Nursing Research PDF

INTRODUCTION - Research is critical in nursing because it leads to new discoveries and can change peoples’ lives by improving health and wellbeing for patients and their families. - All research starts with an idea or question based on personal experiences. - Research shapes the world we live in by...

INTRODUCTION - Research is critical in nursing because it leads to new discoveries and can change peoples’ lives by improving health and wellbeing for patients and their families. - All research starts with an idea or question based on personal experiences. - Research shapes the world we live in by continually questioning and testing human knowledge and understanding. Definitions of research:- -It is systematic inquiry that uses disciplined methods to answer questions or solve problems. The ultimate goal of research is to develop, refine , and expand abase of Knowledge. -It's diligent systematic investigation to validate old knowledge and generate new knowledge. -It's an original and systematic investigation undertaken in order to increase and understand knowledge to establish facts and principles. Definitions of nursing research:- *It is systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practices, nursing education, and nursing administration *It is systematic inquiry that seeks to add new nursing knowledge to benefit patients, families and communities Goals for conducting nursing research 1. Improve nursing care. 2. Improve patient care outcomes. 3. Improve quality of life. 4. Define and expand the scope of nursing practices. Importance of nursing research Nurses increasingly are expected to adopt an evidence –based practice (EBP) which is broadly defined as the use of the best clinical evidence in making care decisions 1- Essential for continued improvement in patient care. 2-Using research findings to inform their decisions. 3-It helps in abroad array problem solving situation. 4-Develop scientific knowledge base for nursing knowledge and practice. 5-Develop and test nursing theories. 6-Understand nursing phenomena. 7-Provide a link between theory and practice. 8-Improve care outcomes by advancing nursing. Sources of Human knowledge Tradition. Authority. Clinical Experience and Trial and Error. Logical Reasoning. Scientific Research. Tradition Many questions are answered and problems solved based on inherited customs or tradition. Within each culture, certain “truths" are accepted as given. It is efficient as an information source (each individual is not required to begin anew in an attempt to understand the world or certain aspects of it. Tradition or custom also facilitates communication by providing a common foundation of accepted truth.  tradition poses some problems because many traditions have never been evaluated for their validity & may interfere with the ability to perceive alternatives Authority ◼ Authorities are people with specialized expertise—in every field. ◼ their expertise is based primarily on personal experience. ◼ Their knowledge often goes unchallenged. Clinical Experience and Trial and Error ◼ It based on observations an own experiences. ◼ It has limitations as a type of evidence. - Each individual’s experience is fairly restricted. -experience is that the same objective event is usually experienced or Perceived differently by two individuals. Logical Reasoning ◼ Logical Reasoning as a method of knowing combines experience ,our intellectual faculties and formal system of thought (Inductive reasoning & Deductive reasoning ) ◼ Inductive reasoning Is the process of developing generalizations from specific observations. ◼ Deductive reasoning Is the process of developing specific predictions from General principles. ◼ Both systems of reasoning are useful as a means of understanding and organizing phenomena. ◼ Reasoning may be an insufficient basis for evaluating accuracy.  Scientific Research It is the most complex method of acquiring knowledge that humans have developed. The scientific method combines important features of induction and deduction. Characteristic Of The Scientific Research 1. Order. 2. Control. 3. Experimental. 4. Generalization. Order :- The researcher moves in an orderly and systematic fashion from the definition of a problem through the design of the study and collection of information to the solution of the problem. Control:- Control involves imposing conditions on the research situation so that biases and confounding factors are minimized Experimental:- The term experimental refers to systematic and scientific approach to research in which the researcher manipulates one or more variables , and controls and measures any change in other variables. There are three types of variables, independent, dependent and intervening or controlled variables. Generalization :- ،، the degree to which research findings can be generalized important criteria for assessing the quality of research study ،،. Purpose of Nursing Research 1-To develop a scientifically based body of knowledge unique to nursing. 2-To answer questions. 3-To solve problems. 4-To improve the quality of care. 5-To advance nursing as a profession. Types of research 1- Quantitative research: A Formal, objective, systematic process for obtaining information. This research uses numbers as data 2-Qualitative research: Systematic subjective approach used to describe life experiences and give them meaning. This research uses words as data 3-Basic research : Scientific investigation that involves generation of knowledge for the pleasure of learning finding truth The findings of basic research are frequently not directly useful in practice but are the basis for applied research. 4- Applied research:- It is a scientific investigation conducted to answer a clinical question or solve practice related problem. It's conducted to refine and utilize the knowledge generated from basic research. Role of nurse in nursing research 1 -Participating in formal club in a practice setting. 2 -Attending research presentations at professional conferences. 3 -Assisting in the collection of research information. 4 -Assisting with the development of an idea for a clinical research project. 5-Utilizing research by incorporating research results into nursing practices. 6-Evaluating completed research for its possible use in practices. INTRODUCTION TO RESEARCH PROCESS: -Research comprises "creative work undertaken on a systematic basis in order to increase the stock of knowledge including knowledge of humans, culture and society, and the use of this stock of knowledge to devise new applications. -It used to confirm facts, reaffirm the results of previous work, solve new or existing problems, support or develop new theories. -A research project may also be an expansion on past work in the field. Definition of Research process Systematic process of gathering information for the purpose of initiating , modifying, or terminating particular investment ANOTHER DEFINITION: It is a step by step process involves- identifying, locating, assessing & analyzing the research question then developing and expressing your ideas in order to find answers and choosing the tasks and ways in which they are carried out 7 Steps of research process 1)Define and develop a topic 2)Identify types and extent of information needed 3)Access and/or collect the information needed 4)Critically evaluate information collected 5)Interpret and synthesize information 6)Communicate results 7)Use and cite information ethically and legally – avoid plagiarism 1- Define and develop a topic Student identifies a topic which: - meets the requirements of the assignment - is possible to complete given the available resources and services - adds to the knowledge base of the student, class, university, or scholarly discipline. -Develop and refine a thesis statement. 2. Identify types and extent of information needed - Student understands differences between types of information sources. - Student can identify the most appropriate information sources for topic. - Books, journal articles, newspapers, websites, videos, music, podcasts, blogs, interviews, radio shows, social networking sites, government documents, reports from non-profits, statistical data, experiments, 3. Access and/or collect the information needed - Student can locate background information on topic, and if necessary, modify research topic based on initial background information - Student can access information through a variety of sources including: a) Electronic databases b) journal articles and other information c ) Public websites -Student can collect primary data through a variety of sources including: - Surveys -Interviews -Experiments - Archival documents 4. Critically evaluate information collected Students evaluate the appropriateness of information for topic based on: Authority Bias and Objectivity Accuracy Coverage - Student recognizes the cultural, physical, or other context in which the information was created, and understands the impact of that context on interpreting the information 5- Interpret and synthesize information Student organizes and integrates information gathered during research with knowledge and skills transferred from prior experiences to support research topic. Student analyzes information and draws conclusions to support research topic. 6- Communicate results -Student chooses a medium and format appropriate to the topic and the intended audience. -Student communicates ideas, information, and conclusions clearly and with a style designed for the intended audience 7- Use and cite information ethically and legally – avoid plagiarism Student follows a standard documentation style guide (as mandated by instructor or discipline). Student cites all information and data appropriate Student understands and respects legal and ethical issues of information, plagiarism, and copyrightely. FACTORS AFFECTING RESEARCHER DECISION -Researcher beliefs -Researcher experience -Ethical consideration -Resources -Ethical issues. -Personal motivation. -Researcher qualifications. -Feasibility of study. -Time. -Cost. -Supplies, equipment. -Availability of subject. -Administrative support. PHASES OF RESEARCH PROCESS I. The conceptual phase.II. The design and planning phase III. Empirical phase IV. Analytic phase V. Disseminative phase I. PHASE OF CONCEPTION Phase of conception the first phase of original research. In this phase are created content and structure of the planned research. Creation of conception of new research project is structured process. It can be divided into 4 steps as follows: a)Formulation of research problem or research questions, set bounds of them, determine the purpose of the study b)Searching and review the literature relating to the regarding research problem and develop framework c)Development of the theoretical construction of the future research d)Creation of hypothesis which should be verified in future research II. Phase of design and planning phase: include.Selecting a research design.Identifying the population to be studied.Designing the sampling plan III.EMPIRICAL PHASE ✓ Collecting the data. ✓ Conducting the study & making revision. ✓ Preparing the data for analysis. IV.THE ANALYTIC PHASE - Statistical analysis tests -Interpreting the results V.DISSEMINATION PHASE -The job is not completed, however, until the researcher communicates the result of the study to others who may find it useful. -So, dissemination means process when results of the research are or published as presented. -final research report from research project -lectures and/or posters at the congresses and conferences papers in journals -using the result in clinical practice. *Communicating the findings *Utilizing the findings Definition of problem/question:- ❑A question raised for inquiry, consideration or solution. ❑A complex unsettled question  Definition of research problem/question: A research problem is a definite or clear expression (statement)about an area of concern, a condition to be improved upon, a difficulty to be eliminated, or troubling question that exists in literature, in theory or within existing practice that points to a need for meaningful understanding and deliberate. These problems consist of: ✓ Areas of concern. ✓ Conditions to be improved. ✓ Difficulties to be eliminated. ✓ Questions seeking answers. Factors to consider in Selecting a Research Problem:- Interest Expertise Data availability Relevance Ethics  Sources of research problems:- o Social and economic problems like (unemployment, crimes, female genital mutilation, divorce). o Theory. o Funding agencies. o Past researches and literature review. o Observation. o Personal interest and experience. o Previous studies. o Clarification of contradictory research results. Note: Remember the first responsibility is to formulate a problem that is carefully phrased and represents the single purpose of the total research.  Definition of Research Purpose:- The research purpose is a statement of "why" the study is being conducted, or the goal of the study. The goal of a study might be to identify or describe a concept or to explain or predict a situation or solution to a situation that indicates the type of study to be conducted. THREE PURPOSES OF RESEARCH:- 1. Exploration. 2. Description. 3. Explanation.  Definition of hypothesis:- A hypothesis is a specific, testable prediction. It describes in concrete terms what you expect will happen in a certain circumstance.  Purpose of Hypothesis:- Hypothesis is used to define the relationship between two variables & to find the answer to a question. The first variable is called the independent variable. This is the part of the study that can be changed and tested and be considered the cause of any changes in the outcome. The outcome is called the dependent variable. The hypothesis is testable & measurable because you will receive a score on your test performance & you can compare test scores received from when you did study and test scores received from when you did not study. A hypothesis should: ✓ Explain what you expect to happen ✓ Be clear and understandable ✓ Be testable ✓ Be measurable ✓ And contain an independent and dependent variable  Formulating a Hypothesis ❑ You have a question and now you need to turn it into a hypothesis. ❑ A hypothesis is an educated prediction that provides an explanation for an observed event. ❑ An observed event is a measurable result or condition. ❑ If you can't measure it, then you can't form a hypothesis about it because you can't confirm or reject it.  Introduction Nurses are always collecting information ( data ) from the patients. we collect data on blood pressure, age, weight, height, and laboratory values as part of our daily work. Data collection for practice purposes and data collected for research have several key differences. Data collection procedures in research must be objective and systematic. by objective, we mean that the data collected are free from the research's’ personal biases, beliefs, values, or attitudes. By systematic, we mean that the data are collected in a uniform, consistent, or standard way from each subject by everyone who is involved in the data collection process  Definition of Data Collection  Is the process of gathering and measuring information on targeted variables in an established systematic fashion, which then enables one to answer relevant questions and evaluate outcomes.  Data collection is the systematic approach to gathering and measuring information from a variety of sources to get a complete and accurate picture of an area of interest. Data Collection Methods  1- Observational Methods  2- Self –Report Methods A-Interviews B-Questionnaires C-scale  3- Physiological Measurement  4-Existing Data  1) Observational methods  Defined as is way of gathering data by watching behavior, events or noting physical characteristics in their natural setting  Is an important method for collecting data on how people behave under certain conditions To be scientific, observations must fulfill the following four conditions:  1- The observations undertaken are consistent with the study’s aims/objectives  2- There is a standardized and systematic plan for the observation and the recording of data  3- All of the observations are checked and controlled  4- The observations are related to scientific concepts and theories Types of observation 1-Naturalistic and controlled observation 2-Participant and non-participant observation 3-Structured and unstructured observation 4-Overt observation and Covert observation  1- Naturalistic and controlled observation  Naturalistic observation involves observing people in their natural environment without manipulating variables.  controlled observation involves observing people in a controlled environment where variables can be manipulated to create specific conditions. For example, naturalistic observation could involve observing people's behavior in a public park, while controlled observation could involve observing people's behavior in a laboratory setting.  2- Participant and non-participant observation  Participant observation happens when the observer becomes a part of the group being studied and actively participates in the activities being studied.  Non-participant observation involves observing from a distance without becoming a part of the group.  For example, participant observation could involve joining a group therapy session and taking notes on the interactions between group members, while non-participant observation could involve observing a public meeting from a distance and taking notes on the behavior of attendees.  3-Structured and unstructured observation  Structured observation refers to observing people in a structured setting with predetermined activities  Unstructured observation involves observing people without predetermined activities to observe.  For example, structured observation could involve observing children's behavior during a specific game, while unstructured observation could involve observing the behavior of patrons in a coffee shop.  4-Overt observation and Covert observation  Overt observation involves observing people with their knowledge and consent  covert observation involves observing people without their knowledge or consent.  For example, overt observation could involve observing people in a focus group discussion, while covert observation could involve observing people through hidden cameras in a retail store. Advantages of observation Disadvantages of observation More accurate insights Some data are not observable such as beliefs, motivation, and awareness Access to people in real life Time consuming Good for explaining for meaning and context Depend on the role of researcher Some data can only be observed ,such as Overt: may affect situation and validity of people's eye movements finding Remove biases, give the researcher more Covert: ethical principles contravened accurate data. Remove sampling errors  2- Self - Report Methods  Self report data collection methods require subjects to respond directly to either interview or structured questionnaire (often called paper-and pencil instruments)  Self –report methods are commonly used in nursing research and are most useful for collecting data on variables that can not be directly observed or measured by physiological instruments.  Some variables commonly measured by self report in nursing research studies include quality of life, satisfaction with nursing care, social support and pain,  The self-report instruments are interview schedule, questionnaires, and scales.  A) Interviewing  The collection of data by asking people questions and following up or probing their answers. 1-Face –to-Face interview Advantages:  1)Enable the researcher to establish the rapport with potential participant and therefore gain their cooperation  2)Yield the highest response rate in survey research  3)Allow the researcher to clarify the ambiguous answer and when appropriate Disadvantages:  1)Impractical when large sample are involved  2) Can be time consuming and expensive B-Telephone interview Advantages:  1)Less time consuming  2)Less expensive  3) Researcher has ready access to anyone who has landline telephone Disadvantages:  1) As face to face interview the response rate is not a high  2)The sample may be biased as only those people who have landline phone are contacted C-Computer Assist Personal Interviewing (CAPI)  Form of personal interviewing but instead of completing questionnaire, the interviewer bring along laptop or hand held computer to inter information directly into database Advantages:  1)Save time involved in processing the data  2) Save the interviewer from caring around hundreds of questionnaire Disadvantages:  1)Can be expensive to set up  2) Require the interviewer have computer and typing skills  2)Questionnaire:-  It Is a data collection tool in which written questions are presented that are to be answered by the respondents in written form  Questionnaire can take several forms as:- 1. Closed-ended questionnaire. For example:-  1. Gender Status? (a) Male (b) Female  2. Marital Status? (a) Married (b) un-married 2. Open-ended questionnaire. For Example:-  What do you know about poverty?  What are the types of poverty? Types of questionnaire 1) Hand Delivered Questionnaire also called direct questionnaire because the researcher directly distributes the questionnaire among the respondents. Advantages  The researchers have close contact with respondents.  Difficult questions are explained by the researcher to the respondents.  He explains the purpose of the study Disadvantages  It is more expensive and costly.  It more time consuming  2) Mailed Questionnaire  In that type the respondents are living in for-flung areas at a distance and the questionnaire is sent to them by post, they fill it and return back to the researcher or concerned department. A particular guideline or instructions list is attached to the questionnaire for the respondent's guidance Advantages  It is commonly used.  It is useful for the researcher.  It is very easy and simple.  It saves time and money Disadvantages  Lack of returns.  Research take time due to careless and laziness of the respondents.  Lack of skilled respondents.  Errors may occur due to misunderstanding of respondents 3-Scales  Scales are a form of self-report and are a more precise form of measuring a phenomena than questionnaires  Psychosocial variables such as pain, nausea etc., are commonly measured using scales.  the types of scales commonly used in nursing studies are rating scale, Likert scale, Sementic Differential scale (SD) and Visual Analogue Scale (VAS)  Example – Ordinal Scale (Rating Scale )  What is your experience level with computers? Advanced Intermediate Basic Novice Zero Likert scale Semantic Differential scale (SD)  Physiological Measurement  Physiological data collection involves the use of specialized equipment to determine the physical and biological status of subjects. such measures can be physical such as (weight or temperature), Chemical such as blood glucose level, Microbiological ,as with cultures Anatomical as in radiological examinations Advantage 1- Objective 2- Precise and sensitivity associated with this measures Disadvantage  Some instruments may be quite expensive to obtain and use  Physiological instruments often require specialized knowledge and training to be used accurately  The variable of interest may be changed for example, an individual’s blood pressure may increase just because a health care professional enters the room (termed white coat syndrome)  5-Existing data  Existing data can be collected for research purposes by extracting data from medical records, Care plan, hospital records, death certificate or databases using standardized procedures such as U.S census, national cancer data bas Advantage :  Data are already collected ,thus eliminating subject burden  Most data base contain large populations therefore sample size is rarely a problem and random sampling is possible  Use of available records has the potential to Save time and money Disadvantage  The institution may be refuse to allow researchers to have access to their records  the researcher has access only to those records that have survives Define critique Concise & brief: report has specific characteristics Characteristics of a research report: Any research report must be: Concise Brief: ▪ Saves the reader's time ▪ Forces the writer to refine his ideas Clear & easily expressed: ▪ Clarity ▪ Aid the reader to understand the points being made. Honest: ▪ Free from fraud ▪ Maintain the respect of the reader ▪ Accurate & error free. Complete & fully detailed: ▪ The reader can evaluate the study  Title It is the shortest description of the paper. It should be:- Typed in A capital letters of first letter of every words in the title If more than? Lines, These lines should be typed in a Form of inverted pyramid. Easy, concise & accurate language. It should be reflect the content of the study. Convey the central focus of the study. Reasonable length. Not more the 10: 15 ward & 100 letters. It should be contain the important variable in the study. Not contain abbreviation. Show the target group.  Abstract It is a brief summary of the contents of the research report It should be:- ⚫ Should be titled. ⚫ In past – tense. ⚫ Shouldn't contain abbreviations. ⚫ State the purpose & hypothesis & conclusion. ⚫ Indicate are search method ( approach – sample – instrument & presentation) ⚫ It should be summarizing the results. ⚫ It should be not vague or too detailed. ⚫ No references. ⚫ With suitable length. ⚫ One paragraph. ⚫ Don't contain steps.  Introduction ⚫ understand The magnitude Of The Problem ⚫ Appreciate the reason for research. ⚫ First letter is capital. ⚫ The introduction has every ward in the title. ⚫ It should be in an aim of the work. ⚫ It should be Considerable Length. ⚫ Understand if it is original study or replication of other study.  Review of literature ⚫ Was the literature review Specific to the purpose of the study? ⚫ Did the study include both Current & old information? ⚫ Is the literature review section is logically organized? ⚫ Does identify Similarities & differences between the present study & studies done by other researchers? ⚫ Does identify the weakness & short comings of the other studies? ⚫ Does the researcher have selected references? ⚫ Does the literature review is comprehensive a- Books, b- Magazines, c- Journals, d- Internet. ⚫ First letter capitalized.  Hypothesis ⚫ Is the hypothesis is testable & logical? ⚫ Is it directly related to the research problem? ⚫ Is it states a relationship between variables & if so, were the variables identified? ⚫ Is the hypothesis in such a form that it can be accepted or rejected? ⚫ Is it stated clearly or not ? ⚫ Was the hypothesis based on theory? If so what theory?  Research question If s study is developed on research question:- It should be:- ⚫ Clearly stated in an operational terms ⚫ Worthy of study  Methodology Time Setting Sample Tool of data collection Research design  Results A] Data analysis procedures:- - Are data analyzed by computer or by hand? - Does the report describe the coding procedures used? B] Statistical findings:- - Are the results clearly presented? - The analysis data will vary, depending on the approach use. - Does the author specifically name the statistical test applied along with the probability associated with significant value? - were the finding & the data interpreted correctly? - Is the statistical procedure the right one to answer the research question? - was the hypothesis accepted or rejected? - were their sufficient visual aids to make the finding more easily under stood? - were the tables set up correctly? - can the tables stand – alone or is it necessary to read the description of then to understand what they mean? - were there is consistency between the tables & the description of them? - Are there any difference between result presented in graphic form & result presented in the text of report? - Are the Findings clearly & logically organized? - Is the presentation of finding impartial & unbiased? (Honest) - Are the results suggestive to the conclusion?  Tables Presenting the data in concise & visual form. Importance:- 1. Way to economize on space. 2. Avoid repetitions statements. 3. Summarize the results.  Guide lines for table construction:- 1. They must have clear precise title. 2. Should be requiring title effort the part of readers to understand them. 3. They must not be over loaded data. 4. Avoid short table as table have 2 column & 2 rows. 5. Every table should be comprehensive without references. 6. All abbreviations & special symbols should be explained in notes the table. 7. Each table should refer to in the text (e.g. table2 patient who...) thus every table should be numbered. 1. Every table should have comment under it. 2. If there is a choice between what to put on the horizontal & vertical dimensions of the table keep in mind that it is easier for readers to compare numbers down a column then a cross row. Graphs: - easy & designed to attract reader's attention. Bar chart, Pie chart, Line graph  Discussion:- Include major finding, limitation of study, implications of the findings for nursing. Should be:- ⚫ Simple & containing facts. ⚫ Comment on results not repeats it (stating the possible reason for the result). ⚫ State is these results happen with others. ⚫ Discuss Positive & negative results of why? ⚫ Try to explain unexpected results. ⚫ Include the aim of study. ⚫ Mention study limitations. ⚫ Reflecting whether hypothesis supported. ⚫ Relate results to research question & aim of study. ⚫ Describe how your Findings can be used to improve patient Care. ⚫ What risks or benefits are involved for pt. if the research finding used in practice? ⚫ Is application of findings feasible in terms of time, effort & legal & ethical risks?  Conclusion ⚫ Supported by data. ⚫ Supported by the tables results. ⚫ Follow from purpose of study & research questions. ⚫ Conclusion should be modest. ⚫ Stated clearly & concisely.  Recommendation 1. Related to the Problem of study. 2. Suggest Further studies 3. Suggest Other hypothesis 4. Realistic & meaningful & limited  Literature reviews can serve a number of important functions in the research process and they also play a critical role for nurses seeking to develop an evidence- based practice.  Before any research can be started, literature reviews of previous studies and experiences related to the proposed investigations should be done.  Review of literature is defined as a broad, comprehensive in depth, systematic and critical review of publications and print materials. For Researchers,  Identifying a research problem and refining research questions and hypotheses.  Getting oriented to what is known and not known about a topic.  Identifying or developing new clinical interventions to test through research.  Identifying relevant theoretical or conceptual frameworks for a research problem.  Determining suitable designs and data collection methods for a study.  Gaining insights for interpreting study findings and developing implications.  Literature reviews can inspire new research ideas. For Non Researchers,  Acquiring knowledge on a topic (students, clinical nurses, administrators and policy-oriented nurses).  Evaluating current practices and making recommendations for change.  Developing or revising nursing curricula (faculty).  Developing evidence-based clinical protocols and interventions to improve clinical practice (clinical nurses, administrators, graduate students). Good literature review should satisfy the following criteria:  Objectives of literature review are met.  Quality studies that were relevant are included.  Study purpose, sample size, design and specific findings are presented.  The study strength and weakness are critiqued briefly.  Adequate primary sources are reviewed.  Sources are paraphrased and summarized rather than directly quoting the ideas.  There is logical flow of content.  Honesty of information and ethical considerations are considered. Relevant literature can be located through:  Electronic databases  Print resources A- Electronic Databases; are the bibliographical files that can be accessed by computer. One can do it by their own through online search or CD. Electronic databases which are useful for nurse researchers are: ❑ Clinical Database ❑ Combined Health Information Database (CHID) ❑ MEDLINE (Medical Literature Online) ❑ ERIC program B- Print Resources; can be searched manually. The print resources can be located by the use of print indexes and abstract journals. Print indexes include journals, periodicals, publications of professional organization and government documents. Sources of Literature Review: Primary Source  It is written by the person who originally responsible for the published ideas, developed a theory or conducted a research. Secondary Sources  It is the summary of content of primary source. The authors of the secondary source paraphrase and describe the study or studies of the original researcher.  The useful sources are: ❑ Journals ❑ Internet ❑ Books ❑ Guide to library ❑ Government reports ❑ Research reports Literature review is a systematic search for information, which follows the following steps: 1- Search for Sources  Identify the focus question, state the objectives of the study and try to conceptualize the question from a different viewpoint to get a broader concept. Ways to search literature can be: - Manual or - Using computer Manual Search:  It involves searching relevant sources by hand, e.g. catalog lists and indexes. Computer Search:  It provides citations in different databases and identifies sources relevant to a research topic.  Books and other holdings of library can be scanned electronically using online catalog systems.  Computer searches are comprehensive, affordable, accessible and easy to conduct. 2- Locate the Sources Locating sources involves the following steps as: - Organize the identified sources - Record references systematically 3- Review the Selected Literature ❑ Critically read the identified books and articles to pull together themes and issues that are associated. ❑ The kinds of information to be recorded are complete the research question or hypothesis, the theoretical framework used, research methods used and major findings and conclusions. 4- Synthesize the Reviewed Literature  A comprehensive synthesis of the literature is needed to identify and analyze the results from independent studies to determine what is known and not known in a particular subject area.  Synthesis involves clarification and paraphrasing the research report.  Paraphrasing help to combine and inter relate ideas from several studies to determine the current knowledge of a topic. 5- Organize the reviewed literature  Critical task in the literature review is organization of the gathered information.  The way of presentation of review should be logical, provide meaningful integration.  For example, to show the trends over time chronological order may be used,  To show relationship between the work of different researchers and references can be organized alphabetically by author name. 6- Write the literature review A literature review should include the current knowledge of a selected topic. The essential content of literature review is:  Introduction: There should be brief and interesting introduction.  Content: The content should include study's purpose, sample size, design and findings  Paraphrase the content in own words.  Always present findings in logical manner without distortion.  Summary: It should present concisely the research knowledge of the topic.  Steps of Literature Review:  1- Search for sources.  2- Locate the sources.  3- Review the selected literature.  4- Synthesize the reviewed literature.  5- Organize the reviewed literature.  6- Write the literature review. Introduction:  Data analysis is the process through which researcher manages the collected data to identify the key pattern or features that are important when answering or attempt to answer the research question. OR  Data analysis is a process for obtaining raw data and converting it into information useful for decision-making by users. Data is collected and analyzed to answer questions, test hypotheses or disprove theories. DEFINITIONS  Data: Observations those are not interpreted organized or structured (age, blood pressure, weight).  Information: Data that has been interpreted organized or structured to provide meaning to the data.  Knowledge: The synthesis of information to identify relationships that provide further insight to an issue or subject area. Cont ;  Analysis Breaking a whole into its separate components for individual examination.  Data analysis: Is a process of inspecting, cleaning, transforming, and modeling data with the goal of discovering useful information, suggesting conclusions, and supporting decision making.  OR Is the process of systematically applying statistical and/or logical techniques to describe, illustrate, condense, recap, and evaluate data. Purpose of data analysis:  To identify pattern or trends emerging from the data.  To ensure that these pattern or trends are both reliable and valid findings.  Is to obtain usable and useful information.  The analysis, regardless of whether the data is qualitative or quantitative, may:  Describe and summarize the data.  Identify relationships between variables.  Compare variables.  Identify the difference between variables.  Forecast outcomes. Process of data analysis: 1) Data requirements 2) Data collection 3) Data processing 4) Data cleaning 5) Exploratory data analysis 6) Modeling and algorithms 7) Data product 8) Communication  1) Data requirements  The data is necessary as inputs to the analysis are specified based upon the requirements of those directing the analysis or customers who will use the finished product of the analysis. 2) Data collection 3) Data processing Data initially obtained must be processed or organized for analysis. For instance, these may involve placing data into rows and columns in a table format (i.e., structured data) for further analysis, such as within a spreadsheet or statistical software. 4- Data cleaning  Once processed and organized, the data may be incomplete, contain duplicates, or contain errors. The need for data cleaning will arise from problems in the way that data is entered and stored.  Data cleaning is the process of preventing and correcting these errors.  Common tasks include record matching, identifying inaccuracy of data, overall quality of existing data, reduplication, and column segmentation.  Such data problems can also be identified through a variety of analytical techniques. 5- Exploratory data analysis  Once the data is cleaned, it can be analyzed. Analysts may apply a variety of techniques referred to as exploratory data analysis to begin understanding the messages contained in the data.  The process of exploration may result in additional data cleaning or additional requests for data, so these activities may be iterative in nature.  Descriptive statistics such as the average or median may be generated to help understand the data. 6- Modeling and algorithms Mathematical formulas or models called algorithms may be applied to the data to identify relationships among the variables, such as correlation or causation. 7- Data product A data product is a computer application that takes data inputs and generates outputs, feeding them back into the environment. It may be based on a model or algorithm 8-Communication Once the data is analyzed, it may be reported in many formats to the users of the analysis to support their requirements. Data visualization uses information such as tables and charts to help communicate key messages contained in the data. Tables are helpful to a user who might lookup specific numbers, while charts (e.g., bar charts or line charts) may help explain the quantitative messages contained in the data.  The principles of quantitative analysis 1. Finding is grouped together in rows and columns. 2. The researcher looks for consistent trends and pattern in the data and seen how the findings are distributed throughout the sample. 3. The researcher looks for particular trends, pattern and relationship between variable. 4. The researcher presents the findings in a series of charts or tables. 5. The researcher offers interpretation or explanation of the findings and writes the final research report to communicate the findings which address the research question. The choice of statistical tests depends, among others on: 1. sample size 2. sampling method (random or not) 3. Level of measurement (nominal, ordinal) 4. the variables to be measured in the sample are normally disturbed in the population. Criteria of choosing statistical method for data analysis:- Accuracy:  Is the data collected correct and complete?  Are the data entry procedures reliable? Efficiency:  are the resources used to collect data the most economical available to achieve those objectives? Effectiveness:  Have the objectives been achieved ?  Have the specific results planned been achieved?  To what extent are partners maximizing their comparative advantage? Criteria of choosing statistical method for data analysis:- Security:  Is the confidentiality of the learner and the records ensured? Utility:  Does data provide the right information to answer the question posed? Concise. Honest. Validity & reliability  Introduction:- -The research designs form the decisions regarding what, where, when, how much and by what means a research study will be conducted. Definition of research design:- Research design can be defined as a blue print to conduct a research study, which involves the description of research approach, study setting, sampling size, sampling technique, method of data collection & data analysis that all to answer a specific research questions or for testing research hypothesis. Elements of research design Types/approaches of research design: Generally research designs are classified into two broad approaches; that are:- 1) Quantitative research design:- * Role of Quantitative Research: 1-Quantify data and generalize results from sample to population.  2-Facilitates examination of large number of representative cases. 3-Structured approach to data collection. 4-Enables extensive statistical analysis. * Outcome of Quantitative Research: 1-Confirmation of hypotheses, theories, etc. 2-Recommend final course of action. Broad Categories Types of Research Main Features Design I. Experimental 1. True experimental Manipulation of research design independent design - Post-test –only variable, in the control design presence of control - Pre-test-posttest group, control group randomization design - Solomon four-group design - Factorial design - Randomized block design - Crossover design 2. Quasi-experimental Manipulation of design independent - Nonrandomized variable, but absence control group of either design randomization or - Time-series design control group.  3. Pre-experimental Manipulation of design independent - One-shot case variables, but design limited control over - One-group pretest- extraneous post-test design variables, no randomization & control group. Broad Categories Types of Research Main Features Design II. Non 1. Descriptive Accurate description of experimental design characteristics of research individual, situation, or - Univariant design group, & the frequency descriptive with which a certain design: phenomenon occurs in to describe natural setting without characteristics of imposing any control certain groups or manipulation 2. Correlational/Ex post Examining the facto design relationship between two or more variables - Prospective design in a natural setting - Retrospective design without manipulation or control (cause & effect relationship) Prospective: Examining relationship from cause to effect. Retrospective: Examining relationship from effect to cause - Exploratory Univariant descriptive: descriptive Studies undertaken to design:- describe the frequency to formulate the of occurrence of a problem phenomenon rather than to study - Comparative relationship descriptive design:- Exploratory: to provide evidence of Investigating the the relationships phenomenon & its between variables related factors about which very little is known Comparative: Comparing occurrences of a phenomenon in two or more group.  3. Developmental Examining the Research Design phenomenon in respect to the time - Cross-sectional design Cross-sectional: - Longitudinal design Examining the phenomenon only at one point in time Longitudinal: Examining the phenomenon at more than one point in time. 4. Epidemiological design The investigation of the distribution & causes -Case-control studies of disease in a - cohort studies population is known as epidemiology.  5. Survey research Survey studies are design investigation in which self-reported data are collected from sample with the purpose of describing population on some variables of interest. 2) Qualitative research design. * Role of Qualitative Research: 1- Search of academic, trade and professional literature (both traditional & Internet). 2- Use of interviews, brain-storming & focus groups. 3- Use of existing questionnaires/constructs. * Outcome of Qualitative Research: 1- Improve conceptualization. 2- Clarify research design, including data collection approach. 3-Draft questionnaire. Types of research Main features designs Phenomenological Phenomenological research examines human experiences through the research descriptions provided by people involved. Ethnographic Ethnographic research involves the information collected from certain research cultural groups, by living with people of those groups & from their key informants, who are believed to be most knowledgeable about the selected culture. Grounded theory Theory is developed inductively from a corpus of data acquired by a participant-observer Case studies Research on a phenomenon by studying in depth a single case example. The case can be an individual person , an event , a group, or an institution. Historical Systematic collection & objective evaluation of data related to past research occurrences in order to test hypotheses concerning causes, effects, or trends of these events that may help to explain present events & anticipate future events. Action research Action research seeks action to improve practices & study the effect of the action that was taken.  Criteria of Validity Reliability data collection instrument  What is Reliability? Reliability is: – the consistency of your measurement instrument – the degree to which an instrument measures the same way each time it is used under the same condition with the same subjects  a scale 1. How heavy the apples are a yardstick 2. How tall the wall is  Reliability Imagine that you are using a ruler to measure a book What do you think would happen if you waited 10 minutes and measured the book again, how long would it be then? …Probably still 7 inches What if you spun the ruler around! And shook it up really good?! And it measures about 7 inches across Now what would it say? © A. Taylor …Probably still 7 inches Do not duplicate without 8 author’s permission  Reliability Your ruler… – was consistent – measured the same way each time it was used under the same condition with the same object The book did not change and therefore the ruler reported back the same measurement Your ruler is RELIABLE © A. Taylor Do not duplicate without 9 author’s permission  Attributes of reliability 1. Stability 2. Equivalence 3. Homogeneity (internal consistency)  Stability It refers to the instrument’s ability to produce the same results with repeated testing. If the measure employed repeatedly on the same individuals will yield similar results?  Equivalence If it produces the same results when equivalent or parallel instruments or procedures are used. Will the measure employed by different investigators yield similar results?  Homogeneity (internal consistency) It means that all of the items in an instrument measure the same concept or characteristic. Will a set of different operational definitions of the same concept employed on the same individuals, using the same data-collecting technique, yield a highly correlated result?  This brings us to Validity © A. Taylor Do not duplicate without 14 author’s permission  What is Validity? Validity asks – if an instrument measures what it is supposed to – how “true” or accurate the measurement is ? – Validity is whether or not the instrument measures what it is designed to measure. © A. Taylor Do not duplicate without 15 author’s permission  Reliable but not Valid 165 These instruments are very RELIABLE They both report consistently – too consistently But, neither measures what it is supposed to: The scale is not really measuring weight The clock is not measuring time They are NOT VALID © A. Taylor Do not duplicate without 16 author’s permission  Putting Reliability and Validity Together Every instrument can be evaluated on two dimensions: – Reliability How consistent it is given the same conditions – Validity If it measures what it is supposed to and how accurate it is © A. Taylor Do not duplicate without 17 author’s permission  Types of Validity Content Validity Face validity Criterion-related Validity 1. Concurrent validity 2. Predictive validity Construct Validity  Content Validity When an investigator is developing an instrument and issues of content validity arise, the concern is whether the measurement instrument and the items it contains are representative of the content domain that the researcher intends to measure. The researcher begins by defining the concept and identifying the attributes or dimensions that are the components of the concept. The items that reflect the concept and its dimensions are developed.  Face validity ❑It is a rudimentary type of validity that basically verifies that the instrument gives the appearance of measuring the concept. ❑It is a type of validity in which colleagues or subjects are asked to read the instrument and evaluate the content in terms of whether it appears to reflect the concept the researcher intends to measure.  Criterion-related validity Indicates to what degree the subject’s performance on the measurement instrument and the subject’s actual behavior are related. The criterion is usually, the second measure, which assesses the same concept under study. There are two forms of criterion-related validity:  Concurrent validity ❑It refers to the degree of correlation of one test with the scores of another more established instrument of the same concept when both are administered at the same time. ❑A high correlation coefficient indicates agreement between the two measures and evidence of concurrent validit  Predictive validity It refers to the degree of correlation between the measure of the concept and some future measure of the same concept. Because of the passage of time, the correlation coefficients are likely to be lower for predictive validity studies.  Construct Validity It is based on the extent to which a test measures a theoretical construct attribute, or trait. It attempts to validate a body of theory underlying the measurement by testing of the hypothesized relationships. Our goal for today To empower the students' knowledge, skills & positive attitude toward Ethical Considerations In Nursing Research Learning Objectives At the end of this lecture, students should be able to: Define the Ethics. Identify ethical implications for nursing research Explain the strategies for ethical research. Describe role of Institution of Ethical Committees.. Definition of Ethics. Definition of Ethics. Ethics refers to standards of right and wrong; good and bad that prescribe what humans ought to do Ethical implications for nursing research. 1. Respect for participants. 2. adequate information on which to base choices. 3. Understanding and evaluating the issues involved. 4. Vulnerable individuals and groups. 5. Informed Consent. 6. Confidentiality. 7. Protection of subjects 8. Research setting. 1. Respect for participants This key principles is based on the belief that every individual matters and has the right to be treated with respect. Most adult are autonomous: that is , they have the mental ability to deliberate about issues that affect them and to make decision for them. Nurse researchers have an obligation to obtain informed consent from study participants; such consent constitutes an underlying ethical premise of the research processes. 2. adequate information on which to base choices A constant concern for researchers in healthcare is how much information give to people (particularly about unlikely risks) without worrying them unduly. However, the key aspects of participation should be made clear to potential recruits for them to make an informed choice. 3. Understanding and evaluating the issues involved While most adults are able to understand a sufficient depth of information or detail to allow for rational decision making. It is possible for this ability to be temporarily or permanently lost through illness, trauma or degenerative processes of aging or disease so, under normal circumstances, potential participants need to know what harm, if any, might result. 4. Vulnerable individuals and groups Every recipient of healthcare is in some way vulnerable, but those with more limited ability to act autonomously can also be more vulnerable to the impact of research activity. For example, people with different language, young children are self-evidently vulnerable and minority ethnic populations are sometimes difficult to involve in research especially where there are cultural different. 5. Informed Consent Information must be provided so that subjects can make an informed and educated decision about participation including the following: a) Nature /purpose of study. b) Purpose, extent and duration of participation. c) Type of information that is requested. d) Use of record. e) Use of information during and after study. f) Potential risks and benefits. g) Freedom to withdraw at any time without recrimination. Verbal or written consent must be obtained, provided ethical considerations are observed. Other persons affected by the subjects participation must be informed about the study and consent obtained e.g. spouse. 6. Confidentiality ❖The collection of data, usually about people is the principal strategy of nursing research. often these data include personal, biographical and demographic information which, while essential to the analysis should normally be used for this purpose. ❖Information must be handled so that confidentiality and anonymity are maintained. ❖Information may not be used or released outside the terms of agreement. 7. Protection of subjects Subjects must be protected from all types of harm. Potential benefits must outweigh potential risks. When the well-being of the subject conflicts with the integrity of the research a decision must be made that favors the subject. 8. Research setting. The investigator must make a specific request to the agency where the research is to be conducted and provide the agency with the knowledge needed to make an informed consent about approval. The agency has an obligation to provide a valid system for review. All nurses have an obligation to collaborate in the research process with the investigator. Investigators have a responsibility to provide adequate information to the staff members involved in or affected by the study. Staff members have the right to participate or not and should be informed if this is the condition of employment in a particular agency. Strategies for ethical research 1. Balancing risks and benefits 2. Potential benefits from participation in research. 3. Minimizing harm. Institutional Ethics Committees. ❖The council feels that clinical research on normal volunteers or on patients whether for therapeutic, non-therapeutic or diagnostic purpose should be undertaken only after an ethical committee of the concerned institute or college has gone thoroughly into the proposed research, assessed carefully the balance between the possible benefit to the patient/volunteer or to society. ❖The potential risk of the individual participating in the trial and on the basis of such an assessment as approved in the project from an ethical point of view. Institutional Ethics Committees. The ethics committee should review every proposal for research on human subjects to assess among other considerations whether: 1. Voluntary consent of the individual is being obtained. 2. The experiments would be conducted in a manner to avoid all unnecessary physical and mental suffering and injury. 3. Proper preparations would be made and adequate facilitates provided to protect the experimental subject against even remote possibilities of injury, disability or death. 4. Safeguards have been taken to see that the experimentation would be conducted only by scientifically qualified persons who possess the requisite competence, experience and qualities to carry out the research.