Introduction to nursing research,evidence based

nursing,the ethics of nursing and research

process .
  by
Prepared
Walaa Gamal Elsaid
Shimaa Kashef
 
 
 
Under supervision
Prof Dr : Bahega Galal
Prof Dr :Nabila Elsaid
 
out lines:
• Introduction
• Basic Research terminology
• Importance of research in nursing.
• The role of nurses in nursing research
• Nursing process and research process.
• Major steps in the research process & its phases
• Definitions of EBP
• Aims
• Evidence Based guidelines
• The seven steps of EBP
• factors must be considered in carrying EBN
• Barriers to EBP
• Facilitators of EBP
• Code of ethics
• Principle of ethics
• Type of voluntary group
• Critiquing the ethics of research
• Matters of ethical violation of research
• and research misconduct
• Obligation to report
Introduction: -

Research is critical for improving nursing practice and is

the only way as a profession can consistently improve over
time.
Nursing research improves the standards of nursing care
by providing the basis for sound nursing action
particularly, planning, predicting, and controlling patient
care outcomes and decrease cost.
 Basic Research terminology
Research: - is systematic inquiry that uses disciplined method to question or solve problems. Nursing
research: -
is systematic inquiry designed to develop knowledge about issues of
importance to nurses including nursing practice, nursing education and nursing administration.
The scientific study: The scientific approach is used when the researchers address a problem or answer a
question.
A Study is referred to as an investigation or a research project
The Subjects: The people who are being studied and also called study participants. Respondents
or informants when they provide information to the researcher by answering question directly.
The researcher: The investigator or scientist, the person who undertakes the research. When the
study is undertaken by research team the main person directing the investigation is called the
principal investigator "PI" or project director.
 

Theory is an abstract generalization that presents a systematic explanation about the

interrelationships among phenomena. Concepts are the building blocks of theories.
Variables: A variable is something that varies as weight height, body temperature, age.
 Types of variables:
. Quantitative: when data expressing the different variable
levels are measured as numbers.
1. Continuous: as age, weight, height these variables are
expressed as number and its fractions.
2. Discrete: as pulse rate, it is expressed as the number of
occurrence with no fractions. II.
Qualitative: variable is assessed as description.
1. Nominal: as sex it is expressed as either male or female. Just names.
2. Ordinal: as disease severity, it is expressed or mild, moderate or severe.The description has a certainorder.
 
Dependent versus independent variable:
Cause : the independent variable.
Effect : dependent variable.
For example:
- Dose smoking cause using cancer?
- Dose nursing intervention cause more rapid recovery?
The dependent variable usually is the variable the researcher is interested in understanding, explaining, or
predicting. In lung cancer, the carcinoma is the real interest to the researcher, not smoking behavior.
The importance of nursing research: -

a- Description: -
Description involves identifying the nature and attributes of nursing
phenomena. The descriptive research is essential groundwork for studies that
will focus on explanation, prediction and control of nursing phenomena.
b- Explanation: -
In explanation, the Relationships among variables are clarified, and the reasons
why certain events occur are identified, determining relationships among
variables provides a basis for conducting studies for the purpose of predicting
and continuing patient outcomes.
c- Control: -
Control can be described as the ability to write a prescription to produce the
desired results! Nurses could prescribe certain interventions to help patients and
families achieve high-quality outcomes.
The role of nurses in nursing research:
a-At one end : The consumers of nursing research read research
reports to keep up-to-date on relevant findings that may affect their practice.
b-At the other end:The producers of nursing research nurses who actively participate in designing and implementing research
studies.
c-Between these two end points lie a variety of research related
activities include the following:-
1. Participating in a journal club in a practice setting which
involves regular meetings among nurses to discuss and critique research articles.
2. Attending research presentations at professional conferences.
3. Evaluating completed research for it's possible use in practice.
4. Discussing the implications and relevance of research findings with clients.
5. Giving client’s information and advice about participation in studies.
6. Assisting in the collection of research information e.g.
distributing questionnaire to clients.
7. Reviewing a proposed research plan with respect to it's
feasibility in a clinical setting and offering clinical expertise to improve the plan.
8. Assisting with the development of an idea for a clinical
research project.
9. Participating on an institutional committee that reviews the ethical aspects of proposed research before it is undertaken.
Utilizing research by incorporating research results into nursing practice.
Comparing the nursing process to the research process: -

Nursing process Research process

1-Assessment (subjective and objective 1-Identify phenomena.
data).

2-Diagnosis Goal/patient outcomes. 2-Research problems.

-Hypotheses.

3-Plan. 3-Study design.

-Review of literature.
-Theoretical/conceptual framework

4-Implementation. 4-Data collection.

5-Evaluation. 5-Analysis of results. -

Recommendations and implications for
further research.
Major steps in the research process
Phase 1: the conceptual phase
Step 1: Formulating and delimiting the problem
Step 2: Reviewing the related literature
Step 3: Developing a theoretical framework
Step 4: Formulating hypotheses
Phase 2: the design and planning phase
Step1: Selecting a Research Design
Step2: Identifying the Population to be studied
Step3: Specifying Methods to Collect the Research Data
Step 4: Designing the sampling plan
Step 5: Finalizing and reviewing the research plan
Step 6: Conducting the pilot study & making revisions
Phase 3: the Empirical phase
Step 1: Collecting the data. Step 2: Preparing the Data for Analysis .
Phase 4: the analytic phase :Analyzing data , Interpreting the Results

Phase 5: The Dissemination phase; Communicating the Findings , Utilizing the Findings
Definitions of EBP

Evidence Based Practice (EBP) has been defined as “a

problem-solving approach to the delivery of health care that integrates
best evidence from studies and patient care data with clinician expertise
and patient preferences and values”.
• questions to ask, how to find the best practice, and how to critically
evaluate the evidence for validity and applicability to particular care
situation
 Aims of EBP

• Enhances healthcare quality

• Improves patient outcomes
• Reduces costs
• Empowers clinicians; this is known as the quadruple aim in healthcare.

Evidence Based guidelines

• Clinician experience
• Patient preferences
• Scientific findings.
 The steps of EBP
 Step 1: Formulate the Burning Clinical PICOT Question
Step 2: Search for the Best Evidence
Step 3: Critical Appraisal of Evidence
Step 4: Integrate the Evidence with Clinical Expertise and
Patient/Family Preferences\
Step 5: Evaluate the Outcomes of the Practice Change Based
on Evidence
Step 6: Disseminate the Outcomes of the Evidence-Based
Practice Change
Barriers to EBP
Nurses, physicians, and other health professionals cite a number of barriers to EBP including the following:
• Lack of EBP knowledge and skills
• Cultures steeped in tradition (e.g., that is the way it is done here)
• Misperceptions or negative attitudes about research and
evidence-based care
• Lack of belief that EBP will result in more positive outcomes than traditional care
• Voluminous amounts of information in professional journals
• Lack of time and resources to search for and critically
appraise evidence
• Overwhelming patient loads
• Organizational constraints, such as lack of administrative support or incentives
• Lack of EBP mentors
• Demands from patients for a certain type of treatment (e.g.,
patients who demand antibiotics for their viral upper
respiratory infections when they are not indicated)
• Peer pressure to continue with practices steeped in tradition
• Resistance to change
• Lack of consequences for not implementing EBP
• Peer and leader/manager resistance•
Lack of autonomy and power to change practice
• Inadequate EBP content and behavioral skills building in
educational programs along with the continued teaching of how to conduct rigorous research in baccalaureate and
master’s programs instead of teaching an evidence-based
approach to care.
Facilitators of EBP
• Support and encouragement from leaderships
 

• Time to critically appraise studies and implement their

findings
• Clearly written research reports
• EBP mentors with excellent EBP skills as well as knowledge
and proficiency in individual and organizational change
strategies
• Proper tools to assist with EBP at the point of care (e.g.,
computers dedicated to EBP; computer based educational
programs)
• Integrating EBP into health professions curricula
• Clinical promotion systems and performance evaluations
that incorporate the EBP competencies•
Evidence-based clinical practice policies and procedures
• EBP models that can guide implementation and
sustainability of EBP
 CODE OF ETHICS CONCERNING
PARTICIPANTS

A list of ethical guidelines for the conduct of research – the Nuremberg Code
– was developed. An especially important code of ethics was adopted by the
national commission for the protection of human subjects; they issued a report
called Belmont report.
The three primary ethical principles of Belmont report Principles on which
 standards of ethical conduct in research are based
1. Beneficence.
2. Respect for human dignity.
3. Justice.

PRINCIPLE OF BENEFICENCE
A. Freedom from harm
Clearly exposing participants to experiences that results in serious or
permanent harm is unacceptable.
B. Freedom from exploitation
Involvement in a research study should not place subjects at a disadvantage or to a situation
for which they are not prepared.
C. Risk/Benefit Ratio
Researchers are expected to carefully assess the risks and benefits that would be incurred in
the study before its inception.
PRINCIPLE OF RESPECT FOR HUMAN DIGNITY

1-Right to Full Disclosure : Full disclosure means that the researcher has fully described the
nature of
the study, including the researchers responsibilities, and the likely risks and
benefits that would be incurred (before their participation in a study).
Then, the subject has the right to refuse participation or not.

2-Right to Self Determination: The principal of self-determination means that the subjects have the
right to decide voluntarily whether or not to participate in a study
without the risk of incurring any penalties or prejudicial treatment.
 It also means that the subjects have the right to decide at any point to terminate their participation or to refuse
to give information, or to ask for clarification about the purpose of the study or specific questions.

3. Informed Consent Informed consent means the subjects have adequate information
regarding research; are capable of comprehending the information; and have the power
of free choice, enabling them to consent voluntarily to participate or decline
participation.
PRINCIPLE OF JUSTICE
 Right to Fair Treatment
Subjects have the right to fair and equitable treatment as shown in the following:
 The fair and nondiscriminatory selection of subjects so any risks and
benefits will be equitably shared; that should be based on research
requirements and not the convenience, gullibility, or compromised
position of certain types of people.
 The no prejudicial treatment of people who decline to participate or
who withdraw from the study after agreeing to participate.
 Right to Privacy
Research with human subjects constitutes some type of intrusion into the personal lives of subjects. Researchers shouldmaintain
subjects’ privacy
Throughout the study.\
A. Anonymity
• Occurs when the researcher does not link a subject with the data
(e.g. name, address, phone number and so forth) of that subject.
• Substituting identification numbers for subjects names on study
record and computer files to prevent accidental breach of data.
• Reporting only aggregate data for groups of subjects or disguise
persons identity in a research report.
B. Confidentiality includes data collection or analysis; that might divulge the identities of the subjects.
• A promise of confidentiality to subjects is a guarantee that any
information will not be publicly reported or made accessible to
parties other than the involved in research.
 VULNERABLE SUBJECTS
Special vulnerable subjects: -
Children: Legally and ethically, children do not have the competence to give their informed consent.
 The informed consent of parents or legal guardians is obtained.
 If the child is 12 yrs. and developmentally mature enough to
understand basic information, it is advisable to obtain informed
consent also from the child as evidence of respect for the childs right to self-determination.
Mentally or emotionally disabled people: People whose disability makes it impossible for them to weigh
the risks and benefits of participation or make informed consent. E. g mentally retarded people, senility,
mental illness, unconsciousness, and so on. The written informed consent is of legal guardians.
Physically disabled people: Special procedure for obtaining consent is required • E.g. deaf subjects, the
consent should be in the written form.
• For subjects who cannot read and write, use audiotaping or
videotaping.
• Institutionalized people: Institutionalized or hospitalized people. They need a special care because they
depend on health care personnel and may feel pressured in participating or their treatment would be
jeopardized.
• Inmates of prisons and other correctional facilities, who have lost their autonomy.
 MATTERS OF ETHICAL VIOLATION FOR RESEARCHER AND
RESEARCH PRODUCT
Forms of scientific misconduct:
1. Tuskegee syphilis study: In 1932, the united State public health service initiated study of syphilis inthe black males in the
small, rural town of Tuskegee, Alabama, USA. The study, which continued for 40year, was conducted to determine natural
cause of syphilis. The subjects, who consented to the study were not informed about the purpose and procedure of the
experiment and unaware that they were a part of an experiment, none of them received treatment for syphilis even when
penicillin was determined to be effective treatment for syphilis.
2.With regard to obtaining scientific knowledge and research process:
 Plagiarism: Authors who present the words, data, ideas processes, or results of others with the implication that they are
their own without
attribution in a form appropriate for the medium of presentation. They are committing theft of intellectual property and are
guilty of
plagiarism and thus of research misconduct
 Sanction: Rejection of the performance and suspension from studies for a specified period (max. 1 yr.) with no pursuant
right to an extension of studies.
 Data
a. Integrity of Data
Fabrication and falsification of research results are serious forms of
misconduct. It is a primary responsibility of a researcher to avoid either a
false statement or an omission that distorts the research record.
Fabrication is making up results and recording or reporting them. This is
sometimes referred to as "drabbing. Falsification is manipulating research materials, equipment, or processes or changing or
omitting data or results such that the research is not accurately represented in the research record
b. Use and Misuse of Data
It is considered a breach of research integrity to fail to report data that
contradict or merely fail to support the reported conclusions, including the
purposeful withholding of information about confounding factors.
c. Ownership of and Access to Data
Research data obtained in studies performed at a university by researchers of the University are not the property of them or even
to the principal investigator. They belong to the University itself, which can be held accountable for the integrity of the data even
if the researchers have left
d. Storage and Retention of Data
Data should be stored securely for at least seven years after completion of the project, submission of the final report to a
sponsoring agency, or
publication of the research, whichever comes last. Some agencies that sponsor research may specify a longer period for which data
must be retained following final approval (to retain data for as long as there is still scientific interest in the details of the
research)
3. During publication
Authorship and Other Publication Issues:
a. Criteria for Authorship
• Publication must give appropriate credit to all authors for their roles
in the research.
• If more than one person contributes significantly, the decision of
which names are to be listed as co-authors should reflect the relative
contributions of various participants in the research.
b. Order of Authors
It is important that all co-authors understand the basis for assigning an order of names and agree in advance to the assignments.
C. Duplicate Publication
Researchers should not publish the same article in two different places without good reason to do so.
D. Early Release of Information About to be Published
It is unethical to release to the media scientific information contained in an accepted manuscript prior to the publication.
Obligation to Report
a. Reporting Suspected Misconduct
Reporting suspected research misconduct is a shared and serious
responsibility of all members of the academic community. Any person who suspects research misconduct has an obligation to report the allegation
to the dean of the unit in which the suspected misconduct occurred or to the Research Integrity Officer
.b. Correction of Errors
If a finding of error, either intentional or inadvertent, or of plagiarism should be made subsequent to publication, the investigator has an obligation
to submit a correction or retraction in a form specified by the publisher
 
Reference
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September 2020 from  
https://nursingonline.nsuok.edu/articles/rnbsn/why
nursesneedresearch.aspx#:~:text=It%20is%20important%20for%20nurses,to%20develop%20their%20own