Week 1

 Research – the systematic, rigorous, logical investigation with the aim

of answering questions about nursing phenomena.
 Phenomena – can be defined as occurrences, situations, or facts that
are perceptible by the senses.

Significance of Research to Practice

 Expands the discipline’s unique body of scientific knowledge.
 Forms the foundation for evidence-informed nursing practice.
 Allows practice to change with work environments and the most
common health issues.
 Maintains the profession’s societal relevance.

Evidence-informed decision-making
 refers to a continuous interactive process involving the explicit,
conscientious, and judicious consideration of the best available
evidence to provide care (CAN, 2010, p.1).

Evidence-Based Practice
 is a problem-solving approach to the delivery of health care that
integrates the best evidence
 combines the evidence from well-designed studies and patient
care data with patient preferences and values (Melnyk et al.,
2010, p. 51)
 Research and Trends
 An emphasis health disparity among the Indigenous peoples.
 An emphasis on underservices communities and vulnerable
populations.
 A focus on palliative care and Medical Assistance in Dying.
 An increased prevalence of life-threatening illnesses due to new
life-sustaining technologies.
 An increase in mental health illnesses.
 An expanding population of older people.
 An expanding population with chronic illnesses and the impact
on health care.
 The impact of Covid on the health of individuals and
communities.
 A focus on the maternal-neonatal mortality occurrences.

Nurse’s Role in Research

 Consumer
 Generator of clinical questions
 Investigator/participant in research
 Protector of research participants

Key events of the 19th century

 Nursing becomes a formal discipline.
 Florence Nightingale publishes “Notes on Nursing” in 1859 and
introduces the systematic collection and exploration of data to
support health promotion and disease prevention.

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  Schools of nursing are beginning to be established but research
is in the very early stages of development.

Key events from 1900 to 1940

 Emphasis not on research but on preparation of nurses for practice
Key events from 1950 to 1999
 First master’s program in nursing in Canada
 First federally funded grant for nursing research
 Doctoral programs U of A, UBC, McGill, U of T
 Established the Nursing Research Fund, budgeting $25 million for
nursing research in Canada

Key events from 2000 to 2012

 Growth of university based Registered Psychiatric Nursing
programs.
 First master’s degree a U of B for Registered Psychiatric Nurses

Covid-19 Impact on Research

 Created numerous challenges and opportunities for research in
nursing
 Many projects and funding decisions delayed due to pandemic
 Has generated a plethora of research ideas and topics

International Perspectives
 Global research community made possible
 Cross-cultural and cross-national studies could be implemented

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  Requires networks, databases, websites, funding, respect for
cultural perspectives
 International organizations create valuable and accessible
partnerships

CASN Nursing Research Priorities

 Indigenous and other vulnerable and/or equity seeking
communities
 Chronic disease management and care delivery across space and
time
 Home care and primary healthcare nursing
 Care of older adults across divers care contexts
 Roles, scopes of practice, and value of RNs and/or NPs to
healthcare
 Nursing care, quality improvement, and patient safety
 Nursing education outcomes

CFHI Priority Health Challenges

 The Government of Canada created these two health priorities as a
shared concern among provincial, federal, and territorial
governments.
o Improving access to addiction and mental health services
o Home and community care

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 Theoretical Framework

Theoretical/Empirical Knowledge
 More commonly referred to as scientific knowledge.
 Serves as the guide for evidence-informed practice.
 Theoretical knowing is concerned with developing or testing
theories or ideas that nurse researchers have about how the world
operates.
 Theoretical knowing is informed by empirical knowing, which
involves observations of reality.

Paradigm
 From the Greek word meaning “pattern.”
 A set of beliefs and practices, shared by communities of
researchers, that guide the knowledge development process.
 Synonym of worldview.

Philosophical Terms
 Ontology – is the science or study of “being.”
 Epistemology - Addresses the issue of “truth.”
 Methodology - refers to discipline-specific principles, rules, and
procedures that guide the research process.
 Context - refers to the personal, social, and political environment
in which a phenomenon of interest occurs.
 Aim of inquiry - refers to the goals or specific objectives of the
research.

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 Nursing Paradigms – How the philosophical questions are answered
depends on the nursing paradigm used to guide the research process
 Post-positivist
 Critical Social
 Constructivist

Quantitative Research
 Used to explore research questions or test hypotheses that
describe phenomena, test relationships, assess differences, and
try to explain cause-and-effect interactions among the variables
being studied
 Data usually consist of numbers and statistical formulas
 Use of precise and controlled measurement techniques.

Quantitative Research Process

 Step 1 – Identify the research purpose and question
 Step 2 – Review the literature to see what is known about the
concepts of interest
 Step 3 – Identify a framework that best explains how the
concepts relate to one another
 Step 4 – Decide on the most suitable and rigorous study design
 Step 5 – Select a sample and measure the concepts of interest
 Step 6 – Analyse the data and report whether your hypotheses
are likely to be true or false

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 Approaches to Science
 Inductive reasoning: Start with details of experience and
move to a general picture and is used by qualitative
researchers.
 Deductive reasoning: Start with a general picture and move
to a specific direction; uses two or more concepts. This
approach is followed by quantitative researchers.

Variable
 The property that is being studied
 Something that changes or varies
 Height
 Weight
 Religion
 Ventilation
 Health
 Illness
 Researchers often conduct studies to understand how
changes in one variable relate to changes in another
variable (e.g., sex and mental health).

Concept
 An image or symbolic representation of an abstract idea
(e.g., pain, knowledge, God)
 the major components of theory and convey the abstract
ideas within a theory

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 Theory
 A set of interrelated concepts that serve the purpose of
explaining or predicting phenomena
 A blueprint or a written or diagrammatic depiction of both
the concepts that compose a theory and how they are
related

Hypothesis
 A best guess or prediction about what a researcher
expects to find with regard to the relationship between
two or more variables
 A variable: a defined concept; a property that takes on
different values (e.g., gender, height)

Conceptual Frameworks
 A structure of concepts, theories, or both that is used to
construct a map for the study
 Presents a theory that explains why the phenomenon
being studied exists
 Constructed from a review of the literature or is developed
as a part of a qualitative research project (Imenda, 2014)

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 Model of Conceptual Foundation

Theoretical Frameworks
 May also be defined as a structure of concepts, theories,
or both that is used to construct a map for the study
 Based on a philosophical or theorized belief or
understanding of why the phenomenon under study exists

Function of a Framework
 Clarifies concepts
 Identifies and states underlying assumptions of a study
 Specifies relationship among and between concepts

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  A conceptual or theoretical model is a visual symbolic
representation of the concepts in a framework.

Definition of “Hospital Stay”

 Conceptual
o Time during which a person is a registered patient at
a hospital
 Operational
o Sum of days as a registered patient, beginning with
admission day and concluding with dismissal day

Definitions of “Ambulation”
 Conceptual
o To walk from place to place, move about
 Operational
o Taking four steps without assistance

Evaluating a Framework
 Is the framework clearly identified, consistent with a
nursing perspective and appropriate for the topic?
 Are the concepts and variables clearly and appropriately
defined?
 Did the study present sufficient literature to support the
selected concepts and hypotheses?
 Is there a logical, consistent link between the framework,
the concepts being studied, and the methods of
measurement?

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  Are the study findings examined in relation to the
framework?

CNO Professional Standards Related to Research

 Use research to inform practice/professional service
 Seek and critique theoretical and research-based literature
in nursing, health services, etc.
 Integrate research findings into professional service and
practice
 Use research based/informed approaches for application
to practice
 College of Nurses of Ontario (CNO) - Professional
Standards
https://www.cno.org/globalassets/docs/prac/41006_profs
tds.pdf

CNA Position Statement

 “CNA believes that nurses – including clinicians, educators,
researchers, administrators and policy-makers – must
collaborate with other health-care stakeholders to
facilitate evidence-informed decision-making and
practice”. (CNA Position Statement, 2018, p. 1)

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Week 2

Critical Thinking
 The rational examination of ideas, inferences,
assumptions, principles, arguments, conclusions, issues,
beliefs, statements, and actions
 Involves disciplined, self-directed thinking
 Includes the display of mastered intellectual skills and
abilities, such as applying research critique criteria

Critical Reading
 An active, intellectually engaging process in which the
reader participates in an inner dialogue with the writer
 Actively looks for assumptions (accepted truth), key
concepts
 Both critical thinking and reading are developed by
learning the research process

Critical Reading Process

 Identify concepts
 Questions assumptions
 Clarify unfamiliar terms
 Assess the study for validity
o Preliminary understanding: skim abstract and article
o Analysis understanding: Understand parts, critique
soundness

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 o Comprehensive understanding: understand author’s
intent, review unfamiliar terms, understand terms in
relation to context
o Synthesis understanding: put together and make
sense

Steps to Develop Evidence-Informed Practice

 First step: Be able to critically read the literature
o Research articles
o Clinical articles
o Clinical guidelines

Steps to Evidence-Informed Practice

 Critical reading
 Read widely
 Be an intelligent consumer of knowledge
 Critical thinking
 Understand scientific principles
 Can develop evidence-informed interventions

Levels of Evidence
 Level 1 – Systematic review or meta-analysis of
randomized controlled trials (RCTs). Evidence-informed
clinical practice guidelines based on systematic reviews
 Level 2 – A well-designed RCT
 Level 3 – Controlled trial without randomization
(quasiexperimental study)

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  Level 4 – Single nonexperimental study (case-control,
correlational, cohort studies)
 Level 5 – Systematic reviews of descriptive and qualitative
studies
 Level 6 – Single descriptive or qualitative study
 Level 7 – Opinion of authorities and/or reports of expert
committees

Assessing Strength
 Quality: Extent to which a study’s design, implementation,
and analysis minimizes bias
 Quantity: Number of studies that have evaluated the
research question, including sample size across studies
 Consistency: Degree to which studies have similar and
different designs yet the same research question and
similar findings

Research Articles
 Follow the steps of the research process
 Formatting and space allocation are controlled by the
journal’s guidelines
 Not a how-to but answers a question with all the
components of the research clearly presented

Format and Style

 Journal: need to identify the purpose, space limitations,
author guidelines, type of study
o Author: information and brief bio

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 o Abstract: synopsis of the study placed at the
beginning of the article

Steps of the Research Process and Journal Format: Quantitative

Research
Research problem
Purpose
Literature review
Theoretical framework, conceptual framework, or both
Hypothesis/research questions
Research design
Sample: type and size
Legal–ethical issues
Instruments (measurement tools)
Validity and reliability
Data-collection procedure
Data analysis
Results
Discussion of findings and new findings
Implications, limitations, and recommendations
References
Communicating research results

Communicating Results
 Dissemination of results is important.
 Can publish article in a journal.
 Present study at conferences.
 Apply study findings to evidence-informed practice
activities such as:

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  Nursing care plans
 Practice protocol guidelines
 Practice standards

Systematic Reviews
 Includes meta-analysis, integrative reviews, and meta-
syntheses
 An analysis of the available literature (that is evidence)
and a judgement of the effectiveness or otherwise of a
practice, involving a set of complex steps

Clinical Guidelines
 Systematically developed statements or recommendations
 Serves as a guide for practitioners to bridge the gap
between research and practice

Clinical Question
 The first step in developing evidence-informed practice is
to ask a question:
o Is chlorhexidine or povidone-iodine more effective?
o What happens when …?
o What is the experiences of …?
o What characteristics are associated with …?
o What is the effect of … on patient outcomes?
 Has 5 components:
o Population – adolescents aged 13-18, with type 1
diabetes

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 o Intervention – educational intervention
o Comparison – standard care or no intervention
o Outcome – improved knowledge about diabetes
management
o Time – outcome measured at 3 months after the
intervention

Developing Clinical Questions

 Consider 3 elements:
1. The situation: is the patient or problem being
addressed (palliative care of patients with cancer)
2. The intervention: the dimension of health care
interest and/or if an intervention is a useful
treatment (pain diaries)
3. The outcome: as they frame their focused question –
whether the intervention makes a difference for the
patient population (decreased pain) and (low cost
diaries)

Research Question
 A concise, interrogative statement written in the present
tense and including one or more variables/concepts
 Focus on describing variables, specifying the population
being studied, examining testable relationships among
variables

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 Research Question Development Process
 Define specific topic area
 Review the relevant literature
 Identify the potential significance to nursing
 Reflect the feasibility of studying the research question

Clinical vs. Research Questions

 Clinical Questions:
o Posed by consumers of research
o First step in evidence informed practice
o Often arise from clinical situations
o Posed by clinicians interested in making a decision
about how to approach a patient care issue
o Guide the nurse in searching for best available
evidence to support practice
 Research Questions:
o Posed by researchers
o Key preliminary step in the research process
o Provides foundation for research study
o Starts with a research idea –can be based on practice
experience, appraisal of the literature or untested
theoretical ideas
o Refined as researcher determines feasibility and
significance of topic

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 Characteristics of the PICOT question
 The variables under consideration are clearly identified.
 The population being investigated is specified.
 The possibility of empirical testing is implied.

Variables – is an attribute or property in which organisms vary

(people, events, objects)
 The X factor – Independent variable (X) – the variable that
has the presumed effect on the dependent variable (Y)
o It is either manipulated or not manipulated
o E.g., the higher the food intake, the heavier a person
will be, study time affects GPA of university students,
and chronic conditions influence the ability to
engage in sports
 Dependent Variable (Y) – the presumed effect that varies
with a change in the independent variable (X)
o It is not manipulated

Population
 Is a well-defined set that has certain properties
 Either specified or implied in the research question
 The researcher or reader will have an initial idea of the
composition of the study population from the outset

Study Purpose
 Aim or goal the researcher hopes to achieve
 Suggests the type of design to be used

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  Implies the level of evidence to be obtained (discover,
explore, or describe versus compare, test the effectiveness
of, etc.)

Purpose Statement Examples

 “The purpose of this ethnographic study was to investigate
nurses’ workplace culture as it relates to tobacco use and
control” (Shultz et al., 2006, p. 317).
 “The objective of this study was to determine the cost and
effectiveness of a transitional discharge model (TDM) of
care with patients who have a chronic mental illness”
(Forchuk et al., 2005, p. 556).

Hypothesis
 A formal statement of the expected relationship(s)
between two or more variables in a specified population
that suggests an answer to the research question,
statement that predicts the outcomes of a study
 Characteristics: Relationship Statement:
o Casual – researcher predicts that the IV (X) causes a
change in the DV (Y)
o Vs.
o Associative – IV and DV are related in non casual
ways

Testability
 The second characteristic of a hypothesis is its testability.
 For a hypothesis to be testable;

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  study variables must lend themselves to observation,
measurement, and analysis
 researcher must make a prediction about expected
outcome
 The predicted outcome proposed by the hypothesis is or is
not congruent with the actual outcome when the
hypothesis is tested.
 The hypothesis is either accepted/supported or not
supported/rejected (never proven) after the data have
been collected and analyzed.

Wording the Hypothesis

 Variables to be tested
 Population to be studied
 Design to be used
 Outcomes to be predicted

Relationship Statement
 Casual: Cause and effect versus associative
 Simple: Relationship between two variables
 Complex: Relationship between three or more variables

Types of Hypothesis
1. Research Hypothesis: “scientific hypothesis” is the
statement about the expected relationship of the variables
and indicates the predicted outcome:
a. Directional vs. Nondirectional
b. Simple vs. Complex

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 Examples:
• There will be a difference in fatigue between
two groups of caregivers of preterm infants
(i.e., infants on versus not on apnea monitors)
during three time periods (i.e., before
discharge, 1-week post discharge, and 1-
month post discharge).
• There will be a significant difference in
menopausal hot flashes between conditions of
fasting and experimentally sustained (130 to
140 mg/dL) blood glucose concentrations.

2. Statistical Hypothesis (Null hypothesis)

 States there is no relationship between the IV and
DV
 Example: there is no difference between the number
of adverse patient events in hospitals with higher
nurse to patient ratios as compared with those with
lower nurse to patient ratios
 Serves as a basis for statistical analysis

Types of Hypotheses:
 Directional: states which way the relationship should exist
 Nondirectional: states that the relationship exists, but not
the direction
 Null (Ho): statistical hypothesis
 Research: alternative hypothesis (H1 or Ha)

Complex Hypotheses

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  Contains more than one independent or dependent
variable
 Difficult for the findings to indicate unequivocally that the
hypothesis is supported or not supported
 The reader must infer which relationships are significant
from the “findings” or “discussion” section
 Examples:
o There will be a positive relationship between phase-
specific telephone counseling and emotional
adjustment in women with breast cancer and their
partners.
o There will be a greater decrease in anxiety scores for
patients receiving structured informational videos
before abdominal or chest tube removal than for
patients receiving standard information.

Critiquing Research Questions

 Does the question express a relationship between
variables?
 Does the question specify the nature of the population
being studied?
 Does the question imply the possibility of empirical testing
Critiquing Hypotheses
 Evaluate the wording for
o Clarity of statement
o Implications for testability
o Congruence with theory
o Appropriateness for research design used

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Week 3 - FINDING AND APPRAISING THE LITERATURE

Literature Search
 Searching various scholarly sources to identify appropriate
literature
Literature Review
 Once literature is found, it is then reviewed to determine
its strengths, limitations, and gaps that may exist
 Purpose: to discover what is known about a topic
o Follows a clinical question
o For knowledge: reviewing the literature, reading to
learn

Purposes and uses for nurses in Evidence-informed projects

 Uncover - Uncover one or more new practice interventions or obtain
supporting or contrary evidence for revising, maintaining, or stopping
current interventions, protocols, and policies
 Promote - Promote evidence-informed revision and development of
new practice protocols, policies, and projects or activities related to
nursing practice
 Generate - Generate clinical questions that guide development of
evidence-informed practice projects

For a study:
 Known vs. unknown
 Gaps
 Discover unanswered questions

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  Discover frameworks used to study the problem
 Generate research questions/hypotheses
 Helps to narrow design and methods
 Helps to determine need for replication

As a consumer:
 Known vs. unknown
 Gaps
 Traditions
 Strengths and weaknesses of an area
 Developing evidence-informed practice uncovers a new practice
that can be used, further tested, or revised

PICOT to guide Literature Review

• In post-menopausal women with osteopenia, does regular exercise
compared to no exercise prevent osteoporosis after one year?
• P: postmenopausal women with osteopenia
• I: regular exercise
• C: no regular exercise
• O: prevention of osteoporosis
• T: after one year

Conceptual or Theoretical Framework

• The conceptual framework, or theoretical framework, of a research
report is a structure of concepts or theories that provides the basis for
development of research questions or hypotheses.
• A concept is an image or a symbolic representation of an abstract idea.

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 • A theory is a set of interrelated concepts, definitions, and propositions
that convey a systematic view of phenomena.

Quantitative Research Purposes

 Develop conceptual/theoretical framework: primary and secondary
sources
 Problem statement and hypothesis refinement
 Methodology: design, sample, instruments, procedure
 Outcome and analysis

Types of Literature: Data-based and Conceptual

 Data-based: research literature, studies found in journals; also known
as empirical, scientific
 Conceptual: reports of theories or reviews, how-to types of articles

Systematic Reviews
 Special kind of literature review that uses rigorous methods to
identify, critically appraise, and synthesize primary studies
 Can provide a summary on what is known on a topic
 Can help to identify gaps in the knowledge
 Are also considered a research study

Sources
 Primary: Data-based, theory, research – e.g., published research study
 Secondary: Summary of material, critique, analysis of a theory, topic,
practice – e.g., article about an analysis of a clinical practice

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Journals
 Peer-reviewed
 Blind reviewed by external reviewer(s)
 Judged using a set of criteria

Steps and Strategies for Conducting a Literature Search

 Step 1 – Determine the topic and generate keywords
 Step 2 – Choose databases to search
 Step 3 – Conduct your search
 Step 4 – Refine search results
 Step 5 – Select relevant source
 Step 6 – Critically read, summarize, and synthesize
 Step 7 – Present the findings

Searching for Evidence

 Recall, a topic is a broad area of interest
 Something you want to know more about
o E.g., something you’ve seen in your practice, read about in a
journal etc.
o Should be relevant to nursing
 Start broad e.g., COVID-19 and then narrow focus to something more
specific e.g., impact of COVID-19 on well-being of families
 Developing a Clinical Search Question – The clinical question is
developed using the PICOT acronym used as the basis for a literature
search

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 o P – population
o I/E – intervention (I) or (E) event, exposure
o C – comparison group, comparator
o O – outcome of interest
o T – time frame for the study
 Devising a Search Strategy
o Define your topic
 1. Choose a topic – e.g., shift work and nurses’ fatigue
 2. Narrow your focus further to one particular issue,
problem, or debate – e.g., the impact of shift work on
nurses’ fatigue
 Once you have defined your research topic, you need to
state it in the form of a clinical (search) question
o Stating your topic as a (searchable) question
o Identify your keywords – describes your subject. Use these
keywords as search terms to help find information that answers
your research question.
o Related words – include synonyms or variant spellings.
o Connecting keywords – using the “or” operator. Use OR
between related words to find either term in each search result.
Connect the related words from our search questions to create
the following search statements
o Connecting keywords – using the “and” operator. Use AND
between keywords to find all the terms in each search result.
Connect the keywords from our search question to create the
following search statements: you can use different combinations
of keywords/related words to formulate search statement
options

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 o Connecting keywords – using the “not” operator. Use NOT to
exclude or omit unwanted terms from your search results. Using
NOT narrows your search; you will retrieve less results, use with
caution
 AND- narrow
 OR- broaden
 NOT- exclude items from search
o Connecting keywords – using phrase searching. Use phrase
searching to find the exact phrase (a term containing two or
more words) in each search result. Place quotation marks
around the words in the phrase. Using phrase searching narrows
your search, e.g., you will retrieve less results

Critiquing Quantitative Research Articles

 To develop evidence informed practice, nurses need to develop and
use critiquing skills to assess the value of the study, its findings, and
the strength of evidence applicable to practice

Stylistic Considerations
 Style of published paper will reflect the journal’s style guideline
criteria and the author’s personal judgement
 Stylistic variations can affect the scientific merit of a published study
 Essential sections
o Introduction
o Methodology
o Results
o Discussion

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 Scientific Merit
 The degree of validity of a study or group of studies
 Critiquing involves judging the overall quality or validity of a
study
 Critiquing scientific merit: hallmark of promoting quality
evidence base for nursing practice

Critiquing Guidelines
 Problem statement and purpose
o Clearly stated?
o Is the relationship between variables stated? Is it testable?
 Literature review and theoretical framework
o Are variables and main concepts addressed? Are
relationships discussed? Are variables linked to
framework?
o What gaps are identified?
o How does this study address the gaps?
o Are references primary or secondary sources?
o Are operational and conceptual definitions articulated?
 Hypotheses or research questions
o Are these used appropriately?
o Are independent and dependent variables clearly stated?
o Are null or alternative hypotheses given?
o Are the hypotheses directional? Testable?
 Sample

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 o What type of sampling method was used? Is it
appropriate?
o Does the sample reflect the population?
o Is the size adequate?
o What population can the findings be generalized to? What
are the limitations?
 Instruments- physiological
o Rationale for selection provided?
o How is accuracy maintained?
 Instruments- observational
o Who did the observing? Did they use a guide?
o How were they trained to minimize bias?
o Were they required to make inferences?
o Did their behaviour affect participants?
 Instruments- interviews (more for Qualitative Research)
o Who were the interviewers?
o How were they trained to minimize bias?
 Instruments- questionnaires
o What types of questionnaires were used (e.g., Likert-
type?)
o Are they consistent with conceptual definitions?
 Instruments- available data and records
o Appropriate
o Used to describe the sample? To test hypotheses?
 Reliability and validity

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 o What type and level of reliability is reported for each
instrument? Is the level acceptable?
o What type of validity is reported? Is it adequate? Why?
 Data analysis
o What level of measurement is used?
o What descriptive and/or inferential statistics are given?
o Is the level of significance provided?
o Are the inferential statistics used appropriate for the
hypotheses?
o Do tables and graphs clearly enhance the text?
 Conclusions, implications, and recommendations
o Were hypotheses supported?
o Do the results reflect the previous sections?
o What limitations are mentioned?
o What relevance to nursing is discussed?
o What generalizations are made? Are they appropriate?
o What recommendations are made?
 Applications and utilization for practice
o Do the study’s strengths outweigh its weaknesses?
o Similar findings to other studies?
o What risks or benefits are likely if applied to practice?
o Is application to practice feasible?
o How are the findings applicable to nursing?
o Is replication possible?

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Week 4 - INTRO TO RESEARCH DESIGNS: EXPERIMENTAL,
QUASI-EXPERIMENTAL, NON-EXPERIMENTAL

Purpose of Research Design

 Provides plan to aid in solving problems, answering questions,
testing hypotheses
 The design involves a plan, a structure, and a strategy
 Allows researcher to apply different levels of control so it can be
suggested that it was the independent variable that influenced the
dependent variable and not something else

Basic vs. Applied Research

 Basic Research – Expand nursing knowledge (e.g., theoretical
questions)
 Applied Research – Designed to solve clinical problems

Elements of Research Design

 Participants (who)
 Observations (what)
 Measurement of time (when)

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  Selection of participants (where)
 Role of investigator

Design Purpose: Plan Control

 Considerations
o Objectivity
o Accuracy
o Feasibility
o Control – measures that the researcher uses to hold constant
the conditions in a study to avoid bias (distortion of study
results). Goal- to rule out extraneous (mediating variables) by
the following:
o Homogeneous sample – research participants should be similar
with respect to extraneous variables relevant to the research
study; inclusion criteria and exclusion criteria
o Constancy – each participant is exposed to the same
environmental conditions, timing of data collection, data
collection instruments, and data collection procedures
o Manipulation – manipulation of IV – administration of the
intervention, treatment, program to one group (i.e.,
experimental group) but not to other study participants (i.e.,
control or comparison group).
 Blinding- used in experimental and quasi-experimental
research where participants are not aware of whether
they are receiving the intervention.
 Double blinding – both researcher and participants
are not aware of who is receiving the intervention
o Randomization – each participant in has an equal chance of
being assigned to either the experimental or control group.

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  Block randomization procedure was used to establish an
even distribution of participants between the intervention
and control groups.

Internal Validity
 Asks if it is the independent variable (or something else) that caused
or resulted in the change in the dependent variable
Threats to Internal Validity
 History
 Selection
 Maturation
 Testing
 Mortality
 Instrumentation

External Validity
 Questions the conditions under which the findings can be
generalized; deals with the ability to generalize the findings outside
the study

Threats to External Validity

 Selection (who)
 Reactive effects (where-how)
 Measurement effects (how-when-what)

Critical Thinking Decision Path: Potential Threats to a Study’s Validity

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Critiquing Criteria
 Study design appropriate
 Control measures match design
 Design reflects feasibility
 Design flows form research question, framework, literature review,
hypothesis
 Control of threats to internal validity
 Control of threats to external validity
 Design linked to levels of evidence hierarchy

Experimental and Quasi-experimental Designs

 Purpose of research designs
o To provide the plan for testing the hypothesis about the
independent and dependent variables
o Experimental and quasi-experimental designs differ from
nonexperimental ones since the researcher actively seeks to
bring about the desired effect and does not passively observe
behaviours and actions
 Research Design – use a design that

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 o Is appropriate to the research question
o Maximizes control
o Holds the conditions of the study constant
o Establishes specific sampling criteria
o Maximized the level of evidence
 Maximizing Control – rule out extraneous variables
o Homogeneous sampling
o Constancy in data collection
o Manipulation of the independent variable
o Randomization

Experimental and Quasi-experimental Designs

 Experimental and quasiexperimental designs differ from
nonexperimental designs since the researcher actively seeks to
bring about the desired effect and does not passively observe
behaviours and actions.
 Suitable for testing cause and effect relationships (IV caused the
outcome/DV)
 Inferring causality requires that:
o Causal variable and the effect variable must be associated
with each other
o Cause must precede the effect
o The relationship must not be explainable by another variable

Experimental Designs provide level II evidence – evaluate outcomes in terms

of efficacy and cost effectiveness
 True experimental design

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  Solomon four-group design
 After-only design

Experimental Design Features

 Randomization of participants to control or treatment group
 Control: Independent variable – dependent variable
 Manipulation of independent variable

Experimental Design: Advantages and Disadvantages

 Most appropriate for testing cause-and-effect relationships
 Provides highest level of evidence for single studies
 Not all research questions are amenable to experimental
manipulation or randomization
 Participant mortality ... especially control group participants
 Difficult logistics in field settings
 Hawthorne effect

Quasi-Experimental Design Types – Level III Evidence

 Nonequivalent control group design
 After-only nonequivalent control group design
 One-group (pretest–posttest) design
 Time series design

Characteristics of Quasi-Experiments
 Manipulation of an independent Variable
 May lack randomization (random assignment) and

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  May not include a control-group

Quasi-Experimental Design: Advantages and Disadvantages

 Practical and more feasible, especially in clinical settings
 Some generalizability
 Difficult to make clear cause-and-effect statements
 May not be able to randomize

Evaluation Research
 Uses both experimental and quasi-experimental designs
 Seeks to determine the outcome of a program
 Can be formative or summative

General Critiquing Criteria

 What design is used?
 Is the problem one of a cause-and-effect relationship?
 Is the design suited to the study setting?
 Is the design experimental or quasi-experimental?
 Is the method used appropriate for the problem?

Experimental Critiquing Criteria

 What experimental design is used? Is it appropriate?
 How are randomization, control, and manipulation applied?
 Are there reasons to believe that alternative explanations exist for the
findings?
 Are all threats to validity, including mortality, addressed in the report?

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Quasi-Experimental Critiquing Criteria
 What quasi-experimental design is used? Is it appropriate?
 What are the most common threats to the validity of the findings?
 What are the plausible alternative explanations for the findings? Are
they addressed?
 Does the author address threats to validity acceptably?
 Are limitations addressed?
Evaluation Research Critiquing Criteria
 Is the specific problem, practice, policy, or treatment being evaluated
identified?
 Are the outcomes to be evaluated identified?
 Is the problem analyzed and described?
 Is the program involved described and standardized?
 Are the measurements of change identified?
 Are the observed outcomes related to the activity or to other causes?

Nonexperimental Design Rationale

 Used in studies to:
o Construct a picture of a phenomenon at one point over a period
of time
o Explore people, places, events, or situations as they naturally
occur
o Test relationships and differences among variables
 Characteristics:
o No manipulation of the IV

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 o No randomization
o No control
 Designs:
o Survey studies:
 Descriptive
 Exploratory
 Comparative

o Relationship or difference studies:

 Correlational Studies
 Developmental studies
 Cross-sectional studies
 Longitudinal and prospective studies
 Retrospective and ex post facto studies
o Critical Thinking Decision Path: Nonexperimental Design Choices

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 o Nonexperimental Design Advantages
 Difficulty explaining cause-and-effect relationships
 Important to develop knowledge base on phenomenon of
interest
 Useful in forecasting or making predictions
 Important designs when randomization, control, and
manipulation are not appropriate or possible
 Useful in testing theoretical models of how variables work
together in a group in a particular situation
o Methodological Research
 Used to develop and evaluate data collection instruments,
scales, and techniques
 Psychometrics= theory and development of measurement
instruments (surveys or questionnaires) and measurement
techniques
o Meta-analysis
 A strict scientific process that synthesized the findings
from several separate studies in a specific area and
statistically summarized the findings to obtain a precise
measure of the effect
o Secondary Analysis
 Researcher reanalyzes. The data from a (experimental or
nonexperimental) study for a completely different purpose
o Epidemiological Studies
 Examine factors affecting the health and illness of
populations in relation to their environment

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  Investigate the distribution, determinants, and dynamics
of health and disease
 Are often prevalence or incidence focused
o Nonexperimental Critiquing Criteria
 Which nonexperimental design is used in the study?
 In accordance with the theoretical framework, is the
rationale for the type of design evident?
 How is the design congruent with the purpose of the
study?
 Is the design appropriate for the research problem?
 Is the design suited to the data collection methods?
 Does the researcher present the findings in a manner
congruent with the design used?
 Does the researcher theorize beyond the relational
parameters of the findings and erroneously infer cause-
and-effect relationships between the variables?
 Are alternative explanations for the findings possible?
 How does the researcher discuss the threats to internal
and external validity?
 How does the researcher deal with the limitations of the
study?

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Week 5 - SAMPLING AND DATA COLLECTION IN
QUANTITATIVE STUDIES

Sampling Concepts
„ Population—a well-defined set that has certain properties
„ People
„ Animals
„ Objects
„ Events

Identifying Population Descriptors

„ Specify inclusion (eligibility) criteria
„ Specify exclusion (delimitations) criteria
 Inclusion and exclusion criteria lead to the population from which the
sample is selected.

Population Descriptor Criteria

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  Gender
 Age
 Marital status
 Socioeconomic status
 Religion
 Ethnicity
 Education
 Health status
 Diagnosis
 Comorbidities

Population Descriptor Example:

„ Study by Jackson and Dennis, 2017: on the effects of applying lanolin
for the treatment of nipple pain in breasting feeding had strict
inclusion and exclusion criteria.
„ Inclusion criteria: breastfeeding women who
1. had nipple pain and visible nipple damage;
2. delivered a full-term (> 37 weeks), singleton infant within the
previous 72 hours;
3. were able to speak English.
„ Exclusion criteria included:
1. infants not expected to be discharged home with their mother;
2. infants with a congenital abnormality that would impair
breastfeeding, or ankyloglossis (tongue-tie);
3. maternal allergy to lanolin;
4. maternal health condition(s) that might interfere with
breastfeeding;

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 5. maternal aversion to, or strong desire to use lanolin.

Sampling Procedure:
 Step 1 – Identify target population
 Step 2 – Delineate the accessible population
 Step 3 – Develop a sampling plan
 Step 4 – Obtain approval from research ethics board

Homogeneity vs. Heterogeneity of a Sample

 Homogeneity: similar-limited variation in characteristics
 Heterogeneity: divers-dissimilarities in a sample group inhibits ability
to interpret findings meaningfully and to make generalizations

Target Population and Accessible Population

„ Population criteria establish the target population –the entire set of
cases about which the researcher would like to make generalizations.
„ Accessible population-is one that meets the study eligibility criteria
and is available

Samples and Sampling

„ Sampling is a process of selecting a portion or subset of the designated
population to represent the entire population.
„ A sample is a set of elements that make up the population.
„ An element is the most basic unit about which information is
collected.
„ Sample Elements: People, Places, Objects

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Goal of Sampling
o Quantitative researchers select samples that that are as
representative of the population as possible because they aim to
generalize findings to the population of interest

Representativeness
o The sample must be similar in characteristics to the population from
which the sample was selected.
o How to best ensure representativeness?
o By using a probability sampling approach
o By having a clear eligibility criteria
o By having a large enough sample (more to come)

Sampling Strategies
1. Nonprobability sampling
ü Participants are selected using non-random methods.
2. Probability sampling
ü Uses random methods for selecting sample.
ü All potential participants have an equal chance of being selected
(representativeness).

Nonprobability Sampling Quantitative Research

o Convenience: most readily accessible persons/objects.
o Quota: knowledge about the population of interest is used to
seek representativeness by using strata.
o Disadvantages

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 o Sample will likely not be equal with regards to the
characteristic of interest and might involve researcher bias
and self-selection bias (participant selecting themselves).
o Limits generalizability of the findings.
o Convenience sampling is the weakest approach in
quantitative research.
o Advantages
o Convenience sampling is a relatively easy way to find
participants.
o Improving representativeness of sample…
o Statistically to show that the study participants are similar
in characteristics if more than one group is used.

Probability Sampling: Random Selection vs. Random Assignment

o Random selection: All participants or elements of the
population have an equal and independent chance of
being included in the sample.
o Random assignment/Randomization: Refers only to the
assignment of participants to either an experimental or a
control group purely on a random basis. Does not mean
that participants were first randomly selected.
o Ex. Participants are invited to be part of a study and then
were randomized to study groups.

Probability/Random Sampling= Representative Sample

o Simple random sampling
o Stratified random sampling
o Multistage sampling (cluster)

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 o Systematic sampling

Simple Random Sampling

o The most basic approach to probability sampling
o Researcher(s) establish a sampling frame if available.
This contains all the elements of the population. For
example, a student roster where each student name
would be labelled from 1-20,000
o Researchers could use a table of random numbers or a
randomizer to draw (select) participants randomly for the
sample size needed.
o If 1000 participants are to form the sample, the first
number appearing to the top left is selected and the
student with this number. This will be repeated for all
participants.
„ Table of random number (generator):
Ihttps://www.randomizer.org/

Example: Use of a Sampling Frame

 RNs and RPNs who worked on the in-patient units or
emergency departments of acute care hospitals
were eligible to participate in the study. The sample
was randomly selected from the CNO database,
using a proportional stratified random sampling
strategy. In collaboration with CNO, potentially
eligible RNs and RPNs were identified and stratified
to from the sampling frame.

Stratified Random Sampling

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 o The population is first divided in two or more strata.
o Elements (participants) are selected from each of those
individual strata randomly.
o This approach is used to enhance representativeness
when there is a need to represent people based on
specific characteristics.
o Example:
o “The stratum was defined by the distribution of RNs
(72%) and RPNs (28%) who met the study’s
eligibility criteria, as calculated by CNO’s statistical
service department for this study”. p. 96
o The authors specified that they have used a
proportional sample:
o “The sample was randomly selected from the CNO
database, using a
o proportional stratified random sampling strategy”.
p.96

Sampling Procedure (Stratified):

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 Proportional vs. Non-Proportional Sampling
o Proportional sampling consists of attempting to select
individuals in the same proportion (%) that they exist in
the population.
o The goal of using a proportional sampling approach for
nonprobability or probability sampling is to enhance
representativeness.

Multistage (Cluster)
o Involves a successive random sampling of units (clusters)
that meet the eligibility criteria.
o Proceeds from large to small.

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 o See example in you tube video.
 Ex: Selecting full time RN working in intensive care
across Canada
o 1. Sampling all hospitals in Canada
o 2. Then sampling all intensive care units in
each of those selected hospitals.
o 3. Then sampling nurses who work full time in
those units.

Systematic Sampling
o Involves the selection of an interval at which point
individual participants are selected.
o The size of the population is divided by the size of the
desired sample.
o Let’s say that we have a population size of 10,000 and that
we need a sample size of 1000.
„ 10000 divided by 1000= 10 (interval needed)
 As a starting point we can use a table of random
numbers but after that, each 10kth individual would
be selected.

Advantages/Disadvantages of Probability Sampling

o Overall, sample should be representative of the
population.
o Costly and more difficult to achieve, may not always be
practical.

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 o Obtaining a full list of all elements (sampling frame) is not
always possible and because of that, this adds an element
of bias.
o The probability of selecting a representative sample
increase
o The ability to generalize findings is enhanced.

Sample Size
o Sample size should be determined before the study is
conducted.
o Larger the sample, the more likely it is to be
representative of the population.
o Large samples have less sampling errors = the difference
between the sample value and the population value is
minimized.
o When expected differences are known to be large
between groups, a large sample is not needed to show
statistical significance, but a large sample is needed to
show a small difference.
o Researchers can conduct a POWER ANALYSIS to estimate
how large their sample ought to be to show significance.
This is based on previous studies testing this hypothesis.

Factors Influencing Sample Size

o Type of design used
o Type of sampling procedure used
o Type of formula used for estimating optimum sample
size

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 o Degree of precision required
o Heterogeneity of the attributes under investigation
o Relative frequency of occurrence of the phenomenon of
interest in the population (i.e., common versus rare
health problem)
o Projected cost of using a particular sampling strategy

Sampling Bias
o The systematic over or underrepresentation of some segments of the
population in terms of a characteristic relevant to the research
question.

Critiquing Criteria
• Have the sample characteristics been completely
described?
• Can the parameters of the study population be inferred
from the description of the sample?
• To what extent is the sample representative of the
population as defined?
• Are criteria for eligibility in the sample specifically
identified?
• Have sample delimitations been established?
• Would it be possible to replicate the study population?
 How was the sample selected? Is the method of sample
selection appropriate?
 What kind of bias, if any, is introduced by this method?
 Is the sample size appropriate? How is it substantiated?

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  Does the researcher identify the limitations in
generalizability of the findings from the sample to the
population? Are those limitations appropriate?
 Is the sampling strategy appropriate for the design of the
study and level of evidence provided by the design?
 Does the researcher indicate how replication of the study
with other samples would provide increased support for
the findings?

Data Collection – In Quantitative Research

„ Data must be translated into concepts that can be measured,
observed, and recorded.
„ Researcher chooses the data collection method that matches the
research study purpose and question.
„ Objective approach
„ Consistent approach- method used to collect data is done in the same
way across study participants.
„ Intervention fidelity- ensuring that the data was collected consistently
and systematically.

Importance of Data Collection Methods

„ To a large extent, the success of a research study depends on the
quality of the data collection methods chosen and implemented.

Research Study Definitions

o Conceptual definition: derived from the literature; the accepted
definition of a concept

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 o Operational definition: translates the conceptual definition into
behaviour or verbalizations that can be measured
o Measure: assigns numbers to events, objects – based on a set of rules

Research Study Procedures

 Operationalizations
„ The process of translating a concept of interest to a researcher into
observable and measurable phenomena.

Goodness of Fit
„ Purpose
„ Design
„ Research question(s) or hypotheses
„ Conceptual and operational definitions
„ Data collection method

Data Consistency (constancy of conditions)

„ Achieved by measuring the data in the same manner for each
participant.
„ A data collection protocol is needed to ensure intervention fidelity.
„ Co-investigators and assistants need to be trained to ensure all follow
the same protocol.
„ Ensures interrater reliability.

Data Collection – must be

o objective: the data must not be influenced by the person who
collects the information; and

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 o systematic: the data must be collected in the same methodical
way by each person involved in the collection procedure

Existing vs. New Data

 Existing data
„ Existing information (e.g., hospital records, historical documents,
audio, or video recordings).
„ Example-retrospective chart reviews.
 Advantages
o Can save time and provide information about trends over time.
 Disadvantages
o Missing data, accuracy of information obtained from available
data.
 New data

Concealment

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Physiological or Biological Measurements
„ Biological and physical indicators of health
„ Blood pressure
„ Heart rate
„ HgbA1c
„ T3, T4
„ Production of breast milk
„ Blood glucose

Observation
1. Observations undertaken are consistent with study’s objectives and
theoretical frameworks.
2. Standardized and systematic plan for observation and recording of
data.
3. Training of data collectors.
4. All observations are checked and controlled.

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Scientific Observation Methods
„ Concealment without intervention
„ Concealment with intervention
„ No concealment without intervention
„ No concealment with intervention

Interviews and Questionnaires

„ Open-ended questions (Qualitative or Mixed Methods)
„ Closed-ended questions (Quantitative)
„ Likert-type scales
„ True/false
„ Semantic differential

Likert Type Scale

Semantic Differential Scale Example:

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Constructing New Instruments
o Define the construct to be measured
o Formulate the items or questions
o Assess items or content validity
o Write instructions for users
o Pretest and pilot test new instrument
o Assess and validity

Critical Thinking Decision Path: Data Collection Methods

Critiquing Criteria

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 • Is the framework clearly identified?
• Are the data collection methods clear?
• Are all instruments identified?
• Is the method used appropriate?
• Were the collection procedures similar for all participants?
• Could you replicate the data collection?
• Was intervention fidelity ensured? How?
• Were precautions taken to prevent bias?

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