2. NURSING RESEARCH Is a systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administration, and informatics.

4. COMPARISON BETWEEN COHORT AND CASE-CONTROL STUDY 1.Research design 2.Conduction Measure of risk Temporal relationship between exposure and disease Cost of study Population size Best when Problems 安居木

5. RESEARCH DESIGN

6. EXPOSEDNOT EXPOSED DISEASE DEVELOPS DISEASE DOES NOT DEVELOP DISEASE DEVELOPS DISEASE DOES NOT DEVELP AND START WITH: THEN FOLLOW TO SEE IF Design of cohort study

7. DESIGN OF A CASE-CONTROL STUDY Were exposed Were not exposed Were not exposed HAVE THE DISEASE DO NOT HAVE THE DISEASE START WITH THEN DETERMINE EXPOSURE HISTORY

8. IN A COHORT STUDY NON-EXPOSED PEOPLE AND EXPOSED PEOPLE PEOPLE WITH THE DISEASE PEOPLE WITHOUT THE DISEASE AND IN A CASE-CONTROL STUDY GROUPS COMPARED ‘CASES ‘‘CONTROLS’

9. IN A COHORT STUDY NON-EXPOSED PEOPLE AND EXPOSED PEOPLE PEOPLE WITH THE DISEASE PEOPLE WITHOUT THE DISEASE AND IN A CASE-CONTROL STUDY DETERMINE THE PROPORTIONS EXPOSED IN: DETERMINE INCIDENCE RATES OF DISEASE IN: CASESCONTROLS

10. Cohort studyCase-control study Measure of risk Relative risk Odds ratio Temporal sequence Easy to establishSometimes hard Multiple association Possible to study associations of an exposure with several disease Possible to study associations of a disease with several exposures or factors Time and cost required Long and expensive Relatively short and inexpensive Population sizeRelatively largeRelatively small Potential biasAssessment of outcomeAssessment of exposure Best when Exposure is rare, and disease is frequent among exposed Disease is rare, exposure is frequent among the diseased

11. Cohort study Case-control study Problems Selection of non- exposed comparison group often difficult; Changes over time in criteria and methods Selection of appropriate controls often difficult; Incomplete information on exposure

12. Exposed Not Exposed Develop Disease A Do not Develop Disease A B C C B Develop Disease A C B Do not Develop Disease A C B

13. Exposed to A Not Exposed To A Exposed to A Not Exposed To A BB BB CCCC Disease No Disease casesControls

14. PURPOSE OF NURSING RESEARCH To test, refine and advance the knowledge on which improved education, clinical judgment, and cost-effective, safe, ethical nursing care rests.

15. DEVELOPMENT AND PROGRESSION OF NURSING RESEARCH

16. THE ORIGIN OF NURSING RESEARCH FLORENCE NIGHTINGALE – viewed as the person who first elevated nursing to the status of a PROFESSION, as presented in her first book NOTES ON NURSING (1859) Believed in the importance of “naming nursing” by the use of observed data to support the need for health- care reforms. Methodical Data gathering

17. A LOOK AT NURSING EDUCATION 1923 – Committee for the Study of Nursing Education Studied educational preparation of nurse teachers, administrators, public health nurses and the clinical experiences of nursing students.

18. Gold Mark Report – identified many inadequacies in the educational backgrounds of the group studied and concluded that advanced educational preparation was essential.

19. 1940s (WWII) – tremendous need for educated nurses Nursing education practices were evaluated in the study commissioned by the National Nursing Council for War Service headed by Brown Brown revealed numerous inadequacies in nursing education and thus, recommended that education of nurses occur in the collegiate level.

20. CENTER FOR NURSING RESEARCH 1950s Walter Reed Army Institute of Research – center for nursing research Nursing Research (journal)

21. SOURCE FOR NATIONAL DATA 1986 National Center for Nursing Research

22. EVIDENCE-BASED PRACTICE Defined as the use of the best clinical evidence in making patient care decisions to achieve cost- effective, high quality care based on scientific inquiry.

23. PARADIGMS AND METHODS: QUANTITATIVE AND QUALITATIVE RESEARCH

24. POSITIVIST PARADIGM ASSUMPTIONPOSITIVIST PARADIGM Ontologic (what is the nature of reality?) Reality exists; there is a real world driven by real natural courses Epistemologic (How is the inquirer related to those being researched?) The inquirer is independent from those being researched; findings are not influenced by the researcher Axiologic (What is the role of Values in the inquiry?) Values and biases are to be held in check; objectivity is sought Methodologic (How is knowledge obtained?) Deductive process, emphasis on discrete, specific concepts; fixed design, tight controls over context, emphasis on measured, quantitative information; statistical analysis; seeks generalization

25. NATURALISTIC PARADIGM ASSUMPTIONNATURALISTIC PARADIGM Ontologic (what is the nature of reality?) Reality is multiple and subjective, mentally constructed by individuals Epistemologic (How is the inquirer related to those being researched?) The inquirer interacts with those being researched; findings are creation of the interactive process Axiologic (What is the role of Values in the inquiry?) Subjectivity and values are inevitable and desirable Methodologic (How is knowledge obtained?) Inductive process; emphasis on entirely of some phenomenon, holistic; emerging interpretations grounded in participants’ experiences; flexible design; context-bound; emphasis on narrative information Qualitative analysis

26. RESEARCH METHODS Are the techniques used by researchers to structure a study and to gather and analyze information relevant to the research question.

27. THE SCIENTIFIC METHOD AND QUANTITATIVE RESEARCH SCIENTIFIC METHOD – refers to a general set of orderly, disciplined procedures used to acquire information.

28. QUANTITATIVE RESEARCH Uses deductive reasoning Systematic Uses control Uses measurements Researchers gather empirical evidence (objective in nature) Information gathered is usually (but not always) quantitative/numerical Uses statistical analysis Cannot be used to answer moral or ethical questions

29. NATURALISTIC METHODS AND QUALITATIVE RESEARCH NATURALISTIC METHOD – attempt to deal with the issue of human complexity by exploring it directly. Investigations place a heavy emphasis on understanding the human experience as it is lived.

30. QUALITATIVE RESEARCH Uses inductive reasoning Used for theory development Approach is flexible Always takes place in the field Concurrent collection and analysis of data Gathers rich and in-depth information (subjective in nature) Report is written in narrative form Involves small group of people or subjects Cannot be used to answer moral or ethical questions

31. KEY CONCEPTS AND TERMS IN QUANTITATIVE AND QUALITATIVE RESEARCH

32. People who are being studied Quantitative – subjects, study participants, respondents Qualitative – informants, key informants, study participants Sample – composed of the people being studied Person who undertakes the research Quantitative – researcher, investigator, scientist Qualitative – researcher, investigator

33. Research Settings – specific places where data collection occurs Quantitative – laboratory setting, (sometimes) field settings Example: Pierce and Clancy (2001) studied the effects of hypoxia on diaphragm activity in anesthetized rats. Qualitative – naturalistic setting/field Example: Carlisle (2000) studied the search for meaning in the care giving experience among informal carers of people living with HIV and AIDS. The researcher gathered in-depth information from carers in their homes and in HIV/AIDS org.

34. BUILDING BLOCKS OF A STUDY Phenomena – occurrence or events Concept – abstract ideas Examples of phenomena and concepts: pain, coping, and grief Constructs – abstractions that are systematically invented by a researcher Example: self-care

35. THEORIES AND CONCEPTUAL FRAMEWORKS Theory – systematic, abstract explanation of some aspect of reality Example: Nightingale’s Environmental Nursing Theory Conceptual Frameworks/Models – interrelated concepts or abstractions assembled together in a rational scheme by virtue of their relevance to a common theme. Example: Betty Neuman's Health Care Systems Model

37. VARIABLES Are something that varies Examples: weight, body temperature, income, anxiety level, etc Are central building blocks of a quantitative study Constant – opposite of variables

38. DEPENDENT AND INDEPENDENT VARIABLES

39. Independent variable – presumed cause Dependent variable – presumed effect Independent and dependent variables are used to indicate direction of influence rather than causal link. The effect of initial bath timing on the temperature of newborns The effect of sautéed garlic on the blood pressure of elderly patients The relationship between teacher’s qualification and student education

40. RESEARCH DATA Pieces of information obtained in the course of investigation

41. Quantitative data – numerical Example: Thinking about the past week, how depressed would you say you have been on a scale from 0-10, where 0 means “not at all” and 10 means “the most possible.” Subject 1 – 9 Subject 2 – 0 Subject 3 - 4 Qualitative data – narrative descriptions Example: tell me about how you’ve been feeling lately. Have you felt sad or depressed at all, or have you generally been in good spirits? Participant – I’ve had a few ups and downs in the past week, but basically things are pretty even keel. I don’t have too many complaints.

42. CRITERIA IN STUDY QUALITY ASSESSMENT

43. Reliability – refers to the accuracy and consistency of information obtained in the study Generalizability – asses the extent to which the findings can be applied to other groups and settings.

44. Validity – complex concept that broadly concerns the soundness of the study’s evidence. If methods used in the study are really measuring the concept/s that they have to measure.

45. Dependability – in qualitative studies, refers to evidence that is consistent and stable Confirmability – is similar to objectivity; it is the degree to which study results are derived from characteristics of participants and study context. Credibility – is achieved to the extent that the research method engender confidence in the truth of the data and in the researcher’s interpretations of the data.

46. Transferability – the extent to which qualitative findings can be transferred to other settings.

47. RESEARCH CONTROL Involve holding constant other influences on the dependent variable so that the true relationship between the dependent and independent variables can be understood.

48. Attempts to eliminate contaminating factors that might cloud the relationship between the variables of central interest. Example: Effect of sautéed garlic on the blood pressure of elderly patients – get subjects who are of almost the same age and engage in the same type of activities.

49. RANDOMNESS A powerful tool in quantitative studies to eliminate biases. Is not considered in qualitative studies

50. KEY TERMS USED IN QUANTITATIVE AND QUALITATIVE RESEARCH CONCEPTQUANTITATIVE TERMQUALITATIVE TERM Person Contributing Information Subject, Study Participant, Respondent Study participant, informant, key informant Person undertaking the study Researcher, investigator, scientist Researcher, investigator Being investigatedConcepts, constructs, variables Phenomena, concepts System of organizing concepts Theory, theoretical and conceptual framework, Theory, conceptual framework Information gatheredData (numerical)Data (narrative descriptions) Connections bet. concepts Relationships (cause-and- effect, functional) Patterns of association Quality of evidenceReliability, Validity, Generalizability, Objectivity Dependability, Credibility, Transferability, Confirmability

51. MAJOR CLASSES OF QUANTITATIVE RESEARCH EXPERIMENTAL RESEARCH – type of research wherein researchers actively introduce an intervention or treatment. Explicitly designed to test causal relationships Offer the possibility of greater control

52. EXPERIMENTAL RESEARCH Example: A researcher gave bran flakes to one group of subjects and prune juice to another to evaluate which method facilitated more effective elimination.

53. MAJOR CLASSES OF QUANTITATIVE RESEARCH NONEXPERIMENTAL RESEARCH – type of research wherein researchers collect data without making changes or introducing treatment.

54. NONEXPERIMENTAL RESEARCH Example: A researcher compared elimination patterns of two groups of people whose regular eating patterns differed – some normally took food that stimulated bowel elimination and others did not – there is no intervention.

55. MAJOR CLASSES OF QUALITATIVE RESEARCH GROUNDED THEORY – seeks to describe and understand the key social, psychological, and structural processes that occur in social setting Focus is on a developing social experience – the social or psychological stages and phases that characterize a particular event of episode.

56. GROUNDED THEORY Hauck and Irurita (2002) conducted a grounded theory study to explain the maternal process of managing late stages of breastfeeding and weaning the child from the breast.

57. MAJOR CLASSES OF QUALITATIVE RESEARCH PHENOMENOLOGY – concerned with the lived experiences of humans An approach to thinking about what life experiences or people are like and what they mean. Answers the question: What is the meaning of the phenomena to those who experience it?

58. PHENOMENOLOGY Example: Sundin, Norberg, and Jansson (2001) conducted a phenomenological study to illuminate the lived experiences of care providers who were highly skilled communicators in their relationship with patients with stroke and aphasia.

59. MAJOR CLASSES OF QUALITATIVE RESEARCH ETHNOGRAPHY – provides a framework for studying the meaning, patterns, and experiences of a defined cultural group in a holistic fashion.

60. Ethnographers typically engage in fieldwork and often participate to the extent possible in the life of the culture under study Aim is to learn from members of a cultural group.

61. ETHNOGRAPHY Example: Powers (2001) undertook an ethnographic analysis of a nursing home residence focusing on the ethical issues of daily living affecting nursing home residents with dementia.