Nursing Research Class Notes Essay

Nursing research is the process that underpins all the other things we have talked about. How was it determined that one particular way of carrying out nursing care was better than another way? How was it decided that a particular framework of understanding will explain certain behaviors better than another? When we discussed frameworks of understanding or conceptual models earlier in the course you learnt that there are various ways of viewing mental illness were discussed and the treatments were based upon eradicating or fixing the cause. This can be described as ways of knowing and ways of intervening. These beliefs came about as the result of research. That is asking, and trying to answer such questions as â€Å"Why does this occur?†, â€Å"Does this treatment work better than that treatment?†, â€Å"How do we know?†, â€Å"Do more people improve if we do this rather than that?†. Research is a way of gaining knowledge about concerns that psychiatric nurses have. What is the best way to help this client with this particular distress?† â€Å"Is there any evidence that suggests that this way of caring is better than that?† Nursing research is relatively new in some ways but in other ways gathering-nursing knowledge has been going on since the early days of nursing. Women learned through watching and observing what treatments worked best. This is one particular kind of knowledge. Potter and Perry discuss this in Chapter 5 â€Å"Nurses Ways of Knowing†. Ethical, personal, esthetic knowledge was identified and scientific became one more way of knowing. In terms of nursing research we can re turn to Florence Nightingale who of course made the observation that there were more deaths closer to the open sewer than there were for men whose beds were further away. This is an excellent example of drawing a conclusion by making observations thereby developing new knowledge. Research itself is a way of developing knowledge but there are other ways of developing knowledge. They are differentially respected and acknowledged but each is a way of `knowing’. When you take your research course in fourth year you will learn more about the various kinds of research. For now I just want to highlight the major ways of gathering knowledge. This is Chapter 5 in Potter and Perry and there is also reference to research in Stuart and Laraia under Evidenced Based Practice p 76-83. The opening section of the chapter in Potter and Perry gives a little background on the emergence of nursing practice and theory. Nursing science came into its own: no longer a discipline applying the knowledge of other disciplines but a unique body of knowledge. A good activity for you to consider doing is to go onto the Library website and click on journal holdings, once there search psychiatric nursing. Journals that publish the results of nursing research and in particular psychiatric nursing are a very important part of your reading and learning how to read a research article is an important skill to develop. We will discuss this further momentarily, for now I want now to review ways of gaining knowledge. 1. Tradition certain beliefs are accepted sometimes without too much enquiry. Its â€Å"we’ve always done it that way†. This may be good but sometimes it is appropriate to question these traditions. 2. Expert Authority: Asking an expert or authority is a very common way of gathering information. All of us ask for information from time to time but we also have to be somewhat cautious about confusing information and knowledge. But certainly we do seek out knowledge and assistance from others. There are, of course, some limitations since not all authorities are always right and like tradition, we do not always challenge this knowledge. 3. Experience A lot of what we know we have learned ourselves. Children certainly do this all the time. Sometimes through unfortunate experience like putting their little hand on a hot stove: Learning is also part of knowledge acquisition. But we also solve problems from experience. Like, if I turn off the alarm and don’t get out of bed in the morning, I am late for work. So we learn not to do that. The ability to generalize and recognize patterns and make predictions is one of the hallmarks of the human mind and has been a large part of how our ancestors developed knowledge. It is always rains every time there are black clouds, then the next time you see black clouds, rain is predicted.. But there are limitations, first each person’s experience may be too limited to generalize all the time. Maybe black clouds predicting rain only occurs in your part of the world for some environmental reason. Secondly your personal experiences may be colored by biases. 4. Investigating Ideas: Where would we be if no one pursued their ideas for instance, testing molds for their antibiotic value That the earth is not flat but round 5. Reasoning or Problem Solving Thinking through problems and finding solutions. There are two intellectual methods used in reasoning. Inductive reasoning is the process of drawing conclusions and generalizations from specific observation. For example a nurse may observe anxious behavior in children who are removed from their parents and conclude that separation is a stressful event.. Deductive reasoning. This is the process of developing specific predictions from general principles. For example, if you assume that separation anxiety occurs in children removed from their parents then you may predict that children, in your hospital will show signs of anxiety. So we have gone from a general assumption to a specific’ situation. So, induction is to make or develop a theory from actual observation or grounded in observation. Deduction is to have a hypothesis or a theory and then test it. These terms will become important when you are considering qualitative and quantitative research. Both of these reasoning systems are important for you to think about. They are both useful. But errors can also occur or faulty reasoning. However it may lead to the development of questions 6. The scientific method, which is considered the most objective and accurate way of developing knowledge. However, it, too, can certainly be questioned as you may discover but it is also considered one of the primary ways of developing knowledge. Beginning on p. 85 of Potter and Perry they describe the characteristics of research with a number of definitions you need to study. The sooner you grasp these concepts the better off you will be in future courses. To understand the research process and for your future endeavors I like to begin with the components of a research article in a journal. I have briefly described these below: Title: A succinct description of key elements of the study Running head: Usually a two to three word description of the key elements of the study, which runs at the top of each page. Abstract: A succinct paragraph describing key features of the study, the population studied, the variables manipulated; the findings and discussion point. Usually of 150 words or so. Literature Review: A summary of key research findings from other studies, which lead into your study. If you are studying in a new emerging field this may be short; if in a well established area it may be lengthy or, it might focus on one key area for instance of child development (i.e. there are numerous areas of child development-your study may be focused on cognitive development so it is not required to review all areas of child development within the literature review). The review should provide the reader with an understanding of the area, without missing key studies and without losing the audience with obscurely related information. The literature review should cover research related to your key variables of interest and should draw the reader into your hypotheses. Hypothesis: what you think the relationship between variables is. Depending on the level of research one might have an exploratory hypothesis or you may have predictive hypotheses suggesting the results are going to be in the direction of (one way or the other). This might be a good time to review any of the terms used thus far in Potter and Perry and especially look at table 6-2 which describes levels of research. It is difficult to keep a complex topic simple. Method: The method contains subsections. It usually begins with a description of the sample (who did you interview, who comprised your sample (children, parents, university students etc). One would also find how the sample was selected (was it randomized, was it a captured audience, was it every blonde haired blue eyed left handed boy) Detail is expected. The method section will also describe the research design and procedures. Both are essential for someone else who might say I don’t believe these results. I want to try and replicate the study. Which has been done with interesting results in many areas. Research designs are very complex and influence the type of statistical analysis that can be done. I refer you back to table 6-2 for a beginning understanding of this. Test in struments and their reliability and validity are also expected in the methodology section. Identification of independent and dependent variables would also be described here. The independent variable is that variable you are manipulating i.e. temperature of the room; the dependent variable are the observations you are making i.e. number of complaints of room temperature in a given interval of time. Results: This section will go through sample characteristics, main findings described pictorially sometimes in graphs or may be tables. Results are described matter of factly with little interpretation. Limitations of the study: these become important to the conclusions one can draw. For example if I were studying teen pregnancy and the needs of young mothers and my group ended up being older teens would this be representative of younger teens. Conclusions: This is where results can be interpreted and tied back to the literature review. Were findings supportive to the hypothesis or not and if not what might explain the findings. Implications for nursing practice: it would be found in nursing research studies, not often in other research. The application of nurs ing research is an important area for future discussion. As psychiatric nurses we must however be able to critique research. Sometimes it is conducted under ideal conditions where there is control over a number of variables and there may be difficulty applying it in the real world. That is perhaps why observations of a patient’s behavior may be better to understand their experience in the real world. Research is the use of a series of steps to gather objective knowledge and nursing research of course is the study of phenomenon of interest to nurses, which is often the patient’s response to illness and nursing interventions. The second point there is control but we have to understand what scientific research is attempting to state. It is the relationships between 2 variables. That is, if I do one thing will it influence another? So just to take a simple nursing example, we might theorize or predict that a patient who lies on their back for long periods will develop pressure sores. So if the patient is turned frequently and does not develop pressure sores we might conclude that turning is related to unbroken skin. Say, however, at the same time as turning the patient’s skin is gently massaged; now we can’t tell if it is the turning or the massage that resulted in the unbroken and healthy skin. So this is what is meant by control of external factors. Sometimes you may hear this referred to as level of control over the variables of interest. If you are using the scientific method then you probably have a hypothesis you want to test and you would set up your experiment to either prove or disprove. This would be quantitative research. But if you are observing a phenomenon and want to study it in its natural state then you are more likely doing qualitative research. Qualitative research is particularly well suited to psychiatric nursing because it. involves gathering information about people’s experiences which we could use an instrument to assess which would give us a quantitative measure i.e., how traumatized were you 0-10. Asking a person to tell their story gives us significantly more information. Methods can be combined. The ethnographic qualitative research method tends to look at humans in their natural environment. This research always takes place in the field often over a long time. Collection and analysis of data takes place concurrently, as insights are gained new questions may emerge. Often the opinions of the people under study are sought which is very different from quantitative research where opinions and feelings are not considered valid. You will become m ore proficient at reading, understanding and critiquing research but there is no reason why you should not be locating and reading nursing research journals now. Research Principles and terms The practice of Psychiatric Nursing is guided by nursing knowledge. As a profession nursing has developed a unique body of knowledge, which guides the practice of nursing. There is a number of ways in which knowledge is developed and disseminated. They are listed in Potter & Perry. Question: State 6 ways of acquiring knowledge. Polit and Hungler (1997) use these terms to describe the scientific research method: †¦Disciplined Research. Research conducted within a disciplined format is the most sophisticated method of acquiring knowledge that humans have developed. Nursing research combines aspects of logical reasoning with other features to create systems of problem solving that, although fallible, tend to be more reliable than tradition, authority, personal experience, intuition, or inductive or deductive reasoning alone. (P.11) The scientific method does have its drawbacks however, it is conducted under ideal conditions and sometimes there may be difficulties in applying it to the real world. There are however two main categories of research Quantitative and Qualitative. Quantitative research follows the scientific model and has a series of clearly defined steps. Quantitative research Process Identify an issue Gather information? State the hypothesis? Review the literature? Design the study? Gather the data? Evaluate the findings Qualitative Research Qualitative research differs from quantitative in that it is a less linear process. It more often involves gathering information about individuals by observing them in their natural environment or through interviews. This type of research takes place â€Å"in the field† rather than the laboratory. The information is rich and varied and subject to the interpretation of the researcher. This is one of its limitations. Nurse researchers can be involved in either quantitative or qualitative research, but most importantly, nursing research should be able to be applied to psychiatric nursing practice. Here is a list of some research projects of psychiatric nurses: Examples of research studies conducted by nurses in Psychiatric Nursing and Mental Health topics: Client expectation and perception of the nurse’s role in re lationship to client satisfaction. A comparative study of widows’ and widowers’ perceived social support during the first year of bereavement. The effects of cognitive-behavioral nursing intervention for depressed patients and their families. Factors affecting staff nurses’ use of limit setting with disruptive patients. Nurses’ attitudes toward the suicidal patient. Nursing interventions with long-term patients in regard to their physical appearance: An evaluation study. The nurse’s therapeutic use of touch as related to withdrawn patients. Observable signs of anxiety or distress during psychiatric interviews conducted by nurses. Patient and situational factors that affect nursing students’ like or dislike of caring for patients A study of alcoholic patients’ perception of the role of the nurse. A study of the confidence level of nurses in caring for patients with depression. A study of psychiatric patients’ knowledge about their prescribed medications. Question: What do you think would be a good research topic for psychiatric nurses? Some terms to Learn in Relation to Research