NURSING RESEARCH & STATISTICS Second Edition SuRESH K. SHARMA MScN, PhD, RN (USA) Professor & Principal College of Nursing Alll India Institute of Medical Sciences (AIMS) Rishikesh, Uttarakhand India ELSEVIER Adivision of RELX Indi Private Limited (Fromerly Reed Elsevier India Private Limited)Section I FUNDAMENTALS OF NURSING RESEARCH 1. Foundation of Nursing Research Introduction Methods of Acquiring Knowledge in Nursing Problem Solving Scientific Methods Meaning of Research and Nursing Research Characteristics of Good Research Types of Research Scope and Areas of Nursing Research Problems in Nursing, Health, and Social Research Concept of Evidence-Based Practice Review Questions 2. Overview of Research Process Introduction Basic Research Terms Quantitative Research Process: Overview Qualitative Research Process: Overview Ethics in Nursing Research Review Questions 3. Research Problem Introduction Definitions Identification of Research Problem Formulation of Research Problem Identification of Variables Writing Research Objectives Review Questions 4. Hypothesis and Assumption Hypothesis ‘Assumption Review Questions 39 39 41 45 48 58 63 68 a 6 81 85 92 97 5. Literature Review Introduction 101 Meaning of Literature Review 101 Importance of Literature Review 102 Purposes of Literature Review 103 ‘Types of Literature Review 103 Sources of Literature Review 105 Steps of Literature Review 109 Points to Be Considered for Literature Review 115 Review Questions 116 6. Theories, Models, and Frameworks in Nursing Research Meaning of Theory 121 Meaning of Conceptual Model 121 Theoretical and Conceptual Frameworks 122 Nature and Characteristics of Theories 127 Purposes and uses of Theories, Models, and Frameworks 128 Using Theory in Research 130 Testing and Developing Theories 130 Developing Conceptual or Theoretical Framework and Models 132 Review Questions 134 7. Research Approaches and Designs Introduction 138 Definitions 138 Elements of Research Design 138 Selection of Research Design 140 Validity of Research Designs 141 ‘Types of Research Design 144 Experimental Research Designs 146 Randomized Control Trials in Nursing 157 Quasi Experimental Research Design 162 Pre-Experimental Research Design 165 ‘Nonexperimental Research Design 166 Descriptive Research Designs 167 Correlational/Ex-Post Facto Research Design 170 Developmental Research Design (72EES CONTENTS xiv Epidemiological Research Designs a 10. Analysis of Data rei h Desi ee Diadvertoges of Nonexperimental Introduction 299 Neg ak Delle 177 Definitions 299 Other Additional Research Designs 177 Scales of Measurements a Qualitative Research Designs 182 Analysis of Quantitative Data 3 i Phenomenological Research 184 Parametric Tests 2 e Ethnographic Research 188 Nonparametric Tests 7 Grounded Theory 188 — Computer Analysis of Quantitative Data 314 Historical Research Design 192 Analysis of Qualitative Data 315 ‘Action Research 197 Review Questions pay Triangulation (Mixed Methods) 200 : Review Questions 201 11. Communication and Utilization of : R ch 8. Population, Sample, and Sampling oe 2 Introduction 333 Introduction x 206 Criteria for Communicating the Research 333 Terao in Sampling 206 Methods of Communication of Research 334 Chace a ae 8 207 — Writing a Research Report 336 hecteiies A pdame 208 Forinat of a Thesis or Dissertation 339 see eee ; 208 Writing the References/Bibliography 342 Tes of Sampling Techniques 211 Vancouver Style of Reference Writing 343 ene echniques 211 American Pychologial Association Sele of 2 Sampling References 350 sane She Determination 227 Writing a Research Article 354 tone 3 reset pling Errors 238 Critical Review of a Research Work, 356 Rens. bain amping 240 Utilization of Research Findings 361 MESON 241 Dereloring and Presenting a Research Proposal 366 mputer in Nursing Ri 9, Tools and Methods of Data Collection Review Quating 3 Introduction 246 Concept of Data Collection 246 : Ieren 350 Section II juestionnaire 256 ‘Composite Scales/Attitude Scales 261 STATISTICS Visual Analogous Scale 266 Ghameatiscs oe 12. Introduction and Descriptive Rating Scale Statisti 210 ics Checklist 13 Biophysiologic Methods 75 Introduction 7 Projective Technique 279 Definitions 382 - U: ; vee 282 Tn Aplications of Statistics oe Nien 23g Belted to Statistics 382 Reliability of Research Too! 286 GUS of Measurements 383 Pilot Study 287 Revie non Of Statistics 383 Review Questions 290 “Seview Questions 386 293 404CONTENTS: 13. Normal Distribution and Measures of Relationship Normal Probability Curve (Z Score) Correlation Coefficient Scatter Diagram Method Product Moment Correlation Regression Analysis Review Questions 14. Inferential Statistics Introduction Basic Terms Parametric Tests Nonparametric Tests Review Questions 409 4iL 414 417 420 425 430 430 434 441 449 15. Application of Statistics in Health and Uses of Computer in Statistics Introduction Rates, Ratios, and Trends Vital Health Statistics Measures of Fertility Measures of Mortality Measures of Morbidity Statistical Packages and Applications Review Questions Appendices Glossary Index 454 454 454 456 458 461 463 465 467 489 509SECTION-I FUNDAMENTALS OF NURSING RESEARCH This section contains the following chapters: Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. Chapter 6. Chapter 7. Chapter 8. Chapter 9. Chapter 10. Chapter 11. Foundation of Nursing Research 003 Overview of Research Process 038 Research Problem 062 Hypothesis and Assumption 084 Literature Review 100 Theories, Models, and Frameworks in Nursing Research 120 Research Approaches and Designs 137 Population, Sample and Sampling 205 Tools and Methods ef Data Cellection 245 Analysis ef Data 298 Communication and Utilization ef Research 3321 Foundation of Nursing Research ‘This chapter is designed to enable the reader to: «Understand the concept of research and nursing research + Determine the sources of acquiring knowledge in nursing. «Describe and compare the problem-solving process with nursing process. + Discuss the concept, characteristics, purposes, steps, and limitations of scientific process. + Define research and nursing research. «+ Appraise the need, purpose, importance, and significance of nursing research. ‘+ Recall historical evolution of nursing research in India and abroad. « Identify characteristics of good research. «Classify the types of research and recite the relevant example. * Compare the basic elements of qualitative and quantitative research. + Explore the scope and areas of nursing research. * Recognize the problems in nursing, health, and social research. vis evidence-based nursing. Explain the concept of evidence-based practice vis- Applied research 23 Evidence-based © Qualitative research 21 © Authority 05 practice (EBP) 29 Quantitative research 21 © Basic research 23 Experience 06 © Research 10 * Deductive reasoning 06 ~—*_Inductive reasoning 06. * Scientific methods 09 * Evidence-based © Intuition 05 *¢ Tradition 05 nursing (EBN) 29 © Nursing research =, | 11 ¢ Trial and error 06 * Problem solving o75 INTRODUCTION st of pro. : ng the younge: r finds place amo) y al enaeah Nursing is considered one of the een : ceatinuously growing and Ps a ions. It is an evolving profession, w ugh research. ch is or asa aieae lose eich can be developed only fo 8 ‘discipline can maintain its ic ated, ; tion on which " 5 vhich knowledge can be gener ides a solid founda of the few ways by which owed ge can oe rch provides a sO non oa ck professional status and growth. Mo i knowledge and prac y nurses can develop and refine their professional vledge od latest therapies, such as knowledge, nursing cannot improve techniques for n wer onion, of many more such infant care, pain management, grief counselling, clien interventions. eee js to answer questions or a Research laa systematic inquiry that uses disciplined ne snd expand a Body of solve problems. The ultimate goal of research is to develop, Aiacetaries thavaid’ gus daily knowledge. Research strives to garner knowledge and male onan Hie piofecsion shit lives. Nurses are increasingly engaged in disciplined aruales | ses Lacuiesabeue ie patients. Nursing research is a systematic inquiry design: aucation santdradraiaieteaGon: issues of importance to nurses, including nursing practice, edu y a = fi he practice of the profession. It uses Nursing research provides the scientific basis for the pr ‘ i i i heoretical approaches to understand the multiple diverse methodologies, philosophical and theoretical app: Se Rene patterns of newer acute and chronic morbidities, prevention or delayed ons} a z disability, or slowing the progression thereof; finding effective approaches to acl eve an sustain optimal health; and improvement of the clinical settings in which care is provided. Recently, the main focus of the nursing research is on educational methods that best Prepare nurses and nurse scientists, exploring efficacies of traditional as well as modern nursing care interventions and developing effective strategies of nursing management and leadership. ping Bi Ss gt 'P: The present era of complex health problems makes interdisciplinary research an essential characteristic of nursing research, because multi : ‘ iety: The expansion of new knowledge is required {ora growing profession lke nursing..However, nursing research must be relates oe indig- Treally sagercndiiness pattems and current societal and health care issues when are scien- tfically rigorous and readily translatable into practice and heal nn should recognize that nursing i: it At san Polley ane nuise scholars of rapidly growing demand of new knows a foundation for any profession, This well as loosely ar- re used to develop -and-errorMETHODS OF ACQUIRING KNOWLEDGE IN NURSING 5 problem-solving process is a primitive way of generating new knowledge as compared to scientific research. Informal methodologies are used for problem identification, lx pothesis sci ulation, observation, analysis, and conclusion. Research is considered to be a Thore for- spelen and intensive process for the purpose of developing or refining a profes- al body of knowledge. Thus the methods of acquiring the nursing knowledge may be ified under two broad categories, i.e. unstructured methods of acquiring the ienowledge structured methods of acquiring the knowledge as discussed below (Fig. 1.1). ss mal, dla and Unstructured Methods | Tradition: The bulk of knowledge has been accumulated over centuries and passed down from one generation to another through various media. Traditional nursing knowledge is Jeant mainly from books, journals, by word of mouth, and by observing the practices of oth~ ers. Much traditional practice takes the form of rituals. For example, it may be a tradition in Some hospitals that, after patients are washed, talcum power is dusted over their body. This “tual is performed consistently with little : thought to the rationale behind it. Traditions are important not only in passing down knowledge, put also in giving groups in society a sense of ea identity, belonging, and pride. Through social- knowledge ization, we learn the culture of those who have gone before us. Similarly, traditional nursing knowledge and practices are learnt by novice Unstructured. SS nurses through the process of socialization in eitods meee | nursing colleges, universities, and clinical area. Much of those traditional knowledge and many er ritual practices are the outcome of sound rea~ Taaditon a soning. Today’s new knowledge and practices 4} will likewise eventually become traditional. « Authority: In our complex society, there are au- SE thorities (people with specialized expertise in at reasoning every field). We are constantly faced with mak- ing decisions about matters with which we have J had no direct experience; therefore, it seems Intuition Assembled natural to place our trust in the judgment of I | information people who are authoritative on an issue by virtue of specialized training or experience. The || people with higher length of experience in a Experience Frcolery |_| discipline and with virtue of their position are Wing believed to be a sound source of knowledge and understanding. However, authority as source of knowledge do has many shortcomings. ] Trial and error * Intuition: Intuition is considered as an impor- tant source of knowledge in nursing profession . FIGURE 1.1 Methods z . > . of since past. However, the knowledge obtained , innursing acquiring knowledge1, FOUNDATION OF NURSING RESEARCH 6 m intuition, nove form the rationalizing the FO ee apertant intuition is an imp: sr on rn irical test. ‘ ‘mad rt : Bipevenee Nurses and midwives base their Ee ee ee a useful way of gain- ence and toa lesser extent on the experience of o' er Pe se ccided in the practice and FE nt ea nicer nnes 1984} It is also reckoned that what we know-how of expert nurses and clinicians (Benner, as However, our experience learn by experience is more enduring than what we are taugl a nurse may use one or two isin ilpelfrathet:natrow. For example; in training depression to pe untamniliat with approaches. Although the experience obtained is invaluable, she ejeat thecal hand other treatments and many cither be reluctant to try them or m: y Me nec hateber. Nurses are not alone in relying on their experience even other pro! ees rit oink coh efit of that. Experience is, therefore, an important source of knowledge, ‘acs on it and overhanging its importance can be detrimental to nursing pract rites Trial and error: Trial and error is the most common approach of gaining the vis ee In this approach, alternatives are tried successively until a solution to a problem is! oan In day-to-day life, everybody uses this technique to solve much type of problems, includ- ing professional ones. For example, a new nurse is not aware of the different keys used to change the head end of patient’s bed up and down; she tries different alternatives before achieving her task successfully. Trial and error may offer-a practical means of securing knowledge, but it is fallible. This method is haphazard and the knowledge obtained is often unrecorded and hence, inaccessible in subsequent clinical situations, ing. Thus it is also ic feeling, without rational reasoning. Thuis tt is $29 ip tong at trough sixth sense without a aor that there ation ovtetaton may not be obtained. In intuition, re the recognition that informa explain what itis and why itis? Despite # Sue rant foo in the human repertoire of knowing, concer Ise when put to berda trongest intuitions are sometimes proved false on their own experi- Structured Methods * Logical reasoning: Reasoning is the mental reasoning, as a method of knowing, systems of thought. Two intellectu deductive reasoning. © Inductive reasonin tion. For example, children and conclu: <1 Processing of ideas to solve problems. Logical combines experience, intellectual faculties and formal al mechanisms used in reasoning are inductive and i if we assume that separation swice? econ OM general children (in general), th ji eT ee ty Occurs in hospital; piebwhee a len we might predict that (specific) childro n hospitalized Both systems of reaso nomena, and both play an important of itself is limited because the validi mation with which One star 2 accuracy, ning are usefy i a ae means of understanding and organizin, hi ae eae Tesearch, However, reasonin, Pi id ris Also, reasons nine 18 dependent on aceneee Of the infon 7 8 May be an insufficient basin? of the infor-—_ PROBLEM SOLVING + Assembled information: In making clinical decision, information that has been assembled for 7 health care professionals also rely on 1 t sem variety of purposes. For example, local, national, and international data provide information on such issues as the rates of using various procedures (i.e. rates of caesarean deliveries in private hospitals) or rates of infection (ie. hospital-acquired infection rates) and can serve as a guide to evaluate clinical practices. similarly, the regularly assembled data in hospital as patient census and in community as opulation census services as good source c of much needed information for nurses and i ther health care professionals, + Problem solving: Nurses encounter several problems in their day-to-day life, when they use problem-solving process to solve a particular problem and find a particular interven- tion effective. They may use the same intervention to solve the same problem in future. Thus, problem solving for one situation contributes to the nurse’s knowledge for problem solving in other similar situations. + Scientific methods/research: Research conducted within a disciplined format is the most sophisticated method of acquiring knowledge that human has developed. Research is ‘most accurate, reliable, and valid method of knowledge acquisition. The current empha- sis on evidence-based health care practices requires nurses to base their clinical practices to the greatest extent possible on research-based finding rather than on tradition, author- ity, intuition, or personal experiences. Findings from rigorous research investigations are considered to be at the pinnacle of the evidence hierarchy for establishing evidence-based nursing (EBN) practices. PROBLEM SOLVING In problem solving, nurses try to understand a problem and search for possible solutions. In this approach, possible solutions are carefully evaluated and one of them is chosen for implementation. The situation is carefully monitored over time to ensure the initial and continued effectiveness of the solution. The nurse does not discard the other solutions, but holds them in reserve in the event that the first solution is not effective, other choices can be used. The nurse may even encounter a similar problem in relation to a different patient, where an alternative solution may be determined to be the most effective. Therefore, prob- lem solving for one situation contributes to the nurse’s knowledge for problem solving, in other similar situations. Problem-Solving Process The problem-solving process consists of a series of steps (Fig, 1.2) that are followed depend- ing on the type of problem to be solved. These are as follows: * Problem definition: The normal process for solving a problem initially involves defining, the problem that is to be solved. In this first stage, there is a need to write down what exactly the problem entails, which helps to identify the real problem that is under stud: and needs an immediate solution. This is considered as the most es: sential step of the problem-solving process, because without this the next steps cannot be executed.1. FOUNDATION OF NURSING RESEARCH Evaluation GED problem and definition revision Implementing Problem the solution(s) analysis Problem-Solving Process Generating possible solutions Selecting the best solution(s) Ren, Analyzing EF the ‘solutions FIGURE 1.2 Problem-solving process Problem analysis: The next step is to analyse how the problem affects the researcher and his or her current situation and the other people involved in the situation. In addition, the gravity of the problem and all the factors that are contributing to the problem are deter- mined. Furthermore, the analysis helps in understanding the source of the problem, and Pon it affects the current developments and the researcher's environment. After this in- vestigation, itis often good to reconfirm, if the initial problem definition is still valid. Frequently, after the analysis and investigation, people discover that the problem they really want answered is very different from their original interpretation of it. Generating possible solutions: When the real problem is discovered, its contributing fac- tors should be investigated. At this stage, focus must be on identifying and gener: ‘in IL possible solutions for a problem. Each potential idea for solution of a ror ‘ ab considered without discarding it through value judgement; however, cath id Sarees tented as ev idea ints ovn rigktand wertw of consideration. ee ‘Analysing the solutions: In this section ine Aner fe join oldero ee ivedizned whats i tp-pealive ed case ie sop of each solution are analysed. paghetehs alps postive and eS Selecting the best solution(s): is i solutions, and eventually Be Reece cent made to compare the avaiable switche Sippced tocol ty ion is selected based on the ca: practically solve th Pa al’ step of the problem-solvin; is Eras ed een? peg eed ekg, after implementation of the most potential sles the problem solving Process where ee ion, an evaluation is made to judge the reful judgement, |SCIENTIFIC METHODS ABLE 1-1 Comparison between the Steps of the Research Process and the Problem-solving Process esearch Process Problem-solving Process je a research question or proble1 So Bee Problem definition pefine the purpose or the rationale for the study jew related literature Problem analysis Revi yormulate hypothesis and define variables Generating possible solution(s) a method to test hypothesis select \ypothesis Analysing the solution(s) a population, sample, and setti select a pop' P setting Selecting the best solution(s) Conduct a pilot study the data Collect the dat Implementing the solution(s) ‘Analyse the data Communicate the findings Evaluation and revision effectiveness of the solution in resolving the problem. This stage also helps to redefine the problem and revise the problem-solving process in case the initial solution fails to manage the problem effectively. A comparison between the steps of the research process and the problem-solving process is presented in Table 1.1. SCIENTIFIC METHODS ontrolled, systematic investigations that are rooted in Scientific methods are defined as c phenomena. chjective reality and that aim to develop general knowledge about natural Characteristics ‘of Scientific Methods Based on the above definition, the characteristics of scientific methods are as follows: * They are orderly and systematic processes. * Scientists attempt to control external factors § * Their findings are based on the empirical evidences. * Findings of scientific methods can be generalized, which means that they can be used in situations other than the one under study. * They are based on assumptions or hypotheses. ; * They are basically conducted to develop or test theories. that are not under direct investigation. Purposes of Scientific Methods tific methods are description, exploration, explanation, predic- The basic purposes of scien TE TLR APCS tion, control, prescription, and identificafion’of relationship of the facts.10 1, FOUNDATION OF NURSING [SEARCH Steps of Scientific Methods The steps of scientific methods depend on the type of the study, which follows celther a qualitative ora quantitative approach, However, the main steps used in any scientific aithod or approach are as follows: «Selecting the topic and identifying the problem. Defining the objectives of the study. Reviewing the literature from theory and other related studies. Defining concepts and variables to be studied. : Stating hypothesis about expected observations or phenomenon to be studied. Identifying assumptions and implications. Determining the ethical implication of the proposed study. Describing the research design and methods for data collection. Defining study population and sample. Planning the data analysis and discussion. Collecting data from subjects. Analysing and interpreting data. Communicating findings of the study. Limitations of Scientific Methods Scientific methods are generally regarded as the one of the best ways of attaining knowl- edge that human being has devised. There are, however, some limitations in applying og fic approaches to nursing problems, some of which are listed below: . Moral or etic) Meet nursing studies would require humans as the subject of their ener, The conan, oe Te egie mete is one such ethical problem, Thus, reliable scienti Gata cannot always be collected, Ls s, Teliable scientific Human complexity: ‘Human behaviour is complicated, subtle, and vari 4 : | subtle, and varied. iti if Pa to categorize human behaviour In adcition, when human behaviour panandoa e by other human beings, te persona biases come into the picture and dlstort th ie analysed «_ Bleneurement problems: Dilfeent aspects of human behaviour are be abaya ce fare, which eannot be accurately measured. Human behaviour fence slpgical Jae Predictable. All the people do not behave in the same way in similar ci Paes Fore, with humans as subject, measurements become a challen; a ess tet é Eternal variable contra problems: Scientific studies conduction oa imitation of weak or no cont have 3 mn humans ma trol over external variables in scientific activity. Raves MEANING OF RESEARCH AND NURSING RESEARCH Research ‘The word research is derived from the Fren a prefix, re, ich ter ie ie. E and a verb, search. Re means ‘once Se hier, a compound word composed of tes ain’, ‘anew’, , or ‘afresh’ and search means ‘toook for something or examine closely and carefully’, ‘to look for information’, ‘to test and tt “to prove "Langford (2001) also mentions that research means ‘to.search. again.or ‘care- fully examine’. Thus, research means close and careful examination of facts and their rela- tionship to discover new knowledge. karl is defined as a systematic and scientific process to answer. to questions about facts and Maship between facts.) It is an activity, involved in, seeking answer to unanswered questions. esearch seeks t0 generate an answer to the problem as well as suggesting additional questions Ravoed of further inquiry. Research is a systematic method of exploring, describing, explaining, relating, or establishing the existence of phenomenon, the factors that cause change in the phenomenon and how the phe- Somenon influences other phenomena. esonrch is a systematic inquiry that uses disciplined methods to answer questions or solve prob- mms, The ultimate goal of research is to develop, define, refine, and expand a body of knowledge for a discipline. esearch is a scientific, systematic, controlled, orderly, and objective investigation to develop, refine, and expand body of knowledge. esearch essentially is a problem-solving process, a systematic, intensive study directed towards full scientific knowledge of subject studies. (Ruth M. French, 1968) Reearch may be defined as the systematic and objective analysis and recording of controlled Reanvltion that may lead to the development of generalizations, principles, theories, resulting fn prediction and possible ultimate control of events. (J. W. Best, 1969) Resear is the process of systematically obtaining accurate ans to significant and pertinent questions by the use of the scientific method of gathering and interpreting information. (Clover and Balsley, 1979) Research may be defined as planned, systematic search for information for the purpose of increas ing the total body of man’s knowledge. It involves Joking for information which at the time is not available or for which that has no generally accepted evidence. (Archold Lancaster, 1982) and critical investigation of natural phe- Scientific research is a systematic, controlled, empirical the presumed relations among such nomena guided by theories and hypotheses about phenomena. (Fred N. Kerlinger, 1986) Nursing Research The ultimate purpose of nursing is to provide high-quality patient care. Clinical nursing prac- tice without research is based on tradition without empirical evidences. Research is needed to evaluate the effectiveness of nursing treatment modalities, to determine the impact of nursing care on the health of the patients, or to test theories. Nursing practices are undergoing tremen- we changes and challenges- In order to meet social challenges and needs, nursing practice ae be research based. The discipline of nursing is as concerned as other sciences are with use of the research process to generate new knowledge. It is accepted as the through which nursing science has evolved in the d wil i amen nursing scienct h past afd will continue to do so in the future.eee 12 1. FOUNDATION OF NURSING RESEARCH is is defi icati jentific inqui yhenomena of concern ‘Nursing research is defined as the application of scientific inquiry to the P’ fed i to nursing, Nursing research ‘seeks to find new knowledge that can eventually be applied in providing nursing care to patients. of nursing problems through creative studies, edge useful in nursing. ; finding way to improve Systematic study and assessment or phenomenon: in is oe nursing practice and patient care initiating and evaluating changes and. taking action to make new know! (Vreeland, 1963) omenon of,concern to fences is the primary (Schlotfeldt, 1977) ‘The term research refers to the application of scientific enquiry to phen nursing. The systemic investigation of patients and their health experi concern of nursing research. Nursing research refers to the use of systematic, controlled, empirical, and critical invest ee in attempting to discover or confirm facts that relate to specific problem or ques practice of nursing. (Walls and Bausell, 1981) th over the full lifespan, bout health and promotion of heal a tual or potential Nursing research develops knowledge al care of person with health problems and disabilities to respond effectively to ac American Nurses Association, 1981) health problems. (Commission of Nursing Research, A Riursing research is a way to identify new knowledge, improve professional education and prac- tices andl use of resources.effectively. a (International Council of Nurses, 1986) Nursing research is the testing of knowledge that can be used to guide nursing, practice. It is concerned with examining questions and verifying interventions based on human experiences. (National Center for Nursifig Research, 1986) sh is defined as a systematic detailed attempt to discover or confirm facts that Nursing researcl Malate tea specific problem fo improve the practice and profession of nursing. (Abdeilah and Levine, 1994) Nursing research is defined’ as a formal, systematic, rigorous and intensive process used for solu- tion to nursing problems or to discover and interpret new facts and trends in the clinical practice, nursing education and nursing administration. pecs (Waltz and Bausell, 2001) Nursing research is defined as a systemati j : ne 5 ys ic search for knowledge about issues of importance to (Polit and Hungler, 2001) Nursing research is a scientific process that validates and refines existi ates new knowledge, which directly and indirectly influences ane pane eae (Burns and Grove, 2005) Nursing research i prone orderly process to find out solution for problems nursing car nursing education, and nursing administra 8 © MPFOVE Quality of (S. K, Sharma, 2005) Nursing research is a s 7 z systematic approach t ing i questions and solvin, A gathering information for the ‘i Siacaton nd cones problems in the pursuit of creating new knowledge about nara ce ne ; : j ing practice, (Hek and Moule, 2006)1 IMPORTANCE AND SIGNIFICANCE OF ‘NURSING RESEARCH NEED AND PURPOSES OF NURSING RESEARCH Nurses engage in research for number of r «ontifi ‘easons. As professi a scientific base of knowledge f s. As professionals, nurses seek t i jniormation enables nurses to better dehnete oe ay the systematic accrual clara contribution nursing makes to health care, determine tho often document the unique t determine th i Ne ona ea au ine the effectiveness of nursi i derelop ee ee oe for clinical Practices, and enhance more informe lineal : Ki © is growing consensus that knowledge of nursin hi to enhance the professional practices of all nurses BEET pete Research is a fundamental essential of nursing research includés identific tion, and control of facts. Therefore, 13 Lect erprtbica tent nntsingSeecaeh ore ploration, explanation, predic- Develop, refine, and extend the scientific b: so Rae eset vale pening fate, édiication, and ne seventies base of knowledge, which is required for quality Enhance the body of professional knowledge in nursing. Provide foundation for EBN practices. ? Help in expansion of knowledge, which is essential for continued growth of nursing profession. Enhance their professional identity as research is an essential component of any profession. Define the parameters of nursing, which will help nurses to identify boundaries of nursing profession. Refine and eliminate old knowledge so that it helps in elimination of nursing actions that have no effect on the achievement of desired client outcomes. Identify nursing care practices that make a difference in health care status of individuals and are cost-effective. Enhance accuracy of different nursing educational and administrative techniques. Develop and refine nursing theories and principles. Solve the problems or answer the questions related to nursing practices, nursing educa- tion, and nursing administration. IMPORTANCE AND SIGNIFICANCE OF NURSING RESEARCH nursing, It provides the power to nurses to be profes- te nursing knowledge for providing effective patient ration. Nursing research promotes evidence-based ig profession, provides accountability for nursing ‘fective care. There are several arguments that g research. Some of the facts that prove the as follows: Research must be an integral part of sional and develop, define, and refin care, nursing education, and administra| practice (EBP), ensures credibility of nursin Practices, and enables availability of cost-ell slate the importance and significance of a importance or significance of nursing researc are _. ation of nursing knowledge is essential for continued development a aeidop or refine this knowledge by the help of nursing research. ted to adopt a research-based or EBP, using research find- actions, and interactions with patients, patients’ family, * The development and ut inpatient care; nurses can * Nurses are increasingly exPec ings to guide their decisions,14 and community, Res arch is the only way that can provide nurs: ances on which they can build their EBN practices. © With a fast-developing world, nurses are realizing # actions and decisions on evidences indicating that the actions are cl cost-effective, and result in positive patient outcome. This can research conducted in the nursing discipline. © Another major reason for which nurses must get invo ment in medical science and technology; to keep pace wit conduct research to learn about efficacy of particular tecl patient outcome. * Nursing research is essential for nurses to understand the v: profession. Pah * Research enables nurses to study characteristics of particular nursing ce aeiget about which little is known, explain the phenomena that must be considered in planning nursing care, predict the probable outcome, ‘and initiate activities to promote desired patient behaviour. : +» Nurses need to get involved in research because the cost of care is increasing day by day. Therefore, they nwwst find solution for cost-effective care through research. + Research also helps nurses to eliminate nursing actions that do not achieve desired care outcome for patients. Furthermore, nursing research findings may help nurses to identify the practices that improve health care outcome of patients and remain cost-effective. -hand experi- es fi he need to base specific nursing inically appropriate, achieved through ved in research is rapid advance. this advancement, nurses must Jhnology in reference to positive aried dimensions of their To summarize, the basic importance of nursing research is that it helps in identifying and describing a phenomenon in the nursing profession, exploring and explaining the facts re- ated to this phenomenon and their relationship; and predicting its occurrence. Therefore, in a nutshell, research helps to * build and expand the body of nursing knowledge, * validate and refine the existing nursing practice, and « make health care efficient and cost-effective. HISTORICAL EVOLUTION OF NURSING RESEARCH Research on nursing practices began slowh i : ly, but since 19: i Currently, lot of attention is being paid to research on nursing uke seating rapidly in the years to come, and will have its implicatia sing, which it seems will continue nurse educators, as well as practitioners, ns and impact on nurse administrators, Understanding of how historical issues influenced current and future developments. If ‘ . analysed isto into the past, leading i Properly, historical kn ide insi see ret ning scat of preset and futuefsses rnuaes testa es enables one to better understand the connen Reviewing the histo Sa ee current status and project the modern health care provides a basis forHISTORICAL EVOLUTION OF NURSING RESEARCH 15 records of observations about the effects of nursing actions. During 1970s and 1980s, numer- ous studies were conducted that focused on clinical practice. Thereafter, the conduct of clinical research continued to be a major focus of the 1990s, with the intent of developing research-based practices and EBP. Contribution of Florence Nightingale (1820-1910) Florence Nightingale was one of the founders of professional nursing and is considered as the first nurse researcher. She understood the importance of scientific methods in nursing health care. During the Crimean War, she kept a meticulous record and statistics of mortality rates among the sick and the wounded. Nightingale initiated nursing research nearly 150 years ago. Her notes on nursing (1859) describe her initial research activities, which focused on the importance of healthy environment in promoting patients’ physical and mental well-being. She mostly carried out her data collection and statistical analysis during the Crimean War. She gath- cred data on soldier morbidity and mortality. Her research enabled her to instigate at- titudinal, organizational, and social change. Research evolved slowly in nursing from investigations of Nightingale in the nineteenth century to the studies of nursing educa- tion in the 1930s and 1940s and the study of nurses and nursing role in the 1950s and 1960s. Major Milestones of Nursing Research in Western Countries 1950; There was an increase in federal funding for research in nursing. American Nurses Foundation was devoted exclusively to the promotion of research in nursing. 4952: For the first time, there was publication of nursing research. 4953: The Institute of Research and Service in Nursing Education was launched at Colombia University. 1954: PhD programme was introduced in nursing education. 1955: American Nurses Association (ANA) established American Nurses Foundation as an independ- ent organization for the purpose of development of nursing research by conducting and supporting research projects. 1957: A department of nursing research was established at Walter Reed Army Institute. 1960: The 1960s brought reordering of nursing research. The focus was to target practice-oriented research to improve the quality of patient care. 1965: ‘The ANA took an official position in educational preparation of licensed nurses in which the need for research in nursing and for educating nurse researchers was recognized. 1970: A content analysis of articles published in nursing research from 1970 to 1975 showed a shift from research in nursing being conducted by a large group of members of other disciplines, especially social sciences which served as the basis for much of what nurses do in precdes today. 1976; ‘The ANA Commission on Nursing Research published guidelines for the academic preparatio of nurses in participation in research and its utilization, Pere1. FOUNDATION UF nusens 16 National Centre for Nursing Research (NCNR) was established at National Ins jationa (NIH) under the Health Research Extension Act, 1985. 1990: The 1990s brought the promise of reducing the gap betw tion Henlthy People 2000 in 1992 by the US Department o! national health agenda for the future. stitute of Health rch. The publica- Services laid the 1986: tice and resea? een prac an f Health and Hum: onal Institute for Nursing Research i i Nati ‘ 41993: National Centre for Nursing Research was renamed uy SS Messe (NINR). The Cochrane Collaboration was ctablished. In addition, Journal of Nursing ments started being published. toot: The journal Qualitative Research started being published. : . i was established in Australia. an international EBP collaboration, lation was establishe' (AHCPR) was renames 3995: The Joanna Biggs Institute, 1997: Canadian Health Services Research Found: 1999: US Agency for Health Care Policy and Research care Research and Quality (AHRQ). NINR issued funding priorities for 2000-2004; Canadian Institute of Health Research was launch started being published. 2004: The journal Worldviews on Evidence 2005: Sigma Theta Tau International issued a position paper on nursing reseal porated priorities from nursing organizations internationally. 4 with federal funding. ‘d as Agency for Health- eded US$100 million. The annual funding exce : logical Research for Nursing 2000: ed, The journal Biol Based Nursing started being published. rch priorities that incor- Major Milestones of Nursing Research in India Research related to nursing in India has its roots in the philosophy of Florence Nightingale, which stated that the profession is committed to the task of enlarging professional bod; of knowledge through systemic approach to solve problems in nursing. The statistics pele unsanitary conditions in the Indian Army prepared by Florence Nightingale may be starti : point of mirsing research in India, Afterwards, many developments have eens aris including the emergence of associations, growth of educational instituti Se eae prominent educators and administrators to directly or indizectly ad honey anid Stott of come of the main historical milestones that influenced the d Vs opt scien ine appioacties: in India are as follows: evelopment of nursing research 4946: Bhore Committee (1943) submitted a report i eport i improvement of various aspects of iting ines “nieing working conditions, nursing services in beth hospital, higher education to abroad, etc, ae 41953: Ms Edith Buchanan, Vice Principal, Raj Delhi, was the first nurse from India we wl endations were made for the He fing education, nursing research, Is a i t nd community, sending nurses for programme, a World Health : Organization son Ne egret Ca Pncp, (WHO) fellowship ouncil of Nurses (1 “rocllege of Nursing, in India. ICN) meet in France to Present a pa New Delhi, per on the seats, led International nursing resear ch.HISTORICAL EVOLUTION OF NURSING RESEARCH 17 ago: * First two year master degree programme in nursing was started by RAK College of Nursing, New Delhi, which included nursing research as a full subject with a thesis work on nursing topics. + Nursing research commenced on an all-India basis along with a master's programme in nurs- ing in an intensive manner, although nurse leaders had been already participating in research at various levels. + Clinical studies were even being carried out on short-term basis by the beginning-level post- graduate nursing students. 496s: A study of health services was carried out in connection with the revision of syllabus of General Nursing and Midwifery by the Indian Nursing Council in 1963. The study provided valuable insights into the trends in the health services and implications for nursing. Dr Marie Ferguson, a public health nurse who joined RAK College of Nursing, New Delhi, was able to create greater appreciation and understanding and value of the research in nursing for nursing practices, administration, and education, With senior nursing leaders of the country, she conducted a research study titled Activity Study to Define Nursing and Non-Nursing Functions of ‘Nurses in Selected Health Institutes of India. Trained Nurses Association of India (TNA) established a research section under the guidance of Chairwoman Ms Margareta Craig. TNAI conducted Nurses’ Time- Utilization Study with assistance from ‘Ms Anna Gupta, Principal, RAK College of Nursing, under supervision of Dr Sulochana Krishnan. TNAI conducted a study on the socioeconomic status of nurses in India. Dr Marie Farrell and Dr Aparna Bhaduri of RAK College of Nursing, New Delhi conducted semi- nars on nursing research for educationists at Delhi, Mussoorie (Uttarakhand) and Yercaud (Tamil Nadu) to strengthen the nursing research in India. Dr Farrell and Dr Bhaduri’s book Health Research: A Community-Based Approach was by the World Health Organization (WHO). a national conference titled Nursing Research in India: Prospect and Retrospect was as the first conference in India related to nursing research, and was held at Bangalore. Some of the recommendations of the participants of the confer 1964: 1966: 1971: 1976: 1981: published 11932: During October, organized, which w: College of Nursing, ence were as follows: « Each college of nursing should have a research cell. + ‘The faculty at nursing colleges should encourage students and provide them time for con- ducting research. * Colleges of nursing should fo: * Central and state governments an‘ their budget. * Opportunities should be provi earn about nursing research. Efforts should be taken to establish collaborative activities in the area of research and scholastic interactions with the nursing colleges in other countries. 1984: » A nursing research workshop was conducted titled Teaching Nursing Research to Nursing Col- lege Teachers at Bangalore, which was sponsored by the University Grants Commission. This workshop was open t0 all the teachers of all the nursing colleges in India. «A workshop was conducted on ‘Nursing process’ by Dr Marie Farrell at Leelabai Thackersey College of Nursing, SNDT Women University, Mumbai, which was sponsored by the WHO. ister research attitude among nursing students. \d private organizations should include nursing research in ded for faculty to visit foreign countries on short-term basis to1, FOUNDATION OF NURSING RESEARCH 18 1986: 1998; 2002: 2004; 2005: 2005: 2007: 2009: 2009: ety of India (NRSI) was established to promote research + The Nursing Research Soci president, and Mr within and related to nursing. Dr (Mrs) Inderjit Walia was founds aoa Uina Handa was its first secretary. This association continues to orga! r ry year. : thor ihe fist sie MPhil programme in nursing started at RAK College of Nursing ‘versity of Delhi, New Delhi. ; y pean of nursing research process was introduced in BSc Nursing curriculum by Indian Nursing Council (INC). All colleges of nursing 3 aa have a uniform nursing research course ie be taught at undergraduate and postgraduate levels developed by Indian Nursing Council. : PhD in Nursing was for the first time started in College of Nursing, PGIMER, Punjab University, Chandigarh; however, it was later discontinued because of unavoidable circumstances. Later in south India, some private institutions, such as Manipal College of Nursing, Manipal and Shri Ramchandran College of Nursing, Chennai, started PhD Nursing programmes. Nursing Research Interest Section was organized under the chairmanship of Mr R. Rajarathnam (Senior Nursing Tutor—NIMHANS). Recently revised syllabus of Indian Nursing Council for General Nursing and Midwifery Course (revised, 2002) and Post-Basic BSc Nursing (revised, 2005) has included nursing research as a full subject. Publication of Nightingale Nursing Times was started by Jain & Co., Noida, Uttar Pradesh. Publication of an exclusive research-based journal titled Nursing and Midwifery Research Journal was started at National Institute of Nursing Education, PGIMER, Chandigarh under the editorship of Dr Indarjit Walia, an eminent nursing researcher and educationist of * north India. National Consortium PhD Nursing has been constituted by Indian Nursing Council under the leadership ofa is Dileep Kumar, President, INC, New Delhi, to promote research activities in various fields of nursing in collaboration with Raji i Unit i ii i velots Helos asin ian Rajiv Gandhi University of Health Sciences, University of Health Sciences, Bangalore. WH designated as study centres; these are College of Nursin of Nursing, New Delhi; CMC College of Nursing, Vello: Government College of Nursing, Thiruvananthapura Hyderabad. These centres are co nected i education. a 8, NIMHANS, Bangalore; RAK College ei CMC College of Nursing, Ludhiana: im and Government College of Nursing, ‘o-conferencing facilities to impart the Nursing Research Society of Research Society of India at Coll 23 February 2007 under the editorship of Dr Tapti Bhattacharj ec. Central Institute of Nursi i ing and Research Trained Nurses Associati ch (CIN) was brought in exi tion of India i 7 ight in existence uy, if Indira Gandhi Natio, ia in New Delhi, inder control o nal Open Universi India has launched its official i Jour et Official i i = © Official journal titled Journa) of Nursing ‘Yapeeth Deemed University, Pune, onCHARACTERISTICS OF GOOD RESEARCH 19 govt: Publication of several nursing scholarly journals started in India, such as Kerala Nursing Forum, Indian Journal of Nursing Studies, Trends in Nursing Administration and Education, Indian Journal of Holistic Nursing, Indian Journal of Continuing Nursing Education, The Nurse, The Journal of Nursing Trendz, Prism’s Nursing Practice, The Journal of Nursing Research, Interna- tional Journal of Nursing Education, Indian Journal of Psychiatric Nursing, Baba Farid Univer- sity Journal of Nursing Sciences, International Journal of Nursing Care, etc. Thus increasing number of nurses started publishing their research work in these journals, and these journals helped nurses to disseminate the research evidences generated by them. go: * Nursing Research Society of India has started an initiative to create database of thesis ab- stracts for the nursing research conducted by the nurses during their postgraduate and doc- toral level nursing education. + Several private universities started offering the PAD degree in nursing through distance mode in India; a trend is observed that many nurse educators and few nursing administrators are opting to join the PhD degree in nursing in these private universities, but quality of schol- arly research done by these doctoral level nursing research scholars remains a matter of concern because of poor research infrastructure, experienced /competent faculty for guidance and other desired resources with these private universities, 2013: Ministry of Health and Family Welfare, Government of India, constituted an Expert Advisory Committee of Nursing Education and Research to work and provide recommendation on start- ing the Doctoral Nursing Programmes in addition to undergraduate and postgraduate nursing programmes in new six AIIMS started by the government of India at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, and Rishikesh. Nursing research continues to develop at a rapid pace and will undoubtedly flourish in the twenty-first century, Broadly speaking, the priority for nursing research in the future will be the promotion of excellence in nursing practices. oe varniterice OF GOOD erg cap. BAUS FRAUD cco See Sa Research employs scientific methods. Good research is systematic, logical, empirical, and also replicable. However, one expects that a good research must satisfy the following criteria: * Orderly and systematic process: A research can only be considered good if itis conducted * inanorderly and systematic way, because this is the most important criterion for a scien- tific research process. : ; : * Based on current professional issues Resolving current issues of any discipline is one of the fundamental purposes of any search. Therefore, a good research must be based on the current professional issues, s0 that a particular discipline can be up to date with solu- tions to professional concerns. * Begin with clearly defined purposes: A research can only be conducted in effective man- ner if it is started with clearly defined purposes. However, in absence of clarity about objectives, research may not yield very good results. a * Emphasize tg develop, refine, and expand professional knowledge: The main purpose of the |Research is to develop the new knowledge or refine the existing professional knowledge, Ever- |. &panding professional body of knowledge is the most important need of any profession, There- fete, good research is always directed towatds expansion of professional body of knowledge.20 1. FOUNDATION OF NURSING RESEARCH Directed towards development or testing theories: Theory ina discipline. Therefore, only systematic process of equity ible to.develop or test a theory: - ional problems j Finding ‘solution ota problem: Finding answer or solution to Peay aneae another important purpose of a research. Therefore, esa fessional problems towards finding an answer or solution for the pertinent emerging iE oe of the research i Dedicated to develop empirical evidence: Another important ie ee ofessional practices to generate empirical evidences, which can be used to mp 6 ose: Therefore, a good research always strives to develop empitica’ ct dee ducted by colk Strive to collect first-hand information/data: ‘Asuccessful researc h is co vieevlows lec. tion of data directly from subjects by different methods like questioning, S, Or observation. ‘An objective and logical process: Rese means or in haphazard manner will neve research emphasizes on objective and logical Generate findings to refine and improve pro! considered successfully conducted until and unl improvement in professional practices as per the need of time. Use of appropriate methodology: Selection of a methodology in any research depends on several factors, because each variable and research has unique features. Therefore, a good research always employs the most appropriate and suitable methodology. Conducted on representative sample: Generalization of research findings is only possible if study is conducted ona sample which has characteristics similar to the population of the study. Therefore, a good research is conducted on a representative sample. Conducted through appropriate use of methods and tools of data collection: Based on the nature of phenomenon and subjects under study, methods and tools of data collection will be different, Therefore, only the most appropriate and suitable methods and tools of data Se es snethed! only be measured through observation Use of valid and reliable data collection tools: Evi ; eee Vi Sncliced iubicktejatier etl tat rites ne ‘Therefore, a good research always depends on the valid ehva land reliable research tools Carefully recorded and reported: A research can onl eb reliability of research tools. fadration i carefully Seconded and reported because in sbciea eee e in absence of careful recoding and reporting, the evidences generated durin; ‘ BES ‘ \g tesearch may bi i generate quality empirical evidences, itis essential to carry oat ore re enezetore, 0 very carefully, carry out recording and reporting Adequately and i asi Heat irreraley analysed research: A research activity is i and accepted meth: equately and appropriately ang baci te : ne ds ofdnta ate ately analysed using standardized ly cartied out activity: Research, eyes y: Research cannot be carri i hee aoe pene and endurance Senn a ae tanec g00d research activity needs exper tio and courage: is neal Ceres ers. In absence of these wtbae ce Interest, motivation, ‘and ¢ oo cantoi be imagined Ben les among researchers, accom i re eee : aa 'plishment of a good research @ ood researcher, development and testing is , a good research can make j lected through subjective arch information CO) sults. Therefore, a good lead to satisfactory te research process. fessional practices: ‘A research cannot be less it contributes towards refinement and