Nursing Research: Paradigms, Methods, & Reviews PDF

Nursing paradigm - what health is to nursing 1.​ Environment 2.​ Personal beliefs ​ i.e.) collection of theoretical knowledge based on clinical experiences and understanding Paradigm - philosophical beliefs Research - systematic inquiry using disciplined methods to solve or answer...

Nursing paradigm - what health is to nursing 1.​ Environment 2.​ Personal beliefs ​ i.e.) collection of theoretical knowledge based on clinical experiences and understanding Paradigm - philosophical beliefs Research - systematic inquiry using disciplined methods to solve or answer problems ​ Nursing research - inquiry to answer or solve problems specifically related to nursing ​ Nurses gathering data in the clinical environment is usually MD led Purposes of nursing research - dependent on the question being answered 1.​ Identification 2.​ Description 3.​ Exploration a.​ Explorative qualitative - most common 4.​ Explanation 5.​ Prediction 6.​ Control Nurse roles in research ​ May move from clinical to research role - join a research team ○​ Producer of research ○​ Consume research findings ​ Nurses help bring a patient centered focus ○​ Nurses provide a different perspective by interacting directly with the patients ○​ Understanding the statistics and research helps nurses to explain and justify the interventions they are providing to their patients ​ Consumers and producers are important ○​ i.e.) important in translating data to knowledge ​ Evidence based practice - use of clinical evidence in making care decisions History of nursing research ​ Florence nightingale pioneered research ○​ Equated moral purity to good health ○​ Lots of religious basis ○​ Not really true that she pioneered research ​ 1950s first journal on research ○​ Nursing journals are not well respected ​ 1970s Clinical research becomes important ○​ Organizations try to coordinate internationally ​ National health research development program + medical research council of Canada ○​ Identify research topics ○​ Federal gov funding ​ Canadian institutes of health research Future directions for nursing research ​ Heightened focus on evidence based practice ​ Community health ○​ How do environmental changes impact those living by the ocean ​ Greater emphasis on reviews ​ Increased multidisciplinary collaboration ​ Expanded dissemination of research findings ​ Patient centered research ​ Consideration of cost Paradigm - worldview; general perspective on complexities of the world, with certain assumptions about reality Nursing research paradigms 1.​ Positivist paradigm 2.​ Constructivist paradigm What is the nature of reality 1.​ Positivist assumptions - data driven a.​ Reality is driven by natural causes b.​ Objective c.​ Research - no interactions with what is being observed d.​ Understanding that just observing something is influencing the object being observed i.​ Minimize bias and interaction for most objective results 2.​ Constructivist assumptions - reality is multiple and subjective; constructed by individuals a.​ Individual experiences and knowledge which shapes one’s understanding of the world b.​ There is no one answer c.​ person-centered d.​ i.e.) we construct our own realities How is the researcher related to those being studied 1.​ Positivist assumption - researcher is independent of those being studied a.​ Don’t interact b.​ This isn’t necessarily true when studying humans 2.​ Constructivist assumption - Researcher interaction with subjects influences how they view their reality Role of values in inquiry 1.​ Positivity - values are held back a.​ Objectivity is prioritized 2.​ Constructivist - subjectivity and values are inevitable and desirable Research methods - techniques to structure a study to father, analyze, and interpret data ​ Something that is repeatable makes findings more credible Methods of obtaining knowledge ​ Quantitative research - collection and analysis of numeric information ○​ RCT gold standard ○​ Systematic and controlled process ○​ Comparative approach - what is the outcome with or without an intervention or exposure ○​ Traditional scientific method ​ Qualitative research - collection and analysis of subjective narrative ○​ Understanding the lived experiences ○​ More intuitive than quantitative ○​ Analysis and interpretation happens simultaneously, one process informs the other Steps in quantitative research 1.​ Conceptual - identify the problem 2.​ Design and planning a.​ What design is most appropriate to answer the question b.​ Applying for grants c.​ Creating the proposal 3.​ Empirical - what data is required to answer the question a.​ How will you gather it 4.​ Analytic - analyse the gathered data a.​ Data collection is done, focus on analysis b.​ Discussion and conclusion 5.​ Dissemination a.​ Going to conferences b.​ Publishing c.​ i.e.) knowledge translation Qualitative research applied designs 1.​ Sociology - grounded theory 2.​ Anthropology - ethnography 3.​ Philosophy - phenomenology Qualitative health research domains 1.​ Id of health needs 2.​ Examining process of accessing health care 3.​ Exploration of the illness/health experience 4.​ … Qualitative research activities - certain words indicate qualitative research 1.​ Planning the study 2.​ Developing data collection strategies a.​ Happens in tandem with gathering data b.​ Who are we sampling from 3.​ Gathering and analyzing data a.​ Incorporates all of the senses that contribute to the human experience 4.​ Dissemination a.​ Those who are part of the study may also help disseminate the information to their own communities Coded language differentiating between quantitative and qualitative ​ Subjective measures may still be assigned quantitative values making it more positivist + quantitative ​ Qualitative doesn’t seek to prove that there are relationships between 2 subjects Research reviews - it is also a literature review ​ Systematic, explicit, ad reproducible method for identifying, evaluation, and synthesizing the existing body of completed and record work ​ All reviews are systematic  ○​ Vary in degree to which they are systematic ○​ Dependent on the purpose of the review Review purpose - there is an overabundance of information due to modern databases i.e.) the internet ​ Determine how a certain work contributes to understanding an issue ​ How certain works relate to other works ​ Identify ways to interpret and identify gaps ○​ i.e.) to justify whether there needs to be more or larger scale research ​ Identify and resolve conflicts across studies ​ Identify work done to avoid duplication ​ Highlight future focuses Systematic approaches ​ Literature searching ○​ Cherry picking - whatever most supports your research ​ Quality assessment ​ Synthesis ​ Analysis ​ presentation Common types of research reviews 1.​ Systematic review - seek best available information to answer a specific question to support decision making a.​ Features i.​ Exhaustive, reproducible ii.​ Selection is based on explicit criteria 1.​ Typically picking from single studies 2.​ ALL relevant studies are included before being filtered out for what is most applicable to the question being answered iii.​ Meta analysis may be included - were all the studies measuring the same thing and was it reproducible 1.​ Combines findings from all single studies into one quantitative answer 2.​ whether the interventions works, and by how much of an effect it has 3.​ Not always possible or appropriate to conduct i.e.) if all the studies are not homogenous iv.​ 6-12 months v.​ Review team with odd number of people to reach a consensus on what to include or exclude b.​ Method i.​ Cochrane handbook for systematic review of interventions ii.​ Center for reviews and dissemination c.​ Answers - what intervention is most effective or whether it works 2.​ Scoping - examine nature and extent of literature, identify key gaps in base knowledge a.​ Features  i.​ Answers broad questions i.e.) general knowledge questions ii.​ time/scope may limit the completeness of the study iii.​ Minimal or no quality appraisal iv.​ 12+ months b.​ Can identify gaps to justify a systematic review c.​ Can identify new areas to study 3.​ Realist - what works and for which groups under which circumstances a.​ Used to understand how complex interventions work b.​ Features i.​ Literature search aims for theoretical saturation 1.​ Not exhaustivity ii.​ Theory-driven iii.​ Qualitative iv.​ Mixed method v.​ Assesses relevance and rigor vi.​ 12+ months - usually one reviewer parsing studies 4.​ Integrative - broad review to understand a phenomenon a.​ Combines theoretical and empirical literature b.​ Features i.​ Exhaustive search to maximize number of sources ii.​ Resources are coded for quality but not necessarily excluded 1.​ Just to comment on overall quality of the literature that supports the findings iii.​ 12+ months 5.​ Qualitative - looks for themes across qualitative studies a.​ summarizes qualitative data to form a new interpretation b.​ Features i.​ Related terms 1.​ Meta-ethnography 2.​ Meta-narrative 3.​ Meta-synthesis ii.​ May include quality appraisals - not to exclude, to mediate messages 1.​ i.e.) analyzing for common themes iii.​ 12+ months or less c.​ No accepted overall method 6.​ Umbrella - compiles evidence where there are already multiple reviews a.​ For broad conditions or problems where there are competing interventions b.​ To assess overall picture of findings c.​ Features i.​ Examine Heterogeneity in evidence ii.​ Quality assessment of sources iii.​ Synthesis at review level or individual study level iv.​ < 12+ months SALSA - framework to decide what type of review is being used 1.​ S - search a.​ What is being questioned b.​ What are they trying to find 2.​ A + L- Appraisal of quality 3.​ S - Synthesis - looking for patterns a.​ Is there a method for detecting the patterns 4.​ A - Analysis - making sense of patterns a.​ What do the patterns mean ​ Strength and quality to determine overall quality of a review