NUR1212 – NURSING RESEARCH 1

MODULE 1 Paradigms and Methods: Quantitative and

I. Introduction to Nursing Research Qualitative Research
Nursing research Research Methods
- a systematic inquiry to develop evidence on problems - the techniques researchers use to structure a study and
of importance to nurses to gather and analyze relevant information.
- nurses in various settings are adopting an evidence- The Scientific Method Quantitative Research
based practice (EBP) that incorporates research - The traditional, positivist scientific method involves
findings into their decisions and their interactions with using a set of orderly procedures to gather information.
clients - Quantitative researchers typically move in a
- knowledge of nursing research enhances the systematic fashion from the definition of a problem to
professional practice of all nurses—including both a solution.
consumers of research (who read and evaluate studies) - Quantitative researchers use objective methods
and producers of research (who design and undertake designed to control the research situation with the goal
studies) of minimizing bias and maximizing validity.
Clinical Nursing Research - empirical evidence—evidence that is rooted in
- research designed to guide nursing practice. Clinical objective reality and gathered directly or indirectly
nursing research typically begins with questions through the senses rather than through personal beliefs
stemming from practice problems—problems you or hunches.
may have already encountered. Constructivist Methods and Qualitative Research
Evidence-Based Practice (EBP) - Researchers in constructivist traditions emphasize the
- is the use of the best evidence in making patient care inherent complexity of humans, their ability to shape
decisions. Such evidence typically comes from and create their own experiences, and the idea that
research conducted by nurses and other health care truth is a composite of realities.
professionals. - constructivist studies are heavily focused on
Disciplined Research understanding the human experience as it is lived,
- Disciplined research is considered the best method of through the careful collection and analysis of
acquiring reliable knowledge that humans have qualitative materials that are narrative and subjective.
developed. Evidence-based health care compels - Constructivist studies yield rich, in-depth information
nurses to base their clinical practice, to the extent that can potentially clarify the varied dimensions (or
possible, on rigorous research-based findings rather themes) of a complicated phenomenon.
The Positive Paradigm Multiple Paradigms and Nursing Research
- The paradigm that dominated nursing research for Ultimate goals
decades is called positivism. - The ultimate aim of disciplined research, regardless of
- Positivism is a reflection of a broad cultural movement paradigm, is to answer questions and solve problems.
(modernism) that emphasizes the rational and Both quantitative and qualitative researchers seek to
scientific. capture the truth with regard to the phenomena in
- An assumption is a principle that is believed to be true which they are interested.
without verification. External evidence
- The assumption of determinism refers to the - The word empiricism is often associated with the
positivists’ belief that phenomena are not haphazard scientific method, but researchers in both traditions
but rather have antecedent causes. gather and analyze evidence gathered empirically, that
- In positivist paradigm, research activity is often is, through their senses.
aimed at understanding the underlying causes of Reliance on human cooperation
natural phenomena. - Human cooperation is essential in both quantitative
The Constructivist Paradigm and qualitative research. To understand people’s
- sometimes called the naturalistic paradigm. characteristics and experiences, researchers must
- The constructivist paradigm is a major alternative encourage people to participate in the study and to
system for conducting research in nursing. speak candidly.
- The constructivist paradigm assumes that knowledge Ethical constraints
is maximized when the distance between the inquirer - Research with human beings is guided by ethical
and participants in the study is minimized. principles that sometimes interfere with research
goals. Ethical dilemmas often confront researchers,
regardless of paradigms or methods.
Fallibility
- Virtually all studies have limitations. Every research
question can be addressed in different ways, and
inevitably, there are tradeoffs.
Identification and Description
- “What is this phenomenon?” and “What is its name?”
- In descriptive studies, researchers count, delineate,
and classify. Nurse researchers have described a wide
variety of phenomena, such as patients’ stress, health
beliefs, and so on. Quantitative description focuses on
the prevalence, size, and measurable aspects of
phenomena. Qualitative researchers describe the
nature, dimensions, and salience of phenomena
Exploration
- Exploratory research begins with a phenomenon of
interest; but rather than simply describing it,
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exploratory researchers examine the nature of the Prognosis

phenomenon, the manner in which it is manifested, - Studies of prognosis examine the consequences of a
and other factors to which it is related—including disease or health problem, explore factors that can
factors that might be causing it. modify the prognosis, and examine when (and for
- For example, a descriptive quantitative study of which types of people) the consequences are most
patients’ preoperative stress might document how likely.
much stress patients experience. An exploratory study - Such studies facilitate the development of long-term
might ask: What factors increase or lower a patient’s care plans for patients.
stress? Etiology (Causation) and Harm
Explanation - It is difficult to prevent harm or treat health problems
- Explanatory research seeks to understand the if we do not know what causes them. For example,
underlying causes or full nature of a phenomenon. there would be no smoking cessation programs if
In quantitative research, theories or prior findings are research had not provided firm evidence that smoking
used deductively to generate hypothesized cigarettes causes or contributes to many health
explanations that are tested statistically. Qualitative problems. Thus, determining the factors and exposures
researchers search for explanations about how or that affect or cause illness, mortality, or morbidity is
why a phenomenon exists or what a phenomenon an important purpose of many studies.
means as a basis for developing a theory that is Meaning and Processes
grounded in rich, in-depth, experiential evidence. - Many health care activities (e.g., motivating people to
Prediction and Control comply with treatments, providing sensitive advice to
- Many phenomena defy explanation, yet it is often patients, designing appealing interventions) can
possible to predict or control them based on research greatly benefit from understanding the clients’
evidence. For example, research has shown that the perspectives.
incidence of Down syndrome in infants increases with - Research that offers evidence about what health and
maternal age. We can predict that a woman aged 40 illness mean to clients, what barriers they face to
years is at higher risk of bearing a child with Down positive health practices, and what processes they
syndrome than a woman aged 25 years. We can experience in a transition through a health care crisis
attempt to influence the outcome by educating women is important to evidence-based nursing practice.
about the risks and offering amniocentesis to women
older than 35 years of age.
- The ability to predict and control in this example does
not rely on an explanation of what causes older women
to be at a higher risk.
- In many quantitative studies, prediction and control
are key goals. Although explanatory studies are
powerful, studies whose purpose is prediction and
control are also critical to EBP.

II. History of Nursing Research

• Nursing research began with Florence Nightingale
• National Institute of Nursing Research (NINR) was
established at the U.S. National Institutes of Health (NIH)
in 1993, and affirms the stature of nursing research in the
United States.
Research Purposes Linked to Evidence-Based III. Key Concepts in Nursing Research
Practice • Although logical reasoning is, in itself, insufficient as an
Therapy, Treatment, or Intervention evidence base, both deductive reasoning (the process of
- Studies with a therapy purpose seek to identify developing specific predictions from general principles)
effective treatments for improving or preventing and inductive reasoning (the process of developing
health problems. Such studies range from evaluations generalizations from specific observations) are used in
of highly specific treatments to complex research.
multicomponent interventions designed to effect IV. Sources of Evidence for Nursing Practice
behavioral changes • Tradition and Authority
Diagnosis and Assessment • Clinical Experience, Trial and Error, and Intuition
- Many nursing studies concern the rigorous • Logical Reasoning
development and testing of formal instruments to • Assembled Information
screen, diagnose, and assess patients and to measure • Disciplined Research
clinical outcomes.

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MODULE 2 Experimental studies are explicitly designed to test

Concepts, Constructs, and Theories causal relationships—to test whether an intervention
Concepts caused changes in the outcome.
Research involves real-world problems, but studies are Quantitative Research: Nonexperimental Studies
conceptualized in abstract terms. For example, pain, In nonexperimental research, on the other hand,
fatigue, and obesity are abstractions of human researchers are bystanders—they collect data without
characteristics. These abstractions are called phenomena introducing treatments (most often, to address etiology,
(especially in qualitative studies) or concepts. prognosis, or diagnosis questions).
Construct nonexperimental studies also explore causal
- which also refers to an abstraction, but often one is relationships, but causal inferences in nonexperimental
deliberately invented (or constructed). For example, research are tricky and less conclusive.
self-care in Orem’s model of health maintenance is a
construct. The terms construct and concept are In medical and epidemiological research, experimental
sometimes used interchangeably, but a construct often studies usually are called clinical trials, and
refers to a more complex abstraction than a concept. nonexperimental inquiries are called observational
Theory studies.
- is an explanation of some aspect of reality. In a theory, Qualitative Research: Disciplinary Traditions
concepts are knitted together into a coherent system to Grounded Theory Tradition
describe or explain some aspect of the world. - seeks to describe and understand key social
- In a quantitative study, researchers often start with a psychological processes.
theory and, using deductive reasoning, make - The focus of most grounded theory studies is on a
predictions about how phenomena would behave in developing social experience—the social and
the real world if the theory were valid. psychological phases that characterize a particular
- In qualitative studies, theory often is the product of event or episode.
the research In qualitative studies, theory often is the - A major component of grounded theory is the
product of the research: The investigators use discovery of a core variable that is central in
information from study participants inductively to explaining what is going on in that social scene.
develop a theory rooted in the participants’ Phenomenology
experiences.The investigators use information from - Phenomenology is concerned with the lived
study participants inductively to develop a theory experiences of humans.
rooted in the participants’ experiences. - Phenomenology is an approach to thinking about what
Variables life experiences of people are like and what they mean.
- concepts are usually called variables. A variable, as the The phenomenological researcher asks the questions:
name implies, is something that varies. Weight, What is the essence of this phenomenon as
anxiety, and fatigue are all variables—they vary from experienced by these people? or
one person to another. Most human characteristics are - What is the meaning of the phenomenon to those who
variables. experience it?
- Variables are the central building blocks of Phenomenology
quantitative studies. - the primary research tradition in anthropology,
Characteristics of Variables provides a framework for studying the patterns and
- Variables are often inherent human traits, such as age lifeways of a defined cultural group in a holistic
or weight, but sometimes researchers create a variable. fashion.
Dependent and Independent Variables - Ethnographers typically engage in extensive
- The dependent variable is the outcome that fieldwork, often participating to the extent possible in
researchers want to understand, explain, or predict. the life of the culture under study.
- The independent variable corresponds to the “I” (the - Ethnographers strive to learn from members of a
intervention, influence, or exposure), plus the “C” (the cultural group, to understand their worldview, and to
comparison). describe their customs and norms.
Data MAJOR STEPS IN A QUANTITATIVE STUDY
- Research data (singular, datum) are the pieces of Phase 1: The Conceptual Phase
information gathered in a study.
Relationships
- is a connection between phenomena.
- In quantitative studies, researchers are interested in
the relationship between independent variables and
outcomes.
- qualitative researchers may seek patterns of
association as a way of illuminating the underlying
meaning and dimensionality of phenomena of interest.
Patterns of interconnected concepts are identified as a
means of understanding the whole.
MAJOR CLASSES OF QUANTITATIVE AND
QUALITATIVE RESEARCH

Quantitative Research: Experimental Studies

In experimental research, researchers actively introduce
an intervention or treatment—most often, to address
therapy questions.

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During this phase, researchers call on such skills as Step 7: Developing Protocols for the Intervention
creativity, deductive reasoning, and a grounding in In experimental research, researchers create the
research evidence on the topic of interest. independent variable, which means that participants are
Step 1: Formulating and Delimiting the Problem exposed to different treatments. An intervention protocol
- Quantitative researchers begin by identifying an for the study must be developed, specifying exactly what
interesting research problem and formulating research the intervention will entail (e.g., who will administer it,
questions. over how long a period the treatment will last, and so on)
- The research questions identify what the study and what the alternative condition will be. In
variables are. In developing questions, nurse nonexperimental research, this step is not necessary.
researchers must attend to Step 8: Identifying the Population
- substantive issues (Is this problem important?) Quantitative researchers need to specify what
- theoretical issues (Is there a conceptual framework characteristics study participants should possess—that is,
for this problem?) they must identify the population to be studied. A
- clinical issues (Will findings be useful in clinical population is all the individuals or objects with common,
practice?) defining characteristics (the “P” component in PICO
- methodologic issues (How can this question be questions).
answered to yield high-quality evidence?) Step 9: Designing the Sampling Plan
- ethical issues (Can this question be addressed in an Researchers typically collect data from a sample, which is
ethical manner? a subset of the population. The researcher’s sampling plan
Step 2: Reviewing the Related Literature specifies how the sample will be selected and how many
- Quantitative research is conducted within the context subjects there will be. The goal is to have a sample that
of previous knowledge. adequately reflects the population’s traits.
- Quantitative researchers typically strive to understand Step 10: Specifying Methods to Measure Variables
what is already known about a topic by undertaking a Quantitative researchers must find methods to measure the
thorough literature review before any data are research variables accurately. A variety of quantitative
collected. data collection approaches exist; the primary methods are
Step 3: Undertaking Clinical Fieldwork self-reports (e.g., interviews and questionnaires),
Researchers embarking on a clinical study often benefit observations (e.g., watching and recording people’s
from spending time in relevant clinical settings (in the behavior), and biophysiologic measurements. The task of
field), discussing the topic with clinicians and observing measuring research variables and developing a data
current practices. Such clinical fieldwork can provide collection plan is complex and challenging.
perspectives on clinicians’ and clients’ viewpoints. Step 11: Developing Methods to Safeguard
Step 4: Defining the Framework and Developing Human/Animal Rights
Conceptual Definitions Most nursing research involves human subjects, although
When quantitative research is performed within the some involve animals. In either case, procedures need to
context of a theoretical framework, the findings may have be developed to ensure that the study adheres to ethical
broader significance and utility. Even when the research principles.
question is not embedded in a theory, researchers should Step 12: Reviewing and Finalizing the Research Plan
have a conceptual rationale and a clear vision of the Before collecting data, researchers often undertake
concepts under study. assessments to ensure that procedures will work smoothly.
Step 5: Formulating Hypotheses For example, they may evaluate the readability of written
Step 5: Formulating Hypotheses materials to see if participants with low reading skills can
Hypotheses state researchers’ expectations about comprehend them. Researchers usually have their research
relationships between study variables. Hypotheses are plan critiqued by reviewers to obtain clinical or
predictions of the relationships researchers expect to methodologic feedback. Researchers seeking financial
observe in the study data. The research question identifies support submit a proposal to a funding source, and
the concepts of interest and asks how the concepts might reviewers usually suggest improvements.
be related; a hypothesis is the predicted answer. Most Phase 3: The Empirical Phase
quantitative studies are designed to test hypotheses The third phase of quantitative studies involves collecting
through statistical analysis. the research data. This phase is often the most time-
Phase 2: The Design and Planning Phase consuming part of the study. Data collection may require
Phase 2: The Design and Planning Phase months of work.
In the second major phase of a quantitative study, Step 13: Collecting the Data
researchers decide on the methods they will use to address The actual collection of data in a quantitative study often
the research question. Researchers make many proceeds according to a preestablished plan. The plan
methodologic decisions that have crucial implications for typically spells out procedures for training data collection
the quality of the study evidence. staff, for actually collecting data (e.g., where and when the
Step 6: Selecting a Research Design data will be gathered), and for recording information.
The research design is the overall plan for obtaining Step 14: Preparing the Data for Analysis
answers to the research questions. Quantitative designs Data collected in a quantitative study must be prepared for
tend to be structured and controlled, with the goal of analysis. For example, one preliminary step is coding,
minimizing bias. Research designs also indicate how often which involves translating verbal data into numeric form
data will be collected and what types of comparisons will (e.g., coding gender information as “1” for females, “2” for
be made. The research design is the architectural backbone males, and “3” for other).
of the study. Phase 4: The Analytic Phase
Quantitative data must be subjected to analysis and
interpretation, which occur in the fourth major phase of a
project.

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Step 15: Analyzing the Datas - An effect represents the difference between what
To answer research questions and test hypotheses, actually did happen with the exposure and what would
researchers analyze their data in a systematic fashion. have happened without it.
Quantitative data are analyzed through statistical - A counterfactual clearly can never be realized, but it is
analyses, which include some simple procedures (e.g., a good model to keep in mind in thinking about
computing an average) as well as more complex, research design.
sophisticated methods. Experimental Design: Randomized Controlled Trials
Step 16: Interpreting the Results Intervention
Interpretation involves making sense of study results and - The researcher does something to some subjects-
examining their implications. Researchers attempt to introduces an intervention (or treatment).
explain the findings in light of prior evidence, theory, and - Pre and post tests
clinical experience and in light of the adequacy of the Control
methods they used in the study. Interpretation also - The researcher introduces controls, including the use
involves coming to conclusions about the clinical of a control and experimental groups.
significance of the new evidence. - The term control group refers to a group of
Phase 5: The Dissemination Phase participants whose performance on an outcome is used
In the analytic phase, researchers come full circle: The to evaluate the performance of the experimental
questions posed at the outset are answered. The group (the group getting the intervention) on the same
researchers’ job is not completed, however, until study outcome.
results are disseminated. Randomization
Step 17: Communicating the Findings - The experimenter assigns participants to a control or
A study cannot contribute evidence to nursing practice if experimental condition on a random basis
the results are not communicated. Another—and often - Random assignment
final—task of a research project is the preparation of a - The purpose is to make the group equal with regard to
research report that can be shared with others. We discuss all other factors except receipt of the intervention.
research reports in the next chapter. - Meet certain criteria
Step 18: Putting the Evidence Into Practice Crossover design
Ideally, the concluding step of a high-quality study is to - involves exposing people to more than one treatment.
plan for its use in practice settings. Although nurse - has the advantage of ensuring the highest possible
researchers may not implement a plan for using research equivalence among the people exposed to different
findings, they can contribute to the process by developing conditions.
recommendations on how the evidence could be used in
practice, by ensuring that adequate information has been A placebo or pseudointervention presumed to have no
provided for a meta-analysis, and by pursuing therapeutic value
opportunities to disseminate the findings to practicing
nurses. Advantages and Disadvantages of Experiments
ACTIVITIES IN A QUALITATIVE STUDY - RCTs are the “gold standard” for intervention studies
(Therapy questions) because they yield the most
persuasive evidence about the effects of an
intervention.
- First, many interesting variables simply are not
amenable to intervention.
- Second, many variables could technically—but not
ethically—be experimentally varied.
- Sometimes, RCTs are not feasible because of practical
issues.
Quasi-Experiments
- Involve an intervention but lack either randomization
or control group.
- called trials without randomization in the medical
literature
- the time-series design involves collecting data over an
extended time period and introducing the treatment
during that period.
Nonequivalent Control Group Designs
MODULE 3 - Those getting the intervention are compared with a
The research design of a study spells out the strategies nonrandomized comparison group.
that researchers adopt to answer their questions and test Within-subjects Designs
their hypotheses. - One group is studied before and after the intervention.
Causality
- Many research questions are about causes and effects. Advantages and Disadvantages of Quasi-Experiments
- Causality is a hotly debated issue, but we all - May be easier and more practical than true
understand the general concept of a cause. experiments but
- Causes are seldom deterministic; they only increase o They make it more difficult to infer causality
the likelihood that an effect will occur. o Usually there are several alternative rival
hypotheses for results
A counterfactual is what would happen to people if they
were exposed to a causal influence and were
simultaneously not exposed to it.
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Non-Experimental Studies Longitudinal design

- If researchers do not intervene by controlling - Data are collected two or more times over an extended
independent variable, the study is nonexperimental period
(observational). - Follow-up studies
- Not all independent variables (“causes”) of interest to
nurse researchers can be experimentally manipulated. Controlling the Study Context
o Gender cannot ever be manipulated - Controlling external factors (such as research context)
o Smoking cannot ethically be manipulated o Achieving constancy of conditions
- correlation is an association between two variables, o Control over environment, setting, time
that is, a tendency for variation in one variable to be o Control over intervention via a formal
related to variation in another protocol: intervention fidelity
Controlling Participant Factors
Types of Nonexperimental Studies - Randomization
- In a prospective correctional design, potential cause o Subjects as own controls (crossover design)
in the present is linked to a hypothesized later - Homogeneity (restricting sample)
outcome. - Matching
- This is called a cohort study by medical researchers. - Statistical control (analysis of covariance)
a. Retrospective Designs
- In a retrospective correlational design, an outcome in Characteristics pf Good Quantitative Research Design
the present is linked to a hypothesized cause occuring • Statistical conclusion validity – the ability to
in the past. detect true relationships statistically.
- One retrospective design js a case-control design in • Internal validity – the extent to which it can be
which “cases” are compared to “controls” on prior inferred that the independent variable caused or
potential causes. influenced the dependent variable.
b. Descriptive Research • External validity – the generalizability of the
- Not all research is cause probing. observed relationships across samples, setting, or
- The purpose of descriptive studies is to observe, time
describe, and document aspects of a situation. Threats to Statistical Conclusion Validity
c. Survey - Low statistical power (sample too small)
- Provides quantitative description of trends, attitudes, - Weakly defined “cause” – independent variable not
and opinions of a population. powerful
- Tests association among variables of population by - Unreliable implementation of treatment – low
studying a sample of the population intervention fidelity
Questions answered by Survey Threats to Validity
1. Descriptive questions 1. Internal Validity Threats
2. Questions about relationship of variables • History
3. Questions about predictive relationship between • Maturation
variables overtime • Regression to the mean
The Survey Design • Selection
1. Identify the purpose of survey research
• Mortality
2. Indicate why a survey method is the preferred type
of approach for the study
3. Indicate whether the survey will be cross-sectional
or longitudinal
4. Specify form of data collection
Instrumentation
1. Name the survey instrument to collect data
2. Validity of scores using the instrument
a. Content validity
b. Predictive or concurrent validity
c. Construct validity
3. Reliability of scores on the instrument-consistency
or repeatability of an instrument
4. Sample items
5. Content of instrument
6. Pilot testing
7. Administering the survey
Advantages and Disadvantages of Nonexperimental
Research
- Disadvantage: does not yield persuasive evidence for
causal inferences
- Advantage: efficient way to collect large amounts of
data when intervention and/ or randomization is not
possible.
Time Dimension in Research Design
Cross-sectional design
- Data are collected at a single point in time.

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