Introduction to Nursing Research

1. TOGETHER, WE CAN MAKE THE ORDINARY EXTRAORDINARY Introduction to Nursing Research Mid-Atlantic States Regional Nursing Competency

2. Learning Objectives After completing this competency presentation, the nurse should be able to Know what research is and is not Determine required steps in the research process Distinguish quantitative from qualitative research Understand the process for research at KP Know what resources are available to support research Consider a draft research question and study purpose 2

3. What is needed to be a nurse researcher? Knowledge – know how to do it Competence – be able to do it Experience – novice to expert Now: Focus is on building knowledge base, process, and tools Future: Building research skills (competence) and program of research at KP (experience)

4. Novice to Expert: Benner’s model Steps to build competence in any field Any new field or practice – novice level – need lots of guidance Build skills with experience, learning and mentorship Most nurses are starting in research at the novice or advanced beginner level Purpose of the competency is to provide basic knowledge and resources for gaining experience

5. Novice to expert: Research skills Expert:Experienced at research, can use complex methods, Write grants, serve as a resource to nursing scientific community Proficient: Leads research as PI and serve as mentor to others Competent: Knows how to do research independently Advanced Beginner: Completed competency and beginning mentored research Novice: Basic knowledge, limited skills, no experience

6. Barriers to nurses doing research Complex language and mystery words – seems too hard to comprehend and illusive Academic focus gets lost on clinicians in the real world Lack of knowledge of how to do it or where to start Lack of real training to do meaningful research Few people are doing clinical research –difficult to control and messy! Lack of mentors to learn how to do research Misunderstanding about what research is and is not

7. Barriers Research seems to be kept behind a guarded door with secret language “Club” of scholars, nerds, and geeks whose skills are unreachable – too complex for people to learn Secret society with a secret pass key to open the door

8. Debilitating and paralyzing vocabulary methodology variables Paradigms Analysis Qualitative Quantitative IRB Constructs Independent ROL Theoretical framework Randomized controlled trials controls

9. Ways of knowing and learning things without research Tradition “we’ve always done it that way” Authority “because we told you so” Borrowing “if it works in another field, it must be able to work in nursing” Trial and error “let’s keep trying until we figure out the best way” Personal experience “ My way is better because”

10. Definitions: Research Root meaning – “search again” or “examine carefully” Systematic process to do research Search – investigation, inquiry to Prove – validate – “show me” and What we know (knowledge) and What we don’t know (generate new knowledge)

11. What it is… Definitions Seeks answers to questions in an orderly and systematic way Method of problem solving – ask a question with a desire to answer it Much like the nursing and scientific process: Assess (what is known? What is in question?) Plan how to do the study (proposal includes steps); Implement study (follow the plan) ; Evaluate results (findings from the study, analysis) Most respected way to attain knowledge – for any professional discipline

12. Characteristics of research Attention to detail, accuracy in measurement, precision Held to a higher degree of scrutiny and rigor Study expected to add to the body of knowledge or science either to reinforce or substantiate previous studies (replication) or to generate new information about a particular area. This is called “generalizable”. Most clinical research is conducted on how nursing is practiced (is one way better or equal to another), which contributes to outcomes of practice.

13. What is nursing science? Started with Florence Nightingale in 1800s – examined practice, collected data and analyzed data Body of knowledge unique to the discipline of nursing ANA (2003) Definition of Nursing: the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations Nursing studies should focus on understanding human needs and use of nursing interventions to promote health and manage illness; holistic

14. Types of nursing research Clinical practice – impact of nursing interventions, patient responses to care, quality of care, testing results of initiatives, nursing sensitive outcomes, body of science including how nursing is practiced Education – impact of nursing education on knowledge, practice, outcomes – which strategies promote nursing understanding and practice? Administration – impact of nursing leadership on operations, costs of care, retention, work environment, leadership sensitive outcomes

15. Definition: Research is systematic inquiry that uses disciplined methods to answer questions or solve problems (Polit and Beck, 2008). Ultimate goal in nursing: provide care that has evidence to back it up and produces quality outcomes for patients, families, and system

16. What it isn’t Going to the library or internet looking for information Doing a performance improvement project Unplanned study without using research process and IRB approvals

17. Why is nursing research important? Find out best ways to provide care for patients from a nursing perspective Allows a way to answer questions or solve nursing problems that come up every day Way to evaluate the outcomes or effectiveness Provides evidence behind what we do and more confidence for why we’re doing what we’re doing Opportunity for professional advancement Elevates nursing to a science and profession rather than a job Definition of a professional is that they control their own practice Builds a scientific and knowledge base for nursing practice beyond experience and tradition

18. Limitations with research Cannot answer all questions – i.e. moral or ethical issues All things are not measurable or good tools not available Statistics may show significance, but in the real world may not really be important (clinical significance) Studies are done many different ways, it’s hard to repeat them to confirm and verify results – one study rarely tells the whole story

19. General Steps General idea about a topic or question for the study Review of the literature – what is known about your question Purpose and aims of the study – what do you want to do? Research question – specific and measurable Methods – how will you go about answering your question Subjects – who and what to include (data) and exclude Protection of human subjects and informed consent Procedures of the study – what exactly will be done and when Analysis of results – how will you test and summarize your findings Recommendations for future research Dissemination

20. Start with a question or idea Usually generated by clinical observations Why does this happen? Are there things that cause things to happen? What would happen if we did something different? Can come from questions raised from other studies – recommendations for further study

21. Jump Starters for research ideas What interventions do you do in practice? Things nurses do every day Hemodynamic monitoring VS measurement Preventing complications Procedures What is the knowledge base for the practices? Sacred cow or evidence-based? Policy based? Book from school? How we were taught or do it here? How can research improve/influence these interventions?

22. Developing a Research Question (RQ) It is essential to develop a research question that you're interested in or care about! A solid research question is like a lifeline that keeps you anchored during your search. The question should not be too broad or too narrow. Once you've drafted a research question to the best of your ability and knowledge, then a good way to refine your research question is to put it out to peer review or to work one-on-one with a librarian or a mentor colleague.

23. Research Question Checklist • Is my RQ something that I am curious about and that others might care about? Does it present an issue on which I can take a stand? • Does my RQ put a new spin on an old issue, or does it try to solve a problem? • Is my RQ too broad, too narrow, or OK? • Is my RQ researchable… • within the time frame available? • given the resources available at my location? • Is my RQ measurable? What type of information do I need? Can I find actual data to support or contradict a position? • What resources will I have? (journals, books, internet resources, government documents, interviews with people).

24. Review of Literature (ROL) This is a common problem area for new researchers because you may not have received the training to develop skills in computer based searching.

25. ROL – getting beyond the fear Many misunderstand the process of literature review …may seem easy but takes time to do it well It is a skill that can be learned by anyone with practice Help is here! Online KP librarians http://kpmd.org/forms/librarian.php

26. What kind of approach would you use to assess the literature for your topic? Going to research studies that have been published to see what is known about a topic/question Allows to further refine your research question after you learn from what is out there already Prepares you for the background and significance part of the research protocol

27. ROL – Getting started - Resources Looking specifically for research studies dealing with your question or topic – focused area to review Can be electronic or paper – eLibraries and university libraries Work with a librarian- Ask a Librarian (KP resource); http://kpmd.org/forms/librarian.php Look at references list on papers found – many can be found there – and shows if one keeps showing up or referenced over and over

28. ROL - Content Review first for any published guidelines, systematic reviews of research, meta-analysis – may have already answered your question or get you up to speed with the latest and greatest Research on your question specifically Research on your topic that is related Consider time period – latest and greatest (keep showing up in the references) and any really important work done in the past

29. Organizing the Literature Review 2 Key Skills Information seeking Make a written plan for how you are going to search Start broad and then focus down Critique – is it a good study? – also requires certain knowledge and skills – may need help/consultation and practice Summarizing the literature related to your topic Themes – what kind of things keep coming up Trends – are there similar things happening over time?

30. Ten Questions That Will Help You Get Through Any Research Report What is the research question? What is the basis for this research question? Why is this research question important? How was this research question studied? Does the study method make sense? Were the correct subjects selected for the study? Was the research question answered? Does the answer make sense? Does it matter? What is next?

31. What a Literature Review is Not Not a list of as many articles as possible Not just a summary of what you read It is – a careful choice of articles, studies, guidelines, etc that best helps describe background for your research

32. Refining the topic/key words to start Look at the question and pick words that are clearly related to the question; setting; population; type of literature (research, guidelines, systematic review) What discipline might have answers: Nursing, Medicine, education – point to what journals they might go to Example: Research question: What is the impact of follow-up calls to assess compliance of hypertensive patients taking prescribed medications on BP control? Key words: medication compliance, hypertension

33. Final “ROL” Starts with small summaries (abstracts) of studies Choose ones appropriate to review and relevant to your study Should include what is not known and recommendations for other studies

34. Approaches to answer the research question – methods and design If your question sounds like “What is going on here?” “How many patients have X?” This is a probably a descriptive study (most beginners should start here). If your question is “when this happens, is there something else that tends to happen too? Do they go together?” Is diabetes associated with obesity? This may be a correlational study. If your question sounds like “What is the effect of one thing on another? “What are the outcomes of patients who get a standard intervention vs a new treatment?” Or can you predict who would experience something? These are experimental studies. True experiments test what happens without the intervention (control) and with the interventions(s) being experimented. Randomized selects who is in the test and non-test groups in a random way to reduce “bias” in selecting who gets or doesn’t get in the test group.

35. Timing and Studies Retrospective – go back and look at what happened over a particular period of time (often easier for beginners - easier to do, less labor intensive) Before and after – Measure what you had before and then what you have after an intervention or change Prospective (forward as you go), randomized (pick at random who gets the standard treatment and new treatment(s), controlled (with a control group who would represent not receiving treatment) Longitudinal – studies over time periods

36. Types of Research Quantitative: Numbers Qualitative: Quality or Meaning

37. Types of Research Designs Quantitative – will you count something? Measure something? Do any kinds of statistics, even averages? Qualitative – will you interview, get narrative deep information on a subject? Observation of “what is going on here” Gives richer details about a specific phenomenon Seen often in nursing studies – “experience of X group” Often done before quantitative studies to gain more information about things that are not known well Mixed Methods – use some of both

38. Qualitative ResearchSeeks to find meaning behind thingsExplorative and can lead to quantitative studies Phenomenological Research “Lived experience” Grounded Theory Research Generate theory Ethnographic Research Participant observation Key informants Historical Research Documents

39. Descriptive Research Who What Where When How

40. Correlational Research Explains things beyond “what is” Discovers Relationships

41. Quasi/Experimental Research Test interventions Predict outcomes

42. Variables What is to be studied? Value can vary Examples: Gender Height and weight Score on a test Amount of pain Severity of injury

43. Measuring the Variable Conducting the experiment

44. Reliability & Validity Validity = instrument measures what it is supposed to measure Reliability = CONSISTENCY of measurement

45. Proposal Steps Background – summarizes information behind the question Complete Literature Review Determine Theoretical Framework Determine Objectives, Questions, Hypotheses What do you want to find out in this study? What are the research questions you ask? If experiment, what do you think will occur? - hypothesis Identify Study Variables What you want to study Must be MEASURABLE Determine Assumptions: Conditions considered to be true

46. Examples Objectives or purpose of the study: To identify dietary compliance of diabetic patients with two education interventions To compare and contrast nutritionist one-to-one teaching versus group teaching To compare and contrast Hgba1c based on type of education

47. Variables What is to be studied? Independent vs. dependent (experimental) The findings are dependent on something Independent – happen as they occur

48. Hypothesis What you think could happen- this is your educated guess or guess based on prior research

49. Steps in Quantitative Research Population & Sample Who or what do you want to study? How are you going to get a “representative” group? Is your sample and population from a big database, i.e. infection control? Core measures? Methods of Measurement How you are going to “measure” the variables

50. Quantitative Research Steps Data Collection & Analysis How are you going to collect data? Step-by-step; detailed Should be so detailed that someone else could replicate it