Updated Sep 28 Chapter 1 Introduction to Nursing

Chapter 1
Introduction to Nursing
Research in an
Evidence-Based
Practice Environment
What Is Research?
Research
Systematic inquiry using disciplined methods to
solve problems or answer questions
 Its purpose is to develop, refine,
and expand knowledge.
Nursing research
Systematic inquiry to develop knowledge about
issues of importance to the nursing profession
Clinical Nursing Research: is,
Research designed to generate

knowledge to Guide practice &
to Improve the Health & Quality
of Life of Clients.
Roles of Nurses in Research
 Evidence-based practice (EBP)—
• the use of the best clinical evidence in
making patient care decisions
• Both consumers and producers play a
key role in EBP
 Consumer-Producer Continuum
Continuum of participation, from producer of
research to intelligent consumer of research
findings
 Between these two points on the Consumer-Producer Continuum
lie a rich variety of research activities in which nurses may engage.
These activities include:
• Participating in a journal club in a practice setting, which involves

meetings among nurses to discuss and critique research articles
• Solving clinical problems and making clinical decisions based on
rigorous research
• Collaborating in the development of an idea for a clinical study
• Reviewing a proposed research plan with respect to its feasibility in a
clinical setting
• Recruiting potential study participants
• Collecting research information (e.g., distributing questionnaires to
patients)
• Giving clients advice about participation in studies
• Discussing the implications and relevance of research findings with
clients
History of Nursing
Research
 1959 Nightingale’s Notes
 2000 Refereed Journals

History of Nursing Research
 Florence Nightingale pioneered research, 1850s
 First journal on research (Nursing Research)
emerged, 1950s
 Clinical research becomes increasingly
important, 1970s
 National Center for Nursing Research
established at NIH, 1986
 National Institute of Nursing Research (NINR)
established, 1993
 NINR budget exceeds $100 million, 2000s
 Funding continues to grow—for example, NINR
funding in fiscal year 2010 was more than $140
million
Current and Future Directions for Nursing Research
Nursing research continues to develop at a rapid pace and will undoubtedly

flourish in the 21st century.
Funding continues to grow—for example, NINR funding in fiscal year 2010 was
more than $140 million.
Broadly speaking, the priority for future nursing research will be the promotion
of excellence in nursing science.
Toward this end, nurse researchers and practicing nurses will be sharpening
their research skills, and using those skills to address emerging issues of
importance to the profession and its clientele.
Among the trends for the early 21st century are the
following:
• Continued focus on EBP. Encouragement for nurses to engage in evidence-
based patient care
translational research— research on how findings from studies can best be
translated into nursing practice.
• Development of a stronger evidence base through multiple, confirmatory

strategies.
Strong research designs are essential, and confirmation is usually needed
through the replication (i.e., the repeating) of studies with different clients, in
different clinical settings, and at different times to ensure that the findings are
robust.
• Greater emphasis on systematic reviews. Systematic reviews are a

cornerstone of EBP, and will take on increased importance in all health
disciplines. The purpose of a systematic review is to amass and integrate
comprehensive research information on a topic, to draw conclusions about the
state of evidence. Best practice clinical guidelines typically rely on such
systematic reviews.
Trends- cont…
Expanded local research in healthcare settings. In the current evidence-based
environment, there is likely to be an increase of small, localized research designed to
solve immediate problems.
(Magnet status). Mechanisms will need to be developed to ensure that evidence from
these small projects becomes available to others facing similar problems, such as
communication within and between regional nursing research alliances.
• Strengthening of interdisciplinary collaboration.

• Expanded dissemination of research findings.
• Increasing the visibility of nursing research. The 21st century is likely to witness efforts
to increase the visibility of nursing research
• Increased focus on cultural issues and health disparities.

There is growing awareness that research must be sensitive to the health beliefs,
behaviors, and values of culturally and linguistically diverse populations.
• Shared decision making. Another emerging issue in healthcare is shared decision

making, which is a move toward putting patients in a more central role in their decision-
making about healthcare (Barratt, 2008). A major challenge in the years ahead will
involve getting both research evidence and patient preferences into clinical decisions,
and designing research to study the process and the outcomes.
Future Directions for Nursing Research
 Research priorities for the near future have been articulated by NINR, by Sigma
Theta Tau International, and by other nursing organizations.
 NINR’s 2010 budget request identified three areas of research emphasis: promoting
health and preventing disease; symptom management, self-management, and
caregiving; and end-of-life research
 A 2006 survey of nurse executives from hospitals with Magnet recognition

 indicated a number of research priorities for a “national Magnet research agenda,”
including clinical outcomes (e.g., errors and adverse events), practice environment
issues (e.g., failure to rescue), satisfaction (e.g., patient satisfaction with pain
management), and human resource issues (e.g., nursing staff adequacy).
 Research priorities that have been expressed by Sigma Theta Tau International
include: promotion of healthy communities through health promotion, disease
prevention, and recognition of social, economic and political determinants;
implementation of evidence-based practice; targeting the needs of vulnerable
populations, such as the chronically ill and poor; and capacity development for
research by nurses
Sources of Evidence for Nursing Practice
 Tradition
 Authority
 Clinical experience; trial and error; intuition
 Logical reasoning (inductive & deductive)
 Assembled information (e.g., quality improvement data)
 Disciplined research
Research conducted in a disciplined framework is the most sophisticated

method of acquiring knowledge.
Nursing research combines logical reasoning with other features to create
evidence that, although fallible, tends to be more reliable than other methods of
acquiring evidence.
Carefully synthesized findings from rigorous research are at the pinnacle of
most evidence hierarchies.
The current emphasis on EBP requires nurses to base their clinical practice to
the greatest extent possible on research-based findings rather than on tradition,
authority, intuition, or personal experience— although nursing will always
remain a rich blend of art and science.
Relative importance of different ways of knowing to
different belief systems
Religion Government Philosophy Science
1. authority 1. authority 1. logic 1.

observation
2. intuition 2. intuition 2. 2. logic
observation
3. logic 3. logic 3. intuition 3. intuition

4. 4. 4. authority 4. authority
observation observation
Pelham & Blanton, 2003, p. 24

Paradigms and Methods for
Nursing Research
Paradigm—a world view; a general perspective on
the complexities of the real world, with certain
assumptions about reality
Key paradigms for nursing research:
 Positivist paradigm/ logical positivism
 Naturalistic paradigm/The Constructivist

Paradigm
Paradigms for Nursing
Research:
 ** A paradigm, is a World View, a
general perspective on the real
world complexities.
Paradigms for human inquiry are
characterized in terms of the way
in which they respond to basic
questions:
Basic questions
 Ontologic: what is the nature of reality?
 Epistemologic: What is the relationship

between the inquirer & the subject being
studied?
 Axiologic: What is the role of values in the

inquiry?
 Methodologic: How should the inquirer

obtain knowledge?
Key Differences in Research
Methods
Positivist Naturalistic
Fixed design Flexible design
Discrete, specific concepts Holistic
Deductive processes Inductive processes
Control over context Context-bound
Verification of hunches Emerging
interpretations
Quantitative information Qualitative information
Seeks generalizations Seeks patterns
The purposes of
Nursing Research:
 The General purpose of
nursing research is to answer
questions or solve problems of
relevance to the nursing
profession.
Purposes of Nursing Research
 One way to categorize purposes: a description–
explanation continuum
 A basic distinction, especially relevant to

quantitative studies, is whether the study is cause-
probing, i.e., seeks to illuminate the underlying
causes of phenomena.
Research Approaches
 Basic (pure) research -  Basic Research:
tries to answer Understand
fundamental questions Extend the base of
about the nature of a knowledge in a discipline,
problem or to formulate or refine a
theory
 Applied research –
Theory sometimes takes
 Applied Research:
a backseat. This is Finding Solutions to
research designed to existing problems
solve a particular problem
Common features of
quantitative and qualitative
research
Common features of the two
research paradigms:
 Ultimate goal
 External evidence
 Relying on human cooperation
 Ethical Constraints
 Fallibility of disciplined research
Specific Purposes of Nursing
Research
Quantitative Qualitative
 Identification X
 Description X X
 Exploration X X
 Prediction and Control X
 Explanation X X
Selected Key Research Terms
Quantitative Term Qualitative Term
Subject ---
Participant Study participant
Respondent Informant
--- Phenomena
Concepts, constructs Constructs, concepts
Variables ---
Data (numeric values) Data (narratives)
Relationships Patterns of association
Specific Purposes of Nursing
Research—EBP Framework
 Treatment, Therapy, Intervention
 Diagnosis, Assessment
 Prognosis
 Harm and Etiology
 Meaning, Process
Question
Is the following statement True or False?

 Quantitative research attempts to identify a
phenomenon.
Answer
 False
 Qualitative research, not quantitative
research, would be used to identify a
phenomenon.

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Chapter 1

Research designed to generate

• Participating in a journal club in a practice setting, which involves

 2000 Refereed Journals

Nursing research continues to develop at a rapid pace and will undoubtedly

• Development of a stronger evidence base through multiple, confirmatory

• Greater emphasis on systematic reviews. Systematic reviews are a

• Strengthening of interdisciplinary collaboration.

• Increased focus on cultural issues and health disparities.

• Shared decision making. Another emerging issue in healthcare is shared decision

 A 2006 survey of nurse executives from hospitals with Magnet recognition

Research conducted in a disciplined framework is the most sophisticated

Religion Government Philosophy Science

1. authority 1. authority 1. logic 1.

3. logic 3. logic 3. intuition 3. intuition

Pelham & Blanton, 2003, p. 24

Key paradigms for nursing research:

 Positivist paradigm/ logical positivism

 Naturalistic paradigm/The Constructivist

 Epistemologic: What is the relationship

 Axiologic: What is the role of values in the

 Methodologic: How should the inquirer

 A basic distinction, especially relevant to

Is the following statement True or False?

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