions would be easy to
dimensions of a complicated phenomenon. Because understand. Subsequent chapters of this book will
of this feature—and the relative ease with which further elaborate on differences in terminology,
qualitative findings can be communicated to lay methods, and research products. It is equally
audiences—it has been argued that qualitative meth- important, however, to note that these two para-
ods will play a more prominent role in health care digms have many features in common, only some
policy and development in the future (Carey, 1997). of which are mentioned here:
The findings from in-depth qualitative
research are rarely superficial, but there are several • Ultimate goals. The ultimate aim of disciplined
limitations of the approach. Human beings are used inquiry, regardless of the underlying paradigm,
directly as the instrument through which informa- is to gain understanding about phenomena. Both
tion is gathered, and humans are extremely intelli- quantitative and qualitative researchers seek to
gent and sensitive—but fallible—tools. The subjec- capture the truth with regard to an aspect of the
tivity that enriches the analytic insights of skillful world in which they are interested, and both
researchers can yield trivial “findings” among less groups can make significant contributions to
competent inquirers. nursing knowledge. Moreover, qualitative stud-
The subjective nature of naturalistic inquiry ies often serve as a crucial starting point for
sometimes causes concerns about the idiosyncratic more controlled quantitative studies.
nature of the conclusions. Would two naturalistic • External evidence. Although the word empiri-
researchers studying the same phenomenon in the cism has come to be allied with the traditional
same setting arrive at the same results? The situa- scientific approach, it is nevertheless the case
tion is further complicated by the fact that most that researchers in both traditions gather and
naturalistic studies involve a relatively small group analyze external evidence that is collected
of people under study. Questions about the gener- through their senses. Neither qualitative nor
alizability of findings from naturalistic inquiries quantitative researchers are armchair analysts,
sometimes arise. relying on their own beliefs and views of the
world for their conclusions. Information is gath-
ered from others in a deliberate fashion.
Multiple Paradigms and Nursing
• Reliance on human cooperation. Because evi-
Research
dence for nursing research comes primarily from
Paradigms should be viewed as lenses that help to human participants, the need for human cooper-
sharpen our focus on a phenomenon of interest, not ation is inevitable. To understand people’s char-
as blinders that limit intellectual curiosity. The acteristics and experiences, researchers must
emergence of alternative paradigms for the study of persuade them to participate in the investigation
nursing problems is, in our view, a healthy and and to act and speak candidly. For certain
topics, the need for candor and cooperation is a would be hard pressed to quantify such a process.
challenging requirement—for researchers in Personal world views of researchers help to shape
either tradition. their questions.
• Ethical constraints. Research with human beings In reading about the alternative paradigms for
is guided by ethical principles that sometimes nursing research, you likely were more attracted to
interfere with research goals. For example, if one of the two paradigms—the one that corre-
researchers want to test a potentially beneficial sponds most closely to your view of the world and
intervention, is it ethical to withhold the treat- of reality. It is important, however, to learn about
ment from some people to see what happens? As and respect both approaches to disciplined inquiry,
discussed later in the book (see Chapter 7), and to recognize their respective strengths and lim-
ethical dilemmas often confront researchers, itations. In this textbook, we describe methods
regardless of their paradigmatic orientation. associated with both qualitative and quantitative
• Fallibility of disciplined research. Virtually all research.
studies—in either paradigm—have some limi-
tations. Every research question can be
THE PURPOSES OF
addressed in many different ways, and
NURSING RESEARCH
inevitably there are tradeoffs. Financial con-
straints are universal, but limitations exist The general purpose of nursing research is to
even when resources are abundant. This does answer questions or solve problems of relevance
not mean that small, simple studies have no to the nursing profession. Sometimes a distinc-
value. It means that no single study can ever tion is made between basic and applied research.
definitively answer a research question. Each As traditionally defined, basic research is under-
completed study adds to a body of accumulated taken to extend the base of knowledge in a disci-
knowledge. If several researchers pose the pline, or to formulate or refine a theory. For
same question and if each obtains the same or example, a researcher may perform an in-depth
similar results, increased confidence can be study to better understand normal grieving
placed in the answer to the question. The fal- processes, without having explicit nursing appli-
libility of any single study makes it important cations in mind. Applied research focuses on
to understand the tradeoffs and decisions that finding solutions to existing problems. For exam-
investigators make when evaluating the ade- ple, a study to determine the effectiveness of a
quacy of those decisions. nursing intervention to ease grieving would be
applied research. Basic research is appropriate
Thus, despite philosophic and methodologic for discovering general principles of human
differences, researchers using the traditional quan- behavior and biophysiologic processes; applied
titative approach or naturalistic methods often research is designed to indicate how these princi-
share overall goals and face many similar con- ples can be used to solve problems in nursing
straints and challenges. The selection of an appro- practice. In nursing, the findings from applied
priate method depends on researchers’ personal research may pose questions for basic research,
taste and philosophy, and also on the research ques- and the results of basic research often suggest
tion. If a researcher asks, “What are the effects of clinical applications.
surgery on circadian rhythms (biologic cycles)?” The specific purposes of nursing research
the researcher really needs to express the effects include identification, description, exploration,
through the careful quantitative measurement of explanation, prediction, and control. Within each
various bodily properties subject to rhythmic vari- purpose, various types of question are addressed by
ation. On the other hand, if a researcher asks, nurse researchers; certain questions are more
“What is the process by which parents learn to amenable to qualitative than to quantitative inquiry,
cope with the death of a child?” the researcher and vice versa.
Identification and Description quantitative research, by contrast, the researcher

begins with a phenomenon that has been previously
Qualitative researchers sometimes study phenomena studied or defined—sometimes in a qualitative
about which little is known. In some cases, so little study. Thus, in quantitative research, identification
is known that the phenomenon has yet to be clearly typically precedes the inquiry.
identified or named or has been inadequately defined
or conceptualized. The in-depth, probing nature of Qualitative example of identification:
qualitative research is well suited to the task of Weiss and Hutchinson (2000) investigated
answering such questions as, “What is this phenom- people with diabetes and hypertension to discover
enon?” and “What is its name?” (Table 1-3). In the basic social problem that affects their adherence
TABLE 1.3 Research Purposes and Research Questions
TYPES OF QUESTIONS: TYPES OF QUESTIONS:

PURPOSE QUANTITATIVE RESEARCH QUALITATIVE RESEARCH
Identification What is this phenomenon?

What is its name?
Description How prevalent is the phenomenon? What are the dimensions of the
How often does the phenomenon occur? phenomenon?
What are the characteristics of the What variations exist?
phenomenon? What is important about the phenomenon?
Exploration What factors are related to the What is the full nature of the phenomenon?
phenomenon? What is really going on here?
What are the antecedents of the What is the process by which the
phenomenon? phenomenon evolves or is experienced?
Explanation What are the measurable associations How does the phenomenon work?
between phenomena? Why does the phenomenon exist?
What factors cause the phenomenon? What is the meaning of the phenomenon?
Does the theory explain the How did the phenomenon occur?
phenomenon?
Prediction What will happen if we alter a

phenomenon or introduce an
intervention?
If phenomenon X occurs, will
phenomenon Y follow?
Control How can we make the phenomenon ,

happen or alter its nature or
prevalence?
Can the occurrence of the phenomenon
be prevented or controlled?
to health care directives. Through in-depth inter- increase a patient’s stress? Is a patient’s stress related
views with 21 clients, the researchers identified that to behaviors of the nursing staff? Is stress related to
warnings of vulnerability was the basic problem the patient’s cultural backgrounds?
undermining adherence. Qualitative methods are especially useful for
exploring the full nature of a little-understood phe-
Description of phenomena is another impor-
nomenon. Exploratory qualitative research is
tant purpose of research. In a descriptive study,
designed to shed light on the various ways in which
researchers observe, count, delineate, and classify.
a phenomenon is manifested and on underlying
Nurse researchers have described a wide variety of
processes.
phenomena. Examples include patients’ stress and
coping, pain management, adaptation processes, Quantitative example of exploration:
health beliefs, rehabilitation success, and time Reynolds and Neidig (2002) studied the
patterns of temperature readings. incidence and severity of nausea accompanying
Description can be a major purpose for both combinative antiretroviral therapies among HIV-
qualitative and quantitative researchers. Quantitative infected patients, and explored patterns of nausea
description focuses on the prevalence, incidence, in relation to patient characteristics.
size, and measurable attributes of phenomena.
Qualitative researchers, on the other hand, use in- Qualitative example of exploration:
depth methods to describe the dimensions, varia- Through in-depth interviews, Sadala and
tions, and importance of phenomena. Table 1-3 Mendes (2000) explored the experiences of 18 nurses
compares descriptive questions posed by quantita- who cared for patients who had been pronounced
tive and qualitative researchers. brain dead but kept alive to serve as organ donors.
Quantitative example of description:
Explanation
Bohachick, Taylor, Sereika, Reeder, and
Anton (2002) conducted a study to describe quan- The goals of explanatory research are to understand
titative changes in psychological well-being and the underpinnings of specific natural phenomena,
psychological resources 6 months after a heart and to explain systematic relationships among phe-
transplantation. nomena. Explanatory research is often linked to the-
ories, which represent a method of deriving, organiz-
Qualitative example of description:
ing, and integrating ideas about the manner in which
Bournes and Mitchell (2002) undertook an
phenomena are interrelated. Whereas descriptive
in-depth study to describe the experience of wait-
research provides new information, and exploratory
ing in a critical care waiting room.
research provides promising insights, explanatory
research attempts to offer understanding of the
Exploration
underlying causes or full nature of a phenomenon.
Like descriptive research, exploratory research begins In quantitative research, theories or prior find-
with a phenomenon of interest; but rather than simply ings are used deductively as the basis for generat-
observing and describing it, exploratory research ing explanations that are then tested empirically.
investigates the full nature of the phenomenon, the That is, based on a previously developed theory or
manner in which it is manifested, and the other factors body of evidence, researchers make specific
to which it is related. For example, a descriptive quan- predictions that, if upheld by the findings, add
titative study of patients’ preoperative stress might credibility to the explanation. In qualitative studies,
seek to document the degree of stress patients experi- researchers may search for explanations about how
ence before surgery and the percentage of patients or why a phenomenon exists or what a phenomenon
who actually experience it. An exploratory study means as a basis for developing a theory that is
might ask the following: What factors diminish or grounded in rich, in-depth, experiential evidence.
Quantitative example of explanation: the study emphasized in the chapter. A review of

Resnick, Orwig, Maganizer, and Wynne the full journal article likely would prove useful.
(2002) tested a model to explain exercise behavior
among older adults on the basis of social support,
Research Example
age, and self-efficacy expectations.
of a Quantitative Study
Qualitative example of explanation:
Hupcey (2000) undertook a study that McDonald, Freeland, Thomas, and Moore (2001)
involved the development of a model explaining conducted a study to determine the effectiveness of a
the psychosocial needs of patients in the intensive preoperative pain management intervention for reliev-
care unit. Feeling safe was the overwhelming need ing pain among elders undergoing surgery. Their
of patients in the intensive care unit. report appeared in the journal Research in Nursing &
Health.
McDonald (who had conducted earlier research
Prediction and Control
on the topic of pain and pain management) and her
Many phenomena defy explanation. Yet it is fre- colleagues developed a preoperative intervention that
quently possible to make predictions and to control taught pain management and pain communication
phenomena based on research findings, even in the skills. The content was specifically geared to older
absence of complete understanding. For example, adults undergoing surgery. Forty elders, all older than
age 65 years, were recruited to participate in the
research has shown that the incidence of Down syn-
study. Half of these elders were assigned, at random,
drome in infants increases with the age of the mother. to participate in the special intervention; the remain-
We can predict that a woman aged 40 years is at ing half got usual preoperative care. Postoperative
higher risk of bearing a child with Down syndrome pain was measured for both groups on the evening of
than is a woman aged 25 years. We can partially con- the surgery, on postoperative day 1, and on postoper-
trol the outcome by educating women about the risks ative day 2. The results supported the researchers’ pre-
and offering amniocentesis to women older than 35 dictions that (a) pain in both groups would decline
years of age. Note, however, that the ability to predict over time; and (b) those receiving the special inter-
and control in this example does not depend on an vention would experience greater decreases in pain
explanation of why older women are at a higher risk over time.
of having an abnormal child. In many examples of The researchers noted that further research is
needed to determine whether the intervention’s effect
nursing and health-related studies—typically, quanti-
resulted from instruction in pain management or in
tative ones—prediction and control are key objec- pain communication skills (and, indeed, McDonald
tives. Studies designed to test the efficacy of a nurs- reported being in the process of conducting such a
ing intervention are ultimately concerned with study). They also noted that the study was based on
controlling patient outcomes or the costs of care. elders undergoing certain types of surgery at a single
site, acknowledging that the findings need confirmation
Quantitative example of prediction:
in other settings and contexts. Nevertheless, this study
Lindeke, Stanley, Else, and Mills (2002) offers evidence that pain responses of elderly surgical
used neonatal data to predict academic perfor- patients can be lowered through a nursing intervention.
mance and the need for special services among The strength of this evidence lies in several factors—
school-aged children who had been in a level 3 several of which you will appreciate more as you
neonatal intensive care unit. become familiar with research methods. Most impor-
tant, this study was quite rigorous. The intervention
RESEARCH EXAMPLES itself was based on a formal theory of communication
accommodation, which addresses how people adjust
Each chapter of this book presents brief descrip- communication to their own needs. The researchers
tions of actual studies conducted by nurse took care to ensure that the two groups being com-
researchers. The descriptions focus on aspects of pared were equivalent in terms of background and
medical characteristics, so that group differences in the central implications for practice of this study con-
pain responses reflected the intervention and not some cerns the need to revise the search and selection
spurious factor. The research team members who mea- process to make it more efficient in terms of time and
sured pain responses were not aware of whether the effort of the sponsors and residents. In addition, the
elders were in the intervention group, so as not to bias study suggests that increased communication—from
the measurements. Finally, the findings are more per- the acute setting to the aged care facilities being con-
suasive because the team of researchers who conduct- sidered—could play an important role in decreasing
ed the study have developed a solid program of the stress of this guilt-ridden experience. The clinical
research on pain, and their research has contributed implications of the study are strengthened by the fact
incrementally to understanding pain responses and that the researchers took steps to ensure its rigor. For
appropriate nursing interventions. example, the transcripts of these interviews were read
by at least two members of the research team who
individually identified themes from each interview.
Research Example The researchers then compared and discussed the
of a Qualitative Study themes from all the interviews until consensus was
reached. Moreover, the researchers took steps to
Cheek and Ballantyne (2001) undertook a study to weigh their evidence for their thematic conclusions
describe the search and selection process for an aged against potentially competing explanations of the
care facility after discharge of a family member from data.
acute hospital settings in Australia, and to explore the
effects the process had on the individuals and their
families. Twelve residents and 20 of their sponsors S U M M A RY P O I N T S
(the primary contact person responsible for the resi-
dent) participated in the study. Face-to-face in-depth • Nursing research is systematic inquiry to
interviews were conducted with residents in the aged develop knowledge about issues of importance
care facilities and with family members in their to nurses.
homes. They were all asked to talk about their per- • Nurses in various settings are adopting an
sonal experiences of the search and selection process evidence-based practice that incorporates
and its effect on their well-being. research findings into their decisions and their
These interviews were audiotaped and then tran- interactions with clients.
scribed. Analysis of the interview transcripts revealed
• Knowledge of nursing research enhances the
five themes. One theme, for example, was labeled
professional practice of all nurses—including
“dealing with the system—cutting through the maze.”
Dealing with the system was perceived as being in the both consumers of research (who read and
middle of a war zone. This sense of battle was related evaluate studies) and producers of research
to confusion, lack of control, and the feeling of being (who design and undertake research studies).
at the system’s mercy. Contributing to this perception • Nursing research began with Florence
of being at war with the system was the stress of Nightingale but developed slowly until its rapid
having to deal with multiple aged care facilities on an acceleration in the 1950s. Since the 1970s, nurs-
individual basis. A second major theme was labeled ing research has focused on problems relating to
“Urgency—moving them on and in.” Sponsors felt a clinical practice.
sense of urgency in finding a suitable facility to have • The National Institute of Nursing Research
their family member transferred to from the acute
(NINR), established at the U.S. National
setting. Sponsors felt pressured to make on-the-spot
Institutes of Health in 1993, affirms the stature
decisions to accept or reject a place in a facility once
it had become available. of nursing research in the United States.
This thorough and careful study provides a first- • Future emphases of nursing research are likely
hand perspective on the experiences of people going to include outcomes research, research utiliza-
through the process of selecting an appropriate long- tion projects, replications of research, multisite
term care facility for aging family members. One of studies, and expanded dissemination efforts.
• Disciplined research stands in contrast to other STUDY ACTIVITIES

sources of evidence for nursing practice, such as
tradition, voices of authority, personal experi- Chapter 1 of the Study Guide to Accompany Nursing
ence, trial and error, intuition, and logical rea- Research: Principles and Methods, 7th edition, offers
soning; rigorous research is at the pinnacle of various exercises and study suggestions for reinforc-
the evidence hierarchy as a basis for making ing the concepts presented in this chapter. In addition,
clinical decisions. the following study questions can be addressed:
• Disciplined inquiry in nursing is conducted 1. What are some of the current changes occur-
within two broad paradigms—world views ring in the health care delivery system, and
with underlying assumptions about the com- how could these changes influence nursing
plexities of reality: the positivist paradigm and research?
the naturalistic paradigm. 2. Is your world view closer to the positivist or
• In the positivist paradigm, it is assumed that the naturalistic paradigm? Explore the aspects
there is an objective reality and that natural phe- of the two paradigms that are especially con-
nomena are regular and orderly. The related sistent with your world view.
assumption of determinism refers to the belief 3. How does the assumption of scientific determin-
that phenomena are the result of prior causes ism conflict with or coincide with superstitious
and are not haphazard. thinking? Take, as an example, the superstition
• In the naturalistic paradigm, it is assumed associated with four-leaf clovers or a rabbit’s
that reality is not a fixed entity but is rather a foot.
construction of human minds—and thus “truth” 4. How does the ability to predict phenomena
is a composite of multiple constructions of offer the possibility of their control?
reality.
• The positivist paradigm is associated with quan-
titative research—the collection and analysis of SUGGESTED READINGS
numeric information. Quantitative research is Methodologic and Theoretical
typically conducted within the traditional References
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their findings on empirical evidence (evidence
Toward the twenty-first century. Kansas City, MO:
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identification, description, exploration, explana- French, P. (1999). The development of evidence-based
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PA R T

NURSING RESEARCH IN and that contribute to improvements in the entire

The Importance of Research Example of an EBP project:

1859 Nightingale’s Notes on Nursing published

reasoning may be an insufﬁcient basis for evaluating PA R A D I G M S F O R

the scientist in a positivist tradition assumes that The Naturalistic Paradigm

TABLE 1.2 Major Assumptions of the Positivist and Naturalistic Paradigms

ASSUMPTION POSITIVIST PARADIGM NATURALISTIC PARADIGM

Methodologic (How is Deductive processes Inductive processes

Identiﬁcation and Description quantitative research, by contrast, the researcher

TABLE 1.3 Research Purposes and Research Questions

TYPES OF QUESTIONS: TYPES OF QUESTIONS:

Identiﬁcation What is this phenomenon?

Prediction What will happen if we alter a

Control How can we make the phenomenon ,

Quantitative example of explanation: the study emphasized in the chapter. A review of

• Disciplined research stands in contrast to other STUDY ACTIVITIES

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