850 week 3 11_12

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Research Methods 850 Week 3,2011/12Daphne Cockwell School of Nursing, Post Diploma Degree Program, Ryerson University

Reviewing the Literature, Defining the ResearchProblem, Purpose & Question

and Ethics in ResearchLoiselle et al. (2011) chapter 5, 6 & 7.

Prepared by Dr. Elaine Santa Mina

1

Learning Objectives

1. To describe the purpose of a literature review

2. To identify the steps of a literature review

3. To be able to conduct a literature search

4. Describe how the literature review supports the researchproblem, question (s) and

5. hypothesis (es)

6. To describe the standards of ethical research practice

7. To describe the underlying ethical principles of the

Tri Council

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Literature Review

is the background to the research topic

includes a thorough empirical literature

review of key concepts of the research

question.

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Literature Review:

research purposes

• to efficiently and accurately assemble knowledge onthe topic; for researchers and clinicians

• to inform the researcher of current knowledge anddetermine implications for questions

• to identify methodological problems in relevantresearch literature

4

Literature Reviews:

research purposes

• to identify the research problem, refine the

research question, and establish hypotheses

• to reveal need for research replication with

different populations, under different

conditions or with different methodologies

5

Literature Reviews:

purposes for non researchers

• to inform and guide practice

• to develop evidence based protocols

• to revise nursing curricula

• to develop policy statements and practice

guidelines

• to keep current with practice

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Where and How is the Relevant Literature

Located

the traditional method of literature searches is

the manual search through card catalogues.

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Located

computer based searches are making manual

searches obsolete.

literature searches are an important professional skill

to acquire as a foundation of academic work and to

facilitate the clinician to seek and critique the current

literature to support best practices.

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Located

electronic searches are most frequently done online

via the internetcan also be done with a CD ROM.

but files of references on a CD ROM are limited to thedate of production,

whereas the online catalogues and journals areupdated as frequently as every week.

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Located

Ryerson library is online for your literature searches

and can be reached through this web sitehttp://www.ryerson.ca/library.

in addition to electronic and manual searches alsosearch the references at the back of articles, texts,and books.

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Located

the online library has numerous search

engines:

eg OVID and indexes that are subject based

eg. CINAHL.

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Located

Examples of other specialty indexes are: PUBMED,

Medline, Proquest Nursing, Ageline, AIDSLINE. Child

Abuse and Neglect, Contemporary Women’s Issues,

CPI.Q (Canadian Periodical Index Quarterly),

Dissertations Abstract, Health Star, Ingenta,

PsychINFO, Cochrane Library,

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http://www.ryerson.ca/library



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What are the Relevant References for a

Topic?

How does an investigator determine which

references of literature are appropriate for the

specified topic?

a process with a bit of a trial and error

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Topic?

but start with a systematic approach and keep notes

so that if your search is not as fruitful as you expect,

then you can make decisions about how to modify it.

Document your plan and findings and plan revisions

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Topic?

authors can expect to be asked to explain the

search strategy so others will be able to follow

your decision making plan

it is comparable to an audit trail.

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Search strategy example

Research Question:

What is the effect of diabetic education on the compliancewith diet and medication in patients with diabetes?

*Note:literature searches are time consuming;

anticipate that until you become skilled in the search process itis time consuming,

even for a skilled researcher, it takes time, trial and someerror

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Step 1. Key Terms.

Identify the key terms in the research

question.

include all concepts and any common

synonyms in the search to ensure

inclusiveness

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Step 1. Key Terms

Eg. key terms are probably ‘diabetic education’,

‘compliance’, diet, medication, & ‘diabetes’.

Is population of interest young or old, or with

Type I or II diabetes?

Are there synonyms for ‘diabetic education’?

How do we allow for these criteria in the search?

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Step 2. Search Engine

Choose a search engine and a data base

For this particular question the OVID searchengine and CINAHL data base would beappropriate

Why?

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Step 3. Enter search with limits

List the key terms in the search words

section.

set limits for your search by looking at the topic andkey terms and make decisions

regarding the limits

Full text? English only? human subjects only, yearlimits?

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Step 3. Enter search with limits

eg diabetes is a broad topic and has been generally

well researched so there may be many articles on

this subject. ---

You may decide you want only the most recent

literature on this topic. Why might you decide this?

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limits are important!

for either too many articles or not enough, or

the content retrieved is not complete, you

may want to edit your search and try again

with different limits, or a different database or

even revise the key search terms.

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limits are important!

You can also search the terms separately if a

only a few articles are found. Then you can

use the ‘Boolean’

operator term at the top of the search and

combine search findings from each key term

with either ‘and’ or ‘or’ to limit or expand the

combinations

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Step 4. Notes on retrievals

Make note of the number of articles or ‘hits’

retrieved from the search.

gives an idea of the breadth or narrowness of

your findings

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Step 4. Notes on retrievals

you may want to go back to the beginning

(yes to step 1) and revise the topic, terms, and search

strategy to either expand or limit your findings.This is a skill that takes time and practice to develop

The more you know your topic area the more adeptyou will be at efficiently searching for relevantliterature.

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Step 5. Save search strategy

. Save a copy of your search on your computer

so you will be able to retrieve it

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Step 6. Retrieve Article

Step 6. (and most fun step!) Retrieve the

article!

save or print, and read and enjoy!!!

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Step 7. Preparation of the Articles

from a Literature Review

Literature reviews can be large and overwhelming

Organize a plan to gather, collate and retrieve

pertinent information from the articles

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Preparation of the Articles from a

Literature reviewThe following is a suggested series of steps to follow:

• identify references as per process above

• screen references: title, abstract, conclusion, references

• decide if it is a primary source (written by the original author)or a secondary source

(reports by other authors)

• summarize key findings for each article

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Literature review

then: with your topic in mind and key concepts:

create a table: for each article list the pertinentinformation such as:

author (s), year, key concepts and content, studydesign, the problem, question, hypotheses, thepopulation and sample, what is known, thedescription of the findings, what are the gaps,problems, implications for practice or futureresearch, any other measure of comparisonappropriate to the reason for your search

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Literature review

• save and print a copy of your table

• write your narrative from the points of

comparison and the data in the cells

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Style of the Review

• not a subjective or emotional value laden exercise

(avoid “I think, I feel, I believe” statements)

• is an objective accounting of what is present and

what is absent in the research and or theoretical

literature.

• Key attributes of a literature review are:

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Style of the Review

• Objective: the reader could go back to the

original article and find the same information

and draw similar conclusions

• Hypotheses from research are not proved, but

they may be supported or refuted by the

findings

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Style of the Review

• Theories also are not verified, but may be either

supported or refuted by the findings.

• The review is written with the language of

tentativeness: ‘suggests’, ‘indicates’, ‘documents’,

‘demonstrates’ rather than ‘proves’.

• It is not value laden.

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How long should it be??

The length of the review depends on its purpose:

Eg: i) a thesis is lengthy;

ii) proposals are comprehensive;

iii) journal articles are succinct;

iv) meta analyses are extensive as they integrate

statistical research findings across studies, each

study is the unit of analysis

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From the Literature Review to the

Problem, Purpose and Question

the research problem is the broad issue to be pursued

the literature review develops the argument that

defines the specific problem statement that the

study will address

the literature review presents the case that supports

the presence of a problem

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Example of a literature review to

support a BPGRead RNAO BPG for Assessment and care of adults at risk of

suicide p 15 – 18

to see complexity of a literature review to support thedevelopment of a BPG for evidence based practice rather than

to support one research study.

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From the Research

Problem Statement to the Research

Purpose

from the identification of the research problem,

the overall aim of the study or its goal is clarified…this

is the research purpose….

…yet this in itself is not measurable…so…

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From the Research Purpose to the

Research Question

the purpose is then reframed as a question to be

answered,

that question must be worded in congruence with the

chosen paradigm for the study:

either the qualitative paradigm or the quantitative

paradigm.

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Qualitative questions

are broadly worded, with the general

phenomenon of interest, and can be

answered by a narrative format and the

population specified

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Quantitative Questions

are very specifically worded, with the

relationship between or among independent

and dependent variables articulated

the wording must direct objective, numeric

measures.

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Quantitative Questions

each word in the question,

and its placement in the question,

can have a profound change in the intent of the

question and subsequent hypotheses …and if slightly

rephrased will infer completely different

relationships among the variables

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From the Research Question to the

Hypothesis

Hypotheses are only found in quantitative studies,

never in qualitative studies.

a hypothesis tests the relationship between the

variables with statistical significance…more on that in

the next few weeks

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From the question to an ethically

conducted study

All research questions,

qualitative and quantitative,

must be investigated ethically.

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A Definition of Ethics

Health care ethics, also known as“bioethics” has been defined as “thesystematic study of the moral dimensions—including moral vision, decisions, conductand policies—of the life sciences and healthcare, employing a variety of ethicalmethodologies in an interdisciplinarysetting”. Reich, W.T. (1995). Encyclopedia of Bioethics. New York:

Simon & Schuster MacMillan (p. xxi).

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What are some ethical dilemmas

facing nurses?

Can you suggest some ethical dilemmas that

confront you in your practice?

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What are some ethical

dilemmas facing nurses?• Tube feedings

• Testing of new products

• Prolonging life by artificial means

• Research with human subjects

(medications, treatments, etc.)

• Use of restraints

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Ethical dilemmas facing nurses

conducting research?

Amount, nature of information about the study to

share with nurses

Capitalizing on vulnerable clients/family toconduct research during stressful times

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What are some ethical dilemmas facing

nurses conducting research?

Providing a research intervention to selectedgroups only

Establishing relationships with researchparticipants that may lead to sharing of privilegedinformation

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Codes of Ethics

International Standards

– Nuremberg Code (1949) post Nazi atrocities

– Declaration of Helsinki (1964) by World MedicalAssembly

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Codes of Ethics

US: Belmont Report (1978)

National Commission for the Protection of HumanSubjects and Behavioral Research

Principles of: beneficence, human dignity, justice

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Canadian Standards

Canadian Nurses Association Centennial

Edition(2008):

Code of Ethics for Registered Nurses

—available on website:http://www.cna-

nurses.ca/CNA/practice/ethics/code/default_e

.aspx

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Content of Code of Ethics for RNs

(CNA)Values

• Safe, competent and ethical care

• Health and well-being

• Choice, informed consent

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Content of Code of Ethics for RNs

(CNA)• Dignity

• Privacy and Confidentiality

• Justice and Inclusiveness

• Accountability

• Quality Practice Environments

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Codes of Ethics (cont’d)

Policy Statement: “Ethical Conduct for

Research Involving Humans”

Tri-Council

(Canadian Institute of Health Research [CIHR];

Social Sciences and Humanities Research Council

of Canada [SSHRC] & National Sciences and

Engineering Research Council of Canada [NSERC])Note a revision may be released during the delivery of this course

• http://www.pre.ethics.gc.ca/policy-politique/tcps-

eptc/docs/TCPS%20October%202005_E.pdf

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Principles underlying

Tri Council GuidelinesRespect for Free and Informed Consent

Respect for Vulnerable Persons

Respect for Privacy and Confidentiality

Respect for Justice and Inclusiveness

Balancing Harms and Benefits

Respect for Human Dignity

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College of Nurses of Ontario

Ethical Framework for RNs and RPNs in Ontario (2009)

http://www.cno.org/docs/prac/41034_Ethics.pdf

Client well-being

Client choice

Privacy and confidentiality

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College of Nurses of Ontario

Respect for life

Maintaining commitments (To clients, to oneself; tonursing colleagues, to the nursing profession; to healthteam members, to quality practice settings)

Truthfulness

Fairness

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Ethical Principles Guiding Research

The 8 ethical principles are

summarized in 3 core values:

1. Beneficence

2. Respect for Human Dignity

3. Justice

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1. Beneficence:

“above all, do no harm”

Freedom from Harm

• Physical and/or psychological

Freedom from exploitation

• Assurance that participation in a study willnot disadvantage subjects

Risk/benefit ratio

• Degree of risk to participants should neverexceed potential benefits.

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Right to self-determination

• Voluntary participation

• No coercion

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Right to full disclosure

• Full nature of the study has been described

to participants.

Informed consent

• Participants have adequate information,

comprehend the information, and have

power of choice, can withdraw at any time

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3. Justice

Right to fair treatment

• Fair selection of participants

• Non-prejudicial treatment of people who decline

Right to privacy

• Anonymity

• Confidentiality

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Consent

Must include:

Information that it is a research project,

Statement of the

1. research purpose,

2. identity of the researcher,

3. expected duration

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Consent

• nature of participation, confidentiality

• a description of research procedures;

A description of harms and benefits

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Consent cont’d.

An assurance that prospective subjects are

1. free not to participate,

2. have the right to withdraw at any time withoutpenalty

3. will be given continuing opportunities fordeciding whether or not to continue toparticipate.

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Consent cont’d.

The possibility of commercialization of researchfindings, and the presence of any apparent oractual or potential conflict of interest on thepart of researchers, their institutions orsponsors.

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Institutional Review Boards

• Formal committees that review research protocols,

• May be called Human subjects committees

(In Canada called Ethics Review Boards or ResearchEthics Boards),

• Studies must be approved by REB before they canproceed,

• REB at Ryerson

http://www.ryerson.ca/ORS

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Critiquing Ethical Aspects of A

studyWere subjects exposed to any harm?

Did benefits outweigh risks?

Was there any coercion?

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Critiquing Ethical Aspects of A

studyWere vulnerable populations used?

Were participants deceived?

Was privacy safeguarded?

Was research approved and monitored by an IRB or

ERB?

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CNO Professional Standards (2008)

A nurse in a researcher role demonstrates ethicalpractice by:

• Ensuring the safety & well-being of the client aboveall other objectives, including the search forknowledge

• Ensuring client has all information necessary tomake informed decisions,

• Advocating for nursing involvement on ethicalreview boards,

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• Participating in ethical review of research

• Ensuring ethical guidelines are followed to protectresearch participants.

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• Identifying research methods useful to the nursingprofession; Identifying resources to answer

research questions; & sharing knowledge gainedthrough research

• Supporting & evaluating practice through research;facilitating the involvement of others in theresearch process; ensuring high standards are usedin the research process

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• Communicating research findings; promoting nursingresearch; educating staff about the research process;promoting nursing through research that improves orvalidates professional practice & advocating fornursing representation on research reviewcommittees

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References

Burns, N., Grove, S. K. (2001). The Practice of Nursing Research:

Conduct, Critique, & Utilization 4th

Edition. Philadelphia: W. B.Saunders.

Loiselle, C.G., Profetto-McGrath, J., Polit, D., F. & Beck, C. T.(2011). Canadian Essentials of Nursing Research 3rd Edition.Philadelphia: Lippincott Williams & Wilkins.

Polit, D., F. & Beck, C. T. (2004). Nursing Research: Principles and Methods 7 th Edition. Philadelphia: Lippincott Williams &Wilkins.

Reich, W.T. (1995). Encyclopedia of Bioethics. New York: Simon &Schuster MacMillan

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