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THE RESEARCH PROCESS

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1. CONCEPTUAL PHASE 2. THE DESIGN AND PLANNING PHASE 3. THE EMPIRICAL PHASE 4. THE ANALYTIC PHASE 5. THE DISSEMINATION PHASE PHASES OF NURSING RESEARCH

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1. FORMULATING AND DELIMITING THE PROBLEM o Topic o Research Problem o Problem statement articulates the problem to be addressed and indicates the need for a study o Research Questions are the specific queries researchers want to answer in addressing the research problem o Research Hypothesis predictions that are tested empirically o Null hypothesis o Research or alternative hypothesis CONCEPTUAL PHASE

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TermExample TopicSide effects of Chemotherapy Research Problem Nausea and vomiting are common side effects among patients on chemo; interventions have been moderately successful. New interventions that can reduce or prevent these side effects need to be identified Statement of purpose Purpose is to test an intervention to reduce chemotherapy- induced side effects specifically to compare the effectiveness of patient-controlled and nurse-administered antiemetic therapy Research question What is the relative effectiveness of patient-controlled antiemetic therapy versus nurse-controlled antiemetic therapy with regard to (a) medication consumption, and (b) control of nausea and vomiting in patients on chemotherapy? Hypothesis There is no difference on the effectiveness between patient-controlled and nurse-controlled antiemetic therapy with regard to medication consumption and control of nausea and vomiting of patients on chemotherapy.

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1. FORMULATING AND DELIMITING THE PROBLEM o Evaluating research problems o Significance of the problem research problem should have the potential of contributing meaningfully to the nursing knowledge o Research ability of the Problem o Time and timing o Availability of study participants o Facilities and equipment o Money o Experience and interest of the researcher CONCEPTUAL PHASE

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2. REVIEWING THE LITERATURE Done to familiarize researchers with the knowledge base PURPOSES: Orient of what is known and not known regarding the topic Replication of study Identifications of relevant theoretical and conceptual framework Assistance in interpreting study findings and developing implications and recommendations CONCEPTUAL PHASE

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SOURCES OF LITERATURE PRIMARY SOURCES Research reports/studies SECONDARY SOURCES Books Literature review summaries

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THE DESIGN AND PLANNING PHASE 1. Selecting a research design 2. Identifying the population to be studied 3. Sampling plan 4. Methods to measure research variables 5. Finalizing the research study

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RESEARCH DESIGN Based on: Time Frame Control over independent variable Measurement of independent and dependent variables

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DESIGNFEATURESEXAMPLE CROSS-SECTIONAL Data are collected at one point in time Practical, easy to do, economical Mindell and Jacobson (2000) assessed sleep patterns and the prevalence of sleep disorders during pregnancy. They compared women who were at 4 points in pregnancy: 8-12wks, 18-22wks, 25-28wks, 35-38wks. They concluded that sleep disturbance is common in late pregnancy. TIME FRAME

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

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Design of a case-control study Were exposed Were not exposed Were not exposed HAVE THE DISEASE DO NOT HAVE THE DISEASE START WITH THEN DETERMINE EXPOSURE HISTORY

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In A COHORT STUDY NON-EXPOSED PEOPLE AND EXPOSED PEOPLE PEOPLE WITH THE DISEASE PEOPLE WITHOUT THE DISEASE AND IN A CASE-CONTROL STUDY GROUPS COMPARED CASES CONTROLS

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

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

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

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

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

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DESIGNFEATURES LONGITUDINAL Data are collected at two or more points in time over an extended period TREND STUDIES Investigations in which samples from a population are studied over time Different samples are selected but drawn from the same population Based on surveys TIME FRAME

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DESIGNFEATURES EXPERIMENTAL Manipulation of independent variable Control group randomization QUASI -EXPERIMENTAL Manipulation of independent variable No control group No randomization NONEXPERIMENTAL No manipulation of independent variable CONTROL OVER INDEPENDENT VARIABLE

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Is there an intervention? No Yes NONEXPERIMENTALIs there randomization? NoYes QUASI-EXPERIMENTALEXPERIMENTAL

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DESIGNFEATURESEXAMPLE RETROSPECTIVEStudy begins with dependent variable and looks backward for cause Heitkemper, et. al. (2001), used a Retrospective design in their study of factors contributing to the onset of irritable bowel syndrome. They compared samples of women with and without IBS in terms of their history of sexual and physical abuse and found that abusive experiences were more prevalent among women with IBS. MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES

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DESIGNFEATUREEXAMPLE PROSPECTIVEStudy begins with independent variable and looks forward for the effect Brook, et. al. (2000) conducted a prospective study to examine clinical and cost outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. Early tracheostomy was found to be associated with shorter lengths of hospital stay and lower cost. MEASUREMENT OF INDEPENDENT AND DEPENDENT VARIABLES

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IDENTIFYING THE POPULATION TO BE STUDIED POPULATION aggregate or totality of those conforming to a set of specifications. Nurses Students Children Etc.

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SAMPLE subset of a population Sampling techniques: Probability sampling Systematic sampling Fish bowl method Nonprobability sampling Purposive/Judgmental sampling Snow ball technique Convenience/accidental sampling DESIGNING THE SAMPLING PLAN

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Different methods of data collection Biophysiologic measurements Self-reports Observation Use of a research instrument Questionnaires Survey forms METHODS TO MEASURE RESEARCH VARIABLES

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FINALIZING THE RESEARCH PLAN Pretesting of questionnaires Conducting a Pilot study

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Study Design General categories Observational Experimental Cross sectional Case control study Cohort study Community trials Clinical Trials

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Descriptive Studies Today Cross sectional (Prevalence) Retrospective (Case Control) Prospective (Incidence) Historical Prospective Past Future

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Descriptive Study: Advantages Cross sectional Retrospective Prospective Quick Cheap Large sample Attributes Prevalence Public health Complete Risk factors Quality data Natural history Incidence Etiology Rare disease Cheap Uses records Small sample Quick Risk factors

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Cross-Sectional Study It is also called prevalence study. It is conduct at one point of time and try to concurrently evaluate exposure (risk factors ) and outcome (diseases) in a population.

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Collection of data Questionnaire (include every information of interest) Risk factors Investigators

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Cross-sectional Study Design Selection of study population -target appropriate population -acquire a representative sample -Sampling definitions -sampling unit: person, patient, household -Sampling frame: list of all sampling units -Sample: all sampling units chosen rule: each unit has the same probability of being chosen

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Sampling Simple random sampling Systematic sampling Stratified sampling Cluster sampling Multistage sampling

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Prevalence of Metabolic Syndrome:8814 US Adults Age 20+ NHANES 1988-94, JAMA 2002 287

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Prevalence of Cardiovascular Disease in Women with Diabetes NHIS 1997-9 MMWR 2001 50:948-54

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Cross-sectional Studies Analysis: Study sample Cross-sectional collection of data Exposed w/disease a Exposed w/o disease b No exposure w/disease c No exposure w/o disease d

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Cross-sectional Studies Analysis: Study sample Cross-sectional collection of data Exposed w/disease a Exposed w/o disease b No exposure w/disease c No exposure w/o disease d ab cd Exp no exp Dis no dis Compare prevalence in exposed to prevalence in non- exposed Prevalence ratio = a / a+b c / c+d

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Cross-sectional Studies Common methods of Analysis: -t-tests -rate comparisons -categorical data analysis -descriptive analysis -comparisons can be by age, sex, or date, year

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The stages of statistic investigation 1 st stage composition of the program and plan of investigation 2 nd stage collection of material 3 ed stage working up of material 4 th stage analysis of material, conclusions, proposals 5 th stage putting into practice

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DATA COLLECTION DATA ENCODING EMPIRICAL PHASE

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DATA ANALYSIS Statistical analysis DATA INTERPRETATION is the process of making sense of the results and examining their implications CONCLUSION AND RECOMMENDATION THE ANALYTIC PHASE

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RESEARCH REPORT Research Abstract Research published in journals Term papers, theses, dissertations UTILIZATION OF FINDINGS Application to nursing practice and nursing education DISSEMINATION PHASE