Principles of Nursing Research - Lecture 2 PDF

Principles of Research and Evidence- Based Practice NUR 341 Lecture 2 Nursing Research Process  Prepared by Name of Course Coordinator and all Team Members Associate Professor/Dr: Sally M.Farghaly (Course Coordinator) Noha Hassan (Team Me...

Principles of Research and Evidence- Based Practice NUR 341 Lecture 2 Nursing Research Process  Prepared by Name of Course Coordinator and all Team Members Associate Professor/Dr: Sally M.Farghaly (Course Coordinator) Noha Hassan (Team Member) Mona Saeed (Team Member) College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 3 Bartlett Learning.  OBJECTIVES: At the end of this lecture, the student will be able to: -Discuss the roles of nurses in research. -Recognize the basic research terminology. -Discuss the major steps in the research process. 1. Phase (1): The Conceptual phase. 2. Phase (2): The design and planning phase. 3. Phase (3): The empirical phase. 4. Phase (4): The analytic phase. 5. Phase (5): The dissemination phase.  Roles of Nurses in Research 1. Principle investigator (Researcher or Investigator or Scientist)(PI) 2. Member of a research team. 3. Patient advocate during studies. 4. Identifier of researchable problems. 5. Evaluator of research findings. 6. User of research findings. 7. Subject / participant in studies. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 5 Bartlett Learning. - A scientific study or investigation or research project is undertaken by one or more researcher or investigator or scientist. - When a study is undertaken by a research team, the main person directing the investigation is referred to as the principal investigator (PI) or project director. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 6 Bartlett Learning. - A variables is a characteristic or quality that takes on different values; that is, a variables is something that varies from one person or object to another (marital status, age, gender, weight, height, BP, T). College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 7 Bartlett Learning.  ❑ Operational definitions: before a study progresses, the researcher usually clarifies and defines the variables under investigation. ❑ The researcher should specify how the variables will be observed and measured in the actual researcher situation. ❑ For example: Weight: the heaviness or lightness of an object in terms of pounds (rather than grams). College of Nursing, PNU 8 Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  - Data: the actual values of the study variables constitute the data for a research project. - In quantitative research, those values are numbers. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 9 Bartlett Learning.  - Relationships: Researchers focus on the relationship between the independent and dependent variables. - When the independent variables causes the occurrence, manifestations, or alteration of the dependent variables, a cause-and-effect relationship is said to exist. - Variables that are not causally related can be linked by a functional relationship (age and education). College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 10 Bartlett Learning.  Basic Research Terminology Definition Term Person contributing information Subject, Study participant, Respondent, Informant. Person undertaking the study Researcher, investigator, scientist. That which is being investigated Variables, concepts, constructs, phenomena Presumed cause is independent variables, presumed effect is dependent variable or outcome variables. System of organizing concepts Theoretical or conceptual framework Information gathered Data Connections between concepts Relationships.  Hypotheses: - A hypothesis is a statement of the researcher's expectations concerning relationships between the variables under investigation - It is a prediction of expected outcomes; it states the relationships that the researcher expects to find as a result of the study. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & 12 Bartlett Learning. Phases of Nursing Research 1. Conceptual Phase 2. The Design And Planning Phase 3. The Empirical Phase 4. The Analytic Phase 5. The Dissemination Phase College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. 1- CONCEPTUAL PHASE 1-ASK THE BURNING CLINICAL QUESTION IN PICOT FORMAT Patient /population Intervention or issue of interest Comparison intervention Outcome Time frame :time needed for the intervention to achieve the outcome or the time in the course of the disease/symptom that the intervention is applied Example: “In teenagers (patient population), how does cognitive- behavioral skills building (intervention) compared with yoga (comparison) affect anxiety (outcome) after 6 weeks of treatment (time frame)?” College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Types of Questions to Develop Prior to Beginning A Literature Search 1- Background questions Asks for general information about a clinical issue Usually has two components: o 1. The starting place of the question (e.g., what, where, when, why, and how) o 2. The outcome of interest Broader in scope than a foreground (PICOT) question Example: “How does the acetaminophen work to affect fever?” College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. Types of Questions to Develop Prior to Beginning A Literature Search— (Cont.) 2- Foreground questions (PICOT format) Asks for specific scientific evidence about diagnosing, treating, or educating patients The focus is on specific knowledge Use of PICOT format is recommended for a focused literature search Example: “In children aged 3 to 8 years, how does acetaminophen compare with profen in lowering a fever?” College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Types of Questions to Develop Prior to Beginning A Literature Search— (Cont.) Types of foreground questions Intervention questions (What intervention most effectively leads to an outcome?) Prognosis/prediction questions (What indicators are most predictive of an outcome?) Diagnosis questions (What test most accurately diagnoses an outcome?) Etiology questions (To what extent is a factor associated with an outcome?) Meaning questions (How does an experience influence an outcome?) College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  QUESTION Which of the following components of a PICOT question is absent from the following clinical question? “Among patients with dementia, how does the use of reorientation therapy compared with regular, supervised mobility affect patient agitation?” a. P (Population) b. I (Intervention) c. O (Outcome) d. T (Time) College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  ANSWER d. T (Time) Rationale: This question specifies the patient population (patients with dementia), the intervention (reorientation therapy), the comparison (regular, supervised mobility), and the relevant outcome (patient agitation), but does not provide the time frame for an expected outcome. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  CONCEPTUAL PHASE 2- Search for and Collect The Most Relevant Best Evidence—hierarchy of Evidence  CONCEPTUAL PHASE 3 FORMULATING AND DELIMITING THE PROBLEM o Topic o Research Problem o Problem statement – articulates the problem to be addressed and indicates the need for a study o Research Questions – are the specific queries researchers want to answer in addressing the research problem o Research Hypothesis – predictions that are tested empirically oNull hypothesis oResearch or alternative hypothesis o Significance of the problem – research problem should have the potential of contributing meaningfully to the nursing knowledge College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Term Example Topic Side effects of Chemotherapy Nausea and vomiting are common side effects among patients on chemo; interventions have been moderately Research Problem successful. New interventions that can reduce or prevent these side effects need to be identified Purpose is to test an intervention to reduce chemotherapy- induced side effects – specifically to compare the Statement of purpose effectiveness of patient-controlled and nurse-administered antiemetic therapy What is the relative effectiveness of patient-controlled antiemetic therapy versus nurse-controlled antiemetic Research question therapy with regard to (a) medication consumption, and (b) control of nausea and vomiting in patients on chemotherapy? There is no difference on the effectiveness between patient-controlled and nurse-controlled antiemetic therapy Hypothesis with regard to medication consumption and control of nausea and vomiting of patients on chemotherapy. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  CONCEPTUAL PHASE Before starting your research thinks about the following factors: o Researchability of the Problem o Time and timing o Availability of study participants o Facilities and equipment o Money o Experience and interest of the researcher College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  CONCEPTUAL PHASE 4 REVIEWING THE LITERATURE Search for and collect the most relevant best evidence Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis) Done to familiarize researchers with the knowledge base PURPOSES: Orient of what is known and not known regarding the topic Replication of study Identifications of relevant theoretical and conceptual framework Assistance in interpreting study findings and developing implications and recommendations College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  CONCEPTUAL PHASE SOURCES OF LITERATURE PRIMARY SOURCES  Research reports/studies SECONDARY SOURCES  Books  Literature review summaries College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  CONCEPTUAL PHASE 5- Determining If Evidence Should Be Used To Make A Practice Change Once an environment conducive to EBP is established, it needs to be remembered that the confidence to make an evidence-based change comes from a combination of: Level of the evidence + Quality of evidence = Strength of evidence (confidence) (position of evidence in (validity + reliability + hierarchy) applicability) College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  CONCEPTUAL PHASE 6- Critically Appraise The Evidence Critical appraisal of external evidence includes three areas of evaluation: 1.Are the results of the study valid? (Validity) Did the researchers conduct the study using the best research design and methods possible? 2. What are the results? (Reliability) In quantitative research Did the intervention work, and if so, how large was the effect? Can the results be generalized? In qualitative research Does the research approach fit the purpose of the study? College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Critically Appraise The Evidence 3. Will the results help me in caring for my patients? (Applicability) Are the subjects in the study similar to the patients for whom I care? Are the benefits greater than the risks of treatment? Is the treatment feasible to implement in my practice setting? Would my patients readily accept the treatment and do they have the resources needed? College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. 2-The Design and Planning Phase 1. Selecting a research design 2. Identifying the population to be studied 3. Sampling plan 4. Methods to measure research variables 5. Finalizing the research study College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  1-RESEARCH DESIGN selection of research design is based on: ▪Research aim ▪Time Frame ▪Control over independent variable ▪Measurement of independent and dependent variables College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Time Frame DESIGN FEATURES EXAMPLE CROSS-SECTIONAL Data are collected at Mindell and Jacobson one point in time (2000) assessed sleep Practical, easy to do, patterns and the economical prevalence of sleep disorders during pregnancy. They compared women who were at 4 points in pregnancy: 8-12wks, 18-22wks, 25-28wks, 35-38wks. They concluded that sleep disturbance is common in late pregnancy. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Time Frame DESIGN FEATURES LONGITUDINAL Data are collected at two or more points in time over an extended period TREND STUDIES Investigations in which samples from a population are studied over time Different samples are selected but drawn from the same population Based on surveys College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. Control Over Independent Variable DESIGN FEATURES EXPERIMENTAL Manipulation of independent variable Control group randomization QUASI -EXPERIMENTAL Manipulation of independent variable No control group No randomization NONEXPERIMENTAL No manipulation of independent variable College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Is there an intervention? No Yes NONEXPERIMENTAL Is there randomization? No Yes QUASI-EXPERIMENTAL EXPERIMENTAL College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Measurement of Independent and Dependent Variables DESIGN FEATURES EXAMPLE RETROSPECTIVE Study begins with Heitkemper, et. al. dependent variable and (2001), used a looks backward for cause Retrospective design in their study of factors contributing to the onset of irritable bowel syndrome. They compared samples of women with and without IBS in terms of their history of sexual and physical abuse and found that abusive experiences were more prevalent among women College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Measurement of Independent and Dependent Variables DESIGN FEATURE EXAMPLE PROSPECTIVE Study begins with Brook, et. al. (2000) independent variable conducted a and looks forward for prospective study to the effect examine clinical and cost outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. Early tracheostomy was found to be associated with shorter lengths of stay College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. THE DESIGN AND PLANNING PHASE 2-IDENTIFYING THE POPULATION TO BE STUDIED POPULATION – aggregate or totality of those conforming to a set of specifications.  Nurses  Students  Children  Etc. College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  The Design And Planning Phase 3-DESIGNING THE SAMPLING PLAN SAMPLE – Subset of A Population  Sampling Techniques:  Probability Sampling  Systematic Sampling  Nonprobability Sampling:-  Purposive/Judgmental Sampling  Snow Ball Technique  Convenience/Accidental Sampling College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. THE DESIGN AND PLANNING PHASE 4-METHODS TO MEASURE RESEARCH VARIABLES Different methods of data collection  Biophysiologic measurements  Self-reports  Observation  Use of a research instrument  Questionnaires  Survey forms College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. THE DESIGN AND PLANNING PHASE 5-FINALIZING THE RESEARCH PLAN Pretesting of questionnaires Conducting a Pilot study College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. 3- EMPIRICAL PHASE Intervention Data collection College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. 4-THE ANALYTIC PHASE DATAANALYSIS  Data coding and Statistical analysis DATA INTERPRETATION – is the process of making sense of the results and examining their implications CONCLUSION AND RECOMMENDATION College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. 5-DISSEMINATION PHASE it provide answers to the questions in the 1 st phase of the project RESEARCH REPORT/ communicating the findings  Research Abstract  Research published in journals  Term papers, theses, dissertations UTILIZATION OF FINDINGS  Application to nursing practice and nursing education College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. RESEARCH AND ASSOCIATED TERMS LETS PRACTICE THEN… 1. Formulate your research question using PICOT 2. After selecting each group topic and fixing it in the research proposal template (filter to 2 topics among each research team) College of Nursing, PNU Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.  Does hand washing by healthcare providers reduce transmission of hospital-acquired infections? The question first into PICO elements P-Health care providers I-Hand washing C-Alternative to hand washing such as wearing a mask or gloves O-reducing infection Example 2: Do turning bedridden patients reduce the risk of pressure ulcers than pressure mattresses? P-bedridden patients I-Turning a patient C-Pressure mattress O-Prevent pressure ulcers College of Nursing, PNU 46 Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning. 1. Formulating the problem 9. Finalizing and reviewing 2. Reviewing related literature the research plan. 3. Developing/utilizing a 10. Conducting pilot study theoretical framework and making revisions 4. Formulating hypotheses 11. Collecting the data 5. Selecting a research design 12. Organizing the data for 6. Specifying the population analysis 7. Specifying methods to 13. Analyzing the data collect the research data. 14. Interpreting the results 8. Designing the sampling 15. Communicating the plan. findings. 16. Utilizing the findings. College of Nursing, PNU 47 Boswell, C., & Cannon, S. (2022). Introduction to nursing research: Incorporating evidence-based practice. Jones & Bartlett Learning.