Nursing Research I Unit 1: Introduction PDF

NURSING RESEARCH I o User of research findings o Patient/Client advocate during the study UNIT 1: INTRODUCTION o Su...

NURSING RESEARCH I o User of research findings o Patient/Client advocate during the study UNIT 1: INTRODUCTION o Subject/Respondent/Participant What is Research? 4 Core Competencies in Research Webster: “research is a studious inquiry or examination, o CHED Memorandum No. 14 series of 2009 “Policies investigation”. and Standards for Bachelor of Science in Nursing Program” Barr: “any systematic search for understanding limited to a o Core Competency number: particular subject”. 1. Gather data using different methodologies. Treece and Treece: “research, in a broadest sense, is an 2. Recommend actions for attempt to gain solutions to problems”. implementation. 3. Disseminate results of research Best: “research is a formal, systematic and intensive process of findings. carrying on a scientific analysis for the purpose of discovery and development of an organized body of knowledge”. 4. Apply research findings in nursing practice. What is Research? o Articulated the program’s 11 Core Competency Indicators. o A systematic inquiry that uses disciplined methods to answer questions or solve problems (Polit and Beck) 11 Core Competencies: Research 1. Safe and quality nursing care 2. Management of resources and environment o Designed to find answers to problems in a systematic, 3. Health education organized, and comprehensive method 4. Legal responsibility o Looking for an answer to a query 5. Ethico-moral responsibility o Process of using relevant data 6. Personal and professional development o “re” (again) 7. Quality improvement o “search” (seek) 8. Research 9. Records management 2 General Purpose: 10. Communication o To discover 11. Collaboration and teamwork o To verify Characteristics of a Good Researcher Why get excited about research? o Honesty o The essence of all research originates in curiosity - a o Openness to criticism desire to find out how and why things happen” o Resourcefulness o Logical mind Kinds of Research Paper o Patience o The Dissertation Purposes of Nursing Research o The Thesis o The Term Paper o Provides scientific basis for nursing care management o For continuous development in health care Characteristics of Nursing Research o Develops tools for assessing the effectiveness of nursing interventions. 1. Systematic - There is a system that must be followed o Provides solutions to problems in conducting research o Develops and evaluates alternative approaches to 2. Objective - Research is an objective process of nursing education analyzing phenomena o Experience advances the personal and professional 3. Feasible - In the nursing profession, any problem is a qualifications of a nursing practitioner. feasible problem of study. 4. Empirical - There should be adequate evidence Types of Nursing Research discussing the different variables used in the study. 1. Basic or Pure Research 5. Clear - the choice of variables used in the study o This type of research is primarily concerned with should be explained well by the researcher. generating new knowledge/ theory. Roles of Nurses in Research 2. Applied Research o This type of research is concerned with geusing o Principal investigator knowledge to give immediate solutions to a o Member of the research team problem. o Identifier of research problem o Evaluator of research findings rnd ♥ | 1 UNIT 2: RESEARCH PROCESS o A student must choose a research problem that he can manage, i.e., he/she must know whether he/she Research Process has the necessary skills to pursue the study. o The feasibility of a research study is a very important o Refers to the series of steps which make up research consideration. from the development of an idea to the completed o The newness and freshness of the topic must also be research paper. assessed. A researcher… Characteristics of a Good Problem o identifies his/her expertise, competency and interest. o It should be of interest to the researcher o should also know that the problem is researchable. o It is a current and novel issue. o It can be finished within the allotted time Researchable when… o It should not involve physical or psychological harm o there is no known solution to the problem; o The data are available o the solution can be answered by employing statistical o It shall incur expenses affordable to the researcher. methods and techniques; Research Title o there are probable solutions, but they are not yet tested; and o It should not be long and should not be more than 15 words. o the occurrence of the phenomena requires scientific investigation to arrive at precise solution. o “A Study of,” “An Analysis of,” or “An Investigation of” should not be part of the title. Sources of Research Problem o It is not important to include the date and location of the 1. experiences investigation 2. off-shoots of other researches o If the title has more than one line, it must be written like an 3. suggestions from friends or other administrations inverted pyramid & all words should be capitalized and bold. 4. any medical pattern or trend 5. interests of a researcher UNIT 3: NURSING RESEARCH ETHICS 6. literature reviews and previous researches Ethics Considerations in Formulating a Research Problem o Study of moral behavior, what is right and wrong or 1. External Criteria what is good or bad. o Novelty - the practical value of the problem due to its newness to the field of inquiry Research Ethics o Availability of subjects - the existence of o Involves being sensitive to person’s rights people with the capability and willingness to o Concerns with how research abides by ethical participate in the study; the sample of the standards. study participants must be representative o Development of these ethical standards has a dark enough to ensure reliability and validity of history results. o Administrative Support - sponsorship by a Tuskegee Syphilis Study 1932-1972 professional organization or academic institution, to cover the cost of the study. o Syphilis − emerging disease during this time 2. Internal Criteria o Ethical standards and considerations of research are o Experience, training and professional not yet in place qualifications o Discrimination of black people during this time o Motivation, Interest, Intellectual Curiosity o Employed or recruited black Americans to be and Perceptiveness of the Researcher enrolled in the study without fully disclosing what the o Time Factor - studies must be pursued in the human participants will go through given time frame. o However, the means of going to that are somehow o Costs and Returns - Research is an expensive very questionable undertaking. The amount of funding o They did not disclose that they will be infected with needed, of course, depends on the size of syphilis the sample, the place where the research is o People are subjected to observation and be tested to be conducted and the treatment of data, for different medications as well as the research design. o What we know now is taken from this study but in the expense of those humans who participated in this Some considerations… study o The black men who were asked to joined were o The identified problem must of course be be promised to have medical services and be given significant to nursing medical check-ups and free services and medications o Their wives had syphilis and their children had congenital syphilis rnd ♥ | 2 Nazi Human Experiments 1940s o Adequate representative sample o Valid, reliable and objective research o Employed scientists to make human experiments tools/instruments o Members of the Nazi had this aim of making their o Appropriate statistics army elite and they do this by experimenting o Meticulous data-gathering o Exposing them to extreme conditions to see how far o Honest reporting of results. the human body can go o Objective interpretation, well-founded conclusions o Deliberately operated on infants to make them conjoined It is justifiable to sacrifice a life, if in the process, it saves the o Performed lobotomy lives of millions? No Codes of Ethics o No type of science should risk the life of anyone. If it risks a life, even just one, makes a research not worth 1. The Nuremberg Code (1947) it. 2. The Declaration of Helsinki (1964, World Medical Association) Ethical Soundness 3. The Belmont Report (1979) 4. Ethical Guidelines in the Conduct, Dissemination, and o Concerns the research being rooted on the Implementation of Nursing Research (1995, overarching principle of research ethics American Nurses’ Association) Will man benefit as an end? is the benefit greater? o Address the question: Does the research abide by The Nuremberg Code ethical principles? o Is concerned with several criteria for research 3 major/fundamental ethical principles in research are: including the following: 1. Researcher must inform subjects about 1. Beneficence; the study 2. Respect for human dignity; and 2. Research must be for the good of 3. Justice society The Principle of Beneficence 3. Research must be based on animal experiments, if possible “Above all, do no harm.” 4. Researcher must try to avoid injury to research subjects o Beneficence involves: 5. Researcher must be qualified to 1. The protection of participants from physical conduct research and psychological harm; 6. Subjects or the researcher can stop the 2. The protection of participants from study if problems occur exploitation; and o The leading code for all subsequent codes made to 3. Benefits from research. protect human rights in research. o The only weak point of this code was the self- Freedom from harm regulation of researchers which can be abused in some research studies. 1. Physical 2. Psychological Declaration of Helsinki 3. Social 4. Economic/Financial o The Declaration of Helsinki emphasized the protection of subjects in any kind of research and Avoid or Minimize Psychological Harm by: strongly proclaimed that the well-being of individuals is more important than scientific and social interests. 1. Carefully phrasing questions; or 2. Debriefing sessions where participants may ask 1979 questions or air complaints after data are collected; or Debriefing is a meeting with research participants o The National Commission for the Protection of that ensures their understanding of the reasons and Human Subjects of Biomedical and Behavioral justification for the procedure used in the study. Research (also called the Belmont Commission) 3. Making referrals to appropriate health, social, or ✓ Defined ethical principles for the protection psychological services. of human subjects of research. Freedom from Exploitation Key Components of Ethical Research o Participants need to be assured that their Scientific Soundness participation, or the information that they might provide, will not be used against them in any way. o Qualifies and suitable researcher o Clear, attainable objectives o Prior literature and studies o Feasible, adequate study site and resources rnd ♥ | 3 Major Potential Benefits to Participants o the right to privacy. 1. Access to an intervention that might otherwise be Fair treatment includes: unavailable to them 2. Comfort in being able to discuss their situations or o Non-discriminatory selection of participants problems with a friendly, objective person o Respect for cultural and other forms of diversity; 3. Increased knowledge about themselves or their o Non-prejudicial treatment of those who decline to participate; conditions o Honoring of all agreements between researchers and 4. Escape from normal routine participants 5. Satisfaction that the information they provide may help others with similar problems or conditions Privacy 6. Direct monetary or material gains o Privacy is the freedom an individual has to determine Major Potential Risks to Participants under which private information will be shared with or withheld from others. 1. Physical harm, including unanticipated side effects; 2. Physical discomfort, fatigue or boredom; The right to privacy means: 3. Psychological or emotional distress resulting from: self-disclosure o Freedom not to have personal information disclosed introspection publicly; fear of the unknown o Freedom to determine how much personal discomfort with strangers information to disclose fear of eventual repercussions o Data disposal, data storage, and etc anger or embarrassment at the type of Anonymity questions being asked 4. Social Risks, like: o refers to the act of keeping individuals nameless in Risk of stigma relation to their participation in a research project. Adverse effects on social relationships o anonymity occurs when no one can link participants Loss of status to the data they provided. Loss of privacy Confidentiality Loss of time Monetary costs o refers to the researcher’s responsibility to protect all data gathered from being divulged to others. THE PRINCIPLE OF RESPECT FOR HUMAN DIGNITY o It involves protection of the subject’s identity - Involves the participants’ right to self-determination PROCEDURES FOR PROTECTING STUDY PARTICIPANTS and the right to full disclosure. Informed Consent Right to Self-determination o Informed consent is the process of providing an o Participants have the right to decide voluntarily individual with sufficient understandable information whether to participate in a study, without risking any regarding his or her participation in a research penalty or prejudicial treatment. project. o Freedom from coercion of any type. o Informed consent means that participants have ----> Coercion involves explicit or implicit adequate information regarding the research, are threats of penalty from failing to participate in a study, capable of comprehending the information, and have or excessive rewards from agreeing to participate. the power of free choice, enabling them to consent or to decline participation voluntarily. Right to Full Disclosure: The consent form must include the following information: o This means that researchers have fully described to prospective participants their rights and the full o The individual is invited to participate in the research nature of the study. o The reason for considering the individual suitable for o When full disclosure poses the risk of biased results, the study- what is with them that considers them as a researchers sometimes use as a last resort: viable participant; inclusions > Covert data collection or concealment o The number of participants invited in the research. > Deception o The participatory is voluntary o Deception may take two forms: o The individual is free to refuse to participate and is 1. Passive deception (half-truth) free to withdraw from the research at any time without 2. Active deception (untruth) penalty or loss of benefits o Purpose of the research The Principle of Justice o The procedures to be carried out by the investigator Justice includes (including the number and duration of visits and the total time involved) o the right to fair treatment; and rnd ♥ | 4  o Expected duration of the individual’s participation 3. Severely ill or physically disabled people(e.g.,deaf, o Possibility of termination of the individual blind) participation in the study 4. The terminally ill o Any Foreseeable risk, pain or discomfort, or 5. Institutionalized people inconvenience to the individual (or others) associated 6. Pregnant women with participation in research 7. Indigenous people o Direct benefits if any expected to manifest to individuals from participating in the research Confidentiality Procedures o Expected benefits to the research, to the community or to society at large or contribution to scientific A. Anonymity knowledge o Most secure means of ensuring confidentiality o Whether money or other forms of material goods will Ex. Instead of using real names, you can use be provided in return for the individuals participation pseudonyms or alias or assign number or letters and if so, the kind and amount to pertain to the participants o After the completion of the study, the individual will o be informed of the findings B. Other measures in the absence of Anonymity o The research will be published or presented to the o Using fictitious names scientific community and stakeholders o Not disclosing identifying information o The provisions that will be made to ensure respect for o Using ID numbers the privacy of research participants and the o Placing identifying information in a locked file confidentiality of records in which they are identified o Not encoding identifying information onto o The possible use of participants’ data by other computer files researchers o Password protection of research data o Provisions be made to safeguard confidentiality o Destroying identifying information as quickly as o The sponsors of the research, the institutional possible affiliation of the investigators, and the nature and and o Making research personnel sign confidentiality sources of funding for research pledges o Treatment will be provided free of charge for specified types of research-related injury or for Examples of personal identifiers: complications associated with the research, the o name nature and duration of such care, the name of the o birthdate organization or individual that will provide treatment, o social security number and whether there is any uncertainty regarding o home address funding of such treatment. o phone number o In what way and by what organization the research o e-mail address participants or the research participant’s family or o photographs dependents will be compensated for disability or death resulting from such injury. o other leading information o Name and contact details of the researchers, affiliated Treatment of vulnerable groups: Children/ Minors institution and pertinent individuals (clinical psychologist, physician) o Informed consent from parent or child’s legal o Other information which will affect the participant’s representative required for minors/children to decision (has been approved by ethics committee) participate in research o Legally capacitated third party − additional Comprehension permission required if child’s parents are minors − o Is it written and verbally explained in a medium or obtain consent from grandparents language understandable to the participants? o Emancipated minor − not yet 18 but they can provide o Written or digital consent? consent because they have a mature behavior, they make decisions in the family, and etc o Highest form of approval: signature In the absence of parents/judicially declared guardians (in Documentation order): o Was a personal copy given to the participant? o Was ample time given to participant in reviewing I. Grandparents form before signing? II. Oldest sibling over 21y.o o Were vulnerable participants afforded alternative means of documenting consent? III. Actual custodian(caretaker)over 21yrs. old Vulnerable groups include: IV. State (duly-appointed officials of DSWD, incase of orphan street children) 1. Children/Minors 2. Mentally or emotionally disturbed people o Teachers: may give consent in loco parentis (in behalf of rnd ♥ | 5  o the parents) for educational research with minimal risks; can grant permission for their student to join in certain kinds of research. Ex. Attention span of children and comprehension for this certain teaching strategy. Assent o a child's affirmative agreement to participate in research (must be obtained if 7 to 17 years of age) o 15 to 17 y.o.: child co-signs informed consent form of parents; 1 informed consent where parents will sign in the informed consent and the child can co- sign; o 12 to 15 y.o.: child signs simplified Assent Form different from the Informed Consent Form which the parents or guardians sign; prepare 2 consent forms − assent form with more simple words and formal informed consent form o 7 to 12 y.o.: verbal assent; but there should be parent’s consent form; o < 7 y.o.: no assent needed; only the parent’s consent; provided that they can understand o Important!!! In the absence of assent, a childs dissent must always be respected Treatment of vulnerable groups: Cognitively incapacitated adults o Decisional capacity is determined by cognitive assessment o Surrogate decision-makers (next of kin; in order) I. Spouse − legal or married spouse II.Children of legal age III.Parents IV. Brothers and sisters of legal age V. Court-appointed guardian o Important!! The surrogate decision maker and/or researcher must be sensitive to signs of dissent from the participant and must be respected= (PHREB, 2011) Institutional Review Boards o Formal committees for reviewing proposed research plans in terms of its ethical dimensions o Ethical review board o Tasked to do a second line of looking into the ethical aspect as well as the scientific soundness of the paper Types of Research Misconduct o Fabrication - making up data or study results o Falsification -Manipulating research materials, equipment or processes to achieve desired results -Changing or omitting data, or distorting results -Truthful, honest, integrity o Plagiarism – Appropriation of others’ ideas, results or words without giving due credit rnd ♥ | 6