Critique of Research Studies – Part 2: Topic 6 For Part 2 of the critique, focus only on the following segments for each article: (listed below)


PART 2- Topic 6

Critique of Research Studies Instructions –


Complete a critique of the

quantitative and qualitative articles listed below

and are provided – Please use APA format and page numbers.

  • Romeo, E. M. (2010). Quantitative Research on Critical Thinking and Predicting Nursing Students’ NCLEX-RN Performance.

    Journal of Nursing Education

    . Vol 49, No. 7.

  • Martin, J.M., Olano-Lizárraga, M & Saracibar-Razquin, M. (2016).

    The Experience of Family Caregivers Caring for a Terminal Patient at Home: A Research Review

    . International Journal of Nursing Studies 64: 1-12

This assignment will be completed in three parts. Refer to the information below as a guide to the information that should be included in each part.

Follow the guidelines for the quantitative and qualitative article (

that I have provided

) critiques in Box 5.2: Guide to an Overall Critique of a Quantitative Research Report, and Box 5.3: Guide to an Overall Critique of a Qualitative Research Report, in

Chapter 5 of the

Nursing Research: Generating and Assessing Evidence for Nursing Practice



Book provided


  • Utilize a central heading to indicate that what follows is the critique of the articles


  • The side headings of the critique for each article should follow the headings in Box 5.2 and Box 5.3 in Chapter 5 of the

    Nursing Research: Generating and Assessing Evidence for Nursing Practice


  • Note that within these basic guidelines, there are additional references to Detailed Critiquing Guidelines found in additional boxes in other chapters of the

    Nursing Research: Generating and Assessing Evidence for Nursing Practice


    focused on the various elements of a research study report. Use these to expand the research study and to learn specific terminology appropriate to the critique of research


When turning in the final submission, please put the elements in the following order: Quantitative Article Critique, Qualitative Article Critique,

References (which should include the two articles, the text, and any other additional sources).

This assignment uses a rubric listed below:


Critique thoroughly addresses all guidelines and criteria for the quantitative research title and abstract. Critique is supported with relevant evidence.

Critique thoroughly addresses all guidelines and criteria for each of the quantitative research introduction components. Critique is supported with relevant evidence.

Critique thoroughly addresses all guidelines and criteria for the qualitative research title and abstract. Critique is supported with relevant evidence.

Critique thoroughly addresses all guidelines and criteria for each of the qualitative research introduction components. Critique is supported with relevant evidence.

The writer is clearly in command of standard, written academic English.

All format elements are correct.

In-text citations and a reference page are complete

with page number

. The documentation of cited sources is free of error.

Part 2 Topic 6

Critique of Research Studies – Part 2: Topic 6

For Part 2 of the critique, focus only on the following segments for each article:

Quantitative (500 WORDS)

  • Method

    • Protection of human rights
    • Research design
    • Population and sample
    • Data collection and measurement
    • Procedures

Qualitative (500 WORDS)


Protection of participants’ rights

Research design and research tradition

Sample and setting

Data collection


Enhancement of trustworthiness

Quick Guide to Bivariate Statistical Tests
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Nursing research : generating and assessing evidence for nursing practice / Denise F. Polit, Cheryl
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also inspired the inclusion of some new content. Valori Banfi, reference librarian at
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support involves a lot of patience and many sacrifices.
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Associate Professor
The University of Alabama in Huntsville Huntsville, Alabama
Jennifer Bellot, PhD, RN, MHSA
Associate Professor and Director, DNP Program Thomas Jefferson University
Philadelphia, Pennsylvania Kathleen D. Black, PhD, RNC
Assistant Professor, Jefferson College of Nursing Thomas Jefferson University
Philadelphia, Pennsylvania Dee Campbell, PhD, APRN, NE-BC, CNL
Professor, Graduate Department Felician College, School of Nursing Lodi, New
Patricia Cannistraci, DNS, RN, CNE
Assistant Dean
Excelsior College
Albany, New York
Julie L. Daniels, DNP, CNM
Assistant Professor
Frontier Nursing University Hyden, Kentucky
Rebecca Fountain, PhD, RN
Associate Professor
University of Texas at Tyler Tyler, Texas
Teresa S. Johnson, PhD, RN
Associate Professor, College of Nursing University of Wisconsin—Milwaukee
Milwaukee, Wisconsin
Jacqueline Jones, PhD, RN, FAAN
Associate Professor, College of Nursing University of Colorado, Anschutz Medical
Campus Aurora, Colorado
Mary Lopez, PhD, RN
Associate Dean, Research
Western University of Health Sciences Pomona, California
Audra Malone, DNP, FNP-BC
Assistant Professor
Frontier Nursing University Hyden, Kentucky
Sharon R. Rainer, PhD, CRNP
Assistant Professor, Jefferson College of Nursing Thomas Jefferson University
Philadelphia, Pennsylvania Maria A. Revell, PhD, RN
Professor of Nursing
Middle Tennessee State University Murfreesboro, Tennessee
Stephanie Vaughn, PhD, RN, CRRN
Interim Director, School of Nursing California State University, Fullerton
Fullerton, California
Research methodology is not a static enterprise. Even after writing nine editions of
this book, we continue to draw inspiration and new material from groundbreaking
advances in research methods and in nurse researchers’ use of those methods. It is
exciting and uplifting to share many of those advances in this new edition. We
expect that many of the new methodologic and technologic advances will be
translated into powerful evidence for nursing practice. Five years ago, we
considered the ninth edition as a watershed edition of a classic textbook. We are
persuaded, however, that this 10th edition is even better. We have retained many
features that made this book a classic textbook and resource, including its focus on
research as a support for evidence-based nursing, but have introduced important
innovations that will help to shape the future of nursing research.
New Chapters We have added two new chapters on “cutting-edge”
topics that are not well covered in any major research methods
textbook, regardless of discipline. The first is a chapter on an issue of
critical importance to health professionals and yet inadequately
addressed in the nursing literature: the clinical significance of
research findings. In Chapter 20, we discuss various
conceptualizations of clinical significance and present methods of
operationalizing those conceptualizations so that clinical significance
can be assessed at both the individual and group level. We believe that
this is a “must-read” chapter for nurses whose research is designed to
inform clinical practice. The second new chapter in this edition
concerns the design and conduct of pilot studies. In recent years,
experts have written at length about the poor quality of many pilot
studies. Chapter 28 provides guidance on how to develop pilot study
objectives and draw conclusions about the appropriate next step—that
is, whether to proceed to a full-scale study, make major revisions, or
abandon the project. This chapter is included in Part 5 of this book,
which is devoted to mixed methods research, because pilots can
benefit from both qualitative and quantitative evidence.
New Content Throughout the book, we have included material on
methodologic innovations that have arisen in nursing, medicine, and
the social sciences during the past 4 to 5 years. The many additions
and changes are too numerous to describe here, but a few deserve
special mention. In particular, we have totally revised the chapters on
measurement (Chapter 14) and scale development (Chapter 15) to
reflect emerging ideas about key measurement properties and the
assessment of newly developed instruments.
The inclusion of two new chapters made it challenging to keep the textbook to a
manageable length. Our solution was to move some content in the ninth edition to
supplements that are available online. In fact, every chapter has an online
supplement, which gave us the opportunity to add a considerable amount of new
content. For example, one supplement is devoted to evidence-based methods to
recruit and retain study participants. Other supplements include a description of
various randomization methods, an overview of item response theory, guidance on
wording proposals to conduct pilot studies, and a discussion of quality
improvement studies. Following is a complete list of the supplements for the 31
chapters of this textbook: 1. The History of Nursing Research 2. Evaluating
Clinical Practice Guidelines—AGREE II 3. Deductive and Inductive Reasoning 4.
Complex Relationships and Hypotheses 5. Literature Review Matrices 6.
Prominent Conceptual Models of Nursing Used by Nurse Researchers, and a Guide
to Middle-Range Theories 7. Historical Background on Unethical Research
Conduct 8. Research Control 9. Randomization Strategies 10. The RE-AIM
Framework 11. Other Specific Types of Research 12. Sample Recruitment and
Retention 13. Other Types of Structured Self-Reports 14. Cross-Cultural Validity
and the Adaptation/Translation of Measures 15. Overview of Item Response
Theory 16. SPSS Analysis of Descriptive Statistics 17. SPSS Analysis of
Inferential Statistics 18. SPSS Analysis and Multivariate Statistics 19. Some
Preliminary Steps in Quantitative Analysis Using SPSS
20. Clinical Significance Assessment with the Jacobson-Truax Approach 21.
Historical Nursing Research 22. Generalizability and Qualitative Research 23.
Additional Types of Unstructured Self-Reports 24. Transcribing Qualitative
Data 25. Whittemore and Colleagues’ Framework of Quality Criteria in
Qualitative Research 26. Converting Quantitative and Qualitative Data 27.
Complex Intervention Development: Exploratory Questions 28. Examples of
Various Pilot Study Objectives 29. Publication Bias in Meta-Analyses 30. Tips
for Publishing Reports on Pilot Intervention Studies 31. Proposals for Pilot
Intervention Studies Another new feature of this edition concerns our interest in
readers’ access to references we cited. To the extent possible, the studies we
have chosen as examples of particular research methods are published as openaccess articles. These studies are identified with an asterisk in the reference list
at the end of each chapter, and a link to the article is included in the Toolkit
section of the Resource Manual. We hope that these revisions will help users of
this book to maximize their learning experience.
The content of this edition is organized into six main parts.
• Part I—Foundations of Nursing Research and Evidence-Based Practice
introduces fundamental concepts in nursing research. Chapter 1 briefly
summarizes the history and future of nursing research, discusses the
philosophical underpinnings of qualitative research versus quantitative research,
and describes major purposes of nursing research. Chapter 2 offers guidance on
utilizing research to build an evidence-based practice. Chapter 3 introduces
readers to key research terms and presents an overview of steps in the research
process for both qualitative and quantitative studies.
• Part II—Conceptualizing and Planning a Study to Generate Evidence further
sets the stage for learning about the research process by discussing issues
relating to a study’s conceptualization: the formulation of research questions
and hypotheses (Chapter 4), the review of relevant research (Chapter 5), the
development of theoretical and conceptual contexts (Chapter 6), and the
fostering of ethically sound approaches in doing research (Chapter 7). Chapter 8
provides an overview of important issues that researchers must attend to during
the planning of any type of study.
• Part III—Designing and Conducting Quantitative Studies to Generate
Evidence presents material on undertaking quantitative nursing studies. Chapter
9 describes fundamental principles and applications of quantitative research
design, and Chapter 10 focuses on methods to enhance the rigor of a
quantitative study, including mechanisms of research control. Chapter 11
examines research with different and distinct purposes, including surveys,
outcomes research, and evaluations. Chapter 12 presents strategies for sampling
study participants in quantitative research. Chapter 13 describes using structured
data collection methods that yield quantitative information. Chapter 14
discusses the concept of measurement and then focuses on methods of assessing
the quality of formal measuring instruments. In this edition, we describe
methods to assess the properties of point-in-time measurements (reliability and
validity) and longitudinal measurements—change scores (reliability of change
scores and responsiveness). Chapter 15 presents material on how to develop
high-quality self-report instruments. Chapters 16, 17, and 18 present an
overview of univariate, bivariate, and multivariate statistical analyses,
respectively. Chapter 19 describes the development of an overall analytic
strategy for quantitative studies, including material on handling missing data.
Chapter 20, a new chapter, discusses the issue of interpreting results and making
inferences about clinical significance.
• Part IV—Designing and Conducting Qualitative Studies to Generate
Evidence presents material on undertaking qualitative nursing studies. Chapter
21 is devoted to research designs and approaches for qualitative studies,
including material on critical theory, feminist, and participatory action research.
Chapter 22 discusses strategies for sampling study participants in qualitative
inquiries. Chapter 23 describes methods of gathering unstructured self-report
and observational data for qualitative studies. Chapter 24 discusses methods of
analyzing qualitative data, with specific information on grounded theory,
phenomenologic, and ethnographic analyses. Chapter 25 elaborates on methods
qualitative researchers can use to enhance (and assess) integrity and quality
throughout their inquiries.
• Part V—Designing and Conducting Mixed Methods Studies to Generate
Evidence presents material on mixed methods nursing studies. Chapter 26
discusses a broad range of issues, including asking mixed methods questions,
designing a study to address the questions, sampling participants in mixed
methods research, and analyzing and integrating qualitative and quantitative
data. Chapter 27 presents innovative information about using mixed methods
approaches in the development of nursing interventions. In Chapter 28, a new
chapter, we provide guidance for designing and conducting a pilot study and
using data from the pilot to draw conclusions about how best to proceed.
• Part VI—Building an Evidence Base for Nursing Practice provides additional
guidance on linking research and clinical practice. Chapter 29 offers an
overview of methods of conducting systematic reviews that support EBP, with
an emphasis on meta-analyses, metasyntheses, and mixed studies reviews.
Chapter 30 discusses dissemination of evidence—how to prepare a research
report (including theses and dissertations) and how to publish research findings.
The concluding chapter (Chapter 31) offers suggestions and guidelines on
developing research proposals and getting financial support and includes
information about applying for NIH grants and interpreting scores from NIH’s
new scoring system.
This textbook was designed to be helpful to those who are learning how to do
research as well as to those who are learning to appraise research reports critically
and to use research findings in practice. Many of the features successfully used in
previous editions have been retained in this 10th edition. Among the basic
principles that helped to shape this and earlier editions of this book are (1) an
unswerving conviction that the development of research skills is critical to the
nursing profession, (2) a fundamental belief that research is intellectually and
professionally rewarding, and (3) a steadfast opinion that learning about research
methods need be neither intimidating nor dull. Consistent with these principles, we
have tried to present the fundamentals of research methods in a way that both
facilitates understanding and arouses curiosity and interest. Key features of our
approach include the following: • Research Examples. Each chapter concludes
with one or two actual research examples designed to highlight critical points made
in the chapter and to sharpen the reader’s critical thinking skills. In addition, many
research examples are used to illustrate key points in the text and to stimulate ideas
for a study. Many of the examples used in this edition are open-access articles that
can be used for further learning and classroom discussions.
• Critiquing Guidelines. Most chapters include guidelines for conducting a
critique of each aspect of a research report. These guidelines provide a list of
questions that draw attention to specific aspects of a report that are amenable to
• Clear, “user-friendly” style. Our writing style is designed to be easily digestible
and nonintimidating. Concepts are introduced carefully and systematically,
difficult ideas are presented clearly, and readers are assumed to have no prior
exposure to technical terms.
• Specific practical tips on doing research. This textbook is filled with practical
guidance on how to translate the abstract notions of research methods into
realistic strategies for conducting research. Every chapter includes several tips
for applying the chapter’s lessons to real-life situations. These suggestions are
in recognition of the fact that there is often a large gap between what gets taught
in research methods textbooks and what a researcher needs to know to conduct a
• Aids to student learning. Several features are used to enhance and reinforce
learning and to help focus the student’s attention on specific areas of text
content, including the following: succinct, bulleted summaries at the end of each
chapter; tables and figures that provide examples and graphic materials in
support of the text discussion; study suggestions at the end of each chapter; a
detailed glossary; and a comprehensive index for accessing information quickly.
T E A C H I N G – L E A R N I N G PA C K A G E
Nursing Research: Generating and Assessing Evidence for Nursing Practice, 10th
edition, has an ancillary package designed with both students and instructors in
• The Resource Manual augments the textbook in important ways. The manual
itself provides students with exercises that correspond to each text chapter, with
a focus on opportunities to critique actual studies. The appendix includes 12
research journal articles in their entirety, plus a successful grant application for
a study funded by the National Institute of Nursing Research. The 12 reports
cover a range of nursing research ventures, including qualitative, quantitative,
and mixed methods studies, an instrument development study, an evidencebased practice translation project, and two systematic reviews. Full critiques of
two of the reports are also included and can serve as models for a
comprehensive research critique.
• The Toolkit to the Resource Manual is a “must-have” innovation that will save
considerable time for both students and seasoned researchers. Included on
thePoint, the Toolkit offers dozens of research resources in Word documents
that can be downloaded and used directly or adapted. The resources reflect bestpractice research material, most of which have been pretested and refined in our
own research. The Toolkit originated with our realization that in our
technologically advanced environment, it is possible to not only illustrate
methodologic tools as graphics in the textbook but also to make them directly
available for use and adaptation. Thus, we have included dozens of documents
in Word files that can readily be used in research projects, without requiring
researchers to “reinvent the wheel” or tediously retype material from this
textbook. Examples include informed consent forms, a demographic
questionnaire, content validity forms, and a coding sheet for a meta-analysis—
to name only a few. The Toolkit also has lists of relevant and useful websites
for each chapter, which can be “clicked” on directly without having to retype
the URL and risk a typographical error. Links to open-access articles cited in
the textbook, as well as other open-access articles relevant to each chapter, are
included in the Toolkit.
• The Instructor’s Resources on the Point include PowerPoint slides
summarizing key points in each chapter, test questions that have been placed
into a program that allows instructors to automatically generate a test, and an
image bank.
It is our hope that the content, style, and organization of this book continue to
meet the needs of a broad spectrum of nursing students and nurse researchers. We
also hope that this book will help to foster enthusiasm for the kinds of discoveries
that research can produce and for the knowledge that will help support an
evidence-based nursing practice.
Chapter 1: Introduction to Nursing Research in an Evidence-Based Practice
Chapter 2: Evidence-Based Nursing: Translating Research Evidence into Practice
Chapter 3: Key Concepts and Steps in Qualitative and Quantitative Research
Chapter 4: Research Problems, Research Questions, and Hypotheses
Chapter 5: Literature Reviews: Finding and Critiquing Evidence
Chapter 6: Theoretical Frameworks
Chapter 7: Ethics in Nursing Research
Chapter 8: Planning a Nursing Study
Chapter 9: Quantitative Research Design
Chapter 10: Rigor and Validity in Quantitative Research
Chapter 11: Specific Types of Quantitative Research
Chapter 12: Sampling in Quantitative Research
Chapter 13: Data Collection in Quantitative Research
Chapter 14: Measurement and Data Quality
Chapter 15: Developing and Testing Self-Report Scales
Chapter 16: Descriptive Statistics
Chapter 17: Inferential Statistics
Chapter 18: Multivariate Statistics
Chapter 19: Processes of Quantitative Data Analysis
Chapter 20: Clinical Significance and Interpretation of Quantitative Results
Chapter 21: Qualitative Research Design and Approaches
Chapter 22: Sampling in Qualitative Research
Chapter 23: Data Collection in Qualitative Research
Chapter 24: Qualitative Data Analysis
Chapter 25: Trustworthiness and Integrity in Qualitative Research
Chapter 26: Basics of Mixed Methods Research
Chapter 27: Developing Complex Nursing Interventions Using Mixed Methods
Chapter 28: Feasibility Assessments and Pilot Tests of Interventions Using Mixed
Chapter 29: Systematic Reviews of Research Evidence: Meta-Analysis,
Metasynthesis, and Mixed Studies Review
Chapter 30: Disseminating Evidence: Reporting Research Findings
Chapter 31: Writing Proposals to Generate Evidence
Appendix: Statistical Tables
Check Out the Latest Book Authored by Research Expert Dr. Polit
If you want to make thoughtful but practical decisions about the measurement of
health constructs, check out Dr. Polit and Dr. Yang’s latest book, a “gentle”
introduction to and overview of complex measurement content, called
Measurement and the Measurement of Change.
This book is for researchers and clinicians from all health disciplines because
measurement is vital to high-quality science and to excellence in clinical practice.
The text focuses on the measurement of health constructs, particularly those
constructs that are not amenable to quantification by means of laboratory analysis
or technical instrumentation. These health constructs include a wide range of
human attributes, such as quality of life, functional ability, self-efficacy,
depression, and pain. Measures of such constructs are proliferating at a rapid rate
and often without adequate attention paid to ensuring that standards of scientific
rigor are met.
In this book, the authors offer guidance to those who develop new instruments,
adapt existing ones, select instruments for use in a clinical trial or in clinical
practice, interpret information from measurements and changes in scores, or
undertake a systematic review on instruments. This book offers guidance on how
to develop new instruments using both “classical” and “modern” approaches from
psychometrics as well as methods used in clinimetrics. Much of this book,
however, concerns the evaluation of instruments in relation to three key
measurement domains: reliability, validity, and responsiveness.
This text was designed to be useful in graduate-level courses on measurement
or research methods and will also serve as an important reference and resource for
researchers and clinicians.
Introduction to Nursing Research in an
Evidence-Based Practice Environment
In all parts of the world, nursing has experienced a profound culture change.
Nurses are increasingly expected to understand and conduct research and to base
their professional practice on research evidence—that is, to adopt an evidencebased practice (EBP). EBP involves using the best evidence (as well as clinical
judgment and patient preferences) in making patient care decisions, and “best
evidence” typically comes from research conducted by nurses and other health care
What Is Nursing Research?
Research is systematic inquiry that uses disciplined methods to answer questions
or solve problems. The ultimate goal of research is to develop and expand
Nurses are increasingly engaged in disciplined studies that benefit nursing and
its clients. Nursing research is systematic inquiry designed to generate
trustworthy evidence about issues of importance to the nursing profession,
including nursing practice, education, administration, and informatics. In this book,
we emphasize clinical nursing research, that is, research to guide nursing practice
and to improve the health and quality of life of nurses’ clients.
Nursing research has experienced remarkable growth in the past three decades,
providing nurses with a growing evidence base from which to practice. Yet many
questions endure and much remains to be done to incorporate research innovations
into nursing practice.
Examples of Nursing Research Questions: • How effective is pressurized
irrigation, compared to a swabbing method, in cleansing wounds, in terms of
time to wound healing, pain, patients’ satisfaction with comfort, and costs?
(Mak et al., 2015) • What are the experiences of women in Zimbabwe who are
living with advanced HIV infection? (Gona & DeMarco, 2015)
The Importance of Research in Nursing Research findings from
rigorous studies provide especially strong evidence for informing
nurses’ decisions and actions. Nurses are accepting the need to base
specific nursing actions on research evidence indicating that the
actions are clinically appropriate, cost-effective, and result in positive
outcomes for clients.
In the United States, research plays an important role in nursing in terms of cred
entialing and status. The American Nurses Credentialing Center (ANCC)—an arm
of the American Nurses Association and the largest and most prestigious
credentialing organization in the United States—developed a Magnet Recognition
Program to acknowledge health care organizations that provide high-quality
nursing care. As Reigle and her colleagues (2008) noted, “the road to Magnet
Recognition is paved with EBP” (p. 102) and the 2014 Magnet application manual
incorporated revisions that strengthened evidence-based requirements (Drenkard,
2013). The good news is that there is growing confirmation that the focus on
research and evidence-based practice may have important payoffs. For example,
McHugh and co-researchers (2013) found that Magnet hospitals have lower riskadjusted mortality and failure to rescue than non-Magnet hospitals, even when
differences among the hospitals in nursing credentials and patient characteristics
are taken into account.
Changes to nursing practice now occur regularly because of EBP efforts.
Practice changes often are local initiatives that are not publicized, but broader
clinical changes are also occurring based on accumulating research evidence about
beneficial practice innovations.
Example of Evidence-Based Practice: Numerous clinical practice changes reflect
the impact of research. For example, “kangaroo care” (the holding of diaper-clad
infants skin to skin by parents) is now practiced in many neonatal intensive care
units (NICUs), but this is a relatively new trend. As recently as the 1990s, only a
minority of NICUs offered kangaroo care options. Expanded adoption of this
practice reflects mounting evidence that early skin-to-skin contact has benefits
without negative side effects (e.g., Ludington-Hoe, 2011; Moore et al., 2012).
Some of that evidence came from rigorous studies conducted by nurse researchers
in several countries (e.g., Chwo et al., 2002; Cong et al., 2009; Cong et al., 2011;
Hake-Brooks & Anderson, 2008). Nurses continue to study the potential benefits
of kangaroo care in important clinical trials (e.g., Campbell-Yeo et al., 2013).
The Consumer–Producer Continuum in Nursing Research In our
current environment, all nurses are likely to engage in activities along
a continuum of research participation. At one end of the continuum
are consumers of nursing research, who read research reports or
research summaries to keep up-to-date on findings that might affect
their practice. EBP depends on well-informed nursing research
At the other end of the continuum are the producers of nursing research: nurses
who design and conduct research. At one time, most nurse researchers were
academics who taught in schools of nursing, but research is increasingly being
conducted by nurses in health care settings who want to find solutions to recurring
problems in patient care.
Between these end points on the continuum lie a variety of research activities
that are undertaken by nurses. Even if you never personally undertake a study, you
may (1) contribute to an idea or a plan for a clinical study; (2) gather data for a
study; (3) advise clients about participating in research; (4) solve a clinical problem
by searching for research evidence; or (5) discuss the implications of a new study
in a journal club in your practice setting, which involves meetings (in groups or
online) to discuss research articles. In all possible research001-related activities,
nurses who have some research skills are better able than those without them to
make a contribution to nursing and to EBP. An understanding of nursing research
can improve the depth and breadth of every nurse’s professional practice.
Nursing Research in Historical Perspective Table 1.1 summarizes
some of the key events in the historical evolution of nursing research.
(An expanded summary of the history of nursing research appears in
the Supplement to this chapter on
Most people would agree that research in nursing began with Florence
Nightingale in the 1850s. Her most well-known research contribution involved an
analysis of factors affecting soldier mortality and morbidity during the Crimean
War. Based on skillful analyses, she was successful in effecting changes in nursing
care and, more generally, in public health. After Nightingale’s work, research was
absent from the nursing literature until the early 1900s, but most early studies
concerned nurses’ education rather than clinical issues.
In the 1950s, research by nurses began to accelerate. For example, a nursing
research center was established at the Walter Reed Army Institute of Research.
Also, the American Nurses Foundation, which is devoted to the promotion of
nursing research, was founded. The surge in the number of studies conducted in the
1950s created the need for a new journal; Nursing Research came into being in
1952. As shown in Table 1.1, dissemination opportunities in professional journals
grew steadily thereafter.
In the 1960s, nursing leaders expressed concern about the shortage of research
on practice issues. Professional nursing organizations, such as the Western
Interstate Council for Higher Education in Nursing, established research priorities,
and practice-oriented research on various clinical topics began to emerge in the
During the 1970s, improvements in client care became a more visible research
priority and nurses also began to pay attention to the clinical utilization of research
findings. Guidance on assessing research for application in practice settings
became available. Several journals that focus on nursing research were established
in the 1970s, including Advances in Nursing Science, Research in Nursing &
Health, and the Western Journal of Nursing Research. Nursing research also
expanded internationally. For example, the Workgroup of European Nurse
Researchers was established in 1978 to develop greater communication and
opportunities for partnerships among 25 European National Nurses Associations.
Nursing research continued to expand in the 1980s. In the United States, the
National Center for Nursing Research (NCNR) at the National Institutes of Health
(NIH) was established in 1986. Several forces outside of nursing also helped to
shape the nursing research landscape. A group from the McMaster Medical School
in Canada designed a clinical learning strategy that was called evidence-based
medicine (EBM). EBM, which promulgated the view that research findings were
far superior to the opinions of authorities as a basis for clinical decisions,
constituted a profound shift for medical education and practice, and has had a
major effect on all health care professions.
Nursing research was strengthened and given more visibility when NCNR was
promoted to full institute status within the NIH. In 1993, the National Institute of
Nursing Research (NINR) was established, helping to put nursing research more
into the mainstream of health research. Funding opportunities for nursing research
expanded in other countries as well.
Current and Future Directions for Nursing Research Nursing
research continues to develop at a rapid pace and will undoubtedly
flourish in the 21st century. Funding continues to grow. For example,
NINR funding in fiscal year 2014 was more than $140 million
compared to $70 million in 1999—and the competition for available
funding is increasingly vigorous as more nurses seek support for
testing innovative ideas for practice improvements.
Broadly speaking, the priority for future nursing research will be the promotion
of excellence in nursing science. Toward this end, nurse researchers and practicing
nurses will be sharpening their research skills and using those skills to address
emerging issues of importance to the profession and its clientele. Among the trends
we foresee for the early 21st century are the following: • Continued focus on EBP.
Encouragement for nurses to engage in evidence-based patient care is sure to
continue. In turn, improvements will be needed both in the quality of studies and in
nurses’ skills in locating, understanding, critiquing, and using relevant study
results. Relatedly, there is an emerging interest in translational research—
research on how findings from studies can best be translated into practice.
Translation potential will require researchers to think more strategically about
long-term feasibility, scalability, and sustainability when they test solutions to
• Development of a stronger evidence base through confirmatory strategies.
Practicing nurses are unlikely to adopt an innovation based on weakly designed
or isolated studies. Strong research designs are essential, and confirmation is
usually needed through the replication (i.e., the repeating) of studies with
different clients, in different clinical settings, and at different times to ensure
that the findings are robust.
• Greater emphasis on systematic reviews. Systematic reviews are a cornerstone of
EBP and will take on increased importance in all health disciplines. Systematic
reviews rigorously integrate research information on a topic so that conclusions
about the state of evidence can be reached. Best practice clinical guidelines
typically rely on such systematic reviews.
• Innovation. There is currently a major push for creative and innovative solutions
to recurring practice problems. “Innovation” has become an important
buzzword throughout NIH and in nursing associations. For example, the 2013
annual conference of the Council for the Advancement of Nursing Science was
“Innovative Approaches to Symptom Science.” Innovative interventions—and
new methods for studying nursing questions—are sure to be part of the future
research landscape in nursing.
• Expanded local research in health care settings. Small studies designed to solve
local problems will likely increase. This trend will be reinforced as more
hospitals apply for (and are recertified for) Magnet status in the United States
and in other countries. Mechanisms will need to be developed to ensure that
evidence from these small projects becomes available to others facing similar
problems, such as communication within and between regional nursing research
• Strengthening of interdisciplinary collaboration. Collaboration of nurses with
researchers in related fields is likely to expand in the 21st century as researchers
address fundamental health care problems. In turn, such collaborative efforts
could lead to nurse researchers playing a more prominent role in national and
international health care policies. One of four major recommendations in a 2010
report on the future of nursing by the Institute of Medicine was that nurses
should be full partners with physicians and other health care professionals in
redesigning health care.
• Expanded dissemination of research findings. The Internet and other electronic
communication have a big impact on disseminating research information, which
in turn helps to promote EBP. Through technologic advances, information about
innovations can be communicated more widely and more quickly than ever
• Increased focus on cultural issues and health disparities. The issue of health
disparities has emerged as a central concern in nursing and other health
disciplines; this in turn has raised consciousness about the cultural sensitivity of
health interventions and the cultural competence of health care workers. There
is growing awareness that research must be sensitive to the health beliefs,
behaviors, and values of culturally and linguistically diverse populations.
• Clinical significance and patient input. Research findings increasingly must meet
the test of being clinically significant, and patients have taken center stage in
efforts to define clinical significance. A major challenge in the years ahead will
involve getting both research evidence and patient preferences into clinical
decisions, and designing research to study the process and the outcomes.
Broad research priorities for the future have been articulated by many nursing
organizations, including NINR and Sigma Theta Tau International. Expert panels
and research working groups help NINR to identify gaps in current knowledge that
require research. The primary areas of research funded by NINR in 2014 were
health promotion/disease prevention, eliminating health disparities, caregiving,
symptom management, and self-management. Research priorities that have been
expressed by Sigma Theta Tau International include advancing healthy
communities through health promotion; preventing disease and recognizing social,
economic, and political determinants; implementation of evidence-based practice;
targeting the needs of vulnerable populations such as the poor and chronically ill;
and developing nurses’ capacity for research. Priorities also have been developed
for several nursing specialties and for nurses in several countries—for example,
Ireland (Brenner et al., 2014; Drennan et al., 2007), Sweden (Bäck-Pettersson et
al., 2008), Australia (Wynaden et al., 2014), and Korea (Kim et al., 2002).
Nurses make clinical decisions based on knowledge from many sources, including
coursework, textbooks, and their own clinical experience. Because evidence is
constantly evolving, learning about best practice nursing perseveres throughout a
nurse’s career.
Some of what nurses learn is based on systematic research, but much of it is not.
What are the sources of evidence for nursing practice? Where does knowledge for
practice come from? Until fairly recently, knowledge primarily was handed down
from one generation to the next based on experience, trial and error, tradition, and
expert opinion. Information sources for clinical practice vary in dependability,
giving rise to what is called an evidence hierarchy, which acknowledges that
certain types of evidence are better than others. A brief discussion of some
alternative sources of evidence shows how research001-based information is
Tradition and Authority
Decisions are sometimes based on custom or tradition. Certain “truths” are
accepted as given, and such “knowledge” is so much a part of a common heritage
that few seek verification. Tradition facilitates communication by providing a
common foundation of accepted truth, but many traditions have never been
evaluated for their validity. There is concern that some nursing interventions are
based on tradition, custom, and “unit culture” rather than on sound evidence.
Indeed, a recent analysis suggests that some “sacred cows” (ineffective traditional
habits) persist even in a health care center recognized as a leader in evidence-based
practice (Hanrahan et al., 2015).
Another common source of information is an authority, a person with
specialized expertise. We often make decisions about problems with which we
have little experience; it seems natural to place our trust in the judgment of people
with specialized training or experience. As a source of evidence, however,
authority has shortcomings. Authorities are not infallible, particularly if their
expertise is based primarily on personal experience; yet, like tradition, their
knowledge often goes unchallenged.
Example of “Myths” in Nursing Textbooks: A study suggests that even nursing
textbooks may contain “myths.” In their analysis of 23 widely used undergraduate
psychiatric nursing textbooks, Holman and colleagues (2010) found that all books
contained at least one unsupported assumption (myth) about loss and grief—that is,
assumptions not supported by research evidence. Moreover, many evidence-based
findings about grief and loss failed to be included in the textbooks.
Clinical Experience, Trial and Error, and Intuition Clinical
experience is a familiar, functional source of knowledge. The ability to
generalize, to recognize regularities, and to make predictions is an
important characteristic of the human mind. Nevertheless, personal
experience is limited as a knowledge source because each nurse’s
experience is too narrow to be generally useful. A second limitation is
that the same objective event is often experienced and perceived
differently by two nurses.
A related method is trial and error in which alternatives are tried successively
until a solution to a problem is found. We likely have all used this method in our
professional work. For example, many patients dislike the taste of potassium
chloride solution. Nurses try to disguise the taste of the medication in various ways
until one method meets with the approval of the patient. Trial and error may offer a
practical means of securing knowledge, but the method tends to be haphazard and
solutions may be idiosyncratic.
Intuition is a knowledge source that cannot be explained based on reasoning or
prior instruction. Although intuition and hunches undoubtedly play a role in
nursing—as they do in the conduct of research—it is difficult to develop nursing
policies and practices based on intuition.
Logical Reasoning
Solutions to some problems are developed by logical thought processes. As a
problem-solving method, logical reasoning combines experience, intellectual
faculties, and formal systems of thought. Inductive reasoning involves developing
generalizations from specific observations. For example, a nurse may observe the
anxious behavior of (specific) hospitalized children and conclude that (in general)
children’s separation from their parents is stressful. Deductive reasoning involves
developing specific predictions from general principles. For example, if we assume
that separation anxiety occurs in hospitalized children (in general), then we might
predict that (specific) children in a hospital whose parents do not room-in will
manifest symptoms of stress. Both systems of reasoning are useful for
understanding and organizing phenomena, and both play a role in research. Logical
reasoning in and of itself, however, is limited because the validity of reasoning
depends on the accuracy of the premises with which one starts.
Assembled Information
In making clinical decisions, health care professionals rely on information that has
been assembled for a variety of purposes. For example, local, national, and
international benchmarking data provide information on such issues as infection
rates or the rates of using various procedures (e.g., cesarean births) and can
facilitate evaluations of clinical practices. Cost data—information on the costs
associated with certain procedures, policies, or practices—are sometimes used as a
factor in clinical decision making. Quality improvement and risk data, such as
medication error reports, can be used to assess the need for practice changes. Such
sources are useful, but they do not provide a good mechanism for determining
whether improvements in patient outcomes result from their use.
Disciplined Research
Research conducted in a disciplined framework is the most sophisticated method of
acquiring knowledge. Nursing research combines logical reasoning with other
features to create evidence that, although fallible, tends to yield the most reliable
evidence. Carefully synthesized findings from rigorous research are at the pinnacle
of most evidence hierarchies. The current emphasis on EBP requires nurses to base
their clinical practice to the greatest extent possible on rigorous research001-based
findings rather than on tradition, authority, intuition, or personal experience—
although nursing will always remain a rich blend of art and science.
A paradigm is a worldview, a general perspective on the complexities of the
world. Paradigms for human inquiry are often characterized in terms of the ways in
which they respond to basic philosophical questions, such as, What is the nature of
reality? (ontologic) and What is the relationship between the inquirer and those
being studied? (epistemologic).
Disciplined inquiry in nursing has been conducted mainly within two broad
paradigms, positivism and constructivism. This section describes these two
paradigms and outlines the research methods associated with them. In later
chapters, we describe the transformative paradigm that involves critical theory
research (Chapter 21), and a pragmatism paradigm that involves mixed methods
research (Chapter 26).
The Positivist Paradigm
The paradigm that dominated nursing research for decades is known as positivism
(also called logical positivism). Positivism is rooted in 19th century thought,
guided by such philosophers as Mill, Newton, and Locke. Positivism reflects a
broader cultural phenomenon that, in the humanities, is referred to as modernism,
which emphasizes the rational and the scientific.
As shown in Table 1.2, a fundamental assumption of positivists is that there is a
reality out there that can be studied and known (an assumption is a basic principle
that is believed to be true without proof or verification). Adherents of positivism
assume that nature is basically ordered and regular and that reality exists
independent of human observation. In other words, the world is assumed not to be
merely a creation of the human mind. The related assumption of determinism
refers to the positivists’ belief that phenomena are not haphazard but rather have
antecedent causes. If a person has a cerebrovascular accident, the researcher in a
positivist tradition assumes that there must be one or more reasons that can be
potentially identified. Within the positivist paradigm, much research activity is
directed at understanding the underlying causes of phenomena.
Positivists value objectivity and attempt to hold personal beliefs and biases in
check to avoid contaminating the phenomena under study. The positivists’
scientific approach involves using orderly, disciplined procedures with tight
controls of the research situation to test hunches about the phenomena being
Strict positivist thinking has been challenged, and few researchers adhere to the
tenets of pure positivism. In the postpositivist paradigm, there is still a belief in
reality and a desire to understand it, but postpositivists recognize the impossibility
of total objectivity. They do, however, see objectivity as a goal and strive to be as
neutral as possible. Postpositivists also appreciate the impediments to knowing
reality with certainty and therefore seek probabilistic evidence—that is, learning
what the true state of a phenomenon probably is, with a high degree of likelihood.
This modified positivist position remains a dominant force in nursing research. For
the sake of simplicity, we refer to it as positivism.
The Constructivist Paradigm The constructivist paradigm (often
called the naturalistic paradigm) began as a countermovement to
positivism with writers such as Weber and Kant. Just as positivism
reflects the cultural phenomenon of modernism that burgeoned after
the industrial revolution, naturalism is an outgrowth of the cultural
transformation called postmodernism. Postmodern thinking
emphasizes the value of deconstruction—taking apart old ideas and
structures—and reconstruction—putting ideas and structures together
in new ways. The constructivist paradigm represents a major
alternative system for conducting disciplined research in nursing.
Table 1.2 compares the major assumptions of the positivist and
constructivist paradigms.
For the naturalistic inquirer, reality is not a fixed entity but rather is a
construction of the individuals participating in the research; reality exists within a
context, and many constructions are possible. Naturalists thus take the position of
relativism: If there are multiple interpretations of reality that exist in people’s
minds, then there is no process by which the ultimate truth or falsity of the
constructions can be determined.
The constructivist paradigm assumes that knowledge is maximized when the
distance between the inquirer and those under study is minimized. The voices and
interpretations of study participants are crucial to understanding the phenomenon
of interest, and subjective interactions are the primary way to access them.
Findings from a constructivist inquiry are the product of the interaction between
the inquirer and the participants.
Paradigms and Methods: Quantitative and Qualitative Research
Research methods are the techniques researchers use to structure a
study and to gather and analyze information relevant to the research
question. The two alternative paradigms correspond to different
methods for developing evidence. A key methodologic distinction is
between quantitative research, which is most closely allied with
positivism, and qualitative research, which is associated with
constructivist inquiry—although positivists sometimes undertake
qualitative studies, and constructivist researchers sometimes collect
quantitative information. This section provides an overview of the
methods associated with the two paradigms.
The Scientific Method and Quantitative Research The traditional,
positivist scientific method refers to a set of orderly, disciplined
procedures used to acquire information. Quantitative researchers use
deductive reasoning to generate predictions that are tested in the real
world. They typically move in a systematic fashion from the definition
of a problem and the selection of concepts on which to focus to the
solution of the problem. By systematic, we mean that the investigator
progresses logically through a series of steps, according to a specified
plan of action.
Quantitative researchers use various control strategies. Control involves
imposing conditions on the research situation so that biases are minimized and
precision and validity are maximized. Control mechanisms are discussed at length
in this book.
Quantitative researchers gather empirical evidence—evidence that is rooted in
objective reality and gathered through the senses. Empirical evidence, then,
consists of observations gathered through sight, hearing, taste, touch, or smell.
Observations of the presence or absence of skin inflammation, patients’ anxiety
level, or infant birth weight are all examples of empirical observations. The
requirement to use empirical evidence means that findings are grounded in reality
rather than in researchers’ personal beliefs.
Evidence for a study in the positivist paradigm is gathered according to an
established plan, using structured methods to collect needed information. Usually
(but not always) the information gathered is quantitative—that is, numeric
information that is obtained from a formal measurement and is analyzed
A traditional scientific study strives to go beyond the specifics of a research
situation. For example, quantitative researchers are typically not as interested in
understanding why a particular person has a stroke as in understanding what
factors influence its occurrence in people generally. The degree to which research
findings can be generalized to individuals other than those who participated in the
study is called the study’s generalizability.
The scientific method has enjoyed considerable stature as a method of inquiry
and has been used productively by nurse researchers studying a range of nursing
problems. This is not to say, however, that this approach can solve all nursing
problems. One important limitation—common to both quantitative and qualitative
research—is that research cannot be used to answer moral or ethical questions.
Many persistent, intriguing questions about human beings fall into this area—
questions such as whether euthanasia should be practiced or abortion should be
The traditional research approach also must contend with problems of
measurement. To study a phenomenon, quantitative researchers attempt to measure
it by attaching numeric values that express quantity. For example, if the
phenomenon of interest is patient stress, researchers would want to assess if
patients’ stress is high or low, or higher under certain conditions or for some
people. Physiologic phenomena such as blood pressure and temperature can be
measured with great accuracy and precision, but the same cannot be said of most
psychological phenomena, such as stress or resilience.
Another issue is that nursing research focuses on humans, who are inherently
complex and diverse. Traditional quantitative methods typically concentrate on a
relatively small portion of the human experience (e.g., weight gain, depression) in
a single study. Complexities tend to be controlled and, if possible, eliminated,
rather than studied directly, and this narrowness of focus can sometimes obscure
insights. Finally, quantitative research within the positivist paradigm has been
accused of an inflexibility of vision that does not capture the full breadth of human
Constructivist Methods and Qualitative Research Researchers in
constructivist traditions emphasize the inherent complexity of
humans, their ability to shape and create their own experiences, and
the idea that truth is a composite of realities. Consequently,
constructivist studies are heavily focused on understanding the human
experience as it is lived, usually through the careful collection and
analysis of qualitative materials that are narrative and subjective.
Researchers who reject the traditional scientific method believe that it is overly
reductionist—that is, it reduces human experience to the few concepts under
investigation, and those concepts are defined in advance by the researcher rather
than emerging from the experiences of those under study. Constructivist
researchers tend to emphasize the dynamic, holistic, and individual aspects of
human life and attempt to capture those aspects in their entirety, within the context
of those who are experiencing them.
Flexible, evolving procedures are used to capitalize on findings that emerge in
the course of the study. Constructivist inquiry usually takes place in the field (i.e.,
in naturalistic settings), often over an extended time period. In constructivist
research, the collection of information and its analysis typically progress
concurrently; as researchers sift through information, insights are gained, new
questions emerge, and further evidence is sought to amplify or confirm the
insights. Through an inductive process, researchers integrate information to
develop a theory or description that helps illuminate the phenomenon under
Constructivist studies yield rich, in-depth information that can elucidate varied
dimensions of a complicated phenomenon. Findings from in-depth qualitative
research are typically grounded in the real-life experiences of people with firsthand knowledge of a phenomenon. Nevertheless, the approach has several
limitations. Human beings are used directly as the instrument through which
information is gathered, and humans are extremely intelligent and sensitive—but
fallible—tools. The subjectivity that enriches the analytic insights of skillful
researchers can yield trivial and obvious “findings” among less competent ones.
Another potential limitation involves the subjectivity of constructivist inquiry,
which sometimes raises concerns about the idiosyncratic nature of the conclusions.
Would two constructivist researchers studying the same phenomenon in similar
settings arrive at similar conclusions? The situation is further complicated by the
fact that most constructivist studies involve a small group of participants. Thus, the
generalizability of findings from constructivist inquiries is an issue of potential
Multiple Paradigms and Nursing Research Paradigms should be
viewed as lenses that help to sharpen our focus on a phenomenon, not
as blinders that limit intellectual curiosity. The emergence of
alternative paradigms for studying nursing problems is, in our view, a
healthy and desirable path that can maximize the breadth of evidence
for practice. Although researchers’ worldview may be paradigmatic,
knowledge itself is not. Nursing knowledge would be thin if there were
not a rich array of methods available within the two paradigms—
methods that are often complementary in their strengths and
limitations. We believe that intellectual pluralism is advantageous.
We have emphasized differences between the two paradigms and associated
methods so that distinctions would be easy to understand—although for many of
the issues included in Table 1.2, differences are more on a continuum than they are
a dichotomy. Subsequent chapters of this book elaborate further on differences in
terminology, methods, and research products. It is equally important, however, to
note that the two main paradigms have many features in common, only some of
which are mentioned here: • Ultimate goals. The ultimate aim of disciplined
research, regardless of the underlying paradigm, is to gain understanding about
phenomena. Both quantitative and qualitative researchers seek to capture the truth
with regard to an aspect of the world in which they are interested, and both groups
can make meaningful—and mutually beneficial—contributions to evidence for
nursing practice.
• External evidence. Although the word empiricism has come to be allied with the
classic scientific method, researchers in both traditions gather and analyze
evidence empirically, that is, through their senses. Neither qualitative nor
quantitative researchers are armchair analysts, depending on their own beliefs
and worldviews to generate knowledge.
• Reliance on human cooperation. Because evidence for nursing research comes
primarily from humans, human cooperation is essential. To understand people’s
characteristics and experiences, researchers must persuade them to participate in
the investigation and to speak and act candidly.
• Ethical constraints. Research with human beings is guided by ethical principles
that sometimes interfere with research goals. As we discuss in Chapter 7, ethical
dilemmas often confront researchers, regardless of paradigms or methods.
• Fallibility of disciplined research. Virtually all studies have some limitations.
Every research question can be addressed in many ways, and inevitably, there
are trade-offs. The fallibility of any single study makes it important to
understand and critique researchers’ methodologic decisions when evaluating
evidence quality.
Thus, despite philosophic and methodologic differences, researchers using
traditional scientific methods or constructivist methods share overall goals and face
many similar challenges. The selection of an appropriate method depends on
researchers’ personal philosophy and also on the research question. If a researcher
asks, “What are the effects of cryotherapy on nausea and oral mucositis in patients
undergoing chemotherapy?” the researcher needs to examine the effects through
the careful measurement of patient outcomes. On the other hand, if a researcher
asks, “What is the process by which parents learn to cope with the death of a
child?” the researcher would be hard pressed to quantify such a process. Personal
worldviews of researchers help to shape their questions.
In reading about the alternative paradigms for nursing research, you likely were
more attracted to one of the two paradigms. It is important, however, to learn about
both approaches to disciplined inquiry and to recognize their respective strengths
and limitations. In this textbook, we describe methods associated with both
qualitative and quantitative research in an effort to assist you in becoming
methodologically bilingual. This is especially important because large numbers of
nurse researchers are now undertaking mixed methods research that involves
gathering and analyzing both qualitative and quantitative data (Chapters 26–28).
The general purpose of nursing research is to answer questions or solve problems
of relevance to nursing. Specific purposes can be classified in various ways. We
describe three such classifications—not because it is important for you to
categorize a study as having one purpose or the other but rather because this will
help us to illustrate the broad range of questions that have intrigued nurses and to
further show differences between qualitative and quantitative inquiry.
Applied and Basic Research Sometimes a distinction is made between
basic and applied research. As traditionally defined, basic research is
undertaken to enhance the base of knowledge or to formulate or refine
a theory. For example, a researcher may perform an in-depth study to
better understand normal grieving processes, without having explicit
nursing applications in mind. Some types of basic research are called
bench research, which is usually performed in a laboratory and focuses
on the molecular and cellular mechanisms that underlie disease.
Example of Basic Nursing Research: Kishi and a multidisciplinary team of
researchers (2015) studied the effect of hypo-osmotic shock of epidermal cells on
skin inflammation in a rat model, in an effort to understand the physiologic
mechanism underlying aquagenic pruritus (disrupted skin barrier function) in the
Applied research seeks solutions to existing problems and tends to be of
greater immediate utility for EBP. Basic research is appropriate for discovering
general principles of human behavior and biophysiologic processes; applied
research is designed to indicate how these principles can be used to solve problems
in nursing practice. In nursing, the findings from applied research may pose
questions for basic research, and the results of basic research often suggest clinical
Example of Applied Nursing Research: S. Martin and colleagues (2014) studied
whether positive therapeutic suggestions given via headphones to children
emerging from anesthesia after a tonsillectomy would help to lower the children’s
Research to Achieve Varying Levels of Explanation Another way to
classify research purposes concerns the extent to which studies
provide explanatory information. Although specific study goals can
range along an explanatory continuum, a fundamental distinction
(relevant especially in quantitative research) is between studies whose
primary intent is to describe phenomena, and those that are causeprobing—that is, designed to illuminate the underlying causes of
Within a descriptive/explanatory framework, the specific purposes of nursing
research include identification, description, exploration, prediction/control, and
explanation. For each purpose, various types of question are addressed—some
more amenable to qualitative than to quantitative inquiry and vice versa.
Identification and Description Qualitative researchers sometimes
study phenomena about which little is known. In some cases, so little is
known that the phenomenon has yet to be clearly identified or named
or has been inadequately defined. The in-depth, probing nature of
qualitative research is well suited to the task of answering such
questions as, “What is this phenomenon?” and “What is its name?”
(Table 1.3). In quantitative research, by contrast, researchers begin
with a phenomenon that has been previously studied or defined—
sometimes in a qualitative study. Thus, in quantitative research,
identification typically precedes the inquiry.
Qualitative Example of Identification: Wojnar and Katzenmeyer (2013) studied
the experiences of preconception, pregnancy, and new motherhood for lesbian
nonbiologic mothers. They identified, through in-depth interviews with 24 women,
a unique description of a pervasive feeling they called otherness.
Description is another important research purpose. Examples of phenomena that
nurse researchers have described include patients’ pain, confusion, and coping.
Quantitative description focuses on the incidence, size, and measurable attributes
of phenomena. Qualitative researchers, by contrast, describe the dimensions and
meanings of phenomena. Table 1.3 shows descriptive questions posed by
quantitative and qualitative researchers.
Quantitative Example of Description: Palese and colleagues (2015) conducted a
study to describe the average healing time of stage II pressure ulcers. They found
that it took approximately 23 days to achieve complete reepithelialization.
Qualitative Example of Description: Archibald and colleagues (2015) undertook
an in-depth study to describe the information needs of parents of children with
Exploratory research begins with a phenomenon of interest, but rather than simply
observing and describing it, exploratory research investigates the full nature of the
phenomenon, the manner in which it is manifested, and the other factors to which it
is related. For example, a descriptive quantitative study of patients’ preoperative
stress might document the degree of stress patients feel before surgery and the
percentage of patients who are stressed. An exploratory study might ask: What
factors diminish or increase a patient’s stress? Are nurses’ behaviors related to a
patient’s stress level? Qualitative methods are especially useful for exploring the
full nature of a little-understood phenomenon. Exploratory qualitative research is
designed to shed light on the various ways in which a phenomenon is manifested
and on underlying processes.
Quantitative Example of Exploration: Lee and colleagues (2014) explored the
association between physical activity in older adults and their level of depressive
Qualitative Example of Exploration: Based on in-depth interviews with adults
living on a reservation in the United States, D. Martin and Yurkovich (2014)
explored American Indians’ perception of a healthy family.
The goals of explanatory research are to understand the underpinnings of natural
phenomena and to explain systematic relationships among them. Explanatory
research is often linked to theories, which are a method of integrating ideas about
phenomena and their interrelationships. Whereas descriptive research provides new
information and exploratory research provides promising insights, explanatory
research attempts to offer understanding of the underlying causes or full nature of a
phenomenon. In quantitative research, theories or prior findings are used
deductively to generate hypothesized explanations that are then tested. In
qualitative studies, researchers search for explanations about how or why a
phenomenon exists or what a phenomenon means as a basis for developing a
theory that is grounded in rich, in-depth evidence.
Quantitative Example of Explanation: Golfenshtein and Drach001-Zahavy
(2015) tested a theoretical model (attribution theory) to understand the role of
patients’ attributions in nurses’ regulation of emotions in pediatric hospital wards.
Qualitative Example of Explanation: Smith-Young and colleagues (2014)
conducted an in-depth study to develop a theoretical understanding of the process
of managing work-related musculoskeletal disorders while remaining at the
workplace. They called this process constant negotiation.
Prediction and Control
Many phenomena defy explanation. Yet it is frequently possible to make
predictions and to control phenomena based on research findings, even in the
absence of complete understanding. For example, research has shown that the
incidence of Down syndrome in infants increases with the age of the mother. We
can predict that a woman aged 40 years is at higher risk of bearing a child with
Down syndrome than is a woman aged 25 years. We can partially control the
outcome by educating women 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 depend on an explanation of why older women are at a higher risk of having an
abnormal child. In many quantitative studies, prediction and control are key
objectives. Although explanatory studies are powerful in an EBP environment,
studies whose purpose is prediction and control are also critical in helping
clinicians make decisions.
Quantitative Example of Prediction: Dang (2014) studied factors that predicted
resilience among homeless youth with histories of maltreatment. Social
connectedness and self-esteem were predictive of better mental health.
Research Purposes Linked to Evidence-Based Practice The purpose of
most nursing studies can be categorized on a descriptive–explanatory
dimension as just described, but some studies do not fall into such a
system. For example, a study to develop and rigorously test a new
method of measuring patient outcomes cannot easily be classified on
this continuum.
In both nursing and medicine, several books have been written to facilitate
evidence-based practice, and these books categorize studies in terms of the types of
information needed by clinicians (DiCenso et al., 2005; Guyatt et al., 2008;
Melnyk & Fineout-Overholt, 2011). These writers focus on several types of
clinical concerns: treatment, therapy, or intervention; diagnosis and assessment;
prognosis; prevention of harm; etiology; and meaning. Not all nursing studies have
one of these purposes, but most of them do.
Treatment, Therapy, or Intervention Nurse researchers undertake
studies designed to help nurses make evidence-based treatment
decisions about how to prevent a health problem or how to manage an
existing problem. Such studies range from evaluations of highly
specific treatments or therapies (e.g., comparing two types of cooling
blankets for febrile patients) to complex multisession interventions
designed to effect major behavioral changes (e.g., nurse-led smoking
cessation interventions). Such intervention research plays a critical
role in EBP.
Example of a Study Aimed at Treatment/Therapy: Ling and co-researchers
(2014) tested the effectiveness of a school-based healthy lifestyle intervention
designed to prevent childhood obesity in four rural elementary schools.
Diagnosis and Assessment A burgeoning number of nursing studies
concern the rigorous development and evaluation of formal
instruments to screen, diagnose, and assess patients and to measure
important clinical outcomes. High-quality instruments with
documented accuracy are essential both for clinical practice and for
further research.
Example of a Study Aimed at Diagnosis/Assessment: Pasek and colleagues
(2015) developed a prototype of an electronic headache pain diary for children and
evaluated the clinical feasibility of the diary for assessing and documenting
concussion headache.
Studies of prognosis examine outcomes associated with a disease or health
problem, estimate the probability they will occur, and predict the types of people
for whom the outcomes are most likely. Such studies facilitate the development of
long-term care plans for patients. They provide valuable information for guiding
patients to make lifestyle choices or to be vigilant for key symptoms. Prognostic
studies can also play a role in resource allocation decisions.
Example of a Study Aimed at Prognosis: Storey and Von Ah (2015) studied the
prevalence and impact of hyperglycemia on hospitalized leukemia patients, in
terms of such outcomes as neutropenia, infection, and length of hospital stay.
Prevention of Harm and Etiology (Causation) Nurses frequently
encounter patients who face potentially harmful exposures as a result
of environmental agents or because of personal behaviors or
characteristics. Providing useful information to patients about such
harms and how best to avoid them depends on the availability of
accurate evidence about health risks. Moreover, it can be difficult to
prevent harms if we do not know what causes them. For example,
there would be no smoking cessation programs if research had not
provided firm evidence that smoking cigarettes causes or contributes
to a wide range of health problems. Thus, identifying factors that
affect or cause illness, mortality, or morbidity is an important purpose
of many nursing studies.
Example of a Study Aimed at Identifying and Preventing Harms: Hagerty and
colleagues (2015) undertook a study to identify risk factors for catheter-associated
urinary tract infections in critically ill patients with subarachnoid hemorrhage. The
risk factors examined included patients’ blood sugar levels, patient age, and levels
of anemia requiring transfusion.
Meaning and Processes
Designing effective interventions, motivating people to comply with treatments
and health promotion activities, and providing sensitive advice to patients are
among the many health care activities that can greatly benefit from understanding
the clients’ perspectives. Research that provides evidence about what health and
illness mean to clients, what barriers they face to positive health practices, and
what processes they experience in a transition through a health care crisis are
important to evidence-based nursing practice.
Example of a Study Aimed at Studying Meaning: Carlsson and Persson (2015)
studied what it means to live with intestinal failure caused by Crohn disease and
the influence it has on daily life.
TIP: Several of these EBP-related purposes (except diagnosis and meaning)
fundamentally call for cause-probing research. For example, research on
interventions focuses on whether an intervention causes improvements in key
outcomes. Prognosis research asks if a disease or health condition causes
subsequent adverse outcomes, and etiology research seeks explanations about
the underlying causes of health problems.
This book is designed primarily to help you develop skills for conducting research,
but in an environment that stresses EBP, it is extremely important to hone your
skills in reading, evaluating, and using nursing studies. We provide specific
guidance to consumers in most chapters by including guidelines for critiquing
aspects of a study covered in the chapter. The questions in Box 1.1 are designed to
assist you in using the information in this chapter in an overall preliminary
assessment of a research report.
BOX 1.1 Questions for a Preliminary Overview of a
Research Report
1. How relevant is the research problem in this report to the actual practice of
nursing? Does the study focus on a topic that is a priority area for nursing
2. Is the research quantitative or qualitative?
3. What is the underlying purpose (or purposes) of the study—identification,
description, exploration, explanation, or prediction and control? Does the
purpose correspond to an EBP focus such as treatment, diagnosis, prognosis,
harm/etiology, or meaning?
4. Is this study fundamentally cause-probing?
5. What might be some clinical implications of this research? To what type of
people and settings is the research most relevant? If the findings are accurate,
how might I use the results of this study?
TIP: The Resource Manual that accompanies this book offers particularly rich
opportunities to practice your critiquing skills. The Toolkit on thePoint with the
Resource Manual includes Box 1.1 as a Word document, which will allow you
to adapt these questions, if desired, and to answer them directly into a Word
document without having to retype the questions.
Each chapter of this book presents brief descriptions of studies conducted by nurse
researchers, focusing on aspects emphasized in the chapter. Reading the full
journal articles would prove useful for learning more about the studies, their
methods, and the findings.
Research Example of a Quantitative Study Study: The effects of a
community-based, culturally tailored diabetes prevention intervention
for high-risk adults of Mexican descent (Vincent et al., 2014) Study
Purpose: The purpose of the study was to evaluate the effectiveness of
a 5-month nurse-coached diabetes prevention program (Un Estilo de
Vida Saludable or EVS) for overweight Mexican American adults.
Study Methods: A total of 58 Spanish-speaking adults of Mexican descent were
recruited to participate in the study. Some of the participants, at random, were in
a group that received the EVS intervention, while others in a control group did
not receive it. The EVS intervention used content from a previously tested
diabetes prevention program, but the researchers created a community-based,
culturally tailored intervention for their population. The intervention, which was
offered in community rooms of churches, consisted of an intensive phase of
eight weekly 2-hour sessions, followed by a maintenance phase of 1-hour
sessions for the final 3 months. Those in the group not receiving the intervention
received educational sessions broadly aimed at health promotion in general. The
researchers compared the two groups with regard to several important outcomes,
such as weight loss, waist circumference, body mass index, and self-efficacy.
Outcome information was gathered three times—at the outset of the study (prior
to the intervention), 8 weeks later, and then after the program ended.
Key Findings: The analysis suggested that those in the intervention group had
several better outcomes, such as greater weight loss, smaller waist
circumference, and lower body mass index, than those in the control group.
Conclusions: Vincent and her colleagues (2014) concluded that implementing the
culturally tailored program was feasible, was well-received among participants
(e.g., high rates of program retention), and was effective in decreasing risk
factors for type 2 diabetes.
Research Example of a Quantitative Study Study: Silent, invisible,
and unacknowledged: Experiences of young caregivers of single
parents diagnosed with multiple sclerosis (Bjorgvinsdottir &
Halldorsdottir, 2014) Study Purpose: The purpose of this study was to
study the personal experience of being a young caregiver of a
chronically ill parent diagnosed with multiple sclerosis (MS).
Study Methods: Young adults in Iceland whose parents were diagnosed with MS
were recruited through the Icelandic National Multiple Sclerosis Society, and 11
agreed to be included in the study. Participants were interviewed in their own
homes or in the home of the lead researcher, whichever they preferred. In-depth
questioning was used to probe the experiences of the participants. The main
interview question was: “Can you tell me about your personal experience being
a young caregiver of a chronically ill parent with MS?” Several participants
were interviewed twice to ensure rich and deep descriptions for a total of 21
Key Findings: The young caregivers felt that they were invisible and
unacknowledged as caregivers and received limited support and assistance from
professionals. Their responsibilities led to severe personal restrictions and they
felt they had lived without a true childhood because they were left to manage
adult-like responsibilities at a young age. Their role as caregiver was demanding
and stressful, and they felt unsupported and abandoned.
Conclusions: The researchers concluded that health professionals should be more
vigilant about the needs for support and guidance for children and adolescents
caring for chronically ill parents.
• Nursing research is systematic inquiry to develop knowledge about issues of
importance to nurses. Nurses are adopting an evidence-based practice (EBP)
that incorporates research findings into their clinical decisions.
• Nurses can participate in a range of research-related activities that span a
continuum from being consumers of research (those who read and evaluate
studies) and producers of research (those who design and undertake studies).
• Nursing research began with Florence Nightingale but developed slowly until
its rapid acceleration in the 1950s. Since the 1970s, nursing research has
focused on problems relating to clinical practice.
• The National Institute of Nursing Research (NINR), established at the U.S.
National Institutes of Health in 1993, affirms the stature of nursing research in
the United States.
• Contemporary emphases in nursing research include EBP projects, replications
of research, research integration through systematic reviews, multisite and
interdisciplinary studies, expanded dissemination efforts, and increased focus
on health disparities.
• Disciplined research is a better evidence source for nursing practice than other
sources, such as tradition, authority, personal experience, trial and error,
intuition, and logical reasoning.
• Nursing research is conducted mainly within one of two broad paradigms—
worldviews with underlying assumptions about reality: the positivist
paradigm and the constructivist paradigm.
• In the positivist paradigm, it is assumed that there is an objective reality and
that natural phenomena are regular and orderly. The related assumption of
determinism is the belief that phenomenas result from prior causes and are
not haphazard.
• In the constructivist (naturalistic) paradigm, it is assumed that reality is not
fixed but is rather a construction of human minds; thus, “truth” is a composite
of multiple constructions of reality.
• The positivist paradigm is associated with quantitative research—the
collection and analysis of numeric information. Quantitative research is
typically conducted within the traditional scientific method, which is a
systematic, controlled process. Quantitative researchers gather and analyze
empirical evidence (evidence collected through the human senses) and strive
for generalizability of their findings beyond the study setting.
• Researchers within the constructivist paradigm emphasize understanding the
human experience as it is lived through the collection and analysis of
subjective, narrative materials using flexible procedures that evolve in the
field; this paradigm is associated with qualitative research.
• Basic research is designed to extend the knowledge base for the sake of
knowledge itself. Applied research focuses on discovering solutions to
immediate problems.
• A fundamental distinction, especially relevant in quantitative research, is
between studies whose primary intent is to describe phenomena and those that
are cause-probing—that is, designed to illuminate underlying causes of
phenomena. Specific purposes on the description/explanation continuum
include identification, description, exploration, prediction/control, and
• Many nursing studies can also be classified in terms of a key EBP aim:
treatment/therapy/intervention; diagnosis and assessment; prognosis; harm
and etiology; and meaning and process.
Chapter 1 of the Resource Manual for Nursing Research: Generating and
Assessing Evidence for Nursing Practice, 10th edition, offers study suggestions for
reinforcing concepts presented in this chapter. In addition, the following questions
can be addressed in classroom or online discussions: 1. Is your worldview closer to
the positivist or the constructivist paradigm? Explore the aspects of the two
paradigms that are especially consistent with your worldview.
2. Answer the questions in Box 1.1 about the Vincent et al. (2014) study described
at the end of this chapter. Could this study have been undertaken as a qualitative
study? Why or why not?
3. Answer the questions in Box 1.1 about the Bjorgvinsdottir and Halldorsdottir
(2014) study described at the end of this chapter. Could this study have been
undertaken as a quantitative study? Why or why not?
S T U D I E S C I T E D I N C H A PT E R 1
Archibald, M. M., Caine, V., Ali, S., Hartling, L., & Scott, S. (2015). What is left unsaid: An interpretive
description of the information needs of parents of children with asthma. Research in Nursing & Health,
38, 19–28.
Bäck-Pettersson, S., Hermansson, E., Sernert, N., & Bjökelund, C. (2008). Research priorities in nursing
—A Delphi study among Swedish nurses. Journal of Clinical Nursing, 17, 2221–2231.
Bjorgvinsdottir, K., & Halldorsdottir, S. (2014). Silent, invisible and unacknowledged: Experiences of
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Caring Sciences, 28, 38–48.
Brenner, M., Hilliard, C., Regan, G., Coughlan, B., Hayden, S., Drennan, J., & Kelleher, D. (2014).
Research priorities for children’s nursing in Ireland. Journal of Pediatric Nursing, 29, 301–308.
*Campbell-Yeo, M., Johnston, C., Benoit, B., Latimer, M., Vincer, M., Walker, C., . . . Caddell, K.
(2013). Trial of repeated analgesia with kangaroo mother care (TRAKC trial). BMC Pediatrics, 13,
Carlsson, E., & Persson, E. (2015). Living with intestinal failure by Crohn disease: Not letting the disease
conquer life. Gastroenterology Nursing, 38, 12–20.
Chwo, M. J., Anderson, G. C., Good, M., Dowling, D. A., Shiau, S. H., & Chu, D. M. (2002). A
randomized controlled trial of early kangaroo care for preterm infants: Effects on temperature, weight,
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*Cong, X., Ludington-Hoe, S., McCain, G., & Fu, P. (2009). Kangaroo care modifies preterm infant heart
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Cong, X., Ludington-Hoe, S., & Walsh, S. (2011). Randomized crossover trial of kangaroo care to reduce
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Dang, M. T. (2014). Social connectedness and self-esteem: Predictors of resilience in mental health among
maltreated homeless youth. Issues in Mental Health Nursing, 35, 212–219.
DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St.
Louis, MO: Elsevier Mosby.
Drenkard, K. (2013). Change is good: Introducing the 2014 Magnet Application Manual. Journal of
Nursing Administration, 43, 489–490.
Drennan, J., Meehan, T., Kemple, M., Johnson, M., Treacy, M., & Butler, M. (2007). Nursing research
priorities for Ireland. Journal of Nursing Scholarship, 39, 298–305.
Golfenshtein, N., & Drach001-Zahavy, A. (2015). An attribution theory perspective on emotional labour
in nurse-patient encounters: A nested cross-sectional study in paediatric settings. Journal of Advanced
Nursing, 71(5), 1123–1134.
Gona, C., & DeMarco, R. (2015). The context and experience of becoming HIV infected for Zimbabwean
women: Unheard voices revealed. Journal of the Association of Nurses in AIDS Care, 26, 57–68.
Guyatt, G., Rennie, D., Meade, M., & Cook, D. (2008). Users’ guide to the medical literature: Essentials
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Hagerty, T., Kertesz, L., Schmidt, J., Agarwal, S., Claassen, J., Mayer, S., . . . Shang, K. (2015). Risk
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hemorrhage. Journal of Neuroscience Nursing, 47, 51–54.
Hake-Brooks, S., & Anderson, G. (2008). Kangaroo care and breastfeeding of mother-preterm dyads 0–18
months: A randomized controlled trial. Neonatal Network, 27, 151–159.
Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J., . . . Williamson, A. (2015).
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Worldview on Evidence-Based Nursing, 12, 3–11.
Holman, E., Perisho, J., Edwards, A., & Mlakar, N. (2010). The myths of coping with loss in
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*Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington,
DC: The National Academies Press.
Kim, M. J., Oh, E. G., Kim, C. J., Yoo, J. S., & Ko, I. S. (2002). Priorities for nursing research in Korea.
Journal of Nursing Scholarship, 34, 307–312.
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function. Biological Research for Nursing, 17, 135–141.
Lee, H., Lee, J., Brar, J., Rush, E., & Jolley, C. (2014). Physical activity and depressive symptoms in older
adults. Geriatric Nursing, 35, 37–41.
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Vincent, D., McEwen, M., Hepworth, J., & Stump, C. (2014). The effects of a community-based,
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*A link to this open-access journal article is provided in the Toolkit for this
chapter in the accompanying Resource Manual.
EvidenceBased Nursing: Translating
Research Evidence into Practice
his book will help you to develop the skills you need to generate and evaluate
research evidence for nursing practice. Before we delve into the “how-tos” of
research, we discuss key aspects of evidencebased practice (EBP) to clarify the key
role that research plays in nursing.
This section provides a context for understanding evidencebased nursing practice
and two closely related concepts, research utilization and knowledge translation.
Definition of EvidenceBased Practice Pioneer David Sackett defined
evidence as “the integration of best research evidence with clinical
expertise and patient values” (Sackett et al., 2000, p. 1). Scott and
McSherry (2009), in their review of evidencebased nursing concepts,
identified 13 overlapping but distinct definitions of evidencebased
nursing and EBP. The definition proposed by Sigma Theta Tau
International (2008) is as follows: “The process of shared decisionmaking between practitioner, patient, and others significant to them
based on research evidence, the patient’s experiences and preferences,
clinical expertise or know-how, and other available robust sources of
information” (p. 57). A key ingredient in EBP is the effort to
personalize “best evidence” to a specific patient’s needs within a
particular clinical context.
A basic feature of EBP as a clinical problem-solving strategy is that it deemphasizes decisions based on custom, authority, or ritual. The emphasis is on
identifying the best available research evidence and integrating it with other
factors. In many areas of clinical decision making, research has demonstrated that
“tried and true” practices taught in basic nursing education are not always best. For
example, although many nurses not so long ago were taught to place infants in the
prone sleeping position to prevent aspiration, there is strong evidence that the
supine (back) sleeping position decreases the risk of sudden infant death syndrome
TIP: The consequences of not using research evidence can be devastating. For
example, from 1956 through the 1980s, Dr. Benjamin Spock published several
editions of a top-selling book, Baby and Child Care, which advised putting
babies on their stomachs to sleep. In their systematic review of evidence, Gilbert
and colleagues (2005) wrote, “Advice to put infants to sleep on the fron…
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