Contents
Contributors
Introduction
Section 1 Setting the Scene
Chapter 1 Research and Development in Nursing
INTRODUCTION
NURSING RESEARCH AND DEVELOPMENT
DEVELOPING NURSING KNOWLEDGE
RESEARCH AWARENESS, UTILISATION AND ACTIVITY
RESEARCH AND NURSING PRACTICE
CONCLUSIONS
References
Websites
Chapter 2 The Research Process
INTRODUCTION
DEVELOPING THE RESEARCH QUESTION
USING A HYPOTHESIS
SEARCHING AND EVALUATING THE LITERATURE
CHOICE OF METHODOLOGY, RESEARCH DESIGN
PREPARING A RESEARCH PROPOSAL
GAINING ACCESS TO THE DATA
SAMPLING
PILOT STUDY
DATA COLLECTION
DATA ANALYSIS
DISSEMINATION OF THE RESULTS
IMPLEMENTATION OF THE RESULTS
ENSURING RIGOUR
CONCLUSIONS
References
Websites
Chapter 3 Research Ethics
THE IMPORTANCE OF ETHICS IN RESEARCH
ISSUES FOR RESEARCHERS TO ADDRESS
STRATEGIES FOR ETHICAL RESEARCH
CONCLUSIONS
References
Websites
Chapter 4 User Involvement in Research
INTRODUCTION
A BRIEF HISTORY OF USER INVOLVEMENT IN RESEARCH
MAPPING USER INVOLVEMENT IN NURSING RESEARCH
CHALLENGES FOR USER INVOLVEMENT IN NURSING RESEARCH
WEIGHING USER EXPERIENCES – LEARNING DISABILITY AS A CASE EXAMPLE
SHIFTING THE FOCUS FROM PROCESSES TO OUTCOMES
CONCLUSIONS
References
Further reading
Websites
Chapter 5 Research for a Multi-ethnic Society
INTRODUCTION
THE CONCEPT OF ETHNICITY
IDENTIFYING A RESEARCH FOCUS
ETHNIC CATEGORIES AND LABELS
SAMPLING
DATA COLLECTION
DATA ANALYSIS AND INTERPRETATION
ETHICAL ISSUES
CONCLUSIONS
References
Further reading
Websites
Section 2 Preparing the Ground
Chapter 6 Finding the Evidence
INTRODUCTION
ELECTRONIC INFORMATION RESOURCES AND THE INTERNET
THE RESEARCH LITERATURE
ACCESSING THE LITERATURE
PLANNING A LITERATURE SEARCH
SEARCHING THE LITERATURE
SPECIALIST INFORMATION SOURCES
WRITING A LITERATURE REVIEW
MANAGING REFERENCES
CONCLUSIONS
References
Further reading
Websites
Chapter 7 Critical Appraisal of the Evidence
INTRODUCTION
WHAT IS CRITICAL APPRAISAL?
THE NEED FOR CRITICAL APPRAISAL
VALIDITY OF RESEARCH DESIGNS
HOW TO APPRAISE QUANTITATIVE RESEARCH STUDIES
HOW TO APPRAISE QUALITATIVE RESEARCH STUDIES
HOW TO APPRAISE SYSTEMATIC REVIEWS, PRACTICE GUIDELINES AND ECONOMIC ANALYSIS
APPLYING THE RESULTS OF CRITICAL APPRAISAL
CONCLUSIONS
References
Further reading
Chapter 8 Preparing a Research Proposal
INTRODUCTION
IDENTIFYING A RESEARCH IDEA
IDENTIFYING SOURCES OF FUNDING
THE RESEARCH PROPOSAL
SUBMISSION REQUIREMENTS
MAXIMISING SUCCESS
CONCLUSIONS
Further reading
Websites
Chapter 9 Planning and Managing a Research Project
INTRODUCTION
IDENTIFYING AND FINDING FUNDING
ACADEMIC AND PRACTICAL SUPPORT
TYPES OF SUPERVISOR
SUPERVISION SELECTION CRITERIA
THE RESPONSIBILITIES OF THE SUPERVISOR
THE RESPONSIBILITIES OF THE STUDENT
SOURCES OF EMOTIONAL AND PEER SUPPORT
CONCLUSIONS
References
Websites
Chapter 10 Gaining Access to the Research Site
INTRODUCTION
THE NEED FOR REGULATION OF RESEARCH
RESEARCH ETHICS
R&D APPROVAL
INFORMAL ACCESS TO RESEARCH SITES
BUILDING THE APPROVAL PROCESS INTO RESEARCH PLANNING
CONCLUSIONS
References
Further reading
Websites
Section 3 Choosing the Right Approach
Chapter 11 The Quantitative–Qualitative Continuum
INTRODUCTION
THE CHARACTERISTICS OF QUANTITATIVE AND QUALITATIVE RESEARCH
INFLUENCES AND CONTRIBUTIONS TO THE DEVELOPMENT OF NURSING RESEARCH
EMPIRICISM AND THE SCIENTIFIC METHOD
QUANTITATIVE RESEARCH
QUALITATIVE RESEARCH
CRITICAL ACCOUNTS OF RESEARCH EPISTEMOLOGY
BLENDING QUANTITATIVE AND QUALITATIVE APPROACHES
JUDGING THE QUALITY OF QUANTITATIVE AND QUALITATIVE RESEARCH
CONCLUSIONS
References
Websites
Chapter 12 Sampling
INTRODUCTION
POPULATIONS AND SAMPLES
TYPES OF SAMPLING
SAMPLING SCHEMES IN QUANTITATIVE RESEARCH
CALCULATING SAMPLE SIZE IN QUANTITATIVE RESEARCH
SOURCES OF BIAS IN QUANTITATIVE SAMPLING
SAMPLING IN QUALITATIVE RESEARCH
CALCULATING SAMPLE SIZE IN QUALITATIVE RESEARCH
SAMPLING STRATEGIES USED IN QUALITATIVE AND QUANTITATIVE RESEARCH
CONCLUSIONS
References
Further reading
Chapter 13 Grounded Theory
INTRODUCTION
THE PURPOSE AND MAIN FEATURES OF GROUNDED THEORY
THE RELEVANCE OF GROUNDED THEORY IN NURSING RESEARCH
THE THEORETICAL BASIS OF GROUNDED THEORY: SYMBOLIC INTERACTIONISM
DATA COLLECTION AND INITIAL SAMPLING
DATA ANALYSIS
THE THEORY
WRITING MEMOS
THE USE OF LITERATURE IN GROUNDED THEORY
THE CHOICE BETWEEN GLASERIAN AND STRAUSSIAN GROUNDED THEORY
PROBLEMS AND STRENGTHS OF GROUNDED THEORY
CONCLUSIONS
References
Further reading
Website
Chapter 14 Ethnography
INTRODUCTION
THE CHARACTERISTICS OF ETHNOGRAPHY
THE USE OF ETHNOGRAPHY IN NURSING
DESCRIPTIVE AND CRITICAL ETHNOGRAPHY
SELECTION OF SAMPLE AND SETTING
DATA COLLECTION
FIELDWORK AND FIELDNOTES
MACRO- AND MICRO-ETHNOGRAPHIES
DATA ANALYSIS AND INTERPRETATION
RELATIONSHIPS AND PROBLEMS IN THE SETTING
THE ETHNOGRAPHIC REPORT
CONCLUSIONS
References
Further reading
Chapter 15 Phenomenological Research
INTRODUCTION
THE PURPOSE OF PHENOMENOLOGICAL RESEARCH
THE USE OF PHENOMENOLOGY IN NURSING
MAIN FEATURES
FIELDWORK
ANALYTICAL PROCEDURES
STRENGTHS AND LIMITATIONS
CONCLUSIONS
References
Further reading
Websites
Chapter 16 Narrative Research
INTRODUCTION
THE NATURE AND PURPOSE OF STORIES
NARRATIVE INQUIRY IN NURSING
ILLNESS NARRATIVES OR STORIES OF SICKNESS
ETHICAL ISSUES IN NARRATIVE RESEARCH
COLLECTING AND ANALYSING NARRATIVE DATA
CRITICAL ISSUES IN NARRATIVE INQUIRY
WRITING AND REPORTING NARRATIVE RESEARCH
CONCLUSIONS
References
Further reading
Chapter 17 Experimental Research
BACKGROUND
EXPERIMENTAL VERSUS OBSERVATIONAL STUDIES
CHARACTERISTICS OF EXPERIMENTAL DESIGN
PRE-/POST-TEST STUDIES
INTERRUPTED TIME SERIES
CONTROLLED BEFORE AND AFTER STUDIES
CONTROLLED TRIALS
THE RANDOMISED CONTROLLED TRIAL (RCT)
RANDOMISED CONTROLLED TRIALS AND THE REDUCTION OF BIAS
OTHER EXPERIMENTAL DESIGNS
SINGLE-CASE EXPERIMENTAL DESIGN (N OF 1 TRIAL)
REPORTING AND READING OF RCTS
IMPORTANT CONSIDERATIONS IN USING RCTS
STRENGTHS AND LIMITATIONS OF RCTS
CONCLUSIONS
References
Websites
Chapter 18 Surveys
HISTORICAL DEVELOPMENT OF SURVEY RESEARCH IN HEALTH
DESCRIPTIVE SURVEYS
CORRELATIONAL AND COMPARATIVE SURVEYS
LONGITUDINAL SURVEYS AND COHORT STUDIES
SOURCES OF DATA IN SURVEY RESEARCH
EPIDEMIOLOGY
CONCLUSIONS
References
Further reading
Websites
Chapter 19 The Delphi Technique
INTRODUCTION
DEFINING THE DELPHI TECHNIQUE
THE EXPERT PANEL
DELPHI ROUNDS
RESPONSE RATES
MODIFICATIONS OF THE DELPHI TECHNIQUE
TIME FRAME
ANONYMITY
GAINING CONSENSUS
INTERPRETING RESULTS
SKILLS OF THE RESEARCHER
CRITIQUE OF THE TECHNIQUE
ETHICAL CONSIDERATIONS
CONCLUSIONS
References
Further reading
Websites
Chapter 20 Case Study Research
INTRODUCTION
DEFINITIONS OF CASE STUDY METHODOLOGY
RESEARCH QUESTIONS
SELECTION OF CASES
RESEARCH DESIGN
DATA ANALYSIS
PRESENTATION AND REPORTING
CONCLUSIONS
References
Chapter 21 Evaluation Research
WHAT IS EVALUATION?
WHY EVALUATION RESEARCH?
THE SATISFACTION QUESTIONNAIRE
MODELS OF EVALUATION
QUANTITATIVE OR QUALITATIVE?
THE POLITICAL NATURE OF EVALUATION
EVALUATION RESEARCH AND EVIDENCE-BASED PRACTICE
CONCLUSIONS
References
Further reading
Websites
Chapter 22 Action Research
PRINCIPLES OF ACTION RESEARCH
COMMON MODELS OF WORKING WITH ACTION RESEARCH IN NURSING
ACTION RESEARCH IN HEALTHCARE PRACTICE
THE ROLE OF THE RESEARCHER IN ACTION RESEARCH
ETHICAL ISSUES
METHODS OF DATA COLLECTION
ASSESSING QUALITY
RESEARCH AS AN AGENT OF CHANGE
ADVANTAGES AND DISADVANTAGES OF ACTION RESEARCH
CONCLUSIONS
References
Further reading
Websites
Chapter 23 Practitioner Research
INTRODUCTION
BACKGROUND TO PRACTITIONER RESEARCH
INSIDER AND OUTSIDER POSITIONS
REFLECTING ON THE PRACTITIONER RESEARCH PROCESS
ETHICAL ISSUES
CONCLUSIONS
References
Chapter 24 Systematic Reviews and Evidence Syntheses
INTRODUCTION
BACKGROUND TO EVIDENCE SYNTHESIS
WRITING A SYSTEMATIC REVIEW PROTOCOL
SYSTEMATICALLY SEARCHING THE LITERATURE
ASSESSING THE QUALITY OF THE LITERATURE
EXTRACTING KEY INFORMATION FROM THE SELECTED STUDIES
SUMMARISING, INTERPRETING AND PRESENTING THE FINDINGS
WRITING UP THE REVIEW
SYSTEMATIC REVIEWS OF QUALITATIVE RESEARCH
CONCLUSIONS
References
Further reading
Websites
Chapter 25 Realist Synthesis
INTRODUCTION
REALIST SYNTHESIS: PHILOSOPHY AND PRINCIPLES
REALIST SYNTHESIS: EXAMPLES
STAGES IN CONDUCTING A REALIST SYNTHESIS
DATA SYNTHESIS
NARRATIVE CONSTRUCTION
STRENGTHS AND LIMITATIONS OF REALIST SYNTHESIS
CONCLUSIONS
ACKNOWLEDGEMENTS
References
Chapter 26 Historical Research
INTRODUCTION
WHY STUDY HISTORY?
SHIFTING SANDS
VOYAGE OF DISCOVERY OR JOURNEY WITHOUT MAPS?
PILGRIMS OF PROGRESS?
INTRICACIES OF INTERPRETATION
CALCULATING CHANGE
REPERTOIRE OF RESOURCES
CONCLUSIONS
References
Websites
Chapter 27 Mixed Methods
DEFINING MIXED METHODS
WHY MIXED METHODS?
CAN METHODS BE MIXED?
THE PURPOSE OF USING MIXED METHODS RESEARCH
THE IMPORTANCE OF INTEGRATION IN MIXED METHODS RESEARCH
CHALLENGES WITH MIXED METHOD STUDIES
CONCLUSIONS
References
Further reading
Websites
Section 4 Collecting Data
Chapter 28 Interviewing
INTRODUCTION
THE PURPOSE OF THE RESEARCH INTERVIEW
TYPES OF INTERVIEW
UNDERTAKING AN INTERVIEW
CONDUCTING THE INTERVIEW
COMMON PITFALLS IN CONDUCTING INTERVIEWS
ADVANTAGES AND DISADVANTAGES OF INTERVIEWS
VALIDITY AND RELIABILITY
ETHICAL ISSUES WITH INTERVIEWING
CONCLUSIONS
References
Website
Chapter 29 Focus Groups
THE PURPOSE OF FOCUS GROUPS
CONDUCTING A FOCUS GROUP
DATA ANALYSIS
ISSUES OF VALIDITY AND RELIABILITY
ADVANTAGES OF FOCUS GROUPS
LIMITATIONS OF FOCUS GROUPS
ETHICAL ISSUES
CONCLUSIONS
References
Further reading
Chapter 30 Questionnaire Design
INTRODUCTION
THE PURPOSE OF QUESTIONNAIRES
USING AND ADAPTING PREVIOUSLY VALIDATED QUESTIONNAIRES
RELIABILITY
VALIDITY
DEVELOPING A QUESTIONNAIRE
ADMINISTERING QUESTIONNAIRES
PILOTING
RESPONSE RATES
COMPARISON BETWEEN FACE-TO-FACE STRUCTURED INTERVIEWS AND POSTAL QUESTIONNAIRES
STRENGTHS AND LIMITATIONS OF QUESTIONNAIRES
ETHICAL ISSUES ASSOCIATED WITH QUESTIONNAIRES
CONCLUSIONS
References
Chapter 31 Observation
THE PURPOSE OF OBSERVATION
PARTICIPANT OBSERVATION
NON-PARTICIPANT OBSERVATION
ADVANTAGES AND DISADVANTAGES OF OBSERVATION
VALIDITY AND RELIABILITY
ETHICAL ISSUES ASSOCIATED WITH OBSERVATION
CONCLUSIONS
References
Chapter 32 Think Aloud Technique
INTRODUCTION
WHAT IS THINKING ALOUD?
BACKGROUND TO THINKING ALOUD
APPLYING THINK ALOUD IN NURSING RESEARCH
HOW TO USE THINK ALOUD
RECRUITMENT
DATA COLLECTION
DATA ANALYSIS
VALIDITY AND RELIABILITY
ETHICAL ISSUES
STRENGTHS AND LIMITATIONS
CONCLUSIONS
References
Chapter 33 Outcome Measures
INTRODUCTION
NURSE-SENSITIVE OUTCOMES
OUTCOMES VERSUS PROCESS
CHARACTERISTICS OF MEASURES
VALIDITY AND RELIABILITY
BIAS IN MEASUREMENT
SELECTING OUTCOME MEASURES
OTHER CONSIDERATIONS IN IDENTIFYING OUTCOMES
USING CLINICAL DATA AND OTHER ROUTINELY COLLECTED DATA IN RESEARCH
CONCLUSIONS
References
Further reading
Section 5 Making Sense of the Data
Chapter 34 Qualitative Analysis
INTRODUCTION
PRINCIPLES OF QUALITATIVE ANALYSIS
EXAMPLES OF METHODS OF ANALYSIS
PRACTICALITIES
EXAMPLES OF ANALYSES
USING COMPUTER SOFTWARE FOR QUALITATIVE DATA ANALYSIS
CONCLUSIONS
References
Further reading
Websites
Chapter 35 Descriptive Analysis of Quantitative Data
INTRODUCTION
DATA TYPES
RECORDING DATA
PRESENTING DATA IN GRAPHS
DESCRIBING DATA
PRESENTING DATA AND RESULTS IN TABLES
CONCLUSIONS
References
Further reading
Websites
Chapter 36 Examining Relationships in Quantitative Data
INTRODUCTION
STATISTICAL ANALYSIS
CHOOSING THE STATISTICAL METHOD
THE RELATIONSHIP BETWEEN TWO CONTINUOUS VARIABLES
CONCLUSIONS
Reference
Further reading
Section 6 Putting Research into Practice
Chapter 37 Disseminating Research Findings
INTRODUCTION
COMMUNICATING WITH DIFFERENT AUDIENCES
THE RESEARCH REPORT
WRITING AN ARTICLE FOR PUBLICATION
PREPARING A REPORT FOR THE PUBLIC
PRESENTING RESEARCH AT A CONFERENCE
NETWORKING OPPORTUNITIES, RESEARCH PARTNERSHIPS AND COLLABORATIONS
CONCLUSIONS
References
Further reading
Websites
Chapter 38 Evidence-based Practice
INTRODUCTION
THE NATURE OF ‘EVIDENCE’ IN EVIDENCE-BASED PRACTICE
HIERARCHIES OF EVIDENCE
RESEARCH UTILISATION
THE PROCESS OF EVIDENCE-BASED PRACTICE
BARRIERS TO ACHIEVING EVIDENCE-BASED PRACTICE
IMPLEMENTING EVIDENCE-BASED PRACTICE
CONCLUSIONS
References
Further reading
Journals
Websites
Chapter 39 Translating Research Findings into Practice
INTRODUCTION
TRANSLATING RESEARCH FINDINGS INTO RESEARCH PRODUCTS
CLINICAL GUIDELINES
KNOWLEDGE TRANSLATION FRAMEWORKS
THE KNOWLEDGE TO ACTION FRAMEWORK
INTERVENTIONS TO PROMOTE BEHAVIOURAL CHANGE
ACHIEVING CHANGE
CONCLUSIONS
References
Websites
Chapter 40 The Future of Nursing Research
INTRODUCTION
UK HEALTH RESEARCH POLICY
UK NURSING RESEARCH POLICY
NURSING RESEARCH: FIVE POLICY IMPERATIVES
CONCLUSIONS
References
Websites
Glossary
Index
This edition first published 2010
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Library of Congress Cataloging-in-Publication Data
The research process in nursing. – 6th ed. / edited by Kate Gerrish, Anne Lacey.
p.; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-9048-0 (pbk.: alk. paper) 1. Nursing–Research. I. Gerrish, Kate, 1955– II. Lacey, Anne.
[DNLM: 1. Nursing Research–methods. 2. Data Collection–methods. 3. Research Design. WY 20.5 R4324 2010]
RT81.5.R465 2010
610.73072–dc22
2009048118
A catalogue record for this book is available from the British Library.
1 2010
Leanne M Aitken
PhD, BHSc(Nurs) Hons, RN, Int Care Cert,
GCertMgt, GDipScMed(ClinEpi)
Professor of Critical Care Nursing, Research Centre
for Clinical and Community Practice Innovation,
Griffith University & Princess Alexandra
Hospital, Australia
Teresa Allan
MSc, BA Hons
Senior Lecturer in Health and Care Statistics,
School of Community and Health Sciences, City
University London, UK
Claire Beecroft
MA, BA Hons, DPS
Information Specialist, School of Health and
Related Research (ScHARR), University of
Sheffield, UK
Andrew Booth
MSc, BA, Dip Lib, MCLIP
Reader in Evidence Based Information Practice,
School of Health and Related Research
(ScHARR), University of Sheffield, UK
Jo Booth
PhD, BSc(Hons), BA, RGN, RNT
Reader, School of Nursing, Midwifery and
Community Health, Glasgow Caledonian
University, UK
Tracey Bucknall
PhD, RN, Int Care Cert, GDACN
Professor of Nursing, Deakin University, Head,
Cabrini-Deakin Centre for Nursing Research,
Cabrini Health, Australia
Charlotte L Clarke
DSocSc, PhD, MSc, PGCE, BA, RN
Associate Dean (Research) and Professor of
Nursing Practice Development Research,
Northumbria University, UK
Kara DeCorby
MSc
Research Coordinator, Faculty of Health Sciences,
McMaster University, Ontario, Canada
Jo Dumville
PhD, MSc
Research Fellow, York Trials Unit, University of
York, UK
George Ellison
PhD, MSc (Med), BSc Hons
Professor of Interdisciplinary Studies and Director
of the Graduate School & Research Office,
London Metropolitan University, UK
Catherine Evans
PhD, MSc, BSc, RN, RHV, DN
Research Fellow, Centre for Research in Primary
and Community Care, University of
Hertfordshire, UK
Jenny Freeman
PhD, MSc, BSc, CSTAT
Senior Lecturer in Medical Statistics, School of
Health and Related Research (ScHARR),
University of Sheffield, UK
Dawn Freshwater
PhD, BA Hons, RN RNT, FRCN
Professor of Mental Health and Dean of School of
Health Care, University of Leeds, UK
Leslie Gelling
PhD, MA, BSc Hons, RN MICR FRSA
Senior Research Fellow, Faculty of Health and
Social Care, Anglia Ruskin University, UK
Kate Gerrish
PhD, MSc, BNurs, RN, RM, NDN Cert
Professor of Nursing, Centre for Health & Social
Care Research, Sheffield Hallam University and
Sheffield Teaching Hospitals NHS Foundation
Trust, UK
Claire Goodman
PhD, MSc, BSc, RN, DN
Professor of Health Care Research, Centre for
Research in Primary and Community Care,
University of Hertfordshire, UK
Gordon Grant
PhD, MSc, BSc Hons
Emeritus Professor, Centre for Health and Social
Care Research, Sheffield Hallam University, UK
Peter Griffiths
PhD, BA Hons, RN
Professor and Director National Nursing Research
Unit, King’s College London, UK
Carol Haigh
PhD, MSc, BSc Hons, RGN
Professor in Nursing, Faculty of Health, Psychology
and Social Care, Manchester Metropolitan
University, UK
Felicity Hasson
MSc, PgDip, BA Hons
Research Fellow, Institute of Nursing Research,
School of Nursing, University of Ulster, UK
Immy Holloway
PhD, MA, Bed, Cert Ed
Visiting Professor, School of Health and Social
Care, Bournemouth University, UK
Alison Hutchinson
PhD, MBioeth, BAppSc, RN, Certificate in
Nursing, Certificate in Midwifery
Postdoctoral Fellow, Faculty of Nursing, University
of Alberta, Canada, Honorary Senior Fellow,
School of Nursing and Social Work, The
University of Melbourne, Australia
Martin Johnson
PhD, MSc, RN, RNT
Professor in Nursing, School of Nursing, University
of Salford, UK
Martyn Jones
PhD, CPsychol, BSc Hons, RNMH, Dip Ed
Reader, School of Nursing and Midwifery,
University of Dundee, UK
Sinead Keeney
PhD, MRes, BA Hons
Senior Lecturer, Institute of Nursing Research,
School of Nursing, University of Ulster, UK
Anne Lacey
DPhil, MSc, BSc Hons, RGN, RNT, DipN(Lond)
Diocesan Health Coordinator, Diocese of Madi and
West Nile, Uganda, Honorary Senior Research
Fellow, School of Health and Related Research
(ScHARR), University of Sheffield, UK
Judith Lathlean
DPhil (Oxon), MA; BSc(Econ) Hons
Professor of Health Research, School of Health
Sciences, University of Southampton, UK
Tony Long
PhD, MA, BSc Hons, SRN, RSCN
Professor of Child and Family Health, School of
Nursing, University of Salford, UK
Brendan McCormack
DPhil, BSc Hons, DPSN, PGCEA, RNT, RGN,
RMN
Professor of Nursing Research, University of
Ulster, UK
Hugh McKenna
CBE, PhD, BSc Hons, RMN, RGN, RNT,
DipN(Lond), AdvDipEd, FFN RCSI FEANS,
FRCN, FAAN
Dean, Faculty of Life and Health Sciences,
University of Ulster, UK
Ann McMahon
PhD, MSc, BSc, PGDip, CMS, RMN, RGN
RCN Research and Development Adviser/Manager,
RCN Research & Development Co-ordinating
Centre, Royal College of Nursing, UK
Julienne Meyer
PhD, MSc, BSc, Cert Ed(FE), RN, RNT
Professor of Nursing, Care for Older People, City
University London, UK
Andrea Nelson
PhD, BSc Hons, RN
Professor of Wound Healing, School of Healthcare,
University of Leeds, UK
Susan Procter
PhD, BSc Hons, RGN, Cert Ed
Professor of Public Health and Primary Care,
School of Community and Health Sciences, City
University London, UK
Anne Marie Rafferty
CBE, DPhil, MPhil, BSc, RGN, DN, FRCN, FQNI
Dean and Head of School, Florence Nightingale
School of Nursing and Midwifery, King’s
College London, UK
Paul Ramcharan
PhD, BSc Hons, Grad Dip Ed
Coordinator Research and Public Policy, Australian
Centre for Human Rights Education, RMIT
University, Melbourne, Australia
Janice Rattray
PhD, MN, Cert Ed, RGN, SCM
Senior Lecturer, School of Nursing and Midwifery,
University of Dundee, UK
Jan Reed
PhD, BA, Cert Ed
Professor of Health Care for Older People, School
of Health, Social Care and Education,
Northumbria University, UK
Angie Rees
MA, BA Hons, DPS, MCLIP
Information Specialist, School of Health and
Related Research (ScHARR), University of
Sheffield, UK
Colin Robson
PhD, BSc Hons, BSc Hons, PGCE
Emeritus Professor, School of Human and Health
Sciences, University of Huddersfield, UK
Jo Rycroft-Malone
PhD, MSc, BSc Hons, RN
Professor of Implementation Research, Bangor
University, UK
Sarah Salway
PhD, MSc, BSc Hons
Reader in Public Health, Centre for Health & Social
Care Research, Sheffield Hallam University, UK
Lucy Simons
PhD, MA Hons, RGN
Senior Research Fellow, School of Health Sciences,
University of Southampton, UK
Julie Taylor
PhD, MSc, BSc Hons, RN, FEANS
Professor of Family Health and Research Dean,
School of Nursing and Midwifery, University of
Dundee, UK
Angela Tod
PhD, MSc, MMedSci, BA Hons, RN
Principal Research Fellow, Centre for Health and
Social Care Research, Sheffield Hallam
University, UK
Les Todres
PhD, MSocSc (Clin Psych), BSocSc Hons,
CPsychol
Professor of Qualitative Research, Centre for
Qualitative Research, School of Health and
Social Care, Bournemouth University, UK
Annie Topping
PhD, PGCE, BSc Hons, RGN
Professor of Health & Social Care, Centre for
Health and Social Care Research, University of
Huddersfield, UK
David Torgerson
PhD, MSc
Director York Trials Unit, University of York, UK
Rosemary Wall
PhD, MSc, BA
History of Nursing Postdoctoral Research
Associate, Florence Nightingale School of
Nursing and Midwifery, King’s College London,
UK
Stephen Walters
PhD, MSc, PGCE, BSc Hons, CStat
Professor of Medical Statistics, School of Health
and Related Research (ScHARR), University of
Sheffield, UK
Hazel Watson
PhD, MN, RGN, RMN, RNT
Visiting Professor of Health Sciences, School of
Nursing, Health and Culture, University West,
Sweden, (formerly) Professor of Nursing, School
of Nursing, Midwifery and Community Health,
Glasgow Caledonian University, UK
Rosemary Whyte
PhD, BA Hons, RGN, RCNT, RNT
(Formerly) Research Fellow, School of Nursing,
Midwifery and Community Health, Glasgow
Caledonian University, UK
Since the 5th edition of The Research Process in Nursing was published in 2006, there have been some significant developments in nursing research in the UK. A framework for clinical academic careers in nursing has been developed, creating for the first time the opportunity for nurses to progress through masters preparation, doctoral and post-doctoral research fellowships while combining research activity with clinical practice. The results of the 2008 Research Assessment Exercise, an appraisal of the quality of research in UK higher education institutions, showed marked improvement in the quality of nursing research, with a significant proportion of the research undertaken by nurses judged to be of world-class standard. At the same time, the pace of change in nursing research has been rapid, with a broader range of research approaches and methods being used to answer research questions arising from nursing practice. Finally, the drive to ensure that research evidence is used to inform practice has continued to gain momentum in both policy and the everyday work of practising nurses. Patients expect to receive high quality healthcare informed by the very best evidence. Nursing research is central to this endeavour.
As editors, we have felt it necessary to ensure that this well-established research text reflects these developments in nursing research. In compiling the 6th edition of The Research Process in Nursing, we have made some significant changes to the content of the book, although the overall structure remains unchanged. There are 10 completely new chapters, and several other chapters have been substantially revised or written by new authors. The remaining chapters have been revised and updated to ensure that the reader is provided with the very latest information on research processes and methods. The 6th edition is also the first to include a website associated with the book (www.wiley.com/go/gerrish), enabling readers to complement their studies by accessing the many web resources that are available in the field of healthcare research, and highlighting work being undertaken by some of the chapter authors.
We, the editors, have been privileged to continue to work with chapter authors who are leaders in nursing research and other disciplines across the four countries of the UK, and, in this new edition, in Australia and Canada. We are indebted to our team of authors for their wide-ranging and authoritative contributions to the research methodology literature. We have continued to target the book at novice researchers, be they pre-registration students or those embarking on a postgraduate research degree, but the book should also be of value to many who are further on in their research careers. We have encouraged the authors to write in an accessible style, but not to shrink away from complex debates and technical issues.
The book is structured into six sections.
Section 1, Setting the Scene, deals with the background issues of nursing research in the current policy context in the UK, the nature of the research process, and ethics. This section also includes two chapters encouraging inclusive approaches to the research process. The previous edition included a chapter on user involvement, and in this edition a new chapter on research in a multi-ethnic society has been added. Readers new to the context in which nursing research takes place will find that this section orients them to the subject and, we hope, will enthuse them to engage with an activity that has the potential to change and improve the provision of healthcare.
Section 2, Preparing the Ground, includes chapters that take the reader through the steps that are essential before a research project can begin. Regulatory frameworks governing research in the UK have continued to evolve, and the chapter on this issue has therefore been rewritten by a new author. Chapters dealing with the preparation of a research proposal and management of a project have also been completely rewritten.
Section 3, Choosing the Right Approach, is the longest section and in many ways the heart of the book. It has been expanded considerably from the 5th edition. After an introduction to the philosophical debates underlying the different research approaches available to nurses, and a chapter on sampling, 15 research approaches used in nursing research are explored in detail. New chapters for this edition include narrative research, Delphi approach, practitioner research, realist synthesis and mixed methods. Although some of these approaches are less common in nursing research than surveys and grounded theory, for example, they are now appearing in the literature and represent new ways of thinking about carrying out research. They are commended to the reader as possible ways into difficult-to-research areas, particularly those related closely to nursing practice. A chapter on historical research included in earlier editions of the book has been rewritten for this 6th edition.
Section 4, Collecting Data, and Section 5, Making Sense of Data, are both practical sections dealing with the skills required for data collection and analysis. Here the emphasis is on research tools, such as interviewing and statistical analysis, common to many different research approaches. Two new chapters have been included in Section 4 – on ‘think aloud’ techniques, and on outcome measures. The chapter on outcome measures replaces the chapter on physiological measurement in the previous edition, but includes some of the same content.
Section 6, Putting Research into Practice, concludes the book by taking the reader through the process of disseminating research findings and getting them implemented into policy and practice. As well as addressing active researchers, these chapters will be of use to nurses who, though not wanting to engage themselves in research, want to incorporate it into their professional lives through evidence-based practice. The chapter on translating research into practice has been completely rewritten by the author of the evidence-based practice chapter, which makes for a more coherent central theme in this section. The final chapter has undergone major revision, and now includes a policy review and up-to-date analysis of the state of nursing research and its aspirations for the future.
Although the book is designed in a logical fashion, as outlined above, each chapter is also intended to be complete in itself. Many readers will dip in and out of different sections as necessary. For this reason, wherever possible we have included cross-references to other chapters that may be helpful, and have provided key point summaries at the beginning of each chapter. We have also compiled a glossary of research terms to help the reader with new language with which they may be unfamiliar.
Throughout the book we have adopted certain generic terms to assist readability and reduce repetition. Foremost among these is the term ‘nursing’. By this we mean all the professions of nursing, midwifery, health visiting and related specialisms. We hope that members of these professions will forgive our shorthand, but we have tried to ensure that examples given are taken from a wide range of healthcare settings. We have also used the terms ‘evidence’ and ‘evidence-based practice’ to denote the plethora of resources and implementation activities that have become so important in healthcare today.
This book is intended to be used primarily by nurses, midwives and health visitors, but it has much wider application to any health and social care practitioner who wishes to learn about research. Members of the allied health professions in particular face many of the same debates and dilemmas as nurses in developing research capacity. The contributors to the book are not all nurses, but include statisticians, social scientists, information specialists, academic researchers and psychologists.
We trust that this 6th edition of a well-established book will continue to make a valuable contribution to research capacity building in nursing and healthcare.
Kate Gerrish and Anne Lacey
Editors to the 6th edition,
2010
Nursing research does not exist in a vacuum, but is an applied discipline set in the context of a dynamic academic community and relating to a complex healthcare system. This section explores this context and introduces the reader to the nature of nursing research.
Chapter 1 presents the fundamental concepts of the discipline, reviews the current context of nursing research, and emphasises the essential connection between nursing research and the practice of the profession. Even those who do not see themselves as active researchers should be users of the knowledge generated by research, and so need to understand much of what follows in the sections of this book. Chapter 2 then takes the reader through the essential steps in the research process, each of which will be dealt with in much more depth in later sections, but with the aim of giving an overview of the entire undertaking that is research. Recent examples from the literature are used to illustrate the varied nature of nursing research.
Research in nursing, as in healthcare generally, is complicated by the fact that it is involved with vulnerable human beings, and ethical principles need to be observed from the outset of any research project. Chapter 3, therefore, tackles this moral obligation on the researcher, drawing out the practical implications for the researcher and setting the context for the more specific ethical regulations dealt with in Section 2 of the book.
The final two chapters in this section deal with the need for nursing research to be inclusive in scope. User involvement in research has been advocated from within and outside the profession for more than a decade now, and Chapter 4 argues for the full inclusion in the research process of those to whom the outcomes might apply. New to this edition of the book is Chapter 5 on research in a multi-ethnic society. Although there are many minority groups that deserve special consideration when designing nursing research, ethnicity perhaps merits particular consideration as a major factor impacting on healthcare in UK society.
Significant changes in healthcare have taken place in the 26 years since the first edition of this book was published and these changes are set to continue. Technological developments have led to improved health outcomes and at the same time have raised public expectations of healthcare services. Increased life expectancy and lower birth rates mean that the United Kingdom (UK) population is ageing. An older population is more likely to experience complex health needs, especially in regard to chronic disease, and this places additional demands on an already pressurised health service. At the same time, the escalating cost of healthcare is leading to a shift from expensive resource-intensive hospital care to more services being provided in the primary and community care sectors. In response to these changes, government health policy is increasingly focused on improving the clinical and cost-effectiveness of healthcare, while at the same time reducing the burden of ill health through active public health and health promotion strategies. For example, the recent review of the NHS in England undertaken by Lord Darzi has identified a number of priorities that need to be progressed in order to provide high quality care for patients and the wider public (DoH 2008). The review stresses the importance of improving health outcomes by preventing illness, as well as enhancing the quality of care provided to people with particular needs, for example patients with common long-term conditions such as diabetes, or those in need of palliative and end-of-life care.
To achieve the outcomes for enhancing quality set out in the review, there is a need to change the way healthcare professionals work and the way health services fit together, and to ensure that patients have access to the best available treatments. However, achieving quality in healthcare is a moving target. What was considered high quality care in 1948 when the NHS was first founded is no longer considered to be the case 60 years on. Knowledge about effective healthcare interventions has increased enormously, and this is certainly the case with nursing interventions. In the past, custom and practice, often based on the ward sister’s or doctor’s likes and dislikes, dictated what nurses did to patients, but nursing research has provided a new evidence base to inform the care that nurses provide. One clear example is in the field of pressure area care. It is not that long ago that nurses applied various techniques in an attempt to reduce the risk of a patient developing a pressure sore, these included egg white and oxygen, methylated spirits and vigorously rubbing the area at risk. Yet research by Doreen Norton more than 30 years ago clearly identified that moving patients regularly, keeping their skin clean and dry, and using the right equipment was the most effective way to reduce the risk (Norton et al. 1975).
It is essential that nurses respond proactively to the developments outlined above in order to provide high quality care in response to the needs of the individuals and communities with whom they work. To do this, they need up-to-date knowledge to inform their practice. Such knowledge is generated through research. This chapter introduces the concept of nursing research and considers how research contributes to the development of nursing knowledge. In recognising that nursing is a practice-based profession the relevance of research to nursing policy and practice is examined within the context of evidence-based practice and the responsibilities of nurses is explored in respect of research awareness, research utilisation and research activity.
The definition of research provided by Hockey (1984) in the first edition of this book is still pertinent today:
‘Research is an attempt to increase the sum of what is known, usually referred to as a “body of knowledge” by the discovery of new facts or relationships through a process of systematic scientific enquiry, the research process’ (Hockey 1984: 4)
Other definitions of research emphasise the importance of the knowledge generated through research being applicable beyond the research setting in which it was undertaken, i.e. that it is generalisable to other similar populations or settings. The Department of Health, for example, defines research as:
‘the attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods’ (DoH 2005: 3, section 1.10)
Research is designed to investigate explicit questions. In the case of nursing research these questions relate to those aspects of professional activity that are predominantly and appropriately the concern and responsibility of nurses (Hockey 1996). The International Council of Nursing’s (ICN) definition of nursing research captures the broad areas of interest that are relevant to nurse researchers.
‘Nursing research is a systematic enquiry that seeks to add new nursing knowledge to benefit patients, families and communities. It encompasses all aspects of health that are of interest to nursing, including promotion of health, prevention of illness, care of people of all ages during illness and recovery or towards a peaceful and dignified death’ (ICN 2009)
The ICN has identified nursing research priorities in two broad areas, namely health and illness, and the delivery of care services. These priority areas are outlined in Box 1.1. In addition, research in the field of nursing education is important, for unless nurses are prepared appropriately for their role, they will not be able to respond to the needs of patients, families and communities. Priorities for research in nursing education are broad ranging as illustrated in Box 1.2. Most nursing research investigates contemporary issues; however, some studies may take an historical perspective in order to examine the development of nursing by studying documentary sources and other artefacts (see Chapter 26).
The questions that nursing research may address vary in terms of their focus. More than 20 years ago, Crow (1982) identified four approaches that research could take; these remain pertinent today:
Nursing research does not necessarily need to be undertaken by nurses. Indeed, some seminal studies into nursing practice and nurse education have been undertaken by sociologists. For example, in the 1970s, Robert Dingwall, a sociologist, undertook an influential study of health visitor training (Dingwall 1977). Likewise, nurses who engage in research may not confine their area of enquiry to nursing research. The growing emphasis on multidisciplinary, multi-agency working means that nurse researchers may choose to examine questions that extend beyond the scope of nursing into other areas of health and social care. Nurse researchers may find themselves working in multidisciplinary teams including statisticians, health economists, sociologists and other health professionals, working on research areas such as rehabilitation, which encompass a wide range of disciplines. Nurse researchers work appropriately in university departments such as social science, health services research and complementary medicine, as well as in departments of nursing and midwifery.
Whereas the generation of new knowledge is valuable in its own right, the application and utilisation of knowledge gained through research is essential to a practice-based profession such as nursing. This latter activity is known as ‘development’. Thus research and development, ‘R&D’, go hand in hand.
Research and development can be divided into three types of activity.
Basic research is original, experimental or theoretical work, primarily for the purpose of obtaining new knowledge rather than focusing on the specific use of the findings. For example, biomedical laboratory-based research falls within this category.
Applied research is also original investigation with a view to obtaining new knowledge, but it is undertaken primarily for practical purposes. Much nursing research falls within this category and is undertaken with the intention of generating knowledge that can be used to inform nursing practice and can involve both clinical and non-clinical methods.
Development activity involves the systematic use of knowledge obtained through research and/or practical experience for the purpose of producing new or improved products, processes, systems or services.
Development activity that focuses on the utilisation of knowledge generated through research can take different forms. The most common activities include clinical audit, practice development and service evaluation (see Box 1.3). Like research, these activities often employ systematic methods to address questions arising from practice. Research, however, is undertaken with the explicit purpose of generating new knowledge, which has applicability beyond the immediate setting. By contrast, clinical audit, practice development and service evaluation are primarily concerned with generating information that can inform local decision making (NPSA 2008). Yet, the boundaries between some forms of research, for example action research (see Chapter 22) and practice development, and evaluation research (see Chapter 21) and service evaluation, are often blurred (Gerrish & Mawson 2005). It is, however, important to be able to differentiate between these activities as they require very different approval processes before the work can begin (see Chapter 10).
Nursing research is concerned with developing new knowledge about the discipline and practice of nursing. Nursing knowledge, like any other knowledge, is never absolute. As the external world changes, nursing develops and adapts in response. In parallel, nursing knowledge develops and changes. This year’s ‘best available evidence’ has the potential of being superseded by new insights and discoveries. Therefore nursing knowledge is temporal, and will always be partial and hence imperfect. This does not mean, however, that nurses should not continually strive to develop new knowledge to inform nursing and healthcare policy and practice.
Whereas the focus of this book is on the generation of knowledge through research, it is important to recognise that nursing knowledge may take different forms. In addition to empirical knowledge derived through research, nurses use other forms of knowledge, such as practical knowledge derived from experience, and aesthetic or intuitive knowledge derived from nursing practice (Thompson 2000). Nurses use these different forms of knowledge to varying degrees to inform their practice (Gerrish et al. 2008). It is beyond the scope of this book to examine in detail the various forms of nursing knowledge; however, Chapter 38 introduces the reader to some of these within the context of promoting evidence-based practice.
The definitions of research given earlier in this chapter emphasise the role of systematic scientific enquiry – the research process – in generating new knowledge. The research process comprises a series of logical steps that have to be undertaken to develop knowledge. Different disciplines may interpret the research process in different ways, depending on the specific paradigms (ways of interpreting the world) and theories that underpin the discipline. A biological scientist’s approach to generating new knowledge will be different from that of a sociologist. However, the basic principles of the systematic research process will be followed by all disciplines. Nursing, as a discipline in its own right, is relatively young in comparison to more established professional groups such as medicine, and is in the process of generating theories that are unique to describing, explaining or predicting the outcomes of nursing actions. Nursing theories are generated through the process of undertaking research and may also be tested and refined through further research. However, nursing also draws on a unique mix of several disciplines, such as physiology, psychology and sociology, and any of these disciplines may be appropriate for research in nursing. For example, the management of pain can be studied from a psychological or physiological perspective; whichever approach is chosen will be influenced by the theories relevant to the particular discipline.