Test #1 Flashcards
research
Systematic inquiry about phenomena (follows logical steps)
- Logical and rigorous
A phenomena - occurrences, circumstances, or facts, that are perceptible by the senses (eg. experience of pain)
Challenges assumptions
Knowledge development
significance of research to practice
- Expands the body of scientific knowledge
- Forms the foundation for evidence-informed decision making (EIDM)
- Enables practice to change
- Maintains the profession’s relevance
RN Role in Research
- consumer of research
- investigator
- Primary – someone leading a study (PhD or master)
- Secondary - someone involved in research but not designing research (helping role) (nurses recruit people for a research study) (collecting data)
- Partner – assisting with different parts of study, involved with carrying out the study
ways of knowing
personal ethical empirical aesthetic emancipatory
personal way of knowing
- process of self knowing
- Who you are as a person affects your behaviour, attitudes, and values both positively and negatively
- Reflection on assumptions, beliefs, etc.
- Process of reflection in order to understand how your feelings may affect your nursing care
- Assists in building therapeutic relationships.
- Can build/break relationships
- Assists in minimizing biases that interfere with caring for patients
ethical way of knowing
- About making judgements: what is good, bad, responsible
- What ought to be done
- Nurses bring to practice their own moral understandings
- Relativism – what is right varies for everyone (its relative to the person)
- Principle of beneficence (to do good) (acting for the benefit of others) (putting their needs above your own)
- Focuses on reflection, discussion, and debate of what is ethical/moral
- Important to clarify values and explore alternatives in order to gain new ethical knowledge and apply it to practice.
Aesthetic Knowledge Development
- the art of nursing
- Focuses on understanding unique situations and individual differences
- Entails drawing on experiences in health/illness; nursing; drawing from different ways of knowing (personal, ethical)
- Reflects what we know and how we do
- Ask: What does this mean? How is it significant?
- Grasping meaning of an encounter
- Establishing connection
- Performing in moral and appropriate way
- Helps us know how to deal with circumstances that are unique and unpredictable
Emancipatory way of knowing
- Critical lens to challenge and address social and political contexts to create change.
- Praxis- critical reflection and action used to achieve emancipatory knowledge
- Examining relations of power- dominance of certain ideologies, beliefs, values, or views of the world over other possible viewpoints.
- What are the barriers to equality ?
- What changes need to be made?
- Who benefits?
- What is wrong with this picture?
- Identifies the social and political barriers that prevent health and well-being for all people.
- Assists in addressing injustices and discrimination
Empirical way of knowing
- The science of nursing
- Knowledge grounded in theory, science (research)
- Expressed as theories, statement of fact, descriptions, interpretations of objects, events
- Through logical reasoning and systematic methods
- Testing hypotheses
- Generating theory
- Describing phenomenon
- Knowledge about abstracted generalities (what we can expect in a certain situation)
- Evidence for practice
Evidence Informed Decision Making
The incorporation of empirical research, clinical expertise, client preferences, and other available resources to make decisions about patients
Evidence Based Practice
Evidence based practice (EBP) is the process of collecting, processing, and implementing research findings to improve clinical practice, the work environment, or patient outcomes
EIDM Steps
1) develop a research question
2) gather evidence
3) appraise studies
4) synthesize study findings
5) adapt to practice
6) implement
7) evaluate
Don’t Go Aiming Shotguns At Idle Emo’s
PICOT
Population Intervention Comparison Outcome Time
Hierarchy of Evidence
Highest level
- Resources where evidence is rigorously processed and filtered to ensure its reliability (ie. systematic reviews, meta-analysis, guidelines)
Middle level
- Individual studies such as well conducted randomized controlled trial’s with a similar population of study, as well as observational studies
Lowest level
- Include case reports and expert opinions
Assessing Strength of Evidence
- quality
Extent to which the study design minimizes bias - quantity
Number of studies that have evaluated the research question, including sample size across studies - consistency
Degree to which studies have similar and different designs yet the same research question and similar findings
sources
Primary sources
- Studies: theory development or scholarly discussion by original author
- Peer-reviewed
Secondary sources
- Material written by individuals other than the person who conducted study or developed theory
- May be commentary or critique
History of Nursing
- Nursing has been around forever, but it wasn’t always called nursing (there has always been a need for the care they provide)
- Nurses played a role in caring for the ill since beginning of recorded history.
- Religious orders provided care. (mostly men)
- Prior to 1800’s nurses were classified as any women who cared for ill family members.
- Became less of a religious focus, became more of an untrained, very low prestige, unpaid, volunteer work (not something people aspired to do) (became women’s work)
- During this time nursing was not evidenced based, instead it was influenced by healing traditions within society.
- Did not have a body of knowledge
Lady of the Lamp (Florence Nightingale) (1850’s)
- Founder of modern day nursing
- From an upper class family, educated, fought against social norms of the time (going into nursing)
- Started working in street hospitals in London
- British Crimean War - more soldiers were dying in the hospitals than the war field
- She discovered the hospital conditions were very unclean (unhygienic), she cleaned it up and attended to the environment
- She collected data on what she was doing to the environment and the outcomes of the patients (show cause and effect that nursing and the environment has an effect on the patient) → evidence based practice
- Improved educational standards
- Started first school of nursing in London
Legacy
- Empirical knowledge
- Educational standards
- Believed nursing was distinct from medicine
1900’s-1950’s change in nursing
- loss of nightingale ideal
- apprenticeship learning was how you became a nurse
- persistence of nursing ideal-nursing leaders
Margaret newman
- Health as expanding Consciousness
- Health is about patients finding meaning/connections in their life
- Health of all persons regardless of the presence of absence of disease.
- Understanding of the whole person
Jean Watson
- Theory of Human Caring
- Caring Consciousness
- Connection of human beings through caring
Education in Nursing
Crucial to development of nursing research
1918: establishment of university courses
UBC 1919
1950-1960: master’s program
1990 -2000: doctorate
University of Alberta 1991 PhD program
2000: degree entry to practice
1969 - Canadian Journal of Nursing Research
why is history important to nursing?
Need for nursing leadership
Expand the role and scope of nurses
Encourages critical thinking
Knowing about the history of a profession is important
paradigm
- A set of beliefs and practices, shared by communities of researchers that guide the knowledge development process
- The way we think/do things
framework
Provides a general orientation to understand phenomenon
Structure of concepts and theories
Framework of concepts that make up a phenomenon (social determinants of health)
theory
to explain or predict phenomenon
Set of interrelated concepts
concepts
`things we make up to describe phenomenon
variables
elements that can be observed
research paradigms
post positivist
constructivist
critical social
post positivist
There is a common reality and we have to find it
We all experience reality the same
Proves or disproves theories to explain, predict, and control certain outcomes.
Values objectivity
Intense scrutiny of research findings
Usually quantitative research
Researcher is separate from the research (avoid bias)
How effective is tamoxifen in reducing breast cancer risk among women?
constructivism
Largely dependent on perception Truth is not absolute Focuses on observation and interaction Values subjectivity Usually qualitative research We all experience reality differently cause we come from different environments We construct our reality independently
What is the lived experience of women who are being treated for breast cancer?
critical social
Power differentials at play and reality is influenced by power
Historical perspective
Health is shaped by social, political, economical, and cultural factors
Understanding power imbalances
Can be qualitative and quantitative research
How does access to cancer treatment vary by racial/ethnic groups? Why? How do we do something about this?
ontology
the science or study of “reality/being”
what can be said to exist?
epistemology
Addresses the issue of “truth”
what is knowledge?
How do we know what we know?
deductive reasoning
Start with a general picture and move to specific
Generalizations to specific conclusions
Starts with a structure that guides searching for what is there
Quantitative
Theory → hypothesis → data/observation → analysis → repeat
inductive reasoning
Start with specific and move to a general picture
Figuring out what is there
Specific observations to reach a general conclusion
Based on what is observed
Qualitative
methodology
study design
overarching approach to the study
qualitative, quantitative, experimental, RCT
methods
how the study is done
eg. how the researcher recruited people, how they split up people into groups, how data was analyzed
qualitative research
- Used to explore personal meanings and context of an experience, culture, human patterns, and processes
- Data usually consist of words or text
- Conducted in the natural setting (where the phenomena is happening, not in a lab)
Quantitative research
- Test relationships, assess differences, and try to explain cause-and-effect interactions among the variables being studied
- Data is numerical
- Statistics are used
ethics
discipline dealing with the principles of moral values and moral conduct
Nuremberg Code
- Consent must be voluntary
- Results should be for the good of society
- Study should be based on an animal study that will predict the outcomes
- Risk be less than humanitarian importance of the study
- Study should only be conducted by qualified people
- Informed consent
- Experiment should avoid harm, injury, suffering
- Terminate if intervention showing harm
- Participant may discontinue study at any time
basic ethics principles
- respect for persons
- beneficence
- justice
protection of human rights
Right to:
- self determination (autonomy)
- privacy and dignity
- anonymity and confidentiality
- fair treatment
- protection from discomfort and harm (beneficence)
national regulation and policy (ethics)
- Canadian Nurses Association Code of Ethics – Nurses must uphold human rights and report violations
- Health Canada—Good Clinical Practice: Consolidated Guidelines, 1997
- Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans(CIHR, SSERC, NSERC) TCPS2
informed consent
- Information of potential benefits and risks of study
- Consent must be given without manipulation, undue influence, or coercion
- Ongoing process of communication and mutual understanding
Research Ethics Boards (REB’s)
Review research and assess that ethical standards are met
1) At least five expert members of various backgrounds
2) One non-scientific member
3) One member from outside the institution
4) Members have mandatory training
5) Responsible for protecting subjects from undue risk and loss of personal rights and dignity
REB Approval Criteria
Risks minimized Risks balanced by benefits Subject selection equitable Procedures for obtaining informed consent Procedures for consent documentation Data monitoring provisions Privacy and confidentiality measures Safeguards for vulnerable subjects
ethics: vulnerable persons
Children Prisoners Mentally disabled persons Economically disadvantaged Educationally disadvantaged Subtle vulnerability: language, culture, pregnancy, students, employees, substance abuse, health status
scientific fraud and misconduct
fraudulent studies
- falsified data
- coerced participants
misconduct and unauthorized studies
- product testing (testing medical devices)
nurses are obligated to report if they witness
types of research reports
- presentations at professional conferences (oral, posters)
- journal articles (peer reviewed)
- technical reports (WHO)
types of journal articles
- research studies
- reviews
- conceptual/theory articles
- summary articles
content of a research article
IMRAD
Abstract Introduction Method Results Discussion
qualitative
Identification of the phenomenon Purpose of research study question Literature review Design Sample Legal–ethical issues Data-collection procedure Data analysis Results/findings Discussion and recommendation References
quantitative
Research problem Purpose Literature review Theoretical framework, conceptual framework or both Hypothesis/research questions Research design Sample: type and size (always bigger sample size than qualitative) Legal–ethical issues Instruments (measurement tools) Validity and reliability (objectivity) (post positivist) Data-collection procedure Data analysis Results Discussion of findings and new findings Implications, limitations, and recommendations References
abstract
- Short comprehensive synopsis
- Summary of what the article is about
- Objective, background, methods, results and conclusion
- 100 to 300 words
introduction
- Background picture
- Context of situation
- Definitions of terms
purpose
- At end of introduction or framework or literature review
- Before the methods
- The objective/aim of this article is to present the estimation of the intervention effects on breast milk production outcomes
Literature Review
- Theoretical framework and/or review of the literature
- Current knowledge/literature on a topic
- Tells what is known
- Tells what is not known
- Argues for why study is needed
research question
Depends on methodology/method - Depends on the paradigm Sometimes embedded - Not always explicitly stated Important as the study answers or addresses this question May include a hypothesis - Only quantitative
Method: Research Design
Quantitative
- Research question is quantitative
- Test, compare, effect, associated
- Hypotheses stated or implied
- Control of treatment group
- Random or convenience sample
- Reliability or validity of instruments used to measure
- Statistical analysis used
Qualitative
- Research question is qualitative
- Experience, perception, views
- No numbers – text/words, photos, diagrams
- Qualitative terms used
- Informants, participants
- Lived experience, perceptions
Method: Sampling
Population of interest
Found under
- Methods, methodology
- Subjects, participants, sample (subset of the population)
Who are the participants and how were they selected?
Smaller sample size for qualitative
Method: procedures/data collection
Qualitative
- Interviews, observations, focus groups, document reviews
Quantitative
- Measurements (scales, instruments, tools)
Method: Data Analysis Results/Findings
Data analysis procedures - Statistical tests used - How researchers came to findings Results/findings - Tables, statistics - Text, themes, direct quotations from participants
Discussion
- Findings compared to existing literature
- Interpretations of results (why they found what they found)
- Recommendations
- Implications
- Limitations
Critical Reading Process
Preliminary understanding - Skim abstract and article; highlight/underline; review unfamiliar terms Comprehensive understanding - Understand main points of each section; understand terms Analysis understanding - Understand parts, critique soundness Synthesis understanding - Put together and make sense
critiquing a research study
Is it a study? Read 3 to 4 times!!! Identify steps of the research process (how study was conducted) Clarify terms and concepts Question assumptions and rationale Assess study for validity Use a table
Assessing strength of a study
Quality
- Extent to which a study’s design minimizes bias
Quantity
- Number of studies that have evaluated the research question, including sample size across studies
Consistency
- Degree to which studies have similar and different designs yet the same research question and similar findings
