Essentials of Nursing Research

Essentials of Nursing Research BT Basavanthappa MSc (N) PhD

Professor and Principal (Retired) Government College of Nursing, Bengaluru, Karnataka PhD Guide for Research Work Member Faculty of Nursing, RGUHS, Karnataka Academic Council, RGUHS, Karnataka Examiner UG and PG Courses on Nursing, Various Universities Ex-Programme In-charge IGNOU, BSc Nursing Course, Karnataka and Goa, India Life Member Nursing Research Society of India, New Delhi Trained Nurses Association of India, New Delhi President RGUHS, Nursing Teachers Association, Karnataka, India Winner Bharat Excellence Award and Gold Medal Vikas Ratan Gold Award UWA Life Time Achievement Award Shree Veeranjaneya “Shrujanashri” Award

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to my parents and my nursing profession and my dear students

Preface

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It gives me immense pleasure and satisfaction to present the Essentials of Nursing Research to our nursing community. Nursing research is essential if nurses are to understand the various dimensions of their professions. This book is designed as per request from several nursing professionals and students. The presenation of the subject has been made with the requirements of the undergraduates in mind. Subject areas have been regrouped and made more concise and relevant to the needs of today’s students. Utmost care has been taken to ensure that the work continues to be valuable and serve the nursing community. The simple language, the clarity of thought and lucid styles have been used in this work. I hope this book will continue to serve the nursing community at expected level. BT Basavanthappa

Acknowledgements

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Any author who has interest for writing any book needs help and encouragement of other persons is very essential. The author is indebted to so very many persons that encouragement. However, there are a few individuals who have given much encouragement and help that acknowledgement is due them. It is my bounden duty to express at the outset heartiest gratitude to Shri G Basavannappa, Former Minister of Karnataka, during his tenure in 1960s initiated me to take up this Nobel Profession “Nursing”. I also take this opportunity to express my sincere gratitude to Dr (Mrs) Manjula K Vasundhra, Former Professor and Head of the Department of Preventive and Social Medicine, Bangalore Medical College, Bengaluru, Karnataka India for constant guiding spirit throughout and consistent encouragement for writing books on Nursing. I also take this opportunity to express my deep sense of gratitude to my parents, Shri Thukkappa and Smt Hanumanthamma, my wife Smt Lalitha, and my children Mr BB Mahesh and Ms BB Gaanashree for their unselfish love, endless patience, quite understanding that allow me to devote such a large part of my life to my career and support throughout what is inevitably a continuing but exciting experience. I express my warm appreciation to the M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi and Bengaluru branch for sharing my vision for this Essential Series titles on Nursing and giving me the chance to turn vision into reality. My sincere thanks go to Mr Jitendar P Vij, Chairman and Managing Director; Mr Tarun Duneja, Director Publishing, Mr Venugopal, (Branch manager) Bengaluru and staff for their untiring exceptional efforts and cooperation.

Contents

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1. Concepts of Research .............................................................. 1 2. Research in Nursing ............................................................... 19 3. Classification of Research ...................................................... 36 4. Overview of the Research Process ......................................... 61 5. Review of Literature .............................................................. 68 6. Theory and Theoretical Framework ....................................... 81 7. Research Problem .................................................................. 86 8. Hypotheses .......................................................................... 105 9. Research Design................................................................... 118 10. Sampling .............................................................................. 139 11. Ethical Issues in Nursing Research ....................................... 171 12. Research Planning or Proposal (Protocol) ............................ 177 13. Methods of Data Collection ................................................. 194 14. Techniques of Data Collection ............................................. 250 15. Pilot Study ........................................................................... 290 16. Data Analysis and Interpretation ......................................... 296 17. Communicating Nursing Research ....................................... 318 18. Critiquing Research Report .................................................. 349 Glossary .................................................................................... 353 Appendix .................................................................................. 369 Index ......................................................................................... 379

Concepts of Research

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Concepts of Research

Research is a scientific process. It is called as scientific because the results are verifiable. It is a systematic search for answers to questions about facts and relationship between facts. The systematic method has an order and follows an acceptable procedure for conducting research.

SEARCH FOR KNOWLEDGE Human beings are the unique product of their creation and evolution. In contrast to other forms of animals life, their more highly developed nervous system has enabled them to develop sounds and symbols (letters and numbers) that make possible the communication and recording of their questions, observations, experiences and ideas. It is understandable that their greater curiosity, implemented by their control of symbols would lead them to speculate about the operation of the universe, the great forces beyond their own control. Over many centuries, people began to develop what seemed to be plausible explanation. Attributing the forces of nature to the working of supernatural powers, they believed that the Gods at their whims manipulated the sun, stars, wind, rain and lighting. But gradually people began to see that the operations of the forces of nature were not as capricious as they had been led to believe. They began to observe an orderliness in the universe and certain cause-and effect relationships, they discovered that under certain conditions, events could be predicted with reasonable accuracy. However, these explanation were often rejected if they seemed to conflict with the dogma of religious authority. This reliance on empirical evidence or personal experience challenged the sanction of vested authority and represented an important however, were largely unsystematic and further limited by the lack of an objective method. Observers were likely to over generalise on the basis of incomplete experience or evidence, to ignore complex factors operating simultaneously, or let their feelings and prejudices influence both their observation and their conclusions.

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Essentials of Nursing Research The first systematic approach to reasoning attributed to Aristotle and the Greeks was the deductive method. The deductive method moving from the general assumption to the specific application, made an important contribution to the development of modern problem-solving. But it was not fruitful in arriving at new truths. The acceptance of incomplete or false major premises that were based on old dogmas or unreliable authority could only lead to error. Semantic difficulties often resulted from shifting definitions of the terms involved. Centuries later, Francis Bacon advocated direct observation of phenomena, arriving at conclusions or generalisations through the evidence of many individual observations. This inductive process of moving from specific observations to generalisations freed logic from some of hazards and limitations of deductive thinking. Bacon recognised the obstacle that the deductive process placed in the way of discovering new truth. It started with old dogmas that religious or intellectual authorities had already accepted and thus could be expected to arrive at new truths. Human knowledge works at two levels. At the primary level, it functions on the basis of useful human activities. For example, physician uses his knowledge to cure diseases. At the secondary level, knowledge is employed to obtain increments in the existing knowledge. The activity that produces this new knowledge is known as “research.” Philosophy and science have a common goal of developing and expanding knowledge. But in reality, the approaches of philosophers and scientists are different. A philosopher uses intuition, reasoning, contemplation and introspection to examine the purpose of human life, the nature of being and reality, and the theory and the limits of knowledge, whereas the scientist observes, verifies, constructs, definitions, makes and verifies predictions, and conducts experiments to derive scientific laws and interpret reality.

SOURCES OF KNOWLEDGE

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Ideas generated in many ways. Some sources of knowledge are highly structured and are generally bound by defined rules of process or method, e.g. which includes scientific enquiry, critical thinking and logical reasoning. Other sources are less structured and have few defined rules, they include empathy, intuition, trial and error experience and meditation. For nursing research point of view, these approaches to generating knowledge and divided into two groups as follows: 1. Unstructured—traditions, authority, experience, trial-error, intuition. 2. Structured—induction, deduction, nursing process, research. Human beings acquire knowledge in many ways. A person continuously takes in and processes numerous pieces of information to understand

Concepts of Research experiences. The scientific researcher also seeks to explain or understand reality, but the scientist’s process of acquiring knowledge is systematic and logical. This process or scientific methods is the foundation of research. Scientific research is most reliable and objective of all methods of gaining knowledge. Now the sources of acquiring knowledge is discussed in brief.

Unstructured Sources of Knowledge People will acquire knowledge in the following ways: 1. Tradition 2. Authority 3. Experience 4. Trial and error 5. Intuition Tradition: One way of learning is by tradition. One generation passes knowledge to the next. For example, children often learn about traditional holidays such as “Dussera, Diwali or Christmas” through traditional or customary family practices. In nursing, certain traditional methods of practice such as the change-of-shift report and other daily hospital work practices are passed from one nurse to the next. Tradition is an efficient way of learning, although it can also limit the ability to seek new ways of doing things. If tradition becomes so ingrained that a person does not question the custom, other more appropriate or efficient ways may be overlooked. Authority: Knowledge is also acquired by seeking information from experts in a particular field. Experts are often asked to solve problems or answers for questions. For example, at income tax calculation time, an accountant’s helps is sought to fill out tax forms. Similarly, nursing students often seen the advise of instructors and practising nurses when assessing and caring for clients. Authority, like tradition is not infallible, although it is commonly treated as absolute truth. Experience: A person also learns through experience without this process, a person would have to relearn a procedure every time it was performed. Practice leads to the development of routines that help in building skills. For example, student nurse taking a blood pressure measurement for the first time may feel awkward and unsure of the hearing sounds, but with practice, the student’s technique and confidence improve. Although experience is an important ways of learning, it has limitations. A person may continue to do something simply because it was learned that way and may overlook improved for other ways of doing the same thing. If

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Essentials of Nursing Research experience causes a person to learn something incorrectly, the person uses knowledge in appropriately. Trial and Error: Learning by trial and error is yet another way of gaining knowledge. Making mistakes or repeatedly trying various ways of accomplishing something will eventually result in problem solving. This method of learning is practical, but it is unsystematic and often a haphazard way of learning is practical. In nursing as client’s health status depends on nursing actions, trial and error is not an appropriate way of acquiring new knowledge. Intuition: It is a “power of knowing or knowledge obtained, without recourse to inference or reasoning.” It is a frequently used method of problem solving. It can operate in one of two ways: as a form of interference in which intuition closely resembles sensory perceptions, or as an extrasensory experience independent of sensory input. Intuition helps people gain a deeper understanding of reality that can be obtained from analysing data later on. Intuition is a leap of understanding, grasping of a larger concept unreachable by other intellectual means, yet still fundamentally is an intellectual process. Intuition and practical reasoning may well underlie all forms of reasoning including scientific reasoning and the production of scientific knowledge.

Structured Sources of Knowledge

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Research approach involves the mental processes of logical reasoning concerning the existence and properties of phenomena about which more information, and new knowledge are sought through a systematically planned investigation. As already stated that there are two major modes of logical reasoning, i.e. inductive and deductive. Inductive reasoning involves the observation of a particular set of instances that belong to and can be identified as a part of larger set. This reasoning moves from the particular to the general and underlies qualitative approaches to enquiry, e.g. application of particular nursing conclusions are developed from specific observation. The inductive approach beings with an observation or some other way of obtaining information and leads to a conclusion. Deductive reasoning moves from the general to the particular. It uses two or more variables to related statements that, when combined, from the basis for concluding assertion of a relationship between the variables, and is applied through quantitative enquiry approaches. For example, a specific hypothesis can be deduced from a theory or on organising statement about abstract concepts that serves as a more general statement

Concepts of Research or network of interrelated concepts. As a result of deduction, observation can be made and prediction tested. Scientific approach it is a system of logical and orderly elements, that directs a formal structured enquiry process in the effort to obtain knowledge. Research is accepted as scientific approach to knowledge generation when the processes that are use adhere to principles of logic, standards for data collection and analysis, absence of investigator’s bias, and rules governing generalisability or universality of findings.

Scientific Approach The scientific approach is the most advanced method of acquiring knowledge that humans have developed. The scientific method combines important features of induction and deduction together with severe characteristics to create a system of obtaining knowledge, which, though fallible, is generally more reliable than tradition, authority, experience or inductive or deductive reasoning alone. One important aspect that distinguishes the scientific approach from other methods or understanding is its capacity of self-evaluation, i.e. scientific research uses checks and balances which minimize the possibility that the researcher’s emotions of biases will affects the conclusions. The scientific method is the most advanced objective means of acquiring knowledge, or is characterized by systematic orderly procedures, that although not without fault, seek to limit the possibility for error and minimize the likelihood that any bias or opinion by the researcher might influence the results of research and thus the knowledge gained. Polit and Hungler (1991) describe the characteristics of scientific investigation as follows: 1. The steps of planning and conducting an investigation are undertaken in a systematic orderly fashion. 2. Scientists attempt to control external factors that are not under direct investigation, but that can influence a relationship between phenomena they are studying. For example, if a scientist was studying relationship between diet and heart disease, other contributing factors of the disease. 3. Evidence that if part of reality (empirical data) is gathered directly or indirectly through use of human senses and is the basis for discovering new knowledge. 4. The goal is to understand phenomena is such a way that the knowledge gained can be applied generally, not just to isolated cases or circumstances. 5. Scientists strive to conduct investigations that contribute to testing or developing theories, thereby advancing the knowledge that can be applied toward increasing and understanding of people, places and life events.

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Essentials of Nursing Research The details of the characteristics of the scientific approaches are as follows:

Characteristics of Scientific Approach The scientific approach to enquiry refers to a general set of orderly disciplined procedures used to acquire dependable and useful information. The term “research” designates the application of this scientific approach to the study of a question of interest. As stated earlier, Kerlinger (1973) has defined scientific research as “systematic, controlled, empirical and critical investigation of hypothetical propositions about the presumed relations among natural phenomena.” On the basis of the definition, the characteristics of scientific research are as follows: Order and Control: The scientific method is a systematic approach to problem solving and to the expansion of knowledge. In systematic research, a problem is identified and defined and predictions concerning anticipated outcomes are advanced, information bearing on the solutions of the problem is collected according to a predesignated scheme, the information is subjected to an analysis, and finally conclusions are drawn. Control is a key element of the scientific approach. In trying to isolated relationships between phenomenon (cause and effects), the scientists must attempt to control factors that are not under direct investigation. Empiricism: The term empiricism refers to the process whereby evidence rooted in objective reality and gathered directly or indirectly through the human senses are used as the basis for generalizing knowledge. Empirical inquiry imposes a certain degree of objectivity on the research situation, because ideas or hunches are exposed to testing in the real world situation. Empirical evidence then consists of observations made known to us by way of our sense organs. The observations are verified through sight, hearing, tastes, touch or smell. Generalisation: It is the application of finding from the study sample to the broader population from which the sample was drawn, application of findings to a broader situation. Generalisability of research findings is an important criterion for assessing the quality of an investigation.

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Theory: Scientific generalisations are facilitated by the development of theories. Theories represent a method of organising, integrating and deriving abstract conceptualisations about the manner in which phenomena are interrelated, offer an opportunity for bringing together observed events and relationships for explaining-how and why phenomena are associated with one another, and predict the occurrence of future events and relationships. Theories are strongly linked with the concept of generalisability.

Concepts of Research

Assumptions of Scientific Approach Assumptions refer to basic principles that are accepted on faith, or assumed to be true without proof or verification. The scientists assume that there is an objective reality that exists independent of human discovery or observation. The assumptions of determining refer to the belief that all phenomena have antecedent cause. Natural events or conditions are assumed not to be haphazard, random or accidental. Much of the activity not which a scientific researcher engages is directed towards an understanding of cause-and-effect relationships. Scientific believe that antecedent factors relating to all phenomena exist and can be discovered. For example, heart disease may be caused by smoking, diet, stress and so on. The identification of these causes, i.e. the search for an explanation of why the things are as say they are one of the chief goals of science.

Purposes of Scientific Approach The scientific approach is a method of inquiry or a system for acquiring knowledge. The purpose of nursing researches are to observe in order to know, to know in order to predict, to predict in order to control, to control in order to practice and prescribe in a professional manner. A scientific research study may have two or more goals. Brief explanations of objective or goals are as follows: Description: To observe in order to know is the aim of all nursing research. The nurse who observes, verifies and documents her observations work at a crucial level of research. These studies are often called descriptive or explanatory. A careful and deliberate description is often essential as a foundation for the development of theories. Descriptive research generally does not begin with a theory, but it has got its own importance in development of theories. This types of research begins with the identification of a problem or a problematic situation. A careful analysis of that situation may reveal relevant factors or relationships which were hitherto undetected. Exploration: Exploratory research is an extension of descriptive research and is more directly oriented towards the discovery of relationship. Descriptive investigator observes, describes and perhaps classifies, wherein exploratory research, the researcher focuses on the phenomena of interest, but pursues the question. What factor or factors influence affect, cause or related to this phenomenon. Exploratory researcher will have two basic reasons: i. He may simply be curious and desire a richer understanding of the phenomena of interest, and

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Essentials of Nursing Research ii. The studies are sometimes conducted to estimate feasibility and consist of undertaking a more rigorous or extensive research project on the same topic. Explanation: To predict nurse begins with an explanation predicts what should be found on observation, and tests these predictions in nursing research. Descriptive and exploratory research provides new information, whereas theoretical or explanatory research offers us understanding. Prediction and Control: The researcher may either predict causality or may predict that correlations will be found between specified factors. It is possible to use the scientific approach to make reliable predictions and to develop control mechanisms in the absence of total understanding. For example, she did demonstrate an association between age of mother and Down syndrome, smoking v/s lung cancer. To control is a major purpose of applied nursing research. It means that the nurse has the ability to check, regulate, exercise directing power over factors that influence the health and comfort of patients or clients. Prescription: To prescribe requires a deep involvement in research and practice. A prescription is based on the fact that the goal is to follow the prescription. To bring about and maintaining good health, the prescription states that one must comply with the prescribed regimen of treatment, diet and/or medication. Scientific research strives to describe, explore, explain predict or control phenomena. A second approach of classifying the functions of research is based upon the degree to which the findings have direct practical utility or application. Basic research is concerned with making empirical observations that can be used to formulate or refine a theory. It is not designed to solve immediate problems, but rather to extend the back base of knowledge in a discipline for the sake of knowledge and understanding itself, and its findings may ultimately be applied to the practical problems. Applied research concentrates on finding a solution on immediate practical problem. In the field of nursing, it is designed to: i. Find solutions to nursing problems, ii. Evaluate nursing practices, procedures, policies or curricula, iii. Assess the needs of patients, staff or students, and/or iv. Make decisions to change or continue various aspects of nursing.

Limitations of the Scientific Approach

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The scientific approach to enquiry generally is regarded as the highest form of attaining knowledge that human beings have devised. There are

Concepts of Research some limitations of applying the scientific approach to nursing problems which should be mentioned, lest the impression be given that scientific research is infallible are as follows:

Moral or Ethical Problems Issues that relate to values or ethics are not amenable to the scientific approach, because the problems they raise cannot be tested. For example, the issue of euthanasia (should euthanasia be practised).

Human Complexity One of the major obstacles in the conducting scientific nursing studies is the complexity of the central topic of investigation—human beings. Biological and physical functioning is considerable more regular and consistent and less susceptible-to external influences than psychological functioning. Each human being is unique with respect to his or her personality, social environment, mental capacities, values and life styles. This fact make it relatively more difficult to detect regularities.

Measurement Problems The tools for collecting empirical information concerning biological or physiological functions are much more precise and accurate than are the tools are probing psychological dimension of human activity.

Control Problems The scientist must attempt to control the research situation in order to the confidence in the outcomes. Since the scientist accepts the principle of multiple causations, he must attempt to control factors that are not under direct investigation. Control in a laboratory (for example, experiment on rats) is much more easily achieved than in the real world. This degree of control is not possible with human beings.

Method of Knowing Facts According to Charles Peirce, there are four methods of knowing about facts or fixing our beliefs about various matters. These are tenacity, intuition, authority and science.

Tenacity Tenacity is the tendency to continue to believe a proposition through habit or inertia. We accept a proposition as true simply, because we have

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Essentials of Nursing Research always believed it to be true. When difference of opinion surface, there is no satisfactory method for knowing which of several tenaciously held beliefs is correct.

Authority Another method commonly used to know facts is to consult some authority. Instead of simply holding on doggedly to one’s beliefs, their confirmation is sought from some experts in the area concerned, e.g. medical doctor, engineer, a lawyer, etc. But these may also differ in their opinions. So, this too is not a satisfactory way of knowing about facts.

Intuition Intuition relies upon its appeal to reason. Propositions which agree with reason are considered to be correct. They are self-evident. For example, “The whole is greater than any one of its part,” “Hard work builds character,” and so on. In such instances, there is no basis for asserting that one is any more valid than the other. Conclusively, it can be said that intuition is also an inappropriate way to knowing facts.

Science Scientific approach is a process of knowing new facts and verifying old ones by the application of scientific methods to natural phenomena so as to come to uniform explanation of laws governing those phenomena.

Relation of Scientific Method and Research

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The terms research and scientific method are closely related. Research is an inquiry into the nature of, the reasons for, and consequences of any particular set of circumstances, whether these circumstances are experimentally controlled or recorded just as they occur. In which researcher is interested in more than particular results and also interested in the repeatability of the results and in their extension to more complicated and general situations. Scientific method is the pursuit of truth as determined by logical considerations. It attempts to achieve ideal (the ideal science is to achieve a systematic interrelation of facts) by experimentation, observation, logical arguments from accepted postulates and a combination of these three in varying proportions: The postulates, which are the basis of scientific methods as given below: • It relies on empirical evidence; • It utilizes relevant concepts;

Concepts of Research • • • •

It is committed to only objective considerations; It presupposes ethical neutrality; It results into probabilistic predictions; Its methodology is made known to all concerned for critical scrutiny are for use in testing the conclusions through replication; • It aims at formulating most general axioms or what can be termed as scientific theories. Research employs scientific method. Good research is systematic, logical, empirical and also replicable. But one expects scientific research to satisfy the following criteria: • The purpose of research should be clearly defined and common concepts be used • The research procedure used should be described in sufficient detail, for replication and continuity • The procedural design of research should be carefully planned to yield good results • The researcher report should have complete frankness, flows in design and estimate effect upon findings • The analysis of data should be sufficiently adequate to reveal its significance. Validity and reliability checked carefully for the data • Conclusions should be confined to those justified by the data of the study • Greater confidence in research is warranted by the researcher is experienced, reputed and is a person of integrity. Good scientific method involves an essential requisite which includes • Careful logical analysis of the problem. • Unequivocal definitions of terms and concept and statistical units and measures. • Collection of data pertinent to the problem under study. • Classification of data. • Expression of variables in quantitative terms. • Exact and rigorous experimental or statistical procedure in summarizing the data. • Find logical reasoning as to test hypothesis and draw generalization. • Drawing exact conclusions arrived at from the findings. • Specific and clear statement of generalization to facilitate checking and testing by other.

RESEARCH AND PROBLEM-SOLVING The term research and scientific method are sometimes used synonymously in educational fields although some differences are recognized, “research is considered to be the more formal, systematic

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Essentials of Nursing Research and intensive process of carrying on a scientific method of analysis,” for the purpose of discovering and development of an organised body of knowledge.” In problem-solving, the scientific method “may be informal application of problem identification, hypothesis formulations, observation, analysis and conclusion.”

Problem-Solving Problem-solving is a systematic approach to the solution or alleviation of simple, complex, immediate, long-term problems, characterised by sequential execution of the following observation through action processes. • Identification and definition of the elements composing the problem and interrelationships among elements • Specification of crux of the problem along with theorising about relevance of background facts and theories • Determination and systematic collection of facts germane to the proposed crux of the problems • Analysis and interpretation and synthesis of the collected facts along with previously known facts and theories judged to be relevant to the problems • Proposal of strategic courses of action calculated to solve or alleviate the problems • Selection of a course of action • Action • Observation and evaluation of outcomes of action, followed as warranted by modifications of course of actions.

Research

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Research is a quest for new knowledge pertinent to an identified area of interest, i.e. a problem, through application of the scientific process. Essential components of the process are as follows. • Definition of the problem, including what others have experienced, learned and thought about the problem • Delineation of the focus for the study (specification of the particular dimension of the problem on which inquiry will focus) • Determination of the facts pertinent to the focus (selected from among those identified as being germane to the problem) • Employment of appropriate and expedient techniques and precise measurements for collection of facts, with due consideration to adequate control of factors other than the variable under investigations • Decisions about degree of breadth and depth sought, which in turn, influence the nature, scope and sources of facts, as well as the characteristics of subjects selected for study

Concepts of Research • Submission of quantitative and quantifiable data to statistical analysis • Selection of the data analysis to be done (statistical theoretical and descriptive) and use of original imaginative thinking to reveal previously unrecognised relationships between among variables • Proposals of generalisations based on finding and applicable to populations larger than the one studied – included will be hypotheses recommended for testing in future investigations • Presentations of findings and results of analysis in communicative and verifiable form.

Differences between Research and Problem-solving There are some fundamental differences in the purposes of research and problem-solving. The purpose of research is to reveal new knowledge, the purpose of problem-solving is to solve an immediate problem in a particular setting. And also there are many process differences in between the research and problem-solving as follows (Table 1.1). Table 1.1: Process differences in research and problem solving Problem-solving

Research •

All elements of scientific inquiry must be explicitly and precisely described

•

The same explicitness and preciseness, though they may be utilized are not demanded of problem-solving

•

Where research data are quantitative or quantifiable, they are analysed with appropriate statistical procedures Elaborate pains are taken to control for factors other than the variable understudy A primary aim is to ensure that findings are generalizable to a population larger that the one subject to study

•

Detailed statistical analyses are seldom done, and

•

Such controls are not imposed

•

The facts for investigation are always gathered in the same setting and from many of the same subjects that gave rise to the proposal

Entails a plan written in sufficient detail and explicitness that the study may be replicated and the findings verified The researcher has moral obligation to report his findings in writing that others may share the new knowledge

•

Entails no such requirements

•

The problem solver needs only to provide information, in verbal or tabular form, to those in the immediate setting of the problem and to propose changes that will help them to solve the problem that prompted the study.

• •

•

•

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Essentials of Nursing Research

SCIENTIFIC RESEARCH

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Fred N Kerlinger (1986) defines scientific research is a systematic, controlled, empirical and critical investigation of natural phenomena guided by theory and hypothesis about the presumed relations among such phenomena. This definition emphasises the following characteristics of scientific research: 1. Scientific research involves investigation of some hypothetical propositions A hypothetical proposition is a conjectural or tentative statement about the relation between two or more phenomena or variables, without it any research is not in fruitful sense. It becomes more factgathering activity. Hypothesis alone studies us what facts to gather, what is relevant and what is irrelevant. Hypothesis must be conceived as an assumption which merits consideration. 2. Scientific research is systematic and controlled. This means that the research is so managed that among the many alternative explanation of a phenomenon, all but one are systematically ruled out. One can thus have greater confidence that a tested relation is as it is than if one had not controlled the observations and ruled out alternative possibilities. System and control also make scientific research replicable i.e., the procedure undertaken are stated with such explicitness that any other qualified researcher could repeat the research project if they should so wish. 3. Scientific research is empirical i.e., it is based on larger experience of others. The investigator does not rely on his own senses of hearing, seeing, smelling, touching and tasting. He pursue his experience to a test outside himself. In other words, subjective belief is checked against objective reality. In all other methods, there is a high degree or subjectivity to individuals about what constitutes truth. Unlike all other methods, scientific research aims at knowledge that is objective. It tries to eliminate irrationality, subjectivity and factual errors in knowing about facts. It is a method upon which human thinking has no effect. The ultimate conclusions drawn by this method are the same for every man. They are independent of individual opinion or preference. Several factors affect scientific research. When scientist, use systematic controlled methods of studying events or problems, they have more confidence that the results are accurate and are influenced by opinion or belief. These studies are well organized and follow a specific procedure. For a study to be empirical, the evidence collected must come from objective findings. In addition, other investigators should be able to examine the evidence and see the same phenomena (results). To guide

Concepts of Research the design of the study, scientists create a hypothetical propositions about what they expect to see before conducting the study. Finally, they generally study the way that characteristics or events are different or the way that one event causes the other.

Purposes of Research Research extends knowledge of human beings, social life and environment. Scientific researchers build up wealth of knowledge through their research findings. They search answers of various types of questions: what, where, when, how and why of various phenomena, and enlighten us. The bodies of knowledge have been developed by research in general and pure or fundamental research in particular. Research can be conducted for several purpose, which includes: – Finding answers to questions or solution to problems; – Discovering and interpreting new facts – Testing theories to revise accepted theories or laws in the light of new facts – Formulating new theories. Research has its ultimate aim the systematic development and refinement of an organized body of scientific knowledge that can be used to guide academic and practice disciplines. The purpose of research is to discover answers to questions through the application of scientific procedure. The main aim of research is to find out the truth which is hidden and which has not been discovered as yet. Though each research study has its own specific purposes, but they falling into following purposes: • Research unravels the mysteries of nature brings to light hidden information that might never be discovered fully during the ordinary course of life. • Research establishes generalization and general laws and contributes to theory building in various fields of knowledge. • Research verifies and tests existing facts and theory, which help improving our knowledge and ability to handle situations and events. • Research helps to gain formulating with a phenomenon or to achieve new insights into it (Exploratory studies). • Research helps to portray accurately the characteristics of an particular individual, situation or a group (descriptive studies). • Research helps to determine the frequency with which something occurs a with which it is associated with something else (diagnostic studies). • Research helps to test a hypothesis of a causal relationship between variables (hypothesis terms studies).

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Essentials of Nursing Research • Research help to formulate general laws, which enable us to make reliable predictions of events yet to happen. • Research aims to analyse inter-relationships between variable and to derive causal explanations; and thus enable us to have better understanding of the universe. • Research aims at finding solutions to problems – socioeconomic problems, health problems, human relation problems, etc. • Research also aims to develop new tools, concepts and theories for a better study or unknown phenomena. • Research helps planning and contributes to national development. • Research helps to formulation of strategies and policies by providing factual data to organization to take national decision-making.

Characteristics of Research Research may be defined as a systematic and objective analysis and recording of controlled observations that may lead to the development of generalisations, principles or theories, resulting in prediction and possible ultimate control of events. Because definitions of this sort are rather abstract, a summary of some of the characteristics of research may help to clarity the spirit and meaning as follows: Research directed towards the solution of a problem: The ultimate goal or research is to discover cause-and-effect relationship between variables, though researchers often have to settle for the useful discovery of a systematic relationships, because the evidence for a cause-and-effect relationship is insufficient. Research emphasising the development of generalisations of principles or theories: It will be helpful in predicting the future occurrences. Research usually goes beyond the specific objects, groups or situations investigated and infers characteristics of a target population from the sample observed. Research is more than information retrieval i.e., the simple gathering of information. Although many school research departments gather and tabulate statistical information that may be useful in decision making, these activities are not properly termed research.

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Research demands accurate observation and description: Researchers use quantitative measuring devices, the most precise form of description. When this is not possible or appropriate, they use qualitative on nonquantitative descriptions of their observations. They select or devise valid data gathering procedures, and when feasible, employ mechanical, electronic or psychometic devices to refine observations, description, and analysis of data.

Concepts of Research Research involving gathering new data from primary or first hand source or existing data for a new purpose: Teachers frequently assign a socalled research project that involves writing a paper dealing with the life of a prominent person. The students are expected to read a number of encyclopaedia’s books or periodical references and to synthesize the information in a written report. This is not research, for the data are not new. Merely reorganising or restating what is already known and has already been written – valuable as it may be a learning experience – is not research, as it adds nothing new to what is already known. Research carefully designed: Although research activity may at times be somewhat random and unsystematic, it is more often characterised by carefully designed procedures that apply rigorous analysis. Trial and error are often involved, but research is rarely a blind shotgun investigation or an experiment just to see what happens. Research requiring expertise: The researchers know what is already known about the problem and how others have investigated it. He or she searched the related literature carefully and is also thoroughly grounded in the terminology, concepts and technical skills necessary to understand and analyse the data gathered. Research striving to be objective and logical: It should be objective and logical with applying the every possible test to validate the procedure employed, the data collected and the conclusions researched. The researcher attempts to eliminate personal bias. There is no attempt to persuade or to prove an emotionally held conviction. The emphasis is on testing rather than proving the hypothesis. Although absolute objectivity is as elusive as pure righteousness, the researcher tries to suppress bias and emotion in his or her analysis. Research involving the quest for answers to unsolved problems: Pushing back the frontiers of ignorance is its goal, and originally is frequently the quality of good research project. However, previous important studies are deliberately repeated, using identical or similar procedures, with different subjects, different settings, and at a different time. This process or replication is a fusion of the words repetition and duplication. Replication is always desirable to confirm or to raise questions about the conclusions of a previous study. Research characterised by patient and unhurried activity: It is rarely spectacular and researchers must expect disappointment and discouragement as they pursue the answers to difficult questions.

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Essentials of Nursing Research Research carefully recorded and reported: Each important term is defined, limiting factors are recognized, procedures are described in details, references are carefully documented, results are objectively recorded and conclusions are presented with scholarly caution and restraint. The written report and accompanying data are made available to the scrutiny of associates or other scholars. Any competent scholar will have the information necessary to analyse, evaluate and replicate the study. Research sometime requiring courage: The history of science reveals that many important discoveries were made in spite of the opposition of political and religious authorities. The Polish scientist Copernicus, (14731543) was condemned by church authorities, when he announced his conclusion the nature of the solar system.

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Research in Nursing

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Research in Nursing

Research is a systematic process of utilising the scientific method for generating new knowledge that can be used to solve problem or improve the existing status of a system. Research uses the scientific method to discover facts and their interrelationships and then allows to the application of this new knowledge in practical settings. In nursing research may provide a fresh understanding of the disease process, or mechanism of action of a drug it may provide new tools for disease management such as vaccines or it may generate information on the health problems of a community to help plan health care or nursing care strategies. Everyone now knew that knowledge is power and research is essential for generating information and understanding problems that can enable the community to achieve a better quality of life. In the context of nursing research is undertaken to promote health. Prevention of diseases, cure and control of disease and to take rehabilitative measures to the concerned client. There are some important reason for undertaking research which may induce. • Promote basic knowledge for infrastructure management which includes drug treatment, nursing or medical management of disease or health care or nursing care referred. • Development of new tools, which may be drugs, vaccines, a diagnostic tools are operative technique, etc., are weapon to combat diseases. • Informs public, regarding research findings to emulated in the health practice and lifestyles to maintain their health. • Effective planning. Research provide the data for better management of scarce resources and can guide health policies and actions. Whatever the reason for undertaking research, it will beneficial to the individual or a profession. The following are the main benefits of research: • A critical and scientific attitude is developed. • The chance to study a subject in depth. • Getting to know how to use a library. • Learning to assess the nursing/medical literature critically.

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Essentials of Nursing Research

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• Development of special interest and skills. • Understanding the attitude of others whether in routine a research laboratories. • Obtaining a higher degree. One of the characteristics of a professional group is that it has a unique body of knowledge and skill. It is generally agreed that nursing is still in the process of defining what constitution its unique body of knowledge and skill. Thus it is important to encourage nursing research and to direct efforts towards the systematic investigation of questions related to the practice and profession of nursing. The future nursing practice and ultimately, the future of health care of nation depend on nursing research designed to constantly generate on up-to-date, organized body of nursing knowledge. Society and its approach to health care are experiencing rapid change. This nursing research needs to proceed in orderly directions, generating knowledge built on previous information in order to provide the foundation for nursing education and practice (ANA, 1985). Research in every field and more so in the field of nursing is demand of the day. Progress in any field is directly linked with research in the field. Our problems and difficulties in the field of nursing further necessitates a purposeful and sustained research effort. We need a large number of research scholars who may take up the huge task of providing view directions to our nursing theories and practices. “Nursing” is generally agreed as the body of knowledge on which the practice of nursing should be based, must be developed and structured primarily derivative in nature, at least at this time. Nursing depends upon the selection, systematic application and evaluation of knowledge is utilised in advancing nursing practice and in modifying the systems for providing nursing services that nursing evolves its own significant contribution to human well being. Thus, nursing is developing its own body of knowledge. There is a strong indication that every nurse in the future can expect to be involved in research–his/her own or someone else’s. For that reason, an appreciation for and skills is research should be developed early in undergraduate nursing programs. The reasons for introducing research to students early in their nursing program are as follows (Treece and Treece, 1973): 1. The scientific approach to problem solving and research methodology and techniques will help to develop an objective attitude toward all life situations. 2. An understanding of research and some knowledge of statistics needed in order to read professional journals, articles-are an important aspect of nursing education.

Research in Nursing 3. Nursing staff as well as nursing students should be attempting to upgrade their profession through research. 4. All individuals in the health care field are hopefully, at least, interested in promoting the health and welfare of their patients. 5. Research is stimulating, exciting and interesting and provides opportunity for members of the discipline to make a lasting contribution of general knowledge. Nurses are responsible for assuming various research activities and roles as appropriate to their education. However preparation for research is an evolving process along a continuous of learning. Only through research contributions will the profession meet its mandate to society. So the elements of competence in research that are appropriate to nurse prepared in the various nursing education program, at the degree (U.G), baccalaureate, masters (P.G), doctoral and post-doctoral level. In addition, if nursing is to develop an organized body of scientific knowledge, there are several way in which nurse can participate are: • Learn to evaluate nursing literature critically – this means developing the ability to read nursing literature critically as a means of discovering gaps in knowledge and evaluating the findings of research studies. • Learn how valid research results can be applied to nursing practice and develop ideas about how scientific knowledge can be used in caring for patients. • Begin to generate hunches and pose questions that could form the basis for future research. • Become involved in a research investigation that has the potential to contribute to new knowledge. Nursing practice, nursing education and nursing administration are full of both questions and answers about the business nursing. If a professional nurses wish to rely on their own judgement in the absence of validated information of search out what the question ought to be and what some of the answers means, then nursing research is not needed. The business of nursing is too significant to rely only on past practice and intuition for the clinical judgements necessary to effective health care. Professional nurses are obligate both to use the significant questions that need to be answered and to use research findings on the basis for nursing practice. Today, nursing organizations, and national nursing leader offer professional nurses perhaps both greatest demand and the greatest reward for nursing research. Research opportunities and needs await interested professionals in nursing because research is the rigorous application of the methods of science in order to obtain reliable and valid knowledge about reality. Research in nursing generates the knowledge

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Essentials of Nursing Research that is used to practice, while practice generates ideas for research. Synthesizing what research is that “research is a scientific process of inquiry and/or experimentation that involves purposeful, systematic, and rigorous collection of data.” Analysis and interpretation of the data are then made in order to gain new knowledge. Research has the ultimate aim of developing an organized body of scientific knowledge. From this perspective, research has several purposes: • Finding answers to questions • Finding solutions to problems • Discovering and interpreting new facts • Testing theories to revise presently accepted theories or laws in light of new conditions or facts • Formulating new theories. In the nursing profession, all of these purposes of scientific research must be achieved to ensure responsible nursing practice.

Significance of Research in Nursing

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Nursing’s professional obligation is the provision of caring services to human beings. Providing effective nursing care in contemporary practice setting require a broad knowledge base or understanding and promoting human health, which often must be complemented by knowledge of speciality areas of practice. The knowledge base for nursing practice is developed through research on the responses of individuals and groups to actual or potential health problems, the environment that affect the influence consequences of illness and promote health. Now people are living in a fast moving world where there are great advancement taking place in Biomedical sciences, technological developments, industrialization, urbanisation, automation, computerisation and several such developments. One can go on enumerating the on going advancements in these areas. This is the space are when the human race has shuttled several times between the space and the earth. There are several newer gadgets making the life easy for human race. One can see that travel by air, land and sea has become so fast, comfortable, safe and rapid. The communication network in the world too has progressed a great deal so much so anyone can speak to any one in any part of the world. In other words good communication network brings the distance closer. These changes have brought in newer dimensions to the peoples lifestyle and values, which in turn have influenced Nursing greatly. As a result the health care delivery system has changed also. At present times these advancements have brought in newer equipment such as cat scanners, cardiac pace makers, kidney dialysis, monitors and various other instruments for diagnostic and treatment purposes.

Research in Nursing There are newer drugs, diagnostic procedures and newer surgical interventions in several health disciplines. In hospital may they be teaching or non-teaching, big or small are striving hard in establishing modern facilities such as IC Units, CC Units, Post-operative recovery rooms, and various other facilities in order to meet the demands of present health needs of client able and the demands of newer innovations in Biomedical sciences. There are newer surgical interventions such as kidney transplants, hip replacements, organ transplants, corneal grafts, open heart surgeries etc. All these innovations are due to the untiring efforts of the pioneers in the concerned disciplines who have toiled using systematic studies and experiments and have established such facilities for the welfare of the human race. Computerization has brought in another dimension in the scene of the health care wherein quick diagnosis, prescription of treatment etc., have been built in. Apart from these changes today people can see that all the health professionals politicians, economists and economists and consumers of health care are speaking a different language namely, “Health for All” using the strategy of primary health care. This again is due to the demands and needs of the people. In using this approach it is emphasized that implementing the primary health care to any one, the health care providers should use appropriate, acceptable and available technology. This is because that today’s belief is that Healthconditions and illnesses that are existing in developing countries like India are preventable nature. Also it is believed that people’s participation for their own health is relevant. Hence, today there is another dimension added to the existing concept of health promotion, disease prevention, rehabilitation and curative services namely providing Primary Health Care. All these developments point out that all these mentioned developments have brought in newer lifestyles and values to people in day to day life. Such changes have certainly influenced nursing, nurses and their role all over the world. Nursing has grown from the mere hand maiden status to independent and autocratic position. In the past, nursing was purely sickness and cure oriented, was greatly confined to institutions. But today it has journeyed a long way from that cure aspects to care aspects and from symptom oriented care to wholistic care. Hence, Nursing gives different meaning to different people. Today nursing involves the care to be provided to people of all ages, of all

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Essentials of Nursing Research

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sexes, rich or poor. It has become a profession. Nurses doing nursing are considered as partners in health care system. With this in view again see the nurses role has changed widely. They have become complex although they are challenging. Despite all that, it is feared that computerization etc., may replace the manpower which means that what nursing personnel are doing now may be performed by computers and electronic devices as the progress in Bio-medical sciences and technology have been so vast. It is also envisaged that such developments might gradually remove the human touch of nursing personnel from their clients making ‘Nursing’ as a computerized service. Now it is an exciting- and challenging- time to be a nurse. Nurses are managing their clinical responsibilities at a time when the nursing profession and the larger health care system require an extraordinary range of skills and talents of them. Nurses are expected to deliver the highest possible quality of care in a compassionate manner, while also being mindful of costs. To accomplish these diverse (and sometimes conflicting) goals, nurses must access and evaluate extensive clinical information, and incorporate it into their clinical decision-making. In today’s world, nurses must become lifelong learners, capable of practice on, evaluating, and modifying their clinical practice based on new knowledge. And, nurses are increasingly expected to become producers of new knowledge through nursing research. Therefore, in such development era the questions that are raised concerning nurses and nursing are: What is nursing in today’s context? What are the roles of nursing personnel? What kind of practice in which nurses are involved? Unless research is carried out there is no answer to such question. This bring us to the question, Does Nursing Need Research? Before one can find answers to this questions it is relevant to examine what is meant by the following term “Research” and “Nursing Research.” Research means to search, to find out, to discover again and again. It is the collection of data in vigorous controlled situation for the purpose of prediction or explanation. It is a process based on systematic approach to inquiry. It is an activity involving in seeking answers to unanswered questions. Nursing research: it includes the breath and depth of the discipline of nursing which involves preventive, therapeutic and rehabilitative aspects. Dr. Abdellah says “It is a systematic detailed attempt to discover or confirm the facts that relate to a specific nursing problem or problems.” There should be a research in Nursing, because there is a need: a. To develop nursing theories which will serve as a guide to nursing practice and can be organized into a body of scientific knowledge. b. To discover and develop valid ways and means of nursing action e.g. TPR.

Research in Nursing c. To identify relationships and provide answers to guide the practitioner in her decision-making process. d. Nurses are accountable to their students, clientable and to document their role as well to demonstrate quality of care. Nurses are answerable to every aspect of their action. e. The society is demanding the required services from the health team of which nurse is an important member. So not only for the above reasons but for various other reasons there is a need for research in nursing. World Health Organization has suggested long ago that research in nursing is needed to identify the community needs, to determine whether the care provided by nurses is appropriate or not. The time has come for nurses to study their roles, to determine the exact role of nurses in various disciplines of nursing, such as community health nursing, psychiatric nursing, maternity nursing or reproductive health nursing, and child health nursing etc. It has been observed that is a wide gap between the nursing education and nursing practice in schools of nursing and colleges of nursing. e.g., a. What is prescribed and what is taught? b. Theory based – not clinically oriented c. More weight age given to some subjects in the curriculum. So these gaps should bridged. Research is an integral part of nursing and every nurse! Every nurse has challenge to accept in this area. It gives greater insight into out practices. It begins in day to day life of every nurse, e.g., keeping an account of out activities to see the time spent and to determine how one uses time effectively. Research concepts help nurses to be factual and objective. If an individual is not research oriented one will not learn to be systematic, punctual, scientific, creative and analytical. Nurses need to develop their competencies beyond the hospital walls in order to identify the needs of people which is a paramount importance in the lives of nurses. In order to become sensitised to the concepts of scientific and systematic approach the nursing practice, education it is essential to include the teaching of research in the undergraduate curriculum. This is required if the faculty believe that such approach will promote positive attitudes towards research. Now it has been included in Diploma, UG and PG curriculum. Reading the literature and interpreting the scientific findings meaningfully also is part of the research process.

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Essentials of Nursing Research

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So how and where the research skills in students to be developed? Teaching the course calls for the teacher to make the learners to understand that it is a beginning course. It needs to be taught during pre and clinical areas. As part of this course statistics and computer science to be taught which will add broader dimension to students learning. Researchers are not born but made. Any intelligent nurse can go into research, because research requires sharps observes, quick thinkers, analysts and decision makers. In India, research is still in toddler stage. Several colleges of nursing are functioning so it is a great task and challenge of every college to build this component in our curriculum so that nurses can demonstrate not only to our nursing friends but also to our medical friends that what nurses are doing is scientific, professional in every branch of nursing. We can also make the fact known that the nurses go by established facts of data which is gathered systematically. So research is a challenge to all nurses today. The health care environment is changing at an unprecedented pace. To thrive nursing as a profession as a profession must not only keep up with the pace, but to set the pace for the future health care, the significance of the contribution of research to the profession is linked to the accumulation of new knowledge, the testing of old knowledge, and professional accountability and autonomy. Nursing research provides a specialized scientific knowledge base that empowers the nursing professionals to anticipate and meet these constantly shifting challenges and maintain out societal relevancy. Nursing practice has a direct, significant impact on human health and human life. To make clinical decisions that preserve human life and promote health, nurses need access to valid information about caring for people. The development of knowledge through research is essential for accountability of the profession to clients and to society. In addition to nursing practice, nursing education and nursing administration are important domains of nursing knowledge. The special emphasis of nursing in the educative and administrative process mandated the generation and testing theory pertaining to these processes, if nursing educators and administrators are truly accountable to their clients, students, parents and staff. Autonomy referred as “freedom to make discretionary and binding decisions within one’s scope of practice.” Research efforts contribute to professional autonomy for nursing/ through selection, generation and testing of a unique body of knowledge. Knowledge provides a basis for professional autonomy and power. Research effort that refine the knowledge for the discipline to provide a source of focus/ for nursing, help to distinguish our body of knowledge from other sciences, and

Research in Nursing empower nurses. On an individual basis, the use of research findings to justify or change practice empowers the nurse to challenge existing practice. For the profession, research findings justify nursing services by establishing their value to clients (Chinn and Jocobs, 1987).

Meaning of Nursing Research Research is systematic inquiry that uses disciplined methods to answer questions or solve problems. The ultimate goal of research is to develop, refine, and expand a body of knowledge. Nursing research may not actually be different from research in general, although it needs some additional tool of measurement for those activities peculiar to nursing for example, clinical nursing, nursing research is one area of research which includes the breadth and depth of the disciplines of nursing, the rehabilitative, therapeutic and preventive aspects of nursing as well as the preparation of practitioners and personnel involved in the total nursing spheres. Biomedical research is concerned mainly with discovering the causes and treatments of disease. In contrast, nursing research is directed toward helping well people to improve their health status and stay healthy, as well as assisting clients who are sick or disables by an illness to maintain or improve their health. Nursing also focuses on the full ranges of human responses, which sometimes do not lend themselves to scientific methodology rather than the biological and physical ones. The commission on nursing research of the ANA (1981) has viewed nursing research as follows. “Nursing research develops knowledge about health and promotion of health over the full lifespan, care of persons with health problems and disabilities and nursing actions to enhance the ability of individuals to respond effectively to actual or potential health problems.” Vreeland viewed, “Nursing research is concerned with systematic study and assessment of nursing problems or phenomena, finding ways to improve nursing practice and patient care through creative studies, initiating and evaluating change, and taking actions to make new knowledge useful in nursing.” According to Polit and Hungler, “Nursing research is a process in which the researcher scientifically collects data to be used in the clinical, administrative or instructional area in order to find solutions to nursing problems, evaluate nursing practices, procedures, policies or curriculum, assess the needs of patients, staff or students, and / or make decisions to change or continuous various nursing process which in turn advances the scientific knowledge in nursing field.”

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Essentials of Nursing Research International Council of Nurses (1986) supports the need for nursing research as a means of improving the health and welfare of the people. Nursing research is a way to identify new knowledge, improve professional education and practice and use of resources effectively. The scientific base for nursing practice is referred to as nursing science. Nursing science uses systematic inquiry to develop knowledge that will allow nurses to promote, maintain and restore status of health in human beings. Nursing research refers to the use of systematic, controlled empirical, and critical investigation in attempting to discover or confirm facts than related to specific problem or question about the practice of nursing in all areas of nursing including nursing education and nursing administration. Nursing research is systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administration, and informatics.

Sources of Knowledge in Nursing

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Nursing is a practice discipline that deals with unique physical, emotional and social problems that people experience in regaining, maintaining and promoting health. Carper (1987) describes the knowledge in nursing derived from empirics, aesthetics, personal knowledge and ethics. These are considered as patterns of knowing in nursing. Each pattern of acquiring knowledge represents a necessary but incomplete approach to the problems and questions facing nursing. 1. Empirics refer to knowledge about the experienced world. This is generally organised into laws and theories that help to describe, predict and explain phenomena. In nursing, empirical work describes and classifies nursing phenomena that are open to observation and inspection, e.g. self-care limitations, strains related to life processes, such as birth, growth and development, death and impaired function, such processes as rest, sleep ventilation, circulation, activity, nutrition, elimination and sexuality. 2. Aesthetics refers to knowledge about the art of nursing. Aesthetic knowledge is acquired through instructional processes requiring exposure to and imitation of one who has mastered the art, e.g. development of empathy, the capacity for participating in or vicariously experiencing another’s feelings, in an important mode in the aesthetic pattern of knowing. 3. Personal knowledge refers to knowing, encountering and actualising oneself. In therapeutic encounter, a process possible only from having learned about themselves. Personal knowledge can be characterised as subjective, concrete, and existential pattern of knowing that is concerned with promoting wholeness and integrity in personal encounters and interacting with another person.

Research in Nursing 4. Ethics refers to the moral component of nursing knowledge that influences difficult decisions that must be made in the context of increasingly complex health services. The ethical code of nursing emphasizes principles of obligation through concepts of services to people and the respect for human life. This pattern of knowing necessitates understanding various philosophical orientations about what is right, good or desirable. (For details of source of knowledge please read author’s text “Nursing Theories”)

Purposes of Nursing Research Nursing is both profession and discipline. A profession assists in efforts to improve the future quality of life by resolving the current problems that influence that quality. The profession of nursing is concerned with the activities of practitioners that are channelled toward improving the health and well-being of human beings. A discipline is a realm of learning, a distinct body of knowledge that evolves from a unique way of viewing phenomena. The discipline of nursing includes both nursing science and professional foundations. The nursing science is the body of scientific knowledge that guides nursing practice. Professional foundations include knowledge about the value orientation of the profession, the nature of clinical practice and the historical and philosophical underpinnings of the profession and professional practice. Knowledge and its application are explored through the process of scientific enquiry. Nursing not only generates knowledge for its own sake but also provides direction for the use of that knowledge in nursing practice. Nursing research is the systematic enquiry into the phenomena of interest in nursing science, namely the adaption of individuals and groups to actual or potential health problems, the environment, that influence health in humans, and the therapeutic interventions that affect the consequences of illness and promote health. The purposes of research has been referred to by a number of nurseauthors. Lamberstson suggests, “The purpose of research is to discover answers to meaningful questions through the applications of scientific procedures.” Vreeland says broadly that we should think of the purpose of research in nursing as providing clues for our search for knowledge and understanding. Turning from our own need, consider the uses of research as follows: 1. Discover new facts about known phenomenon 2. Find answers to problems which are only partially solved by existing methods and information

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Essentials of Nursing Research 3. Improve existing techniques and develop new instruments or products 4. Discover previously unrecognised substances or elements 5. Discover pathway of action of known substances and elements. Schlot Feldt says, “The ultimate aim of research in the ordering of related, valid generalisations into systematised science.” Our research benefits us personally and results in a contribution to others and to the nursing profession. According to Seaman and Verhonic, the purpose of nursing research may be summarised as: to observe in order to know, to know in order to predict, to predict in order to control, to control in order to practice and prescribe in a professional manner. 1. To observe in order to know is the aim of all nursing research. The nurse who observes, verifies and documents her observations work at crucial level of research. This type of studies is called descriptive or exploratory 2. To predict, the nurses begins with an explanation of what should be found on observation, and tests these predictions is nursing research. The researcher may either predict causal or correlations between factors (organism and causes) 3. To control is a major purpose-applied research. It means that the nurse has the ability to check, regulate and exercise directing power over factors that influence the health and comfort of the clients. Fact to control pain, our ability to predict allows us to control the harmful factors and promote the positive nursing can fulfill the final purposes-prescription 4. To prescribe requires a deep involvement in research and practice. The prescription based on the fact that the goal to be achieved to a desirable one, and the way to achieve the goal is to follow the prescription. To bring about and maintain good health, the prescription states, one must comply with prescribed regimen of treatment, diet and/or medication.

NEED FOR RESEARCH IN NURSING Nursing research needed to discover, verify, structure and restructure the professional knowledge through systematic inquiry. Research is the only way to: (i) build a body of nursing knowledge; (ii) validate improvements in nursing; and (iii) make health care efficient as well as cost-effective. In addition reasearch in nursing help narration following ways:

To Moulding the Attitudes and Intellectual Competence and Technical Skill

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We believe that nursing is a service to individuals and to families, therefore, to society. It is based upon an art and science which mould the

Research in Nursing attitudes, intellectual competences and technical skills of the individual nurse into the desire and ability to help people, sick or well, and cope with their health needs.

Filling the Gaps in the Knowledge and Practice Most of the leaders from medical and nursing believed that there is a gap between existing knowledge directly affecting nursing and its application. This gap exists in both nursing education and nursing service. The research is of vital importance to nursing today, as it has never been in the past. The rapid advance of knowledge in the field of health maintenance, health promotion and disease prevention, together with the public’s demand for quality of life that good physical and mental health being have moved nursing quickly forward. To meet new challenges, investigate unsolved problems, and scrutinize that changes underway in nursing, the individual nurse must actively seek to understand and apply the basic principles of research.

Fostering a Commitment, Accountability to Clientele The ultimate goal of any profession is to improve the practice of its member so that the services provided to clientele will have the greatest impact. Any profession seeking to enhance its professional image undertakes the continual development of a scientific body of knowledge fundamental to its practice. The development of such body of knowledge can be instrumental in fostering a commitment and accountability to the profession’s clientele. Because if the increasingly high cost of services, consumers are beginning to demand that professionals examine the efficacy of their practices and determine what impact their knowledge and skills have to society.

Providing Basis for Professionalism Nursing like other occupations seeking to establish themselves as profession is experiencing concerns for the development of a service orientation, the continual growth of scientific base from which members practise and the evolution of a fairly distinct body of knowledge that separate nursing from other professions. The increasing awareness by nurses of research as an integral part of professional nursing behaviour is accelerating rapidly in several areas. Nurses recognize a need to extend the base of nursing knowledge as a part of professional responsibility and are endorsing scientific investigations as a way to broaden the body of knowledge. Research provides the abstract knowledge that is foundation for establishing nursing as profession.

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Essentials of Nursing Research

Providing Basis for Professional Accountability The quality of nursing care cannot be improved until scientific accountability becomes as much a part of nursing’s tradition, as humanitarian in scientific accountability is essential for the nurse-teacher in dealing with students, for nurse practitioner dealing with clients or patients, and for the nurse administrator dealing with clients, patients or professionals in the health are delivery system. A professional nurse who has scientifically accountable bases as many decisions and actions as are possible on scientifically documented knowledge and seeks to find scientific answers to perplexing problems. Scientific accountability also includes the scientific literature for new knowledge so that the application of this knowledge becomes part of nursing practice.

Identifying the Role of Nurse in Changing Society Nurses today are being asked more than ever before to document their role in the delivery of health services. Consumers of health care in recent years are recognizing health care as a right, rather than as privilege and with the spiralling costs of health care are asking various groups of health professionals how their services contribute to the total delivery of health care. So, there is a need to evaluate the efficacy of presently existing nursing practices in all areas to modify or abandon those practices shown to have no effect on the health status of the individuals, which in turn helps to provide nursing services according to the needs of clients. Research is also needed to spell out the nurses role in the electronic are and to protect the patient from becoming a part of the automation.

Discovering New Measures for Nursing Practice

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Practice oriented research is the key to discovery for improving nursing practice and strives for measurable benefits to the clientele nurses to serve. Increasingly, nursing practice is focussing on promoting an optimal level of health for persons who are sick or well. Knowledge of which nursing intervention fosters the maintenance of health or facilitate a level of wellness in an ill individual will improve the quality of nursing care. Also knowledge of which factors prevent persons from achieving an optimum level of functioning could assist nurses in thwarting the development of these influences, or in finding solutions to counteract the effects of already developed factors. The practice of nursing – the rendering of nursing care is an ideal yet poorly understood phenomena. Scientific studies are needed to understand and explain the functions and forms of nursing care in meeting the needs of society and in helping individuals regain or maintain health.

Research in Nursing

Helping to take Prompt Decisions by the Administration to Related Problems Nurse-administrators are looking more frequently to the findings from research in solving persistent problems in the organisation, delivery, and evaluation of client or patient care. Research into nursing administration can be useful in organising nursing personnel in most efficacious manner.

Helping to Improve the Standards in Nursing Education Nurse educators utilise the findings from research in structuring programs of study, in developing course contents and in designing methods of teaching. In additions, by conducting research, the nursing faculty demonstrates the students the integral part of nursing research in the profession: (1) changes curriculum needs research and, (ii) liberalization of nursing education needs research.

Refining the Existing Theories and Discovering New Theories The primary task of nursing research is the development and refinement of nursing theories which serve as guides to nursing practice and which can be organised into a body of scientific nursing knowledge. A concomitant take of nursing research is the discovery and development of valid means of measuring the extent to which nursing action attains its goals – these are to be stated in terms of client behaviour. As professionalism has grown in nursing, so to has the commitment to nursing research. Nurse practitioner, administrators and educators seek to understand the phenomena with which they deal, research helps them to explain, predicts and sometimes control the occurrences of the phenomena. Research also aids nurses to be accountable to clients or patients. Scientific inquiries provide information that facilitates effective nursing decisions. In addition, nursing research clarifies the forms and functions of professions in meeting the health needs of the society. 1. Read and interpret report of research in their own nursing fields; so that they can keep up-to-date with current knowledge and where appropriate, base their own policy and practice on research findings, to do this, they must be familiar with research concepts and language. 2. Identify areas of nursing where research is needed, nurses should be aware of the boundaries of their own knowledge and situations in which lack of information is a serious detriment to effectual decisionmaking. 3. Collaborate intelligently with researchers (nurses and others) whose work brings them into contact with nursing, assist them as mush as

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Essentials of Nursing Research possible, and particularly where patients are involved, be aware of ethical issues which may not always be apparent to the research workers themselves. 4. Discuss with patient any research in which they (the patients) are being asked to participate in the same say as nurses are called upon to discuss with patients the diagnostic and therapeutic measures prescribed by medical staff. In addition nurse teacher should: 1. Use research findings as a basis for deciding what to teach and incorporate research findings into their teaching. 2. Use research findings as a basis for deciding how to teach, make use of psychological theories to learning and technique of educational assessment. 3. Plan and supervise students project work in a way which will help the students to develop the ways of thinking, questioning, observing, analysing and testing which are the elements of research. 4. Have information about resources available for carrying out research (financial, human, mechanical) and be able to decide nursing research priorities so that the most effective out of these resources. 5. Initiate and facilitate research is areas where research is needed, provide the appropriate “climate”, have sufficient understanding of research methods to know what type of research is appropriate to the investigation of particular problems and from whom specialist advice should be sought. 6. Monitor the progress of research project to ensure that the work being carried out is consistent with the agreed objectives. In addition, some nurses should: 1. Acquire skill in application of research technique, so that they can make use of existing research tools, e.g. patient-opinion-questionnaire, personality (inventories) to carry out similar studies for themselves.

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And a few nurses should: 1. Become trained workers capable of designing tools for nursing research, of leading unit-and multidisciplinary research teams and of taking part in planning and formulating research policy for the nursing and midwifery profession in both intra-and interprofessional capacity. Thus, every nurse, regardless of educational preparation can be involved in and benefit from nursing research. It is a fact, that as the level of educational preparation increases, the sophistication of the nurses participation is expected to increase. For example:

Research in Nursing a. Nurses with diploma in nursing should understand the value of research in nursing. They could assist in identifying problematic areas in practice and with collecting data within an established protocol. b. Nurses with degree in nursing would be able to read, interpret, and evaluate research for its applicability to practice. In addition, they would be able to assist in the identification of nursing problems in need of study and use the practice of nursing as a means of gathering data from refining and extending their effectiveness. Sharing research to practice c. Nurses with Master’s degree are expected to analyse and reformulate problems in nursing practice so that scientific methods could be applied to their solutions. They can enhance the quality and clinical relevance of nursing research by sharing that experience in clinical problems and by providing consultation to investigators about the manner in which clinical services are delivered. A nurse with Master’s degree can also facilitate that supportive of investigation, by collaborating with others in investigation, and by helping to provide contact with clients. At this level, the nurse can conduct investigations to monitor the quality of practice and assist others in the application of scientific knowledge in nursing practice. d. The Nurse with Doctorate provides leadership for the integration of scientific knowledge with other sources of knowledge to advance the practice of nursing. Developing methods to monitor quality of nursing practice and to measure nursing phenomena is extremely important contribution of the nurse with Doctorate. They are also expected to conduct studies to evaluate the contributions of nursing activities to the well-being of clients and broaden the scientific base supportive of nursing practice. By realising the above expectations, now all levels of nursing education includes the research components in the preparation of nurses to participate in the research process.

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Essentials of Nursing Research

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Classification of Research

Research may be classified by purposes, i.e. it may be classified crudely according to its earnest desire directed towards or methods: I. According to earnest desire directed towards research may be classified as: • Basic research • Applied research • Exploratory research • Descriptive research • Diagnostic research • Evaluative research • Action research. II. According to methods of study research may be classified as: A. Qualitative research • Phenomenological • Grounded theory • Historical • Action research. B. Quantitative research I. Experimental II. Non-experimental I. Experimental • True experimental: – Pre-test/post-test control group design – Solomon four-group design – Two group random sample design – Matching sample design – Factorial design. • Quasi experimental: – One-group pre-test/post-test design – Non-randomized control group design – Counter balanced design

Classification of Research – Time series design – Control group time series design II. Non-experimental Quantitative design • Correlational design • Descriptive design • Time perspective design • Retrospective design • Prospective design • Design that use existing data • Focus group research • Content analysis.

I. CLASSIFICATION OF RESEARCH ON THE BASIS OF DESIRE-DIRECTED A. Classification on the Basis of Purpose 1. Basic Research It is also known as pure, theoretical or fundamental research, which is always aimed to enriching the theory by untravelling the untold mysteries of nature. It is a process in which data are scientifically collected to advance knowledge without particular reference to its immediate or practical use, which means, it advances scientific knowledge, regardless of whether knowledge is immediately usable or not. Basic research is the formal and systematic process of deductiveinductive analysis leading to the development of theories. It is usually carried on in a laboratory situations, sometimes with animals as subjects. In this a scientific inquiry begins with an objective observation of the real world phenomena, called facts. By objective observation, we mean the researcher does not allow his personal feelings or prejudices to influence his observations. He then uses induction, i.e. a process of moving from particular to general for developing explanations of such facts. Rather, he attempts to establish relationships among facts. The number of explanations offered to explain the facts and the relationship developed among them will vary as functions of the researchers’ past experience insight, etc. Thus, for example, a researcher observing that worker’s performance has improve in those organisations which have workers’ participation in management, may tentatively argue that “workers’ participation in management increases workers’ performance.” The researcher then uses deduction, i.e. process of going from general to particular to predict what would happen in the real world of his explanation is a plausible one.

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Essentials of Nursing Research Thus, basic research fulfils the goal of research as the development of theoretical by the discovery of broad generalisations or principles. It is a theoretical or pure research that generates, rests and expand theories that describe, explain, or predict the phenomenon of interest to the discipline without regard to its later use. Basic research which also known as pure research, theoretical or fundamental research always aims as enriching theory by unravelling the untold mysteries of nature. Basic or pure research is undertaken for the sake of knowledge without any intention to apply it in practice e.g. theory of relatively by Einstein.

2. Applied Research Applied research or empirical research always aims at enriching the application of the theory by discovering various new uses to which findings of basic research may be put and by showing limitations of these findings. Applied research refers to “answers questions related to the applicability of basic theories in practical situation; tests the practical limits of descriptive theories that does not examine the efficacy of actions taken by practitioners.” Applied research is also concerned with establishing new knowledge but is further concerned with deriving knowledge that can be immediately applied to solve practical problems directly related to clinical practice. Applied research has been referred to as “practical application of the theoretical.” Applied research is carried on to find solution to a real life problems requiring an action or policy decision. It is, thus, problem-oriented and action-directed. It seeks an immediate and practical result. For example, the results of the applied research study “the effect of a social support boosting interventions on stress, coping and social support in care givers of children with HIV/AIDS” provide an example of research that has the potential for application in specific practice settings. The results of the study indicated the seronegative caregivers participating in a social support boosting intervention showed substantially increased coping abilities. Nursing implications for the study “are to incorporate the social support network of the caregiver in the plan of care and recognize the complexity of the needs of the AIDS caregiver.”

3. Exploratory Research

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Exploratory or formulative study conducted which relatively little is known about the phenomenon, sometimes called pilot study. Exploratory

Classification of Research research, as its very name implies aims at exploring the possibility of doing research on certain subject where due paucity of existing knowledge framing and testing of hypothesis are difficult. The aim of such studies is to collect enough data for this purpose. As enough data relevant to the problem are gathered the researcher knowledge about his subject improves and he becomes capable of formulate a clear hypothesis for further testing and confirmation. Since this type of research the emphasis on discovery of ideas and insights its design is always kept flexible and non-structured to permit considerations of different aspects of a phenomenon. The purpose of this formulative or exploratory study will include: • To generate new ideas, or • To increase the researchers familiarity with the problem, or • To make precise formulation of the problem, or • To gather information for clarifying concepts, or • To determine whether it is feasible to attempt the study. Person who takes the study, selects an unfamiliar problem about which he has little or no knowledge. For example a medical doctor, initial investigation of a patient suffering from an unfamiliar malady for getting some clues for identifying it. It is ill-structured and much less focused on predetermined objectives. Though it is a separate type of research, it is appropriate to consider it as the first stage of three-stage process of exploration, description and experimentation. There are two level of exploration studies. “At the first level is the discovery of the significant variable in the situation; at the second, the discovery of relationships between variables. It is necessary to delimit the area to be studied even at the first level. There are three steps in formulative or exploratory research: • A review of pertinent literature. • An experience survey. • An analysis of insight stimulating cases.

4. Descriptive Research Descriptive research is non-experimental research designed to discover new meaning and to provide new knowledge where thee is very little known about the phenomena of interest. Descriptive research is a factfinding investigation with adequate interpretation. It is simple and more specific than an exploratory study. It is designed to gather descriptive information and provides information for formulating more sophisticated studies. Data and collection by using one or more appropriate methods; observation, interviewing and mail questionnaire. Descriptive research aims at answering the ‘what’ and ‘why’ of the current state of some system. Description and explanation are its two

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Essentials of Nursing Research aims. A descriptive research aims at identifying the various characteristics of a community or institutions or problem under study, but it does not deal with testing proposition or hypothesis, but it can reveal potential relationship between variables. Descriptive studies does not take all problems, but takes that problem should satisfy following criteria: • Problem must be describable and not agreeable. • The data should be amenable to an accurate objective and if possible, quantitative assemblage for reliability and significance. • It should be possible to develop valid standards of comparison. • It should lend itself to verifiable procedure for collection and analysis of data.

5. Diagnostic Research Diagnostic study is similar to descriptive study with a different focus. It is directed towards discovering what is happening, why it is happening and what can be done. It aims at identifying the causes of problem and the possible solutions for it. For example, epidemiological studies. This type of study may also be concerned with discovering and testing whether certain variables are associated. Both descriptive and diagnostic studies share common requirement which include: • Prior knowledge of the problem and the thorough formulation. • Clear-cut definition of the given population. • Adequate methods for collecting accurate information. • Precise measurement of variables. • Statistical analysis and tests of significance. But, the diagnostic studies are: • More directly concerned with causal relationships and with implications for action than descriptive study. • Directed towards discovering not only what is occurring but why it is occurring and what can be done about it. • More actively guided by hypothesis than descriptive study. • Not possible in areas where knowledge is not advanced enough to make possible adequate diagnosis. In the field of medicine, nursing diagnostic studies are already in operation, they are very useful in many aspects in the field.

6. Evaluative Research

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Evaluation is the determination of the results attained by some activity (whether a programme, a drug or a therapy or an approach or nursing approach) diagnosed to accomplish some valid goal or objective.

Classification of Research Evaluation research is the utilization of scientific research methods and procedure to evaluate a programme (e.g., RCH programme), treatment (drug therapy), practice (nursing practice) or policy (effect of national health policy); it uses analytic means to document the worth of an activity. Evaluation study is made for assessing the effectiveness of social, or economical, or health programmes implemented or for assessing the impact of developmental projects on the development of the project area (e.g., evaluate the effectiveness of structured teaching programmes on different topics). Evaluative research is directed to assess or appraise the quality and quantity of an activity and its performance and to specify its attributes and conditions require for its success. It also concerned with change over time. Evaluative research asks about the kind of change the programme views as desirable, the mans by which the change is to be brought about, and the signs according to which such change can be recognized.

7. Action Research Action research arose from social change theory and has become a valuable strategy in a variety of practice settings including nursing. As its name implies, action researchers pursue action and research outcomes at the same time. Action research is a concurrent evaluative study of an action programme launched for solving problems for improving an existing situations. In the quest for development, advancement, excellence and promotions of welfare of people, government, institutions, and voluntary agencies undertake action programme for achieving specific objectives. For example socio-developmental programmes including National Health Programme of India. Action research may be called as another form of applied research. Action research tries to solve an ongoing problem within some organisational framework by introducing a planned change and observing in the process the result of change. Action research is focussed on immediate application, not on the development of theory or on general application. It has placed its emphasis on a problem here and now in a local setting. Its findings are to be evaluated in terms of local applicability, not universal validity. Its purpose is to improve nursing practices and at the same time, to improve those who try to improve the practices to combine the research processes, habit of thinking, ability to work harmoniously with others, and professional spirit. The purpose of action research is to solve practical problems through the application of scientific method. Action research is concerned with a specific problem in a specific setting and is conducted in this setting,

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Essentials of Nursing Research thus facilitating the development of knowledge of understanding as a part of practice. Action research has the advantage of allowing research to be done in situations where other research method may be difficult or impractical use: “To achieve action, action research, is responsive, it has to be able to respond to the emerging needs of the situation. It must be flexible in a way than some research methods cannot be.”

B. CLASSIFICATION OF RESEARCH ACCORDING TO METHODS Qualitative Research and Quantitative Research

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Qualitative research is a systematic, interactive, subjective approach used to describe life experience and give them meaning. Whereas quantitative research is a formal, objective systematic process to describe, test relationships, and examine cause and effect interaction among variables. These two qualitative and quantitative approaches have emerged in recent years to develop nursing knowledge. Quantitative research is based on the measurement of quantity or amount and it is applicable to phenomena that can be exposed in terms of quantity. Qualitative research, on the other hand, is concerned with qualitative phenomena, is phenomena relating to or involving quality or kind. The quantitative and qualitative research approaches have a common purpose to gain understanding. The difference between the approaches focus on the confirmation of theory by “explaining” demonstrating an empirical analytic emphasis; qualitative approaches focus on “discovery and meaning of theory by describing” demonstrating a human science emphasis. In the earlier years of nursing research, the researchers extensively valued the scientific method and used quantitative approaches the develop objective informations. Recently, nurse researchers come to appreciate the complexity of nursing phenomena, the value of exploring the subjective experiences of patients and nurses is being recognised. Currently nurse researchers are open to using qualitative approaches to develop subjective information while also remaining open to using quantitative approaches. The qualitative research has, as its foci, perspectives, meaning, uniqueness, and subjective lived experiences. Its aim is understanding. It is the quality of the experience, nor the number of experiencing phenomenon that is important. Nursing is both a science and an art. Qualitative research combines the scientific and artistic natures of nursing to enhance understanding of the human health experience. It is a general term encompassing a variety of philosophical underpinnings and research methods.

Classification of Research Qualitative research involves broadly stated questions about human experiences and realities, studied through sustained contact with people in their natural environment, generating rich, descriptive data that help us to understand their experiences. According to Leininger (1992) there are more than 20 identified qualitative research methods. Here focuses on four methods most commonly used by nurses which includes: • Phenomenological • Grounded theory • Ethnographic • Historical Each of these methods, although distinct from the others, also shares characteristics that identifies it as a method within the qualitative research approach use of the qualitative approach requires different beliefs, different research activities, and different questions from the use of quantitative research activities and different questions from the use of the quantitative research approach. Qualitative approaches to research have their origins in social anthropology and sociology, and develop theory inductively from the data. The approaches are typically used where very little is known about a topic and the researchers intentions is to construct theory or where the researcher is trying to understand a phenomenon from the perspective of the actors in the situations. In qualitative research the investigators seeks to identify the qualitative (non-numeric) aspects of phenomenon under study from the participant view point to understand the meaning of the totality of the phenomenon. In using this approach the researcher tries to assess the problem with an open mind in order to consider all the possible options available. This style of research has been called ‘soft’ because it does not involve ‘counting’ or statistical analysis and has been suggested by some not to constitute science. An important strength of qualitative research is that it is usually undertaken in a natural setting and so events reflect what would normally taken place as far as possible. In short it is usually conducted in the natural setting, the in-depth narrative data is provide information about the subjective meaning of human experiences and phenomenon. It has been stated that qualitative research has been associated with the social sciences and humanities. The use of qualitative methodology for investigating human behaviour is frequently associated with the discipline of cultural or social anthropology. Currently although majority of nursing studies continue to be quantitative, with the advent of qualitative studies, a wealth of new and valuable insights has been generated, and more nurses are committed to knowing and understanding the use of qualitative research method.

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Essentials of Nursing Research

(1) QUALITATIVE RESEARCH METHODS

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Qualitative research is particularly well suited to study the human experience of health, a central concern of nursing science. Because qualitative methods focus on the whole of human experience and the meanings ascribed by individuals living the experience, these methods permit broader understanding and deeper insight into complex human behaviours that what might be obtained from surveys and other linear measures of perceptions. As above stated there are many types of qualitative methods, among that there are five of many types of will, which include: phenomenology, ethnography, historical research and action research. Any research it may be qualitative or quantitative which include the five basic elements as follows: • Identifying the phenomenon • Structuring the study • Gathering the data • Analysing the data • Describing the findings. Each qualitative method is defined, followed by discussion of the five basic elements. Prior to that with quantitative and qualitative researchers are concerned with establishing validity and reliability during their data collection another the meanings of the term differ for qualitative and quantitative research because the selection of the sample, the data collection, and the data analysis are carried out differently. In quantitative research, the term validity refers to the extent to which data gathering instrument measures which it is supposed to measure – that is, the instrument is valid to the extent that it obtains data that are relevant to what is being measured. For example, clinical thermometer is a valid instrument for measuring an individuals body temperature. In qualitative research, the term validity “refers to the extent to which the research findings represent reality.” During every part of the datacollection process, the researcher must thoroughly check the information gathered to determine whether it “makes sense” – that is whether it is compatible with other information that has already been gathered. For example, if qualitative researchers interviews nurses in a hospital setting and they report that they always perform specific activities in a certain manner, but the researcher then observes that these activities are not being performed as reported, the researcher must attempt to reconcile the difference between the activities reported and the actual behaviours observed. The researcher should then include this information in reporting the validity of the research to ensure that, as much as possible, the findings represent reality.

Classification of Research In quantitative research, the ‘reliability’ refers to the instruments ability to obtain consistent results when it is reused. A measuring instrument is reliable, if it consistently measures whatever it is supposed to measure in the same way each time it is administered. For example, paper-and-pencil test of intelligence. In qualitative research, reliability is defined as “the measure of the extent to which random variation may have influenced stability and consistency of the results.” Two things are here to not an accuracy of the informations gathered from the participants and an accuracy of the data gathering instrument often an interviewer or observer. (Each qualitative method is defined, followed by a discussion of five basic elements: identifying of phenomena, structuring the study, gathering data, analysing the data and describing the findings).

1. Phenomenological Research Method Phenomenology is a “science whose purposed is to describe particular phenomena or the appearance of things as lived experience.” It was first described as the study of phenomenon or a thing phenomenology has been continues to be an integral field of inquiry that cuts across philosophic, sociologic and psychologic disciplines. Phenomenological inquiry brings to language perceptions of human experience with all types of phenomena. It continues to the developing science in terms of its application to nursing as a research method and is necessary to acquire an in-depth understanding of the approach. Phenomenology is both a philosophy and research method. When the philosophy of phenomenology is translated into a research setting several process must occur. Here are some process: • A person must communicate an experience or series of experiences to the researcher. • The researcher then attempts to translate the communicated experience into an understanding of persons experience. • The researcher communicate his or her understandings to an audience in writing so that members of this audience can then relate their understanding of this information to past and future experience.

2. Grounded Theory Glaser and Strauss (1967) developed the systematic approach to the study of interactions, known as the “grounded theory methods, to bridge a perceived gap between theory and research and the consequent undervaluing of qualitative studies. The term “grounded” means that the theory that developed from the research has its roots in the data from

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Essentials of Nursing Research which it was derived. Grounded theory is an inductive, qualitative research method that seeks to understand and explain human behaviour. The emergent theory is based on, or connected to, observations and perceptions of the social scene. The aim of this theory approach is to discover underlying social forces that shape human behaviour. This method is used to construct theory where no theory exists or in situations where existing theory fails to explain a set of circumstances. The goals of this method is the development of theory that explains underlying social and psychological processes. Grounded theory is based on symbolic interaction theory, which holds many views in common with phenomenology. It is different from phenomenology. In this researcher is not seeking to describe the phenomenon under investigation but rather to develop a theory about dominant processes in the social scene under investigations. Symbolic interactions theory explores how people define reality and how their beliefs are related to their actions. Reality is created by attaching meanings to situations. Meaning is expressed in terms of symbols such as words, religious objects, and clothing. These symbolic meanings are the basis for actions and interactions. Interactions may lead to redefinitions and new meanings that can result in the redefining of self. Grounded theory emphasizes the process of generating theory by systematically collecting and analysing data concurrently; the theoretical formulations thereby remains connected to or ‘grounded’ in the data. In this method theory remains closely connected to data through descriptive examples that provide direct empirical evidence that the theory fits the phenomenon under study. Theory generated in this manner may then serve as a conceptual framework on which to base a testable hypothesis and subsequent quantitative studies. Theory generated by each discipline will reflect the discipline and will serve the discipline in explaining the phenomenon. When identifying the phenomenon, in this method, the researchers are interested in social processes from the perspective of human interactions. The basic social processes, or core category that is the foundation of a theory, is often expressed as a gerund, indicating changing across time as social reality is negotiated e.g., recognition of new term in the family.

3. Ethnography

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Ethnography is the systematic process of observing, detailing, describing, documenting and analysing the lifeways or particular patterns of culture or subculture in order to group the lifeways or patterns of the people in their familiar environment.

Classification of Research The ethnographic method focuses on scientific descriptions of cultural group. The primary purpose of this research is to formulate an in-depth description of a culture or subculture of the group being studied. Most definition of culture include patterns of behaviours and values shared by a group or groups. The term ethnography is used to mean both the research technique and product of that technique, the study itself. The goal of ethnographer is to understand the native views of their world or the emic view. The emic or insiders view is contrasted to the etic or outsiders view obtained where the researcher uses quantitative analyses of behaviour. Ethnographic attempts to describe the culture of group from the perspective of the members—that is, how they view their own culture—through in-depth study that involves systematic observations of the group activities language and customs. Ethnographic methods may be used when the researcher must catalogue all activities, or as many as possible, that are taking place in a social situation and then determine which activities are significant and which are trival. The critiques may expect that the phenomenon in an ethnographic study and vary in scope from a long-term study of a very complex culture.

4. Historical Research History is a meaningful record of human achievement. It is not merely a list of chronological event but a truthful integrated account of the relationships between persons, events, times and places. The use of history is to understand the past and to try to understand the present in the light of past event and developments. It is also use to prevent “reinventing the wheel” every few years. Historical analysis may be directed toward in individual, an idea, a movement, or an institution. However, none of these objects of historical observation can be considered in isolation. People cannot be subjected to historical investigation without some consideration of their interaction with the ideas, movements, and or institutions of their times. The focus merely determines the points of emphasis toward which historians direct that attempts. Historical study is a study of past records and other information sources with a view to reconstructing the origin and development of an institution or a movement or a system and discovering the trends in the past. Historical research is descriptive in nature. It is a difficult task; it must often depend upon inference and logical analysis of recorded data and indirect evidence rather than upon direct observations. Hence, it is aptly described as “the induction of principles through research into the past and social forces which have shaped the present.” The objective of historical research is to draw explanations and generalizations from the past trends in order to understand the present

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Essentials of Nursing Research and to anticipate the future. It enables us to grasp our relationships with the past and to plan more intelligently for the future. The past contains the key to the present and the past and the present influences the future. It helps us in visualising the society as a dynamic organism and its structures and functions as evolving, steadily growing and undergoing change and transformations. Nursing is both a very young profession and a very old one. Even before Greek and Roman soldiers were carried home on their shields, sometimes dead and sometimes wounded, someone has always been charged with the care of the ill or injured. Historical research deals with what has happened in the past and how these events affect the present. Historical research lends itself well to nursing; no professional group has been more in the forefront of world history than nursing. By its very nature, nursing is always “where the action is.” Nurses have been active in all areas of the world both in times of conflict and in times of peace. Historians piece together information from the past to get a picture of the actual lives and times of an era. They may use these data to determine the impact of history on the present and may even attempt to predict the future on the basis of this knowledge. Essentially, the historian follows the same research process as any other researcher. First, the problem to be investigated must be selected and formulated within the context of existing knowledge and theory. Like any researcher, the historical researcher must be particularly careful in gathering and interpreting data and in drawing conclusions based on these data. In some instances, the computer can be used to locate and reprint historical documents as well as to facilitate data analysis. Historical research lends itself to the acceptance of evidence that is hard to verify. The careful researcher must do the utmost to corroborate data and to demonstrate their reliability and validity. Although the majority of data in historical research are qualitative, some historians have used computer programmes to examine their numeric data statistically to draw conclusions about the conditions of individuals in a given historical period; this use of mathematics and statistics in historical research is called cliometrics.

(2) QUANTITATIVE RESEARCH 1. Experimental Research Designs

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Experimental Approaches Experimental research is one in which the researcher makes changes in independent variables and studies their effects on dependent variables under controlled conditions.

Classification of Research Nonexperimental research is one in which the researcher simply measures the present level of the independent variable. For example, if a researcher wants to test the hypothesis, whether “increased autonomy of a job increases the level of satisfaction of nurses,” he may carry this out in two ways. I. First, he may take an existing job of nurse and redesign it to vary its levels of autonomy and see if there are concomitant variations in nurse’s level of job satisfaction. This is conducting an experiment in which he actually manipulates autonomy–the study’s independent variables. II. Second, he may look at incumbents in jobs that differed in terms of autonomy and see if jobs with greater autonomy have given greater level of job satisfaction to their incumbents. This is conducting a nonexperimental study. The following are some points of difference between these two types (Table 3.1) Table 3.1: Differences between experimental and nonexperimental research Nonexperimental Research

Experimental Research 1 This type of research always begins with some hypothesis which the researcher wants to test. many descriptive research do not have any hypothesis. 2 Control of extraneous variables is a very important phase in this type of research. Extraneous variables are those which operate in the experimental situation in addition to the independent variable. Since these variables may also affect the dependent variable and since the experimenter is not immediately interested in ascertaining whether or not they do affect the dependent variable, they must be controlled, so that they will not mask the possible effect of the independent variable. 3 Data generated by the research are used to establish cause and effect relationship between two variables. On the basis of this data, one can predict changes in the dependent variable for given changes and the independent variable. 4 This type of re search is narrow in scope. There are number of social science subjects where this type of research is not possible.

•

•

•

•

•

In this type of research, it is not essential to always have a hypothesis. All exploratory and In this type of research, the researcher exercises very little control over extraneous variables. Data generated by this type of research are not helpful in establishing the cause and effect relationship between variables. They can be used only to describe certain relationships without showing that functions interdependent. The scope of this type of research is very wide. All social science research can be done nonexperimentally.

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Essentials of Nursing Research

True Experimental Research

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There are a number of ways to design true experimental research; the designs range from simple to extremely complex. In incorporating the characteristics of a true experiment, each of these designs is characterized by manipulation of the independent variable by the investigator and by some form of control and randomization. Of the many designs that have been developed to meet the requirements of a true experiment, the following five are discussed here: 1. Pretest/post-test control group design 2. Solomon four-group design 3. Two-group random sample design 4. Matching samples design 5. Factorial designs. • The pretest/post-test control group design uses a control group to determine whether a treatment (or other experimental intervention) makes a difference. For example, an experimenter may design a study to measure the effect of reducing cholesterol in subjects with mild angina pain. The subjects would be randomly assigned to two groups: an experimental group and a control group. The subjects in the experimental group would then alter their diets, while the control group subjects would change nothing. At the conclusion of the experiment, the researcher would determine whether there was a statistically significant difference in the cholesterol levels of both groups. If this difference was indeed significant, and if there was a significant difference in the reported incidence of mild angina pain between the experimental and the control group, the experimenter could then conclude that the reduction of blood cholesterol did have an effect on the occurrence of angina. It is important to note there was no attempt to match or otherwise compare the members of either group; the only common element of control the control group shares with the experimental group is mild angina pain. Note also the term “mild.” Pain perception varies greatly from individual to individual, and response to pain varies between cultures as well as between the sexes within a culture. None of these factors were taken into consideration in this example, only the common diagnosis of mild angina pain. • The Solomon four-group design is a frequently used and highly valid experimental design. In this experiment, the investigator would randomly divide the sample into four separate groups, effectively constructing two experimental groups and two control groups. The first experimental group would receive the same procedures as in the pretest/post-test design; that is, subjects would be randomly assigned, pretested, given

Classification of Research the appropriate treatment, and then given the post-test. The first of the control groups is given the pretest, no treatment, and then the post-test. Up to this point, the Solomon design is precisely the same as the pretest/ post-test control group design. However, group 3 is also defined as an experimental group. In the cholesterol example, it would consist of subjects diagnosed as having mild angina. They would not be given the pretest; that is, their cholesterol level would not be measured at all. However, they would receive the treatment; that is, their intake of cholesterol would be reduced and they would be given the appropriate blood tests at the end of the experimental period. Subjects in the fourth group in the Solomon design would have nothing done until the posttest. They would not be pretested for cholesterol levels at the beginning of the experiment and would not receive any treatment. Only at the end of the experiment would their blood cholesterol levels be measured (posttested) and then compared to the incidence of anginal pain in the other groups. Because two of the groups (groups 1 and 3) received the experimental treatment, any differences noted by the experimenter can be more confidently attributed to the treatment, rather than to subject sensitization due to the pretest, if both experimental groups show similar results at the end of the treatment and there is a significant difference between the experimental and the control groups. Similarly, a lack of statistically significant differences between the four groups enables the investigator to accept the null hypothesis that there was no significant difference in the blood cholesterol levels of the subjects in any of the four groups. • In the two-group random sample design, the experimenter may choose to use only the last two groups of the Solomon four-group design; that is, one group is given the treatment and then post-tested with no pretesting, and the control group is given only the post-test. The theory behind this design is that the experimenter, adhering rigorously to the random assignment of subjects to the groups, can say that the two groups were essentially the same because random assignment should avoid any systematic bias in the two groups. This design not only simplifies the experiment but also eliminates the effect of a pretest on the subjects; in effect, it maintains the subjects’ naïveté. It is also noteworthy that there are some things that cannot be pretested or accurately predicted. Patients who already have mild angina pain may or may not have elevated cholesterol levels. The angina pain already exists. If treatment or lack of treatment (cholesterol in the diet) is a factor, there should be a difference between the two groups at the end of the treatment. • The matching samples design is more rigorous than those previously discussed. In this design, the researcher attempts to match (or to pair)

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the subjects in the control and the experimental group. For example, in the cholesterol study, the experimenter might match the subjects in each of the groups on such characteristics as height, weight, gender, age, smoking or nonsmoking, the results of psychological stress tests, and so on. A major problem with this type of experimental design is that unless the subject pool is infinitely large, the experimenter reduces the available sample with each matching or pairing situation. Males can be matched only with other males. Age further reduces the sample size. Eventually, it is entirely possible to reduce the sample down to two very will-matched people! The problem then becomes one of maintaining a sample size large enough to be generalizable. In the experimental designs discussed so far, the experimenter identifies one independent variable and one dependent variable. Through the use of various forms of control, the effect of the independent variable on the dependent variable is then measured. However, there may be a situation when there are two or more independent variables that are manipulated simultaneously and, through interaction, may cause the dependent variable or variables to appear in the way that they did. Each of the independent variables is considered a factor influencing the dependent variable, either alone or in interaction with the other independent variables. Using the cholesterol example, suppose the subjects were overweight when placed on the low-cholesterol diet. In some cases, weight might be maintained because, although saturated fat intake was reduced, nonsaturated fats could be substituted for the saturated fats. The experimenter, however, might want to reduce both the weight and the intake of saturated fats of the subjects simultaneously. At the end of the experiment, it might be found that angina pain had been reduced in both intensity and frequency. It would then become very difficult to ascribe the causal effects to either of the two independent variables. Experimenters can more easily control experiments in which one and only one independent variable is introduced, as in the case of cholesterol intake reduction alone or a weight-loss diet alone. Often the interaction of two or more variables produces more significant results than a single variable does. The experimenter must then use what is called a factorial design. In this type of design, groups of subjects are assigned into all possible combinations of treatments to determine the effect of the independent variables alone and the effect of the interaction of the independent variables. Such factorial designs can grow to enormous complexity very quickly, but such is the work of researchers. Human beings are enormously complex; even the simplest and most tightly designed and tightly controlled experiments has results that are probably influenced by interaction effects. Factorial designs attempt to get at these interactive effects and determine their impact on the experiment.

Classification of Research

2. Quasi-experimental Research Designs When a researcher cannot design a true experimental study because of constraints imposed by subject selection or the study setting, he or she may use a quasi-experimental design, a design that is similar to a true experimental design (quasi means similar to or resembling). A quasiexperimental design may be defined as a quantitative research design in which there is always manipulation of the independent variable(s) and control measures are employed, but the other element of a true experiment, random assignment of subjects, is absent. For example, a researcher may want to investigate the differences between patients who may or may not receive a certain protocol that is routinely ordered by three different physicians. Physician A never orders the protocol, Physician B always orders the protocol at a set time, and physician C always orders the protocol at a set time that is different from physician B’s time. In this case, the researcher cannot randomly assign the study subjects to the treatment groups, even though the impact of the time of the protocol or the lack of it can be measured. This is in contrast to a true experimental design, in which a researcher would be able to randomly assign the study subjects to either the experimental or the control group. Five types of quasi-experimental designs will be presented here: 1. One-group pretest/post-test design 2. Nonrandomized control group design 3. Counterbalanced design 4. Time series design 5. Control group time series design. • The one-group pretest/post-test design is the simplest type of quasiexperimental design. Although this design leaves many things to chance, it is often the only available way to determine the effectiveness of a treatment. Essentially, this design measures what has happened to the experimental group based on the way it was before the beginning of the experiment (pretest state), and the differences achieved at the end of the experiment (post-test state). For example, using the study of a group of subjects with mild angina pain, the experimenter could measure the subjects’ cholesterol level and then ask them to restrict their intake of cholesterol through changes in their diets. After a given period of time, the experimenter would determine whether the mild angina pain had been reduced and whether the blood cholesterol levels had dropped. If the blood cholesterol levels had dropped and angina pain had been reduced, the experimenter might then conclude that lowering cholesterol levels in the blood reduces angina pain. Note that no comparison in cholesterol levels is made in a control group or in a group of subjects who do not make changes in their diets. Minimal control is placed on

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other variables that might affect the evidence in the study subjects: changes in stress patterns, weight, exercise patterns, or many other factors might have contributed to the change. • The nonrandomized control group design, also termed the nonequivalent control group design, is often used in nursing research studies. When circumstances preclude random assignment of subjects to an experimental and control group at the beginning of an experiment, a nontreatment group may be established for the purpose of comparing outcomes. However, there is no way to guarantee that the groups are equivalent as to other characteristics. For example, the experimenter may wish to compare a sample of angina patients from a local Veterans Administration hospital with a sample of angina patients from a privately funded hospital. One of the hospitals may insist on a standardized routine of treatment for angina patients, whereas the other hospital may be available for the experimental treatment. In this case, the subjects in both samples would be given the pretest and one group would be given the experimental treatment. However, the researcher would not be able to control various interaction effects from the confounding variables at the beginning of the experiment. In this instance, where it is impossible to develop controls by assigning subjects randomly to control and experimental groups, alternative methods of statistical analysis are required. The method commonly used is the analysis of covariance, a statistical technique that allows the experimenter to statistically control for varying potential interaction effects after the experiment has been performed. • The counterbalanced design is a more effective design than the nonrandomized control group design, or at least one that attempts to remove some of the previously described problems. This design can be used when more than one treatment method is attempted. Each group of subjects is given a different treatment at the same point in time during the course of the experiment. This means that each group of subjects becomes both the experimental group and also control groups for themselves and for another group. Because of the nonrandom nature of group assignments, the experimenter cannot control for differences between groups. In many instances, the researcher may not be able to give a pretest. However, the testing does allow for greater flexibility in the interpretation of results; differences are noted both between groups and within groups. Using the statistical test of analysis of variance, the experimenter may be able to determine that the effects were caused by the treatment. For example, two groups of psychiatric patients might be subjected to a computer programme designed to interact with individuals and give the

Classification of Research illusion of eliciting feelings at different times during their treatment. At the time of the first treatment session, group A would be given the computerized intervention and group B would receive a standard psychotherapeutic intervention. Both groups would then be given the same test to determine the subjects’ responses to the treatments. At a later time, the treatments would be reversed: group A would receive the standard psychotherapeutic intervention and group B would be given the computerized intervention, and the same test would be given to determine the subjects’ responses to the treatments. The differences in test scores, if any, between the two treatments could be recorded. A number of variations to this design should be noted. More experimental variables could be introduced, such as another type of treatment in addition to computer and standard psychotherapeutic intervention. There would then have to be three groups of subjects, each receiving the treatments in a different order. • The time series design is useful when an experimenter wants to measure the effects of a treatment over a long period of time. In this design, the experimenter would continue to administer the treatment and measure the effects a number of times during the course of the experiment. In the cholesterol example, instead of testing patients with mild angina pain only once (at the end of the diet restriction), the design would call for testing them at stated intervals. Chemical or behavioural changes in a human being can be very subtle and difficult to measure. Responses can vary daily, and some unrecognized confounding variables may lead to incorrect conclusions. Testing over a long period of time helps to reduce such pitfalls and improves the experiment. With a time series experiment, however, variables occurring during and after treatment may go unnoticed by the experimenter and can lead to a false or inappropriate conclusion. A special case of the time series design is known as single-subject research, in which the researcher carries out an experiment on one individual or on a small number of individuals by alternating between administering a treatment and then withdrawing the treatment, with the purpose of determining the effectiveness of the intervention. Singlesubject research has proven to be especially suited for psychiatric and other behavioural settings. The control group time series design can be used to diminish the problems inherent in a time series design, such as subject sensitization or the Hawthorne effect. This design requires that a control group be tested simultaneously with the experimental group without being given the treatment. In our cholesterol example, two groups of randomly selected angina patients would receive a sequential series of blood tests over a period of time. The experimenter would then determine whether blood

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Essentials of Nursing Research cholesterol levels had diminished significantly between the experimental treatment group and the control group, as well as the frequency and intensity of angina pain. This technique, obviously, provides far greater control than a single time series design and is preferable to the single time series design.

2. Nonexperimental Quantitative Research Designs In nonexperimental research, the researcher collects data and describes phenomena as they exist. Unlike experimental research, variables are not manipulated because no interventions take place, there are no control measures, and there is no random assignment of subjects to groups. Much of the research that has been conducted in nursing has been nonexperimental due to difficulty in controlling variables in humans and with random assignment to groups, as well as ethical constraints incumbent on researchers who design experimental research involving human subjects. This type of research often relies on convenience samples. Although descriptive researchers often use simple statistics to analyze their data, they may also test hypotheses and use more complex statistics. The following nonexperimental designs will be discussed: I. Correlational designs II. Descriptive designs III. Time perspective designs IV. Retrospective designs V. Prospective designs VI. Designs that use existing data VII. Focus group research VIII. Content analysis.

I. Correlational Designs

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Correlational designs are nonexperimental designs that allow the researcher to infer relationships among two or more variables, rather than to draw conclusions about cause and effect. In these designs, the relationship between two or more variables is measured by correlation statistics, often called measures of association. Correlations range from –1.0 to +1.0 and are expressed numerically as correlation coefficients. A negative correlation means that as one variable increases, the other decreases. A positive correlation means that as one variable increases, the other increases, or as one variable decreases, the other decreases. A correlation of – 1 is just as strong as a correlation of +1. The closer a correlation coefficient is to either – 1 or + 1, the stronger the relationship

Classification of Research is between the variables being studied. The closer a correlation coefficient is to 0, the weaker the relationship between the variables. Correlations, however, do not imply cause-and-effect relationships. For example, the correlation between houses with roofs and houses with kitchens probably approaches +1.0, but this does not mean that the presence of roofs causes kitchens to be present.

II. Descriptive Designs Descriptive research is often a preliminary to correlational research or to experimental studies. Descriptive research studies (not to be confused with qualitative research) can serve to discover new meaning and to provide new knowledge when there is very little known about a topic of interest. They also provide a knowledge base when a research problem needs to be refined, when hypotheses need to be formulated or data collection and analysis procedures need to be designed. Descriptive research is not the same as qualitative research. Qualitative research, although descriptive or narrative in nature, is a cover term for a number of research traditions that are distinct in purpose, orientation, and design. Survey research and case studies are two types of descriptive research. Survey research is the term used to refer to the collection of data directly from the study subjects, usually by questionnaire or interview. When subjects respond to a survey, their responses are known as selfreports because it is the subjects themselves who are providing the information. Survey data are most often collected by questionnaires and interviews. Most survey researchers also collect demographic data to describe the characteristics of their subjects as part of their surveys. A demographic variable is a characteristic or attribute of a subject, such as age, gender, marital status, ethnicity, educational level, employment status, and family income. Although surveys can be conducted on an entire population of interest to the researcher, they are most often conducted on a sample of the population. Survey researchers use either probability or nonprobability sampling, depending on the purpose of the study. Also, surveys can either be longitudinal, in which case data are collected from the same subjects at different points in time, or cross-sectional, in which data are collected at one point in time. An example of a very extensive survey familiar to all of us is the India’s census survey that is conducted every 10 years by the Census Bureau.

III. Time Perspective Designs In time perspective designs (also called time dimensional designs), time is an important factor. Time perspective designs are concerned with

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Essentials of Nursing Research examining trends or changes across time. Two major types of time perspective designs are longitudinal designs and cross-sectional designs. In longitudinal designs, data are collected from the same subjects over a period of time. Typically, these subjects are members of a single cohort–that is, a group of persons who share a common characteristic, such as age, occupation, or a delineated area of residence. (Although the term cohort was originally used to refer to age as the common phenomenon, the meaning has now expanded to include additional characteristics of the subjects.) In a longitudinal study, the cohort is followed over a designated period of time with the purpose of describing changes that occur during that time. The time intervals may range from months to years. One of the most preeminent longitudinal studies in the health field is the Nurses’ Health Study, which has been ongoing for more than 20 years. Initiated in 1976 by the Harvard Medical School, the purpose of the study was to investigate health risks that pose a special threat to women. The original cohort consisted of more than 100,000 married women born between 1921 and 1946 who lived in the 11 states with the largest total populations. (The senior author of this textbook has served as a subject for this study and has faithfully responded to a yearly questionnaire from the inception of this study to the present). A similar, but younger, cohort has been added to the study with the purpose of examining the long-term effects of contraceptive use.

IV. Retrospective Designs In retrospective designs (retrospective means “looking backward”), changes in the independent variable have already occurred before the research due to the natural course of events. The dependent variable (Y) is identified in the present, and then the researcher looks to the previous event that has already occurred to identify the possible independent variable (X). For example, a group of people attending a family reunion experience gastrointestinal symptoms serious enough to seek medical care. The purpose of a retrospective investigation would be to attempt to determine the possible cause for the current gastrointestinal symptoms. The investigator would “look backward” to determine the possible cause (X) of the present symptoms (Y). Retrospective studies have the same purpose as ex-post-facto studies (literally, “after the fact” studies).

V. Prospective Designs

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In contrast to retrospective studies, which identify the dependent variable in the present and look to the past to identify the independent variable, prospective designs identify the independent variable (X) in the present

Classification of Research and look to the future to identify potential effects (Y). The Nurses’ Health Study, previously discussed as an example of a longitudinal study, is also an example of a prospective study. At one point in the study during the 1980s, the investigators identified intake of milk and dietary calcium as the specific independent variables (X) they planned to investigate into the future. They then continued to analyze the data over the next 12 years to determine the relationship of these variables to hip fractures (Y), the dependent variable. The results of the study were published in 1997: Among Nurses’ Health Study participants, we found no evidence that high consumption of milk or other food sources of calcium protects against hip or forearm fracture. . . . Further follow-up will help us address this issue in more detail and thus inform future dietary guidelines. (Speizer, 1998)

VI. Designs that Use Existing Data Meta-analysis is a technique in which the investigator examines research findings across a number of research investigations relating to the same general phenomenon. The investigator then pools the results of these studies and synthesizes the findings–that is, brings together the findings of the many separate investigations relating to the same general phenomenon. “The original investigators have done the analyzing; the meta-analyst synthesizes the results of these analyses” (Powers & Knapp, 1955, p. 101). Meta-analyses may be performed either quantitatively or qualitatively. The basic procedure for both types of analyses is essentially the same: defining the research problem and identifying the studies to be included; collecting the related data; classifying and coding the distinctive characteristics/variables of the studies; examining the variables; and finally compiling the meta-analysis results and comparing this compilation with the characteristics/variables of the studies that have been examined (Kylma & Vehvilainen-Julkunen, 1997).

VII. Focus Group Research Focus group research design is a method that allows the researcher to examine the points of view of a number of individuals as they share their opinions/concerns about a topic. Essentially, a focus group consists of a small number of individuals who share a common bond. This bond might be any number of things such as age, number of children, wealth or lack of it, a specific disease, or any other commonality defined by the researcher. Focus groups have been a popular strategy for various commercial enterprises, who use them to determine whether a new product or idea would be accepted by the general public. Focus groups can also be used

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Essentials of Nursing Research to evaluate changes in health care delivery systems, educational systems, or health care products. This type of research can provide a great deal of information at a relatively low cost. The focus group usually gathers in an informal setting, where the researcher or the researcher’s designee serves as a moderator to collect data on a specific topic. It is the task of the moderator to keep the group focused on the topic to be discussed by using a series of questions designed to elicit pertinent information. Because of the shifting discussion pattern, audio and/or video recordings may be made of the session, with the permission of the participants. A researcher may use more than one focus group to gather data on a topic to gain more confidence in the responses. Because the purpose of a focus group is to provide data about a topic, it is not important that the group reach a consensus. In analyzing the participants’ responses, the researcher identifies common themes and patterns that reflect the responses of the group (or groups).

VIII. Content Analysis Content analysis is a data-analysis method that is used not only in quantitative research but also in qualitative research. In quantitative research, content analysis can be used as “a method to make inferences based on systematic, objective, and statistical analyses of written text or oral communication and documentation” (Doordan, 1998). In conducting a research study using content analysis, the investigator first formulates a research question, then selects an appropriate communication medium to be analyzed, establishes categories of information to be included in the analysis, then codes the content of the medium according to pre-established rules. Once the content has been coded, the categories are scored and scaled (usually statistically) and comparisons are made. Researchers use content analysis to analyze information from such sources as documentation found in written materials, videotaped and audiotaped materials, and still photographs and pictures. Essentially, any medium of communication can be analyzed for content, depending on the purpose of the research. In qualitative research, content analysis is a process to analyze the content of qualitative information gathered from the study participants by “categorizing observations into themes and concepts emerging from the data” (Doordan, 1998). The following examples describe two research studies. One study used content analysis as a quantitative data-analysis process; the other used content analysis as a qualitative research method.

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Overview of the Research Process

4

Overview of the Research Process

The phases and steps in the research project gives an overview of the research process. Actually, there were five basic phases involved in conducting research, i.e. assessment, diagnosis, planning, implementation and evaluation. 1. In assessment phase, the investigators select the topic and identifies a research problems, formulates the proposal for research project, reviews the literature, concerning the project and defines the concepts and variable to be studied. 2. In diagnosis phase, the investigator states the hypothesis, examines the possible ethical implications of the research proposal, and reviews pertinent literature and also identifies the theory, assumptions and limitations of the proposal. 3. In planning phase, the researcher describes the research design and methods of research including sampling, data collection, instruments to be used and method of data analysis, obtains informed consent from subjects to be studied in the pilot study, conducts the study, and revises proposals in the light of findings, and plans how to communicate findings. 4. In implementing phase, the researcher collects data from the subjects. 5. In evaluation phase, the investigator performs analyses and interpretation of the data collected from the target population and communicates the findings as per plan made in the planning phase. The brief explanation of these five phases indicates that in each phase, the researcher has to follow different steps. Each phase may be divided into various steps that may differ in some ways from project to project. The common steps of each phase will now be examined.

Assessment Phase Identifying a Researchable Problem in Nursing Good research depends to a great degree on good questions, topics for research are generated in a variety of ways. In many cases, a problem

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Essentials of Nursing Research which needs solving will present an immediate topic for the study. In other cases, reading an area of interest will give rise to yet unanswered questions, other researchers are having with their own experiences. The student investigator who is uncertain about what to do, or would like to replicate a good study if possible, may begin immediately with an initial review of the literature. Good research reports state the general importance of the study early in the report and follow this immediately with statement of the specific problems that was studied. Once a general topic, the specific problem to be investigated should be defined as precisely as possible, and statement of the problem should be formulated. The topic converted into problem statement which in turn is refined in several times before a satisfactory working tool is obtained.

Formulating the Research Proposal The research proposal is a written summary of steps stating what the investigator intends to do, how he or she plans to do it, who or what comprises the study sample, when and where the study is to be done, and the time schedule for the study. The proposal is often written for the approval of the guide or committee. The proposal begins with the identification of the problem and moves step by step through all elements of the planning phase. It may be rewritten many times for its refinement. The final writing is usually done after pilot study, when chances may be incorporated in the light of weaknesses and strengths identified at that time.

Defining the Concepts and Variables An investigator or researcher must define each concept or variables early in the studies not only to understand what is to be examined but communicate this information to others’ operational definitions of concepts or variables requiring careful work, as the describe how the variable under study is to be observed and measured. Definitions found in the literature that have already been developed and tested in research should be used whenever possible. At this juncture, researchers should clarify in their own minds, what the independent and dependent variables are actually in the study.

Diagnosis Phase Stating Objectives or Hypothesis

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Objectives are what the investigator proposes to accomplish in research, i.e. the specific short-term measurable goals to be met. These objectives

Overview of the Research Process should be stated clearly because, at the conclusion of the study, both the reader and the researcher can determine whether the objectives of the study were met. Hypothesis are statements formulated to predict a relationship between two or more variables. It is a statement of expectations of a researcher concerning relationships between variables under investigation. A problem statement represents the initial effort to give a research project direction, hypothesis represents a more formulated focus for the collection and interpretation of data. The hypothesis must be testable and verifiable.

Examining the Ethical Implications It is wise and advisable to examine the ethical implications of the research. Should the research proposal deal with problems too research. Should the research proposal deal with problems too complex to solve in the time available, it is possible to modify the research proposal without losing too much time and effort. An ethical study is one that does not harm the study subjects. All subjects are carefully informed concerning the following: i. The purpose of the study, ii. Their part in it, iii. Any possible discomfort, iv. How privacy is guarded? v. Their right to refuse to participate or to stop participating without penalty, and vi. The manner in which data will be used. Therefore, the investigator must also gain the approval of the committee or authority that investigates studies, using, human subjects and must receive the written informed consent of each study subject.

Reviewing of the Literature A review of literature on a research topic serves several purposes. It provides familiarity with existing studies, and information is often indispensable an helping researcher to focus on a particular problem and to formulate suitable research questions and helps in formulating and delineating the problem. An initial review of the research publications often takes place early in the project, as soon as the general area of interest is defined. Initial review of literature must be followed by a more critical review that concentrates on the strengths and weaknesses of each study.

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Essentials of Nursing Research

Identifying Theory, Assumptions and Limitations A theory is a generalised abstract explanation about the inter-relationships among phenomena, with the primary purpose of explaining and predicting those phenomena. The goal of research is to provide scientific explanations for what is observed, and to predict what will be observed, under given circumstances. Nursing is drawn on a broad range of theories from the natural behavioural and social sciences. Currently, nurses are seeking to produce theory peculiar to nursing practice. Research articles usually specify the theory or assumptions upon which the study is based. Limitations are aspects of the research that were not studied. The investigator may summarise the use of theory, assumptions and limitations as he or she examines the research literature. It is good to have conceptual framework or theoretical framework for the study.

Planning Phase Describing Research Design

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The research design is the overall plan for how to obtain answers to the question being studied and how to handle some of the difficulties encountered during the research process. The design should specify which of the various types of research approach will be adopted and how the researcher plans to implement a number of scientific controls to enhance the interpretability of results. Research design will include the experiment, the survey and the documentary (historical) design. 1. An experiment often examines how a treatment or stimulus (the independent variable) affects the subject exposed to the treatment (the dependent variable). The experimental designed describes step by step how the research with be conducted. The crucial elements of experiment include how research subjects are selected and how controls are used. 2. A survey is a research design that uses questionnaires, and interviews. Important elements of the survey include not only how the subjects are selected but also their willingness to answer the questionnaire of interview. The number of returns from a questionnaire and the ability of the respondents to answer the questions determine the extent to which the design is successful. The proper development of the tool and schedule also are crucial 3. The documentary design uses material already in existence, such as public or private records. Getting access to the material, finding records that are complete and legible, and discovering whether or not the writer’s recorded material accurately important.

Overview of the Research Process 4. In “field studies,” the research investigates the phenomenon in its natural settings, i.e. community, hospital or health clinic.

Describing the Research Methods Research methods will include the methods of sampling data collection, and analysis and interpretation. 1. Sampling is the selection of the study subjects from the target population under study. Appropriate methods must be used to able to apply research findings from a small sample to the population from which it was drawn. 2. Methods of data collections include observing, questioning and measuring or a combination of these. Observation is a basic method of collecting data. When the phenomenon under study cannot be observed, the researcher asks questions, either interview or by using questionnaires. Measuring is the set of rule that assign number or values to objects representing the variation of some attributes, e.g. measuring height and weight. 3. For analysis and interpretation of data usually by using description and inferential statistics.

Obtaining Informed Consent from Subjects for Pilot Study Informed consent is obtained from the subject to be used in the pilot study prior to conducting the study. Informed consent is the voluntary consent given by the study subjects, after they are fully informed of every detail of the proposed research, including the right to participate or not, and to with draw from the study at any time without penalty. Informed consent must be obtained from subject in both pilot study and the real study.

Conducting the Pilot Study The pilot study is a small-scale dress rehearsal that proceeds as if it were the actual study, except for the fact, that subjects who will participate in the actual study are not used. The primary objective of the pilot study is the test as many elements of the research proposal as possible in order to correct any part that does not work properly. Usually, some unforeseen events, problems and difficulties may arise in the course of research projects. In order to minimise the possibilities of major difficulties, it is advisable to carry out a pilot study, which is small scale version or trialrun of the actual study. The time and effort to conduct a pilot study is well worth it. Pitfalls and errors that may prove costly in the actual study may be identified and avoided.

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Essentials of Nursing Research

Planning for Communicating the Findings of Research In planning phase itself, it is better to plan how to communicate the research findings. Research reports are often required as a part of the course work. The written report and oral presentation may be the first step in reaching a broader audience. The researcher may wish to investigate the possibility of presenting the paper at a professional meeting or locating a journal that publishes such papers. Careful work in research makes a contribution to the profession, and experience in certain areas of research are reflected in the scientific practice of nursing.

Implementation Phase Collecting the Data

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In earlier phases, the researchers have put a lot of efforts to make research plan and written. The amount of time devoted to the written plan for research probably exceeds the amount of time it takes to carry out the research. A well-organised research plan prevents or keeps to a minimum the unanticipated problems arising from design, method and data analysis. The nurse researcher consistent with ethical premises basic to the nursing profession is responsible for the preservation and protection of human rights throughout the entire process of research. If the study subjects have not been selected from the target population, first step in implementation is to select the sample according to plan. The second step is to contact the subjects, as well as any agencies involved to explain the study and obtain their informed consent. The sampling process is a crucial element of the research design. It determines from whom or what the data are to be collected, which in turn influences the method of data analysis that could be used. The method by which data are collected, which in turn influences the method of data analysis that could be used. The method by which data are collected varies by research design. An experimental observes and measures two groups, i.e. the survey involves questioning and measures two groups, i.e. the survey involves questioning and measurement, and the record review requires asking questions of data. In other words, to use an experimental design, divide the subjects into experimental and control groups to use a survey design, make appointments for interviews or mail questionnaires with explanations and from for informed consent, and to use a record review or historical design, obtain the records. When various recommended to collect data. Once the data collections are completed or stopped for practical reasons, next phase begins.

Overview of the Research Process

Evaluation Phase An evaluation phase involves analysis and interpretation of the data and communicating findings.

Analysing and Interpreting the Data In this step is to examine raw data for completeness and accuracy. An incomplete or inaccurately completed questionnaire must be discarded. Next, the raw data must be transferred to a general tally table or worksheet in order to bring categories of data together. The tally marks are then counted, and the counts are summarised. In addition, special purpose tables help to summarise the data. Rates, ratios, and percentages are used to summarise data such as age, sex, occupation, marital status or type of illness. For quantitative data, summary measures mean, median and mode that are used. These are descriptive summaries and may be used to compare and interpret data from descriptive or exploratory studies. Studies that have used random sampling can use inferential statistics to estimate parameters and test null hypotheses. Once data summaries and estimates are concluded, the investigator can analyse these in the light of research proposal including objectives. An investigator draws conclusions from the analysis and discusses what these mean to nursing in general. Next, the investigator may make recommendations that are relevant to practice, administration or education, or he/she may suggest further research. Finally, the investigator carefully reviews and criticises the research project, in preparation for communicating the findings.

Communicating the Findings The final step of the research process is the communication of findings of the research project. The research report, either written or oral must communicate all the steps involved in research project. It is usually wise to complete tables and graphs, since these help in the process of communication. The report should be well organised and in enough detail to inform, but at the same time, it should be succinct. The organisation and substantive approach depends in part upon the audience. The researcher, re-examines the goals of the research and organises the content in the proper format, using a writing style that is appropriate for the prospective readers-whether scientists or laymen. The task of communication findings may be anticlimactic from the point of the researcher, which requires skilful writhing abilities, clarity of the right, precision and objectives. The length and amount of detail required for a research report vary considerably depending on the topic, type of study and audience.

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Essentials of Nursing Research

5

Review of Literature

Review of literature is a key step in research process. Review of literature refers to an extensive, exhaustive and systematic examination of publications relevant to the research project. Nursing research may be considered a continuing process in which knowledge gained from earlier studies is an integral part of research in general. Before any research can be started whether it is a single study or an extended project, a literature reviews of previous studies and experiences related to the proposed investigations should be done. One of the most satisfying aspect of the literature review is the contribution it makes to the new knowledge, insight, and general scholarship of the researches. A researcher analyses existing knowledge before delving into a new area of study while conducting a study, when interpreting the results of the study, and when making judgments about applications of a new knowledge in nursing practice.

DEFINITION OF REVIEW OF LITERATURE The review of literature is defined as a broad, comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communications. Critical review of literature refers to the process in which the investigator or reader examines the strength and weakness of the appropriate scholarly publications/literature. The term “Scholarly Literature” can refer to published and unpublished data-based literature and conceptual literature materials found in print and nonprint from “Data based resources” are reports of completed research. “Conceptual literature” can be reports of theories, some of which underlie reported research as well as non-research material.

PURPOSES OF REVIEW OF LITERATURE

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The typical purposes for analyzing or reviewing existing literature are to generate research questions to identify what is know and not known about a topic, to identify conceptual of theoretical traditions within the

Review of Literature bodies of literature, and to describe methods of enquiry used in earlier work including their success and shortcomings. Sometimes, investigators discover exciting unanswered questions by reading a body of literature. On research process, the literature review is essential to: i. Determine how well theory and research are developed in the study, ii. Define concepts, iii. Examine research design, methods and scales, instruments, measures and techniques of data collection and analysis used by others, iv. Identify a study for replications or comparison, v. Examine difficulties reported by others, vi. Define ethical implications of similar studies, and vii. Identify a guide to use in writing the research report. Thus, review of literature helps in many ways starting from selection and formulation of problem, providing conceptual framework for the study, assess feasibility, providing methodology, for comparison and replication, avoiding obstacles, and making generalisation.

OBJECTIVES OF THE LITERATURE REVIEW The major goal of the review of the literature is to develop a strong knowledge base to carry out research and other non-research scholarly activities in educational and clinical practice settings, in educational arena, such knowledge enhances the writing of scholarly papers by students and faculty. In the clinical practice arena, the knowledge from critical literature review contributes to the implementation of research based practice interventions, protocols, and evaluation programmes that improve the quality of patient care. The main objectives of the review of the literature are as follows: 1. Determine what is known and not known about a subject, concepts or problem. 2. Determine gaps, consistencies, and inconsistencies in the literature about a subject, concept or problem. 3. Discover unanswered questions about a subject, concepts or problems. 4. Describe the strength and weaknesses of designs/methods of inquiry/and instruments used in earlier works. 5. Discover conceptual traditions used to examine problems. 6. Generate useful research questions or projects/activities for the discipline. 7. Determine the appropriate research design/method (instruments, data collection and analysis methods) for answering research question. 8. Determines the need for replication of well-designed study or refinements of a study.

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Essentials of Nursing Research 9. Promotes development of protocols and policies related to nursing practice (service, administration, education and research). 10. Uncover a new practice intervention of gain support for changing a practice intervention.

USES OF LITERATURE REVIEW The literature reviewed can be utilized for both research and non-research activities.

Research The major research focus of the literature review for qualitative approaches and its use in the steps of research process for quantitative designs are as follows. Qualitative process: The use of the literature review depends on the selected designs types and phases, usually an extensive data base is not available. Conceptual data are somewhat limited, for this reason, a qualitative design is being used. a. Phenomenological–compare findings with information from the review of literature. b. Grounded theory–constantly compare literature with data being generated. c. Ethnographic–more conceptual than data based, provide framework for the study. d. Historical–review of literature is source of data.

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Quantitative designs: The review of the literature is used for all designs/ levels. It is usually a step of the research process and used in developing all the steps of the research process. a. Problem. b. Need significance. c. Question/hypothesis(es). d. Theoretical/conceptual framework. e. Design/methodology. i. Specific instrument (validity and reliability) ii. Data collection method iii. Specific instrument (validity and reliability). f. Data collection method. g. Type of analysis. h. Findings (interpretation). i. Simplifications of findings. j. Recommendations based on findings.

Review of Literature

Nonresearch The major non-research focus of the literature reviewed is on uncovering knowledge for use in educational and clinical practice settings. In educational setting the literature review is used by students to develop academic scholarly papers and to prepare oral presentations or debates of a topic, problem or issue. And it is used by the faculty to develop and revise curricula and to develop theoretical papers for presentations and/or publications. The literature review is used by nurses in clinical setting to: i. Implement research based nursing interventions. ii. Develop hospital-specific nursing protocols or policies related to patient care, and iii. Develop and substantiate hospital/specific quality assurance, continuous quality improvement, or total quality management projects or protocols, and the literature review is used by professional nursing organization/governmental agencies to develop major documents (policies) and standards for clinical practice and also to develop practice guidelines. Thus, review of the literature involves the systematic location, scrutiny, and summary of written that contains information on research problem. So, the literature review. i. Serves as source of research ideas, ii. Gives orientation to what has already been known, iii. Makes provision of conceptual contexts, iv. Provides basis for assessment of feasibility, and v. Provides useful information on research approach. A summary of the writings of recognized authorities and of previous research provides evidence that the research is familiar with what is already known and what is still unknown and untested. Since effective research is based upon the past knowledge, this literature review helps to eliminate the duplication of what has been done and provides useful hypothesis and helpful suggestions for significant investigation. Citing studies that show substantial agreement and those that seem to present conflicting conclusions helps to sharpen and define understanding of existing knowledge in the problem area, provides a background for the research project and makes the reader aware of the status of the issue.

SOURCES OF THE LITERATURE REVIEW The types of information sources for a review of literature are conceptual and data-based literature. The common sources of both these literatures are books, chapters of books, journal articles, abstracts, critique reviews,

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Essentials of Nursing Research abstracts published in conference proceedings, professional and governmental reports, and unpublished doctoral dissertations and thesis. The kinds of information available in written documents can be categorized into five broad classes: 1. Facts, findings or results. 2. Theory. 3. Research procedure or methods. 4. Opinions, points of view or personal commentaries. 5. Anecdotes or impression on a particular event or situation. The references can be categorized as being either primary or secondary sources.

Primary Sources A primary source is written by a person. Who developed the theory or conducted the research or is the description of an investigation written by the person who conducted it. Most primary sources are found in published literature, e.g. nursing research article. A credible literature review reflects the use of mainly primary sources.

Secondary Sources

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A secondary source is written by a persons other than the individual who developed the theory or conducted research. Otherwise, known as it is description of study or studies prepared by someone other than the original researcher. Often secondary source represents a response to, or a summary and critique of a theorist or researcher’s work. The secondary sources may be used when unavailability of primary sources, and if we want to know different ways of looking at an issue or problem. The following recommendation to increase critical evaluation skills when reading above primary and secondary sources of literature: • Read the primary source of a study or theory-not just secondary source • Seek assistance about the critique from researchers • Read secondary sources from referred/pre-reviewed journals that provide a commentary/critique/response by a recognized researcher • Discuss your response to secondary source articles with your guide/ faculty adviser • Form scholarly reading groups with follow nursing students or consumer of research nurse colleagues and discuss the results with your guide/faculty adviser • Confer with the reference librarian and guide/faculty advisers about the most useful reputable referred scholarly journals.

Review of Literature In searching literature, the researcher should note certain important elements given below. • Reports of studies of closely related problems that have been investigated • Design of the study including the procedures employed, and data gathering instruments used • Populations that were sampled and sampling methods employed • Variables that were defined • Extraneous variable that could have affected the findings • Faults that could have been avoided • Recommendation for further research.

Characteristics of Relevant Review of Literature Written summary and critique of each reviewed source of information relevant to the project reflects critical thinking and scholarly writing. The content satisfies the following criteria: 1. Purposes of a literature review were met. 2. Summary is succinct and adequately represent the reviewed source. 3. Critiquing (objective critical evaluation) reflects analysis and synthesis of material a. Application of accepted “critiquing criteria” to analyze for the strengths, weaknesses or limitation, conflicts and gaps in information, as it related directly and indirectly to the area of interest. b. Evidence of synthesis of the critiques of each source of information. Putting the parts together to form a new whole or connecting link or what is to be studied, replicated, developed or implemented. 4. Review consists of mainly primary sources 5. Sufficient number of sources are used, especially data based sources 6. Summaries/paraphrases material rather than continually quoting content 7. Summaries/critiques of studies are presented in a logical flow ending with a conclusion or synthesis of the reviewed material that reflects why are study, project or conceptual stand should be taken.

Selected Sources of Review of Literature 1. 2. 3. 4. 5. 6. 7.

Journals Abstracts and excerpts Bibliography Dictionaries Encyclopaedias Guide to library Handbooks

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Essentials of Nursing Research 8. Indexes 9. Inventories 10. Year books

Examples of Nursing Journals for Literature Reviews 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Advances in Nursing Science American Journal of Nursing Applied Nursing Research Archives of psychiatric Nursing Clinical Nursing Research Computers in Nursing Holistic Nursing Practice Image International Nursing Review International Journal of Nursing Studies Journal of Professional Nursing Journal of Obstetric, Gynecologic and Neonatal Nursing Journal of Qualitative Research Journal of Nursing Scholarship NACOG Nurse Educator Nursing Diagnosis Nursing and Health care Nursing Research Nursing Science Quarterly Research in Nursing and Health Scholarly Inquiry for Nursing Practice The Nursing Journal of India Western Journal of Nursing Research Indian Journal of Nursing and Midwifery.

Examples of Database Print Sources Index

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1. 2. 3. 4. 5. 6. 7.

CINAHL–Cumulative Index to Nursing and Allied Health Literature INI–International Nursing Index (AJN-NLM) Nursing Studies Index–Virginia Henderson, 1900-1959 IM–Index Medicus, 1879 (oldest one) HLI–Hospital literature Index AHA and NLM CIJE–Current Index to Journals in Education (ERIC) Card Catalogues–list books, monographs, theses dissertation and proceedings.

Review of Literature

Abstract Reviews 1. 2. 3. 4. 5.

Nursing Abstracts Psychological Abstracts Sociological Abstracts Dissertation Abstracts International Masters’ Abstracts.

Computerised Database: CD-ROM and UN-LIM 1. CINAHL–Cumulative Index to Nursing and Allied Health Literature 2. MEDLINE–Standard-Medical Literature Analyses and Retrieval system on line (MEDLAR) 3. PSYCHLIT–Psychology Literature 4. ERIC–Educational Research Information Center

Skills Needed for Literature Review As stated earlier, investigators, literature reviews for several purposes. The first stage of reviews of the literature is a general, preliminary search that attempts to locate all pertinent publications for a quick perusal. The second stage is more critical review of the works to identify merits, strengths, weakness and shortcomings of each. As the investigator gains experience, he or she may conduct a critical review as a part of the preliminary review and may immediately discard publications that do not meet standards. While analysing the existing knowledge in the literature, it is essential for the investigator to use his/ her critical thinking and reading skills to read research articles.

Critical Thinking Skill Critical thinking is the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions issues, statements, beliefs and actions. Bandman and Bandman, 1988). In critical thinking process, the investigator (person) will engage in following arts: i. The art of thinking about his/her thinking so as to make it more clear, precise, accurate, relevant, consistent and fair, ii. The art of constructive skepticism iii. The art of identifying and removing bias, prejudice, and one sidedness of thought iv. The art of clarifying what is to understand and what that person does not know.

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Essentials of Nursing Research For example, if you are engaged in the above arts, you are consciously thinking about your own thoughts and what you say, write, read, or do as well as what others say, write, do, while thinking above all of this, you are questioning the appropriateness of the content, applying standards or criteria, and seeing how things measure up, or thinking about alternative ways of handling the same situation. So, critical thinking is considered a highly rational process and highly emotional, and at time anxiety producing.

Critical Reading Skill and its Process In addition to critical thinking, investigator must use critical reading skill/ to evaluate research articles critically. Critical reading “is an active, intellectually engaging process in which the reader participates in an inner dialogue with the writer. It means entering into a point of view other than our own, the point of view of the writer. A critical reader actively looks for assumptions, key concepts and ideas, reasons and justifications, supporting examples, parallel experiences, and any other structural features of the written text to interpret and assess it accurately and fairly (Paul, 1990). Critical reading is a process that involves various levels or stages of understanding as: • Preliminary understanding • Comprehensive understanding • Analysis understanding • Synthesis understanding. We shall discuss briefly the stages of understanding as follows:

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Preliminary Understanding: It is gained by quickly and lightly reading an article to familiarize with its content or to get a general sense of material. The preliminary reading includes the use of the following strategies: • Highlighting or understanding the main steps of the research process • Making notes on the photocopied article • Writing key variable at the top of the photo copied article • Highlighting or underlining on the photocopy new and unfamiliar terms and significant sentences • Looking up the definitions of new terms and writing them in the margins of the photocopy • Reviewing old and new term before next reading • Writing comments, questions, and notes on the photo copy • Keeping a research text and dictionary by your side. These strategies enable the reader to identify the main theme or idea of the article and bring this knowledge to next stage of reading.

Review of Literature

Comprehensive Understanding It is skilled reading designed to increase understanding of the terms in relation to the context or the parts of the studies in relation to the whole article. Comprehensive reading is facilitated by the following strategies: • Reviewing all unfamiliar terms before reading for the second time • Clarifying any additional sources as necessary • Writing cues, relationships of concepts, and questions on the photo copy • Making another copy of your annotated attitude and requesting that your faculty members read it • Stating the main idea or theme of the article in your own words, in one or two sentences in an index card or on the photo copy. These strategies of comprehensive understanding allow next stage of reading. Analysis Understanding: It is designed to break the content into parts so that each part of the study is understood, the critiquing process begins this stage. The critique is the process of objectively and critically evaluating a research report, content for scientific merit and application to practice, theory, and education. It requires some knowledge of the subject matter and knowledge of how to critically read and how to use critiquing criteria. Critiquing criteria are the measures, standards, evaluation guides, or questions used to judge (critique) a product or behaviour. The reader, in analysing the research report, must evaluate each step of the research process. The reader must ask questions about whether each explanation of a step of the process meets or does not meet these criteria. An understanding gained by reading for analysis is facilitated by the following critiquing strategies: • Being familiar with critiquing strategies • Reaching the comprehensive reading stage before applying critiquing criteria; re-reading, if necessary • Applying the critiquing criteria to each step of the research process in the article • Asking whether the content meets the criteria for each step of the research process • Asking fellowmen to analyse the same study with the same criteria and comparing results • Writing notes on the copy about how each step of the process measures up against the established criteria. Synthesis understanding: Synthesis is the combination of putting together, combining of parts into a whole. The goal of synthesis

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Essentials of Nursing Research understanding is to combine the parts of research study into a whole. During this final state, the reader determines how each step relates to all the steps of the research, how well the study meets the critiquing criteria, and the usefulness of the study for practice. Readings for synthesis is facilitated by the following strategies: Reviewing your notes on the article on how each step of the research process measured up against the established criteria. Briefly summarising the study in your own words including in your summary: i. The components of the study ii. The study’s over all strengths and weaknesses Following the suggested format of: i. Limiting the summary to one page ii. Including the citation at the top of the page iii. Stapling a summary to the top of the photocopied article. This type of summary is viewed as the first draft of a final draft of a final written critique. It teaches brevity, facilitates easy retrieval of data to support your critiquing evaluation and increase your ability to write a scholarly report.

Steps in Review of Literature The preliminary review generally includes three steps: • Identification of important publications-earlier works, reports, recent publications-Journals, books MEDLARS, MEDLINC CAT-LINE. • Summarize and record the contents of publication • Comparison of contents–such as theoretical perspective, definitions, research design, methods, instruments, and findings.

How to Review

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1. To select a pertinent books or article from a general review of the literature, examine the book or article quickly. For a book, examine the title page that gives the author credentials, then scan the table of contents, the index, the bibliography, and the charts and table. Read the preface rapidly to determine the author’s purpose; then thumb through the chapters quickly to assess substance. If the book is promising, keep it for a critical review. For an article, examine the author’s credentials, quickly scan the problem statement, and the hypotheses, and then focus on the methods of research used, especially how the sample was selected and the data analysed. Read conclusion and summaries and note the use of theory and other research studies. Retain sound and pertinent literature for summary and critique.

Review of Literature 2. To summarise and record information, first note the author, title of the article, and year of publication. If further information is needed, this immediately refers to the reader to the bibliography card. 3. Record informations from a research report in the following order(s): • Problem statement • Definition of concepts • Hypothesis if any • Theories or assumptions used • Method of research including how samples were drawn • Instruments and scales used • Type of research (description or explanation) • Methods and findings of data analysis • Interpretations of data especially whether hypothesis supported or rejected • Recommendations and suggestions for further research if any • Make special note of implications for nursing practice or theory. 4. Note that data was not included, such as limitations that were not noted, means of establishing the validity and reliability of instruments that was not given, theory that was not used, or former studies that were not examined. Comparison of the recorded summaries of literature enables the researcher to contrast definitions of concepts, uncovered competing theories used to explain the same phenomenon, consider the various designs that have been utilized to study the same problem, examine different methods of data collection, and find valid instruments already developed.

Communicating a Review of Literature The review of literature does not merely summarise findings; it also identifies empirical and theoretical patterns and inconsistencies, interprets earlier literature, and relates earlier literature to one’s own work. Communicating a review of the literature involves consideration of review’s content, organisation of content and style. 1. The content of the review includes the investigator’s recounting and interpretation of the literature that forms the foundation for the current study. Including both theoretical and empirical literature in the review is appropriate. The scope of the review may vary considerably with the type of problem and the space limitation for the review. 2. Initially, organising the review into an outline is helpful. Creating an outline of major concepts areas or major relationships that have special relevance to current study allows the investigator to insert material or each study or theoretical paper at an appropriate point in the review.

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Essentials of Nursing Research In some instances, historical organisations proceeding from earliest to the most contemporary work, is quite effective in illustrating the progression of scientific thought. In other instances, organisation according to specific conceptual or theoretical position is more appropriate. 3. The style of presenting the results of a literature review and analysis will very according to the style requirements for courses, journals, theses and dissertations, and grant proposals. However, each of the styles, required documentation of the citations that support the statements the investigator makes. Example, Reviewed articles writing.

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Theory and Theoretical Framework

6

Theory and Theoretical Framework

Theory is a part of the vocabulary of nurses in all areas. It is an explanation for the inter-relationship among facts, concepts or propositions. It summarises what is known from past work and predicts what will be found on future observation. A theory is a systematic vision of reality that serves a scientific purpose. For example, the theory of gravity helps us to understand body mechanics and positioning. Developmental theories assist in understanding the behaviour of children. A theory consists of words or other symbols that are intended to represent something in the real world. The symbol is not the thing itself, only a label for the object, property or event. The term “systematic” implies that the concepts are organised in an orderly pattern.

DEFINITIONS OF THEORY “A theory” is a statement that purports to account for or characterise some phenomenon” and that it “Pulls out the salient parts of a phenomenon so that one can separate the critical and necessary factors or relationships from the accidental or unessential factors or relationship” (Barnum 1990). “A theory is a set of concepts interrelated to form propositions that are useful for prediction and control.” “A theory is a conceptual system or framework invented for some purposes” (Dickoff and James 1968). “A theory is a set of interrelated constructs (concepts adapted for a scientific purpose), definitions and propositions that present a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting the phenomena” (Kerlinger, 1986). A theory is a “systematic abstraction” means that theory is representation of reality, and purposes include description explanation and prediction of phenomena, and control of some reality. Nursing theory is a set of concepts, depositions, and proposition of phenomena, and control of some reality.

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Essentials of Nursing Research Nursing theory is a set of concepts, depositions, and propositions that project a systematic view of phenomena by designating specific interrelationship among concepts for purposes of describing, explaining, predicting, and/or controlling phenomena (Chinn and Jacob 1983). Nursing theory serves many purposes. Among these purposes are: 1. To develop research propositions 2. To serve as a reservoir for knowledge and research findings 3. To explain observations and predict outcomes 4. To stimulate new directions in practice and in research. There are many theories which are reported in the nursing literature. For example, learning theory, developmental theory, theories of adaptation, stress and homeostasis theory, systems theory, social theories and cultural theories. Learning theory includes theories of conditioning, social learning and cognitive theory. Developmental theory examines changes that occur through time, in the physical, psychological and social structures. Theories of adaptations, stress and homeostasis examine how individuals or groups survive and function in a particular environment. System theory is diverse, focussing at times on behavioural systems and at other times on systems of interaction and communication or adaptation modes. Social theories examine factors that are external to individuals, such as social class, but that affect their life chances and lifestyles. Theories of symbolic interaction, such as Role Theory seek to explain how symbols and meanings establish the rules, roles, roles and images of self and others in daily life. Cultural theories examine how traditional ways of life affect the behaviour, values, beliefs, and perceptions of individuals and groups. The investigator uses theory in research to provide a framework constructed from past ideas, understanding, and research findings, and to provide foundations for the proposed research project, and he/she also uses theory to generate hypothesis. Nursing theory is a source of professional autonomy and power. Theory provides nurses with a sound basis to describe explain, and predict factors that, influence nursing care. The recurrent theme in nursing theory guides nursing education, research, and practice and differentiate nursing practice from other disciplines. In short, theory provides a firm basis for planning and considering our actions and for challenges nursing practice and theory itself. Nursing theory enables nurses to predict outcomes of what they are doing and to explain their selection of patient care approaches.

THEORY CONSTRUCTION

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The development of nursing theory requires a systematic process of inquiry, components of that process include concept analogies, construction of theoretical relationships and practical validation of theory.

Theory and Theoretical Framework The process of theory construction beings with observations. The researcher uses inductive reasoning to order the observations into categories and concepts, and attempts to relate one concepts to the other in a statement the empirical generalisation. From the empirical generalisation, the researcher deduces hypothesis for further testing. As the evidence for relationships between concepts grows, the researcher may use creative abilities to propose a general explanation for the interrelationships that will be found in future observations, forming categories, conceptualisation, and both inductive and deductive reasoning. Jocox (1981) summarises the efforts to develop a theory in following steps: i. Specifying, defining, and classifying the concepts used to describe the phenomena of the field. ii. Developing statements or propositions that propose how two or more concepts are related. iii. Specifying how all of the propositions are related to each other in a systematic manner. In the first step, the emphasis is on concepts. In the second step, the emphasis is on the propositions and in the third step the propositions are related to one another. Nursing research is intricately related to theory development Dickoff and James (1968) suggest that a theory is a mental invention for some purpose-to describe, predict or prescribe. They identified your levels of theory based on the level of existing Knowledge about a phenomenon. These levels can be used to direct an investigator towards the appropriate level of research question for a given study and provide guidance for the design, method, and analysis appropriate to answer the research questions. These levels of theory are: • Factor-isolating theory—What is this? • Factor-relating theory—What is happening here? • Situation-producing themes—What will happen if? • Situation-producing themes—How can I make ‘X’ happen? The brief description of these levels are as follows: Factor-isolating theory is the first/lowest level of theory construction but also the most basic. It is descriptive or concept naming theory of focuses on identification and classification of concepts. The ability to name and to describe the concepts of interest is prerequisite for all subsequent levels of theory. Naming theory puts observation into named categories and includes both the name and phenomenon and its description, e.g. Nursing diagnosis. Here, researcher asks question what is this?

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Essentials of Nursing Research Factor-relating theory is the second level of theory. It relates the named concepts to one another. This is also the same level as the construction of empirical generalisations–a statement that proposes the relationship between two concepts. The researcher is interested in finding out ‘what is happening here’? Situation-relating theory is the third level of theory. It explains the interrelationships among concepts or propositions. Once such explanations have been formulated, predictive statements, or hypothesis may be deduced. The hypothesis, may predict causation or correlation. Here researcher attempts to what will happen if? He asks the question. Situation-producing theory is the fourth level of theory. It prescribes the activities necessary to reach defined goals. These theories involve the practical validation of a theory. Because action is directed towards a specific end, situation-producing theories. A prescriptive nursing theory includes what the nurse must do to bring about certain desired goals. The question concerned is “How can I make ‘X’ happen? and used to prescribe nursing activity.

THEORETICAL FRAMEWORK

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A theoretical framework is analogous to the frame of a house. Just as the foundations supports a house, a theoretical framework provides a rationale for predictions about relationship among variables in the research study. It is also a frame of reference that is a base for observations, definitions of concepts, research designs, interpretations and generalisations, much as the frame that rests on a foundation defines the over all design of a house. Finally, theoretical framework serves as a guide to systematically identifying logical, precisely defined relationship among variables. A theoretical rationale provides a road map or context for examining problems and developing and testing hypothesis. It gives meaning to the problem and study findings by summarising existing knowledge in the field of inquiry and identifying linkages among concepts. When developing a theoretical framework for nursing research studies, knowledge is acquired through two approaches. Either it is developed primarily in disciplines other than nursing and borrowed for the purpose of answering nursing questions or it is derived by asking questions about phenomenon that are unique to nursing. The contribution made by using borrowed theories are most appropriate when data is related specifically to nursing. Theories unique to nursing help is define how it is different from other disciplines. Nursing theories refine particular views of the person, health and other concepts that contribute to the development of a body of knowledge specific to nursing’s concerns.

Theory and Theoretical Framework Nursing theory “is an articulated and communicated conceptualisation of invented or discovered reality (Central phenomena and relationships) in or pertaining to nursing for the purpose of describing, explaining, predicting or prescribing nursing care” (Meleis 1991). The primary use of theory is to guide research. Through interactions, with practice guidelines for practice will evolve. Research validates and modifies theory. Theory then guides practice. Fawcett (1989) defines ‘Nursing theory’ as “a relatively specific and concrete set of concepts and propositions that purports to account for or characterise phenomena of interest to the discipline of nursing.” The central phenomena of interest (concern) to nursing are persons, their environment, their health and nursing itself. Therefore, theories that deal with these phenomena are termed nursing theories. There are several well-known nursing theorists, whose conceptual models have served as a basis, for theory development, e.g. Rogers, King, Orem, Newman, Johnson, Roy etc. (For details of source of knowledge please read author’s text “Nursing Theories”).

CONSTRUCTION OF THEORETICAL FRAMEWORK The theoretical framework for research study presents the reasoning on which the purposes of the proposed study are based. The framework provides the prospective from which the investigator views the problem and is not merely “restatement of previous research but an integration of the existing theoretical traditions and knowledge about the topic.” Theoretical framework consists of concepts and the propositions about how these concepts are related. The framework serves three important functions in nursing research. • It clarifies the concepts on which the study is built • It identifies and states the assumptions, hypotheses underlying study • It specifies relationship among the concepts. Writing a framework requires that the investigator exercises creativity in identifying concepts and specifying relationship. The concepts that forms the basis of the study are clarified so that others will be able to understand the study from the same frame of references as the investigator. The framework set forth the state of the science in the problem area and identifies whether the phenomena still needs description, to whether connections between concepts need to be made, or whether knowledge is needed about how to produce desired outcomes. The purpose of the study is dictated by the framework, which has indicated the current level of knowledge about the phenomenon of interest. (Note: For more details please read another title on “Nursing Research” 2nd Edition)

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Essentials of Nursing Research

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Research Problem

One of the most difficult phases of any research project is the choice of suitable problem. The beginner is likely to take a very long time in making his choice. The identification of a good research problem should be considered a discovery in itself; it is a researcher’s perception or recognition of a problem that motivates research. The problem exists when we do not have enough information to answer a question. This may happen: i. When there is a noticeable gap in the results of investigations. ii. When the results of several enquiries disagree iii. When a fact exists in the form a bit of unexplained information iv. When there is desire for an innovation.

IDENTIFICATION OF RESEARCH PROBLEMS Wilson says, “Many scientists owe their greatness not to their skill in solving problems should strongly interest the investigator. The research problem for the study involves an implicit or explicit question that reminds the research what answers are sought. The words “question” and “quest” are derived from the Latin word “queerer,” which means “to seek.” We continually pose questions in our personal lives and our work. Identifying problems for nursing research is a fundamental first step in the research process, and often it is difficult and challenging. Taking time to think creatively about particular interests and discussing research ideas with another researcher helps to clarify interests and generate ideas about the researchablility of the problem. The process of identification of problems for academic research may consist of the following steps.

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Selection of the discipline: The discipline or subject in which one proposes to do research may be selected, e.g. medical, nursing, pharmacy, psychology etc. the selection of the discipline is easy. One can select any subject, which one has studied thoroughly and which has interested

Research Problem him most. Where one has to do research in his field of specialization (Medical Surgical Nursing, Community Health Nursing, Pediatric Nursing, Psychiatric Nursing, Midwifery, Reproductive Health Nursing, Nursing Education and Nursing Administration) one has to choose the subject of one’s own specialization or interest according needs of the society or community. Previous research: The critical appraisal of research studies that appear in journals may indirectly suggest problem area by stimulating the readers thinking. The organized body of nursing knowledge contains information about previous research. The investigator may have read something that did not make sense or work as predicted. A nurse may have read variety of studies and wonder which findings are most valid. For example, studies related to cost effectiveness. A research idea may also be suggested by a critical appraisal of the literature that identifies gaps in the literature and suggest areas for future study. Research ideas can also be generated by research reports, that suggests the value of replicating a particular study to extend or refine the existing scientific knowledge base, e.g. KAP studies related to nursing field. A research reports are read, the nurse researcher may think of an alternative explanation for the research findings and wish to test this idea. Previous research may have been done with a small sample or a sample that was homogenous in terms of certain participant characteristics. The investigator may wonder if the findings will hold up with larger, more heterogeneous groups. Popular conceptions: While taking care of health, certain traditional practices have been practiced according to their cultural belief or certain old practices of the new world. To test these practices, researcher may get an idea for conducting study. These researchers challenged a popular belief and found evidence that contraindicate the belief. Numerous beliefs guide nursing practice, and they need to be examined through research. Empirical interest: The sudden insight, which may arise from seeing things in a different way, is another source of research problems. Sudden awareness of something that has not been noticed before is another source of nursing research. (Curiosity about every day clinical practice is a rich source for nursing research). Practical needs: Clinical practice provides a wealth of experience from which research problems can be derived. The nurse may observe the occurrence of particular event or pattern and become curious about why it occurs as well as its relationships to other factors, in the client/patient

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Essentials of Nursing Research environment. For example, OPD patients on treatment getting severe dispend (may be due to anxiety). And in clinical area, a nurse may find an ideal answer to any question may be a practical need for nursing may be source for research problem. Political concerns: The political climate, which places emphasis on constraining health-care cost, cause and effect of treatment of diseases and improving the standards of health, and implementation of vertical health programmers, has provided many avenues for research. Priorities: There are so many problems emerging in providing health care services to reach the preserved people. Various groups, within nursing have identified priorities for nursing research that if followed could result in the creation of knowledge that nurses need to care for future generations. The lists of priorities can serve as a source of research problems for the nurse investigator. Another source of priorities for research emanates from the agencies that provide regarding how its money will be spent, an agency may generate formal lists of priorities for a given period, a special emphasis for funding by the agency or organization or a special call for proposals that responds to a particular research need. Priorities for nursing research also have been set for some nursing specialty areas, e.g. Nursing Service, Nursing Administration, Nursing Education, Medical surgical Nursing, Pediatric Nursing, Psychiatric Nursing, Community Health Nursing etc. Interested in untested theory: Verification of an untested nursing theory provides a relatively uncharted territory from which research problems can be derived. In as much as theories themselves are not tested, a researcher may think about investigating particular concepts related to a particular nursing theory. The deductive process would be used to generate the research problem. The researcher would pose questions such as “If the theory is correct, what kind of behaviour would I expect to observe in particular patients and under which conditions? “Or” If this theory is valid, what kind of supporting evidence would I find?”

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Interest of professional organization: Researchable problems also are generated by professional organization priorities and quality, improvement issues. An example, such organization will include Trained Nurses association of India Government Nurses Association of Karnataka and others. The sources from which one may be able to identify research problems or develop problem awareness are.

Research Problem 1. Reading: When we critically study books and articles relating to the subject of our interest, pertinent questions may arise in our mind. Similarly, areas of research may strike to our mind when we read research reports. 2. Academic experience: Classroom lectures, class discussions. Seminar discussions and out-of-class exchanges of ideas with fellow students and professors will suggest many stimulating problems to be studied. 3. Daily experience: Life is dynamic. We learn new things and undergo new experiences every day. If we are alert, inquisitive and sensitive to life situations, we may hit upon questions worth of investigation, “It is a mark of scientific genius to be sensitive to difficulties where less gifted people pass untroubled: Law of Gravitation.” The story about Newton justifies to this. Though apples might have fallen on the heads of people before Newton’s time, only the sensitive Newton applied his mind on this event which led to the discovery of “Law of Gravitation.” 4. Exposure to field situations: Field visits, internship training and extension work provide exposure to practical problems which call for study. 5. Consultations: Field visits, researchers, administrators and business executives will help a researcher to identify meaningful problems for research. 6. Brain storming: Intensified discussion within a group of interested persons may often be a means of identifying pertinent questions, and of developing new ideas about a problem. 7. Research: Research on one problem may suggest problems for further research. 8. Intuition: Sometimes new ideas may strike to one’s mind like a flash. Reflective mind is a spring of knowledge.

Selection of a Problem and its Criteria The selection of a problem in a scientific investigation frequently is an arduous task, particularly for neophyte researchers. It is important that the first step in the research process not be hurried. Many hours will be devoted to investigating the problem that is selected and the time will be more profitably spent if the researcher is devoting his/her efforts to a problem that is of real interest. The identification of researchable problem is not an easy matter, but it is crucial one. It is simply not possible to proceed in an orderly, intelligent fashion on a research project unless a clear nation of the problem has been developed. For example, doctor will not advise medication or to perform surgery without under standing the ailment. So, the researcher alone should not attempt to solve research problem until it has been stated in a concise and unambiguous form.

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Criteria of Problem Selection

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Every problem selected for research must satisfy the following criteria: • Originality: While selecting a problem novelty should be maintained. The purpose of research is to fill the gaps in existing knowledge to discover new facts and not to repeat already known facts. Therefore, preliminary survey of the existing life rapture in the proposed area of research should be carried out to find out the possibility of making original contribution. Knowledge about previous research will serve three useful purposes. 1. It will enable the researcher to identity his specific problem for research 2. It will eliminate the possibility of unnecessary duplication of effort, and 3. It will give him valuable information on the merits and demerits of various research techniques which have been used in the past. • Neither general nor specific: If the problem is very general, it is usually to vague to be tested. On the other hand, if the problem is very specific it is usually too narrow to be important or consequential. Too great specificity is perhaps a worse danger than too great generality. At any rate some kind of compromise must be made between generality and specificity. • Significance while selecting a problem for the study researchers should pose the following kind of questions: - Is the problem important one? - Will client, nurses or medical community benefits out of study? - Will the results lead to practical implications? - Will the findings challenge (or lend support to) untested assumptions? - Will the study help to formulate or alter nursing practices or policies? It should be significant enough and involve an important principle or practice. It should add to the development of nursing. Although the problem statement is not yet its final form, the reader can envision the interrelatedness of the initial definition of the problem area the literature review and the refined problem statement. The person reading a research report examines the end product of this formulation process and thus should have an appreciation of this time-consuming effort. Before proceeding to a final formulation of the problem statement, it is crucial for the researcher to have examined the problem’s potential significance to nursing. The research problem should have the potential for contributing to and extending the scientific body of nursing

Research Problem knowledge. The problem does not have to be of prize-winning caliber to be significant. However, it should meet the following criteria: – Patients, nurses the medical community in general, and society will potentially benefit from the knowledge derived from this study. – The results will be applicable for nursing practice, education, or administration. – The results will be theoretically relevant. – The findings will lend support to untested theoretical assumptions, expend or challenge an existing theory, or clarity a conflict in the literature. – The findings will potentially formulate or alter nursing practices or policies. If the research problem has not met any of these criteria, it is wise to extensively revise the problem statement the significance of the problem includes the following facts: – The number of elderly in the population wills more than double in the next 40 years. – A decline in federally funded programs for the elderly will place further demands on families for care giving responsibilities. – The toll of car giving on families can be high. • Previous research studies have been largely exploratory and theoretical, which makes it difficult to draw conclusions. • Feasibility: The feasibility of a research problem needs to be pragmatically examined. Regardless of how significant or researchable a problem may be, pragmatic considerations such as time, the availability of subjects, facilities, equipment and money; the experience of the researcher; and any ethical considerations may cause the researcher to decide that the problem is inappropriate because it lacks feasibility. The feasibility of carrying out research on the selected problem should be checked against the following considerations: 1. Study design. 2. Access to organizations and respondents. 3. Sample or universe to be studied. 4. Source of data–ensure availability of valid and reliable data gathering devices and procedures. 5. Method of collecting data–availability of co-operation, guidance and other facilities. 6. Type of variables (nominal/ordinal) involved. 7. Selection of scales of measurement and statistics. 8. Character and distribution of variables. • Normal (allowing for parametric statistics) • Non-normal (requiring non-parameter statistics).

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9. Treatment of data-hand calculation, machine calculation or computer. 10. Time required for study and its availability. 11. Issues and feasibility • Time, Timing • Cooperation of others • Facilities and equipment • Money – Literature cost – Personal cost – Subject cost – Supplies – Equipment – Computers – Other service cost • Observation • Skills • Experience of the researches • Ethical considerations. • Suitability: The suitability of the problem for a particular research worker is the matter of the feasibility. He should possess the required competence, knowledge and understanding. He should be skill full enough to develop, administer, and interpret the necessary data gathering devices and procedures. He should be competent enough to carry out all the steps of his project. It should match his special qualification, training and experience. A problem may be a new one and important, but if research on it is not feasible it cannot be selected. Hence, feasibility is a very important consideration. Some of the questions that should be considered in examining the feasibility are: (i) Are suitable research techniques such as measurement devices and techniques of analysis available? (ii) Are accurate and reliable data available? The reliability of the findings depends upon the quality of data. In some cases, available data may be tinged by emotions. Ethnic conflicts, strikes and lockouts, poverty and affluence are examples of topics heavily weighted by emotions. (iii) Will the authorities of the concerned institutions extend the required cooperation in furnishing data or permit access to record? Some organizations like commercial books and partnership concerns and private limited companies do not easily extend cooperation to researcher.

Research Problem (iv) Will the respondents be willing to be interviewed? (v) Can the study be completed within the time available? One the basis of the consideration of the above questions, the feasibility of the problem should be determined. Facilities: Research requires certain facilities such of the problem should make significant contribution to the concerned body of knowledge or to the solution of some significant practical problem must be considered. Usefulness and social relevance: Above all, the study of the problem should make significant contribution to the concerned body of knowledge or to the solution of some significant practical problem. It should be socially relevant. This consideration is particularly important in the case of higher-level academic research and sponsored research. Research personnel: Research undertaken by professors and by research organizations require the services of investigators and research officers. But in India and other developing countries, research has not yet become a prospective profession. Hence, talented persons are not attracted to research projects. Employments in research personnel are not easily available for the study of some problems. Each identified problem must be evaluated in terms of the above internal and external criteria and the most appropriate one may be selected by a research scholar. The overall guideline to be followed in this selection process. Select a feasible and researchable problem which is interesting to you and within your competence and manageable witching the available time and resources and at time same time has some importance and social relevance, and for which required facilities are available. To sum up the selection of one appropriate researchable problem out of the identified problems requires evaluating of those alternatives against certain criteria. These criteria may be grouped into: a. Internal (or personal) criteria or factors, and b. External criteria or factors. Internal criteria consist of (1) researcher’s interest, (2) researcher’s competence, and (3) researcher’s own resource: finance and time. External factors include (1) research ability of the problem, (2) its importance and urgency, (3) novelty of the problem, (4) feasibility, (5) usefulness and social relevance, and (7) research personnel. Researcher’s interest: The problem should interest the researcher and be a challenge to him. Without interest and curiosity, he may not develop sustained perseverance. Even a small difficulty may become and excuse for discontinuing the study.

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Essentials of Nursing Research Interest in a problem depends upon the researcher ’s educational background, experience, outlook and sensitivity. Researcher’s competence: A mere interest in a problem will not do. The researcher must be competent to plan and carry out a study of the problem. He must have the ability to grasp and deal with it. He must possess adequate knowledge of the subject matter, relevant methodology and statistical procedures. Researcher’s own resources: In the case of a research to be done by a researcher on his own, consideration of his own financial resource is pertinent. Does the cost involved in conducting the study of the problem is within the means of the researcher? If it is beyond his means, he will not be able to complete the work, unless he gets some external financial support. Time resource is more important than finance. Research is a time consuming process. What is the time that the researcher can be able to spare for the research work? Is it adequate to meet the time requirements of the problem? If not, the work cannot be competed within the prescribed time limit. As it is difficult to foresee the eventual time constraint, it is desirable to over-estimate the time requirement and to under-estimate the time availability. In this connection, available titbits of time (say 5 or 10 minutes at a time) should not be counted, as nothing could be done in 5 or 10 minutes, only large chunks of time available should be counted. Research ability: The problem should be researchable, i.e., amenable for finding answers to the questions involved in it through scientific method. “Although every problem in science involves a question or a series of questions, not every question qualifies as a scientific problem.” To blew researchable a question must be one for which observation or other data collection in the real world can provide a question must be one for which observation or other data collection in the real world can provide the answer. Many questions cannot be answered on the value elements, e.g. what is merit for the purpose of employee promotion? What is ‘fairness’ to the workers? Some questions may not be researchable because procedures or techniques are inadequate, e.g., how will a new fiscal policy affect distributive justice? Which new management trainees have potential for top management?

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Importance and urgency: Problems requiring investigation are unlimited, but available research efforts are very much limited. Therefore, in selecting problems, their relative importance and significance should be considered. An important and urgent problem should be given priority over an unimportant one. For example, in industrial management today, problems of productivity, capacity utilization, motivation and industrial unrest are more important than problems of productivity, capacity utilization,

Research Problem motivation and industrial unrest are more important than problems of financial leverage, profit planning, vertical/horizontal integration, marketing etc. Research must be focused on useful and urgent problems. Novelty or originality: The problem must have novelty. There is no use of wasting one’s time and energy on a problem already studied thoroughly by others. This does not mean that replication is always needless. In social sciences in some cases, it is appropriate (repeat) a study in order to verify the validity of its findings to a different situation. Solvability: No problem, however, significant is a good choice if it is unsolvable. Generally problem may be unsolvable due to two reasons which are— 1. It may concern some supernatural of amorphous phenomena. For example, problems such as “How does the mind work? Is it possible to change human nature? Who created this world?” And so forth are unsolvable because the domain to which these problems belong is so amorphous, that is impossible to specify, what the relevant observations would be. The impossibility of obtaining relevant data renders the problems unsolvable. 2. It cannot be operationally defined. An operational definition of a problem specifies the activities or ‘operations’ the investigator must perform in order to measure it. Essentially, and operational definition is one that indicates that certain phenomenon exists and does so by specifying precisely how the phenomenon measured. Interesting: The problem should be interesting for the investigator himself. If he is not interested in it, he will not be able to face and overcome the obstacles which come at every step join research. She/he should have strong inherent motivation for it. His/her interest should be purely intellectual and should not be there only for a reward, material benefit, and advancement in position, increased authority, and so forth. The courage and confidence also needed for selecting the problem. Experience and creativity: Good research problems stem from clear understanding of the theoretical, empirical and practical aspects of the subjects derived from personal experience, and from a thorough review of the literature. Conversely, lack of familiarity with the subject is almost sure to result in a poor choice. Another major contributor to the wise choice of problem is creativity and other personality factors that make for originality flexibility, initiative, ingenuity and foresight. Thorough familiarity with a given field is conducive to original thinking.

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Formulation of the Selected Problem

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The problem selected for research may initially be vague. The question to be studied or the problem to be solved may not be clear. Why the answer/ solution is wanted also may not be known. Hence, the selected problem should be defined and formulated. This is a difficult process. It requires intensive reading of a few selected articles or chapters in books in order to understand the nature of the selected problem. The reading at this stage should be focused on the ‘classic’ and research papers on the topic. He should read such selected literatures, digest think and reflect upon what is read and digested. He should also discuss with learned persons. Then only can he gain insight into the chosen problem and be able to define and formulate it. Formulation means translating and transforming the selected research problem/topic into a scientifically researchable question. It is concerned with specifying exactly what the research problem is and why is it studied. The formulation should include both the and the why aspects. Merton identifies three principal components in the progressive formulation of a problem for research. 1. The originating questions (what one wants to know?). 2. The rationale (why aspects). 3. The specifying questions (possible answers to the originating questions). • The originating question: It indicates what the problem is. It may be of different kinds. It may call for discovering new and more decisive facts relating to the subject-matter of study: it may put to question the adequacy of certain concepts may be related to empirical validity; or it may be related to the structure of an organization. • Rationale of the question: Rationale is the statement of reasons why a particular question is posed. It states how the answer to the question will contribute to theory and or practice. The rationale helps to make discrimination between scientifically important and trivial question. In short, it states the case for the question in the court of scientific opinion. • Specifying question: The originating question is decodes into several specific questions in order to identify the observations/data that will provide answer to them. These specific questions should be simple, pointed, clear and empirically verifiable. They are known as ‘investigative’ questions. It is only such specific questions which when synthesized can afford the solution to the problem selected for research. This solution has implications for theory/systematic knowledge and/or for practice.

Research Problem

Formulation Process The process of formulation involves the following steps: 1. Developing title: The title should the carefully worded. It should indicate the core of the study, reflect the real intention of the researcher and show on what is the focus. Title also indicates the setting of the study. 2. Constructing a conceptual / theoretical model: On the basis of theoretical knowledge, of the phenomenon under study, the nature of the phenomenon, its properties/elements and their relations should be identified and structured into a framework. This conceptual or theoretical model gives an exact idea of the research problem and shows various properties and variables to be studied. It serves as a basis for formulation of the objectives of the study and the hypothesis to be tested. In order to workout a conceptual model, researcher must make a careful and critical study of the available literate on the subject matter of the selected research problem. It is for this reason, a researcher is expected to select a problem of research in his/her field of specialization without the adequate background knowledge, a researcher cannot group and comprehend the nature of the research problem. 3. Defining objectives of study: The objectives refer to the questions to be answered through the study. They indicate what researcher trying to got from the study. They are short statements of outcome of the study. They are derived from the conceptual model. They state which elements in the conceptual model – which levels of, which kinds of cases, which properties, and which connections among the properties are to the investigated, but it is the conceptual model that defines, describes and states the assumptions underlying the elements. The objectives way aim at description or explanation or analysis of casual relationships below variable and indicate in respected results or outcomes of the study. They may be specified in the form of either statements or questions as follows: 1. Title of the research problem: Assess the knowledge of staff nurses regarding management of pain among cancer patients working in cancer words of Victoria Hospital, Bangalore with a view to develop information guide sheet. 2. Objectives of the study: In a statement form: The objectives of the study are: a. To assess the knowledge of staff nurses regarding management of pain among cancer patients.

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b. To determine the association between knowledge of staff nurses with selected variables. c. To develop information guide sheet regarding management of pain among cancer patients (while stating objective “To” may be dropped). The objectives may be stated in question form as under: The study aims at seeking answers to the following questions: a. What are the existing knowledge of staff nurses regarding management of pain among cancer patients? b. What are the association between knowledge of staff nurses with selected variables? c. What strategy to adapt for management of pain among cancer patients? The successful research will provide answers to these questions. 4. Setting investigative questions: Once the objectives of the research/ or the general research questions have been defined, the formulation moves to the next level, i.e. investigative questions. These subquestions are set-up for each of the major research objectives/ questions. These specific questions guide the details of the research efforts, including the development of concepts, operational definitions and measurement devices. There may be several sub-levels of the investigative questions each being progressively narrower in scope and more specific. 5. Formulation of hypotheses: The hypotheses are tentative propositions relating to investigative questions. We formulate them to be tested in our research. They either described the properties of variables or show the relationships between them. They aim at answering the research questions. They determine what facts will be sought and what research procedures will be used. 6. Operational definitions of concepts: The next step in the formulation process is to define operationally the concepts involved in the title, objectives, investigative questions and hypotheses. The operational definitions specify the measuring abstract concepts. The operational definitions of concepts and measurement devices enable us to decide exactly the data needs of research. 7. Delimiting the scope of the study: This means demarcation of the scope and dimensions of the study. A complete study of any phenomenon is well-nigh unmanageable. It would entail such an overwhelmingly large volume of data that it would require more than a student’s life time to gain a glimpse of the phenomenon. A beginner is especially over-ambitious. He is tempted to cover too wide a scope without knowing its complexities. For example, a student

Research Problem may propose to study the problem of unemployment in his state for his final term project. Can it be possible to complete this study on his own within a period of three months? The problem is complex and it is related to various categories of occupational groups. It covers sea earl aspects: extent, causes, impacts and remedial measures. Data has to be collected from government institutions and individuals. Even a sample survey may require a large staff of field investigators. And so on. Therefore, a research should take a close view of the implications and dimensions of the selected problem and keep the scope of its study within manageable limits, i.e. within the ability of the mind to grasp the implications and within the amount of time and other resources available. The various aspects that may be delimited are: 1. The objectives to the study, i.e., the number and extent of questions to be investigated: 2. The geographical area to be covered by the study, say, a state, a districts a taluk, a city or a village: 3. The reference period; and 4. The magnitude of the study; the universe to be covered; the types of sampling units to be studied; and the sample size. The delimitation can be done from the standpoint of: 1. Aims and interests of the research worker or the sponsor, as the case may be, 2. Availability of relevant information, 3. Complexity of theoretical basis of the study, 4. The extent and scope of previous research done in the field, 5. The amount of finance, and time available, and 6. The quantity and extent of personnel, tools, techniques and other facilities available. The consideration of all these factors is to bring down the scope and dimensions of the study to a manageable level and yet to make it useful and meaningful.

Statement of the Problem A formal problem statement is not included in most current research articles. They are, however, used in developing grant proposals, theses, and dissertations when greater detail is required. Used more commonly in articles is statement of purpose, usually stated in the introductory paragraph or at the beginning or ended of the literature review section. As such, it is important for the research consumer to be clear about the difference between these two components of the research process. As stated earlier, a research problem is a question for which an answer is to be described, explained, or predicted. It is a brief statement of

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Essentials of Nursing Research relationships among variables. Downs (1993) highlights the importance of including a statement of the relationships the researcher hopes to establish. Presenting this information early in the article facilitates getting to the point of the study by allowing the researcher, now an author, to produce a diagram of the points that need to be addressed in the article. The problem is associated with the purpose of the study, but it is not identical. The purpose of the study encompasses the aims or goals the investigator hopes to achieve with the research, not the problem to be solved. For example, a nurse working with rehabilitation patients with bladder dysfunction may be distorted by the high incidence of urinary tract infections. The nurse is proposing the following research question. “What is the optimum frequency of changing urinary drainage bags in patients with bladder dysfunction to reduce the incidence of urinary tract infection?” If this nurse were to design a study, its purpose might be to determine on the incidence of urinary tract infections in patients with bladder dysfunction. A problem may be written in interrogative form as illustrated in Table 7.1 or in declarative form as illustrated in Table 7.2. Both are acceptable formats. The style chosen is largely a function of the researcher’s preference. A good problem statement exhibits the following four characteristics: • It clearly and unambiguously identifies the variables under consideration. • It clearly expresses the variables’ relationship to each other. • It specifies the nature of the population being studied. • It implies the possibility of empirical testing. Because each of these elements is crucial to the formulation of a Table 7.1: Problem statements in interrogative form Research Focus

Problem Statement

Factors that influence adaptation of preadolescents and adolescents with diabetes.

What are the influences of age, coping behaviour, and self-care on psychological, social, and physiological adaptation in preadolescents and adolescents with insulin-dependent diabetes mellitus.

Effect of therapy on cognitive What is the effect of group therapy on cognitive functioning and depression in functioning and depression in elderly nursing elderly nursing home residents. home residents.

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Spiritual health, coping responses, and devastating physical illness.

What role does spiritual health play in the coping residents of patients to devastating physical illness.

Research Problem Table 7.2: Problem statements in declarative form Research Focus

Problem Statement

Effect of relaxation on anxiety and dyspnea in patients with COPD

This study investigates the effects of relaxation anxiety and dispend in patients with COPD.

Comparison of anxiety symptomatology among Cambodian refugee adolescents before and after resettlement in the United States

Anxiety symptomatology in Pakistan refugee adolescents before and after settlement in the India had not been compared.

Effect of heart transplantation on psychosocial functioning

The study examines the effect of heart transplantation of psychosocial functioning.

satisfactory problem statement, the criteria will be discussed in greater detail. Researchers call the properties that they study variables. Such properties take on different values. Thus a variable is, as the name suggests, something that varies. Properties that differ from each other, such as age, weight, height, religion, and ethnicity, are examples of variables. Researchers attempt to understand how and why differences in one variable are related to differences in another variable. For example, a researcher may be concerned about the variable of pain in postoperative amount of pain/ a researcher may also be interested in what other factors can be linked to postoperative pain. It has been discovered that anxiety is associated with pain. Thus anxiety is also a variable, since not all postoperative patients have anxiety or the same amount of anxiety. When speaking of relationship between variables, the researcher is essentially asking, “Is X related to Y? What is the effect of X on Y? How are X1 and X2 related to Y?” The researcher is asking a question about the relationship between one or more independent variables and a dependent variable. An independent variable, usually symbolized by X, is the variable that has the presumed effect on the dependent variable. In experimental research studies the independent variable is manipulated by the researcher. For example, a nurse I.M. study how different intramuscular injections sites affect the patient’s perception of pain. The researcher may manipulate the independent variable–intramuscular injection sites– by using different injection sites. In no experimental research the independent variable is not manipulated and is assumed to have accrued naturally before or during the study. For example, the researcher may be studying the relationship between the level of anxiety and the perception of pain. The independent variable-the level of anxiety-is not manipulated;

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Essentials of Nursing Research it is just presumed to occur and is observed and measured as it naturally happens. The dependent variable, represented by Y, is often referred to as the consequence or the presumed effect that varies with a change in the independent variable. The dependent variable is not manipulated. It is observed and assumed to vary with changes in the independent variable. Predictions are made from the independent variable to the dependent variable. It is the dependent variable that the researcher is interested in understanding, explaining, or predicting.

Examples of Purpose Statements

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• The purpose of this research was to describe and analyze the relationships among health-promoting behaviour, perceived current health status, and life satisfaction in older black adults. • The aim of the present study was to evaluate quantitatively the effect of hear transplantation on psychosocial functioning by comparing post-transplantation with pretransplantation functioning. • The purpose of this study was to evaluate three subcutaneous injection sites for low-dose heparin therapy. • The goal of this study was to determine (1) the incidence of IV site symptoms and (2) the patient and practice factors associated with the development of these symptoms (Bostrum-Ezrati, Dibble, and Rizzuto 1990). Some examples of topics and problem statement related to nursing research have given in Table 7.3. Reports that provide a precise and unambiguous problem statement not only communicate to the reader the nature of the problem itself, but also demonstrate that the researcher had the problems sharply in focus in the design and conduct of the study. A critique of the research problem involves multiple dimensions. The first dimension is of a substantive or theoretical nature. That is, the reviewer must consider whether the substance of the problem has merit for a research investigation. The research statement should flow from a firm knowledge base (that is, from an understanding of previous research or from nursing experience). Or from a theory relevant to nursing. The study’s relevance to the advancement of nursing knowledge, practice, and theory also need to be carefully evaluated. The second dimension concerns methodological issues. Here the critique must focus on whether the problem statement has been proudly stated, whether the key terms have been adequately defined, and whether the problem is researchable. Other dimensions that need to be considered

Research Problem Table 7.3: Example of problem statement for nursing research General Topic

Formal Problem Statement

Early discharge

Is early discharge for hemorrhoidectomy patients related to postoperative problems?

Chloasma gravidarum

Are women who have chloasma gravidarum more likely to have premature infants than those who do not?

Bladder catheterisation

Is there a relationship between bladder catheterization and urinary infection in patients?

Decubitus ulcers

Is there a relationship between bladder catheterization and urinary comatose patients and the frequency of turning?

Blood pressure variations

Are month-to-month blood pressure variations predictive of cerebral vascular accidents in the elderly?

Effects of visitors

Do hospitalized patients who have daily visitors express fewer somatic complaints than patients without daily visitors?

Attitudes towards the mentally ill

Are nurses ‘attitudes toward the mentally ill related to the nurses’ length of experience in working with them?

Nursing diagnosis

Do nursing diagnoses for surgical patients differ from those for medical patients?

Malparctice risks

How aware are nurses of their malpractice liabilities?

Children’s adjustment to hospitalization

Do children who are instructed about pain adjust better to hospitalisation than those who are not?

concern ethical, stylistic, and practical issues. Guidelines for critiquing all of these dimensions of the research problem are listed below.

Evaluating a Research Problem Research problems or topics are not pulled from thin air. Research problems should indicate that practical experience, a critical appraisal of the scientific literature, or interest in untested theory has provided the basis for the generation of a research idea. The problem statement should reflect a refinement of the researcher’s initial thinking, which includes defining the problem area, beginning the literature review significance of the problem and feasibility. Defining the problem area: The research problem is refined through a process that proceeds from identification of general idea of interest to the definition of a more specific and circumscribed topic.

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Essentials of Nursing Research Literature review: A preliminary literature review reveals related factors that appear critical to the research topic of interest and aids in further definition of the research problem. Significance: The significance of the research problem must be identified in terms of its potential contribution to clients, nurses, the medical community in general and society. Applicability of the problem for nursing practice, education administration as well as its theoretical relevance must be established. The finding should also have the potential for formulating or altering nursing practice or policies. Feasibility: The feasibility of research problem must be examined in the light of pragmatic considerations such as time, availability of subjects, money, facilities and equipment, experience of the research and ethical issues. Research ability: The problem must be researchable, that is it must be capable of being empirically investigated. A philosophical question or an issue of a moral or ethical nature is not amenable to scientific investigation. For example, leprosy is the result of curse or punishment of God.

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Hypotheses

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Hypotheses

The scientific method utilises a hypothesis on a technique of answering a problem. The solution (hypothesis) is then tested by collecting empirical data, i.e. a hypothesis can be put into some observable (empirical) investigations, and if the hypothesis borne out or found to be true, then we can say that hypothesis is accepted. The hypothesis is the most important mental tool the research has. He can make use of the hypothesis to suggest new explorations and observations. Most important of all, he can use the hypothesis to help interpret significance of an obscure event. Hypothesis can be used as tools to uncover new facts rather than as ends in themselves. In research, after defining the problem, the next step is to be followed is to formulate a tentative explanation of that problem in the form of proposition. This tentative explanation, the validity of which is still to be tested is called the hypothesis. A hypothesis is an assumption statement about the relationship between two or more variable that suggest an answer to the research question. It is a tentative prediction or explanation of the relationship between two variables. Actually hypothesis translates the problem statement into a precise, unambiguous prediction of expected outcomes. In other words, hypothesis converts the question posed by the research problem into a declarative statement that predicts an expected outcome. It is an important and integral component of the modern scientific approach. However, it is not absolutely necessary to have hypothesis in order to carry-out a research study, but it does serve a purpose. The formulation of hypothesis or propositions as to the possible answers to the research questions is an important step in the process of formulation of the research problem. Keen observation, creative thinking, hunch, wit, imagination, vision, insight and sound judgement are of greater importance in setting up reasonable hypothesis. A thorough knowledge about the phenomenon and related fields is of great value in its process.

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Essentials of Nursing Research The formulation of hypothesis plays an important part in the growth of knowledge in every science.

Meaning of Hypothesis

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Hypothesis is a tentative proposition formulated for empirical testing. It is a declarative statement combining concepts. It is a tentative answer to a research question. It is tentative, because its veracity can be evaluated only after it has been tested empirically. Lundberg defines hypothesis as “a tentative generalization, the validity of which remains to be tested”. Goode and Hatt define it as “a proposition which can be put to a test to determine its validity.” It is true that hypothesis are useful and they guide the research process in the proper direction. But can hypothesis be set up in all cases? In mere fact-finding investigations, no problems may be raised and the need for formulating hypotheses may not arise. Similarly, in exploratory studies, initially it may not be possible to set up any worthwhile hypothesis. In fact, the very purpose of such exploratory studies may be to formulate meaningful hypothesis for further formal studies. But strictly speaking, the mere fact-finding and the exploratory studies cannot be considered to be typical research studies. In all analytical and experimental studies, hypothesis should be set up in order to give a proper direction to them. A hypothesis is a prediction (FN Kerlinger). It says that if ‘X’ occurs, ‘Y’ will also occur, i.e. ‘Y’ is predicted from ‘X’. If this ‘X’ is made to occur (vary) and it is observed that ‘Y’ also occurs (varies concomitantly) then hypothesis is confirmed. It should, however, be remembered that the formulation of hypothesis, though advisable, is not absolutely necessary in all types of studies, it is least crucial where the study is exploratory in nature. But it is a must where the study is experimental in nature. A hypothesis serves an important function. It narrows the field of research to one or two elements. It identifies in measurable terms, what the researcher believes to be the cause and effect of a given situation. Usually, a hypothesis is a statement of relationship between two phenomena or variables. Normally, in a hypothesis, there is a dependent and an independent variable. The independent variable (IV) is considered cause and comes first. It is prior to the dependent variable (DV). The dependent variable depends upon and occurs after the independent variable. Thus, the independent variable is the cause and the dependent variable is the effect. Usually then, a hypothesis states some type of relationship between and IV and DV.

Hypotheses

Purposes of Hypotheses Hypotheses are formulated before the study is actually conducted, because they provide direction for the collection, analysis and interpretation of data. The purpose of hypotheses is as follows: 1. It provides bridge between before theory and reality and in this sense unifying the two domains. 2. It provides powerful tool, for the advancement of knowledge since they enable the researcher to objectively enter new areas of discovery. 3. It provides direction for any research endeavour by tentatively identifying the anticipated outcome. 4. It is a guide to the thinking process and the process of discovery. 5. It serves as a framework for drawing conclusions.

Role Hypotheses in Nursing Research In social science research, a hypothesis serves several important functions. 1. A hypothesis gives a definite to the investigation, and it guides the direction on the study. Without a hypothesis, research becomes unfocussed, a random empirical wandering. The researcher would get stranded in a cross road, not knowing the direction in which to proceed. A hypothesis, thus, directs our search for the order among facts. 2. A hypothesis specifies the sources of data, which shall be studied, and in what context they shall be studied. 3. It determines the data needs. It defines which facts are relevant and which are not. The use of hypothesis thus prevents a blind search and indiscriminate gathering of data, which may later found to be irrelevant to the problem under study. 4. A hypothesis suggests which type of research is likely to be most appropriate. 5. It determines the most appropriate technique of analysis. 6. A hypothesis contributes to the development of theory. It links theory and investigation. A hypothesis may be deduced from theory. When it is tested through studies and found true, it forms part of the theory. When a social scientist develops a theory to explain a phenomenon, he does not test the theory directly. He tests the hypotheses derived from it. If the tests confirm the hypotheses, the theory is accepted. Thus, hypotheses make it possible to test theories. Occasionally, the reverse process takes place. Theory may be constructed from hypotheses. The above point may be clear, if illustrated. Let us take the hypothesis: “Families with higher income spend more on recreation.”

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Essentials of Nursing Research This shows that families belonging to the various strata of the people in a place have to be studied and their family income and expenses have to be studied. What is relevant is the total income and proportion of expenses on recreation. As this hypothesis describes the relation between two variables, viz. income level and recreation expenditure, it is clear that appropriate research design should be used for testing it.

ADVANTAGES OF HYPOTHESES A hypothesis has the following advantages and disadvantages: 1. Hypothesis builds researches confidence in his results. The researcher, who hypotheses a relation in advance gives the facts a chance to prove or disprove anything. Like a player in game of chance, the researcher also first makes his bet and then waits for the result to confirm or disconfirm his bet. This is more powerful evidence than simple waiting without betting. 2. Sound hypothesis gives direction to the inquiry. Hypothesis helps in delimiting and singling out pertinent facts, and in determining which fact may be included and which omitted. The use of hypothesis thus prevents a blind research and indiscriminate gathering of heaps of data, which may later prove irrelevant to the problem under study. Without hypothesis our research is illusory for, we do not know what specific facts to look for and cannot recognise what is relevant to the inquiry. 3. A good hypothesis enriches theory. After hypothesis has been verified and confirmed it becomes a part of theory. That is why, it is said, that a theory is an elaborate hypothesis. Even, if a hypothesis is not confirmed, it enriches theory, it advances knowledge since it cuts down the total universe of ignorance and sometimes shows alternative lines of investigation. The disadvantage of a hypothesis is that it may bias the investigator towards a particular position and cause him to lose objectivity. This need not always be so if the investigator conceives a hypothesis merely as an assumption which he/she should consider and not as a positions which he/she should consider and not as a positions which he/she should defend.

Characteristics of a Good Hypothesis

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An acceptable hypothesis should fulfil conditions as given below: 1. Conceptual clarity: A hypothesis should be conceptually clear. It should consist of clearly defined and understandable concepts. Clarity

Hypotheses is obtained by means of defining operationally the concepts in the hypothesis. 2. Specificity: A hypothesis should be specific and explain the expected relations between variables and the conditions under which these relations will hold, e.g. “when there is dissatisfaction and no care is taken, deprivation will engender violence”. 3. Testability: A hypothesis should be testable and should not be a moral judgement. It should be possible to collect empirical evidences to test the hypothesis. Statements like “Bad partners produce bad children” are common place generalizations and cannot be tested, as they merely express sentiments and their concepts are vague. 4. Availability of techniques: Hypotheses should be related to available techniques. Otherwise they will not be researchable; therefore, the researcher must make sure that methods are available for testing his proposed hypotheses. 5. Theoretical relevance: A hypothesis should be related to a body of theory. A science can be cumulative only by building on an existing body of facts and theory. It cannot develop, if each study is an isolated investigation. When research is systematically based upon a body of existing theory, a genuine contribution to knowledge is more likely to result. Therefore, a hypothesis should possess theoretical relevance. 6. Consistency: Hypotheses should be logically consistent. Two or more propositions logically derived from the same theory must not mutually contradictory. 7. Objectivity: Scientific hypotheses should be free from value judgement. In principle, the researcher’s system of values has no place in scientific method. However, as social phenomena are affected by the milieu in which they take place, the researcher must be aware of his values and state them explicitly. 8. Simplicity: A hypothesis should be a simple one requiring fewer conditions or assumptions. But ‘simple’ does not mean obvious. Simplicity demands insight. The more insight the researcher has into a problem, the simpler will be his hypothesis about it. Nurses who are conducting research or nurses critiquing published research studies must have a working knowledge about what constitutes a ‘good’ hypothesis. Such knowledge will enable them to have a standard for evaluating their own work or the work of others. The characteristics of hypothesis will present the criteria to be used when formulating or evaluating hypothesis. 1. Hypothesis is declarative statement that identifies the predicted relationship between two or more variables.

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Essentials of Nursing Research 2. This implies that there is a systematic relationship between an IV and DV. The direction of the predicted relationship also specified in this statement. Phases, such as ‘greater than’, ‘less than’ positively, negatively or curvilinearly related (∪ or ∩ shaped) and difference in connotes the directionality that is proposed in the hypotheses. 3. A hypotheses must always be stated in advance of collecting evidence aimed at its testing, i.e. an acceptable hypothesis must be testable/have testability. 4. This means that the variables of the study must lend themselves to observation, measurement and analysis. 5. A sound hypotheses is consistent with an existing body of theory and research findings. 6. Statement of hypotheses should be worded in clear, simple and concise terms used in scientific and research language. 7. This helps the reader to understand the variables of the hypothesis; the population being studied and the predicted outcome of the hypotheses. 8. The statement of hypothesis should not conflict with any law of nature which is known true. 9. A good hypothesis should provide tentative answer to the proposed problem. This can be in the form of a declaration of statement or in the form of a directional or in a null form. 10. It should be operational, that is, there should be a method for recording and measuring the variables involved in the hypotheses. 11. Hypothesis should be specific but not trivial or inconsequential. A broad hypothesis, no doubt makes the problem unworkable. But a very narrow hypothesis cuts the life out of it.

Sources of Hypotheses

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Hypotheses can be derived from various sources: 1. Theory: This is one of the main sources of hypotheses. It gives direction to research by stating what is known. Logical deduction from theory leads to new hypotheses. For example, profit/wealth maximisation is considered as the goal of private enterprises. From this assumption, various hypotheses are derived. “The rate of return on capital employed is an index of business success;” “The optimum capital structure is that combination of debt and equity which leads to the maximum value of the firm.” “Higher the earning per share, more favourable is the financial leverage.” 2. Observation: Hypotheses can derived from observation. From the observation of price behaviour in a market, for example, the

Hypotheses

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relationship between the price and demand for an article is hypothesized. Analogies: Are another source of useful hypotheses. Julian Huxley has pointed out that casual observations in nature or in the framework of another science may be a fertile source of hypotheses. For example, the hypothesis that “similar human types or activities may be found in similar geophysical regions” came from plant ecology. Analogies As layman states, “Hospitals are like a hell”. This gives clue to the investigator to investigate the conditions of the hospital. Such an analogy would provide useful way of looking at nursing or at the hospital. Intuition and personal experience: These may also contribute to the formulation of hypotheses. Personal life and experiences of persons determine their perception and conception. These may, in turn, direct a person to certain hypotheses more quickly. The story of Newton and the falling apple, the flash of wisdom to Buddha under a banyan tree illustrate this individual accidental process. Findings of studies: Hypotheses may be developed out of the findings of other studies in order to replicate and test. State of knowledge: An important source of hypotheses is the state of knowledge in any particular science. Where formal theories exist, hypotheses can be deduces. If the hypotheses are rejected, theories would be modified. Where formal theories are scarce, hypotheses are generated from conceptual frameworks. In either case, the hypotheses are related to conceptual-theoretical level. Culture: Our cultural heritage is a great source of ideas, theories, tentative theories and provisional prepositions. Another source of hypotheses is the culture on which the researcher was nurtured. Western culture has induced the emergence of sociology as an academic discipline. Over the past decade, a large part of the hypotheses on American society examined by researchers were connected with violence. This interest is related to the considerable increase in the level of violence in America. In India in socioeconomic and leadership studies, hypotheses based on caste and economic statuses are common, because Indian society is caste-ridden, hierarchical and segmental, and the Indian economic system is riddled with inequalities and privileges. Continuity of research: The continuity of research in a field itself constitutes an important source of hypotheses. The rejection of some hypotheses leads to the formulation of new ones capable of explaining dependent variables in subsequent researches on the same subject.

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Essentials of Nursing Research 9. Scientific theory: The various scientific laws or theories which are transferable to the field of nursing research, e.g. Maslow’s theory of Hierarchy. 10. Personal experience: All true knowledge beings with experience. Leonardo da Vinci believed that all our knowledge has its origin in our perceptions. Wisdom is the daughter of experience. Good judgement is born of clear understanding and a clear understanding comes or reasons derived from sound rules-and sound rules are issue of sound experience-the common mother of all the sciences and arts. Hence, experience is the source for hypotheses. To derive hypothesis from the theory, we proceed in the classic manner by means of a formal deduction system. To derive hypothesis from assumptions, the researcher first states, the assumptions and then predict, what will be found in research and to derive hypotheses from observation, the researcher makes a statement about the relationship between the observed regularities that is the facts or concept called the empirical generalisation. In addition, existing literature also is considered as good source of hypotheses.

CLASSIFICATION OF HYPOTHESES Hypotheses can be classified according to direction, i.e. directional hypotheses and nondirectional hypothesis.

Directional Hypothesis

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A directional hypothesis is one that specifies the expected direction of the relationship between the independent and dependent variable. The reader of a directional hypothesis may observe that the existence of a relationship is proposed, as well as the nature the existence of a relationship is proposed, as well as the nature or directions of that relationship. 1. There will be a positive relationship between perceived social support by the mother and attachment between their mother and her infant with Down syndrome. 2. Synchrony of maternal and newborn sleep rhythms will be negatively related to postpartum blues. 3. There will be a positive relationship between trust and self-disclosure in marital relationship. 4. There will be a decrease in post-test state anxiety scores in subjects treated with non-contact therapeutic touch than in subjects treated with contact therapeutic touch. 5. Extra-preparation for surgery would decrease the stress and anxiety of patients and would lead to more rapid postoperative recovery.

Hypotheses 6. Structured preoperative education is more effective than structured postoperative education in reducing the patient’s perception of pain.

Nondirectional Hypothesis Nondirectional hypothesis indicated the existence of relationship between the variable. It does not specify the anticipated direction of the relationship. 1. There is a relationship between perception of self-competence and breast-feeding behaviour. 2. There will be a relationship between years of nursing experience and attitude toward parents with HIV disease. Hypothesis can be categorised as either research or statistical hypothesis. 1. A Research hypothesis is also known as a scientific or workable hypothesis consists of a statement about the expected relationship between the variables. A research hypothesis indicates what the outcome of the study is expected to be. A research hypothesis is also either directional or nondirectional, as explained earlier with some examples. 2. A statistical hypothesis is also known as null hypothesis states that there is no relationship between the independent variables and dependent variables. If in the data analysis a statistically significant relationship emerges between the variable at a specified level of significance, the null hypothesis is rejected. Rejection of statistical hypothesis is equivalent to acceptance of research hypothesis. Here are some of the examples of null hypothesis: 1. The incidence of pregnancy in adolescent girls attending birth control education classes will not differ from that of girls who not attend birth control education classes. 2. There is no difference in the amount of fun that women have, based on hair colour. Abdella and Levine suggest a classification in which there are three types of hypothesis based on relationships: i.e. causal, associative and artificial. Researcher uses hypothesis according to the type of design; it may be either experimental or nonexperimental, that influence the wording of hypothesis, for example, where an experiment design is utilised, the relationship statements, • X1 is more effective than X2 on Y • The effect of X1 on Y is greater than that of X2 on Y

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Essentials of Nursing Research Example: Nonexperimental designs are as follows: • X will be negatively related to Y • There will be positive relationship between X and Y. Hypotheses are classified in several ways. With reference to their function. Hypotheses are of two types: (a) Descriptive hypotheses and (b) Relational hypotheses. Another approach is to classify them into: (c) Working hypotheses, (d) Null hypotheses, and (e) Statistical hypotheses. Third approach is to divide them on the basis of the level of abstraction. Three broad levels may be distinguished: (i) Simple description, (ii) Logical derivation, and (iii) Abstraction. Accordingly there are three types of hypotheses: (f) Common-sense hypotheses, (g) Complex hypotheses and (h) Analytical hypotheses.

Developing the Research Hypotheses

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Like the problem statement, hypotheses are often not stated explicitly in a research article. The evaluator often will find that the hypotheses are embedded in the data analysis, results, or discussion section of the research report. It is then up to the reader to discern the nature of the hypotheses being tested. In light of that stylistic reality, it is important to be acquainted with the components of hypotheses, how they are developed, and the standards for writing and evaluating them. Hypotheses flow from the problem statement, literature review, and theoretical framework. Table 8.2 Illustrates this flow. A hypothesis is an assumptive statement about the relationship between two or more variables that suggests an answer to the research question. A hypothesis coverts the question posed by the research problem into a declarative statement that predicts and expected outcome. • Relationship: Hypotheses statement identifies the predicted relationship between two or more variable. This implies that there is a systematic relationship between an independent variable and a dependent variable. The direction of the predicted relationship is also specified in the statement. • Testability: It means that the variables of the study must lend themselves of observation, measurement and analysis. Hypothesis may fail to meet the criteria of testability because the researcher has not made a prediction about the anticipated outcome, the variables are not observable or measurable or the hypothesis is couched in terms that are value laden (Table 8.1). Servable or measurable, or the hypothesis is couched in terms that are value laden. Table 8.2 illustrates each of these points and provides a remedy for each problem.

Problematic issue No predictive statement about the relationship is made; therefore, the relationship is not verifiable. The “postoperative stress” variable must be specifically defined so that it is observable or measurable, or the relationship is not testable. “Better than” is a value-laden phrase that is not objective. Moral and ethical questions containing words such as should, ought, better than, and bad for are not scientifically testable. Casual relationships are proposed without sufficient evidence. The “widowhood” variable must be specifically defined or the relationship is not testable.

Problematic hypothesis

Anxiety is related to learning.

Patients who receive preoperative instruction have less postoperative stress than have patients who do not.

Small-group teaching will be better than individualised teaching for dietary compliance in diabetic patients.

Widowhood causes psychosocial health dysfunction.

Widowed persons with greater resource strength will have less psychosocial health dysfunction than those with lower resource strength.

Dietary compliance will be grater in diabetic patients receiving diet instruction in small groups than in diabetic patients receiving individualized diet instruction.

Patients who attend preoperative education classes have less postoperative emotional stress than have patients who do not.

Anxiety is curvilinearly (U-shaped) related to problem-solving behaviour.

Revised hypothesis

Table 8.1: Hypotheses that fail to meet the criteria of testability

Hypotheses

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116 Literature review 1. Studies related to emotional, physical, social, and financial difficulties associated with caregiving. 2. Studies related to antecedent variables related to caregiver strain, burden, or diminished well-being. a. Demographic characteristics of caregivers and of elders. b. Characteristics of the caregiving situation. c. Variables that mediate the effect of caregiver stress, such as social support.

Problem statement

What is the effect of perceived caregiver stress and social support on the psychological distress of family caregivers of the elderly?

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Family caregivers of the elderly experience significant amounts of stress in relation to the burden of caregiving. The amount of stress varies and is proposed to be a perceptual phenomenon. Social support is proposed to be a variable that mediates (buffers) stress. Social support is positively related to coping effectiveness and reduced burden. Satisfaction with social support is correlated with mental health.

Theoretical framework

1. Perceived stress of caregiving will be positively related to psychological distress. 2. Satisfaction with social support will be negatively related to psychological distress. 3. Social support will have a buffering effect on the relationship between perceived caregiver stress and psychological distress.

Hypotheses

Table 8.2: Flow of data among problem statement, literature review, theoretical framework, and hypothesis

Essentials of Nursing Research

Hypotheses

Theory Base A sound hypothesis is consistent with an existing body of theory and research findings. Regardless of whether a hypothesis is arrived at inductively or deductively, it must be based on a sound scientific rationale. The reader of a research report should be able to identify the flow of ideas from the problem statement to the literature review, to the theoretical framework, and through the hypotheses. Table 8.2 illustrates this process in relation to the problem statement “What is the effect of perceived caregiver stress and social support on the psychological distress of family caregivers of the elderly?” In this example, it is clear that there is an explicitly developed, relevant body of scientific data that provides the theoretical grounding for the study. The hypotheses, as stated in Table 8.1, are logically derived from the theoretical framework. However, the research consumer should be cautioned about assuming that the theory-hypothesis link will always be present. Some researchers refer to the null hypothesis as a statistical contrivance that obscures a straightforward prediction of the outcome. Others state that it is more exact and conservative statistically, and failure to reject the null hypothesis implies that there is insufficient evidence to support the idea of a real difference. Readers of research reports will note that, in general, when hypotheses are stated, research hypotheses are more commonly used than statistical hypotheses. It is more desirable to state the researcher’s expectation. The reader then has a more precise idea of the proposed outcome. In any study that involves statistical analysis, the underlying null hypothesis is usually assumed without being explicitly stated.

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Essentials of Nursing Research

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Research Design

The research design is the plan, structure, and strategy of investigations of answering the research question is the overall plan or blue-print the researchers select to carry-out their study.

PURPOSES OF RESEARCH DESIGN

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According to Kerlinger, “the design has two basic purposes: (i) to provide answers to research questions, and (ii) to control variance.” Variance is controlled by planning the study in such a way as to rule out other hypothesis or other intervening variables as causes of the study outcome. This design entails all the steps in the research process from the definition of variables and formulation of hypotheses through the decision how the data will be analysed. The research design consists of the strategy used to find answers to the research questions. This strategy, of course is tailored by the objective of the study, the expertise of the researcher, the constraints placed on time and expenditure, the availability of subjects and means to elicit information from them. The design must be both scientifically acceptable and practical enough to be manageable in the process of supplying useful information. As already stated above, the research design provides an explicit blue-print of how research activities will be carried out. Its objective is to answer the research questions. The researcher cannot identify the best design for a study by reading a research textbook and selecting a design that seems to fit. A design must be ‘created’, which requires making decisions about a number of specific issues. The design of a research study logically follows the identification of a research question, a search of the literature and a statement of hypothesis. The hypothesis is a statement of the relations between two or more variables and carries clear implication for testing those stated relations. Stating hypothesis lays the ground work for creating conveys the structure and strategy of the investigation. The development of a clean design enables the researcher to move outside of the study, so as to speak, and to test the ideas objectively.

Research Design The correct design helps to isolate items of concern so that they can be examined under known conditions, it eliminates bias and reduces the margin of error, enabling the researcher to state confidently conclusions on which to base future decisions and researchers. The results of the well-planned research are contributions to the growing body of nursing knowledge. Designing a nursing study is the creative process of planning the empirical aspects of an investigation. Research design links the investigators abstract thinking about a topic with the realities of studying a topic. Designs guide investigation. As stated earlier, of studying a topic. Designs guide investigation. As stated earlier, the purpose of the research design is to provide the scheme for answering specific research questions. The design in quantitative research then becomes the vehicle of hypothesis testing. The principle of scientific inquiry are utilised to answer research questions. Therefore, the design involves a plan, structure and strategy. These three concepts of design guide a researcher in writing hypothesis-during operationalisation or the carrying out of the project and in the analysis and evaluation of the data. The overall purpose of the research design is in two fold. i. To help in the solution of research question, and ii. To maintain control. All research attempts to answer questions. The design is coupled with the methods and procedures and together they are the mechanisms for finding solutions to research questions. Control is defined as the measures that the researcher used to hold the conditions of the investigation uniform. In this way the researcher avoids possible impingement of bias on the dependent variable that may affect the outcome.

THE ELEMENTS OF RESEARCH DESIGN A good research design includes several elements: (i) Description of subjects (who), (ii) Observations of variable (what), (iii) Measures of time (when), (iv) Selection of setting (where), and (v) Role of the investigator. Subjects: Subjects are the individuals who take part in the study, who will be recipients of the experiment or who will be observed in a descriptive survey. Designs specify-who the participant will be and what the unit analysis (elements of the sample) will be. Subjects in nursing research studies may be individual human beings, couples, families, groups, communities or animals. Variables: Variables are the focus of the study and reflect the empirical aspects of the concepts being studied, the investigator measures variable.

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Essentials of Nursing Research Research designs are univariate or multivariate. Univariate designs address only one variable. Nursing investigators more commonly study two or more variable, which is not surprising in view of the complexity of human health. Time: The time element of design is the frequency (how often) and the order (when) in which observations are made. In some designs variables are observed at only one point of time. And in the way, an observation or event will be measured. Setting: Setting may be natural setting or laboratory setting depending upon study topic and researcher’s choice. Investigator’s role: In some studies, the investigator remains unobtrusive, attempting not to influence the variables being studied. In other studies the investigator imposes control on many variables, actively manipulates some of the variables being studied, and allocates the participants to different conditions.

Selecting a Research Design While selecting a research design the researchers has to weight many considerations. The prime importance is the purpose and theory development aim of the study. Theory development usually reflects the current level of knowledge about the phenomenon and thus has guided determination of the specific research purpose. Additional influences on the study design include ethical issues related to the phenomenon, feasibility, validity, and availability of data, precision and cost, etc. The brief explanations of these factors influence on the research design are given below. Level of knowledge: Our level of knowledge about the phenomenon affects our design choices. When little is known about a phenomenon, the investigator may undertake a careful description of a single concept rather than attempt to determine the relationship of several factors. Nature of the phenomena: It is an important concern in choosing how to study it. Investigator consider whether the phenomenon can be studied in a naturalistic or non-naturalistic way. For example, certain disasters have helped to health scientists to gain better understanding of how human beings respond to crisis.

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Nature of the purpose: The nature of the research purposes sometimes implies the choice of a specific design.

Research Design Ethical consideration: Research problems that place unethical demands on subjects may not be feasible for study. Researchers must take ethical considerations seriously. The considerations of ethics may affect the choice between an experimental design and a non-experimental design. Feasibility: In some instances feasibility is a key concern in selecting a research design. Many research designs are elegant but not feasible. One of the feasibility considerations is the amount of time the investigator can devote to the study. The research problem must be one that can be studied within a realistic period of time. All researchers have fixed a particular time for completion of a project. It is essential that the scope of the problem be circumscribed enough to provide ample time for the completion of the entire project. Research studies generally takes longer than anticipated to complete. Availability of subjects: The researcher need to determine whether a sufficient number of eligible subjects will be available and willing to participate in the study. If one has captive audience, like students in a classroom, it may be relatively easy to enlist their cooperation. When a study involves the subjects independent time and effort, they may be unwilling to participate, when there is no apparent reward for doing so. Other potential subjects may have fears about harm or confidentiality and may be suspicious of the research process in general. Subjects with unusual characteristics are often difficult to locate. In general, people are fairly cooperative about participating, but a researcher must consider needing a larger subject pool that will actually participate. At times, when reading a research report, the researcher may note how the procedures were liberalised or the number of subjects was altered. This was probably a result of some unforeseen pragmatic consideration. Availability of facility and equipment: All research projects require some kind of equipment. The equipment may be questionnaires, telephones, stationery, stamps, technical equipment or other apparatus. Most research projects require the availability of some kind of facility. The facility may be a hospital site for data collection or laboratory space or a computer centre for data analysis. Validity of data: Validity of data is another important concern in selecting a research design. Precision: An additional dimensions that researchers consider when choosing a research design is precision. Precision refers to the ability to obtain the most accurate estimate of a single variable or of the effect of treatment variable on an outcome variable. Accuracy means that all aspects

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Essentials of Nursing Research of a study systematically and logically follow from the identified problem statement. A design that allows researcher to account for or to control many other factors known to influence the variable of interest maximises the precision of the estimates (e.g. orientation of patient helps in adjustment in hospital). Researchers’ experience: The selection of the research problem should be based on the nurses realm of experience and interest. It is much easier to develop a research study related to a topic that is either theoretically or experimentally familiar. Selecting a problem that is of interest to the research is essential for maintaining enthusiasm when the project has its inevitable ups and downs. Cost: Research projects require some expenditure of money. Before embarking on a study, the researcher probably itemises the expenses and projects the total cost of the project. This provides a clear picture of the budgetary needs for items like books, stationery, postage, printing, technical equipment, telephone and computer charges and salaries. Control: A researcher attempts to use a design to maximise the degree of control over the tested variables. An efficient design can maximise results, decrease errors, and control pre-existing or impaired conditions that may affect outcome. To maximise efforts the researcher should maximise control. To accomplish these tasks the research design and methods should demonstrate the researcher’s efforts at control. Control is accomplished by ruling out extraneous variables that compete with the independent variable as an explanation for a study’s outcome. The means of controlling extraneous variables include the following: • Use of a homogenous sample • Use of consistent data collection procedures • Manipulation of the independent variable • Randomisation.

EXPERIMENTAL RESEARCH DESIGN

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The tern ‘experiment’ is often used loosely in everyday speech to connote the idea of trying something out or using something tentatively. An experiment is a scientific investigation in which observations are made and data are collected according to a set of well-defined criteria. Experimentation is the most scientifically sophisticated research method. It is defined as observation under controlled conditions. It studies observable changes that take place in order to establish a cause and effect relationship. It is the description and analysis of which will be, what will occur, or what can be made to occur under careful conditions.

Research Design A true experiment is characterised by the following properties: 1. Manipulation. 2. Control. 3. Randomisation.

Manipulation Manipulation refers to the process by which the researcher manages the independent variable in order to study the effect on the dependant variable. “Independent variable are the conditions that the researcher or experimenter manipulates in his attempt to ascertain their relationship to observed phenomena. The dependent variable are the conditions that appear, disappear or change as the experimenter introduces, removes, or changes independent variable. Independent variable also called the experiment, causal, stimulus or treatment variable, is manipulated by the researcher to study its effect upon the dependent variable. The dependent variable also called the effect, the response, and at times, the criterion, measure, is the behaviour or outcome, the researcher wishes to predict and explain. The change in the dependent variable is presumed to be caused or associated with the independent variable. Thus, manipulation refers to the fact that the researcher does something with the independent variable. If the dependent variable is a nursing treatment, the researcher manipulates it by giving it to some study subjects and withholding it from others. To make sure that design ensures the collection of verifiable data, i.e. has validity, the researcher must also control extraneous variable. Extraneous variables are those uncontrolled variables or variable not manipulated by the researcher that may have significant influence upon the dependent variable and confuse the effect of the independent variable. Eight classes of extraneous variable may especially interfere with research on human subjects, history, maturation, testing, instrumentation, statistical regression selection, mortality and interaction among these. 1. History, the specific events occurring between the first and second measurement in addition to the experimental variables. 2. Maturation, process within the respondents operating as a function of the passage of time per se (not specific to the particular events), including growing older, growing hungrier, growing more tired and the like. 3. Testing, the effects of taking a test upon the scores of a second testing. 4. Instrumentation, in which changes in the calibration of a measuring instrument or changes in the observers or scores used may produce changes in the obtained measurements.

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Essentials of Nursing Research 5. Statistical regression, operating where groups have been selected on the basis of their extreme scores. 6. Biaser resulting in differential selection of respondents for the comparison groups. 7. Experimental mortality, or differential loss of respondents for the comparison groups. 8. Selection-maturation interaction, etc. which in certain of the multiple group quasi-experimental designs, might be mistaken for the effects of the experimental variable. The above eight factors jeopardises internal validity. The factor, jeopardising external validity or representativeness are: 1. The reactive or interaction effect of testing. 2. The interaction effects of selection bias and experiment variable. 3. Reactive effects of experimental arrangements. 4. Multiple treatment interference.

Control

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Control is the basic element of experimentation. The experiment must be organised, so that the extraneous factors are prevented from operating and confusing the outcome which is to be appraised. Control is acquired by manipulating, by randomising, by careful preparation of the experimental protocols, and by the use of a comparison group or groups. Although control is fundamental to experimentation, care must be taken not to control the situations, so that it becomes artificial, so that the results, even though highly rigorous are inapplicable and meaningless from the standpoint of actual situation. The pure scientist would insist that unless control is exercised, the results are meaningless since there would be no way of knowing what caused them. To him, there would be no way of knowing what caused them. To him, generalisability is a more basic concept, and replicability has to be sacrificed. The practitioner, on the other hand, would insist on applicability to the real situation, regardless of whether the results can be generalised to any general class of events. He would contend that rigorous results that apply nowhere are automatically useless. To the extent that the investigator exercises rigorous control over a situation, he automatically establishes conditions different from those of regular situation and by that very process, alters his problem and make it impossible to apply his findings to an actual situation. To help control these variable, the researcher uses both experimental and control groups whose units are first randomly selected from the target population, and then randomly assigned to either the experimental or control group. For example, in true experimental design, two time periods

Research Design (before and after) refer to the groups before the independent variable ‘X’ is introduced into the experimental group, but withheld from the control.

Randomisation The term random essentially means that every subject has an equal chance of being assigned to any group. Randomisation is the process that first ensures every unit in the target population an equal chance of being chosen for the study sample, and then ensures that each unit in the study sample has an equal chance of being assigned to either the experimental or the control group. Experimental approach is a powerful design for testing hypotheses of causal relationships among variables. Ideally, in the experimental design the investigator throws into sharp relief the explanatory variables, in which he is interested, controlling or manipulating the independent variable, observing its effects on the dependent variable and minimising the effects of the extraneous variable (Riley, 1963). The experimental research provides a systematic and logical method for answering the question. “If this is done under carefully controlled conditions, what will happen?” Experimenters manipulate certain stimuli, treatments, or environmental conditions and observe how the condition or behaviour of the subjects is affected or changed. Their manipulation is deliberate and systematic. They must be aware of other factors that could influence the outcome and remove or control them so that they can establish a logical association between manipulated factors and observed effects. Experimentation provides a method of hypotheses testing. After experimenters define a problem, they propose a tentative answer, or hypothesis. They test the hypothesis and confirm or disconfirm it in the light of the controlled variable relationship that they have observed. It is important to note that the confirmation or rejection of the hypothesis is stated in terms of probability rather than certainty. Experimentation is the classic method of the science laboratory, where elements manipulated and effects observed can be controlled. It is the more sophisticated, exacting and powerful method of discovering and developing and organised body of knowledge. Thus, experimental approach by most investigators in the basic sciences. Although the experimental method finds its greatest utility in the laboratory, it has been effectively applied within non-laboratory settings such as the classroom, where significant factors or variables can be controlled to some degree. The immediate purpose of experimentation is to predict events in the experimental setting. The ultimate purpose is to generalise the variable relationships so that they may be applied outside the laboratory to a wider population of interest.

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Essentials of Nursing Research Experimental research is characterised by tight control over the variables and subjects. In fact the researcher exerts so much control over facets of the study that less quibbling occurs over the results produced by such exactness. Experimental studies usually require more sophisticated knowledge of the problem, more in-depth planning, more expertise, and a greater expenditure of time than some of the other types of research. It often seems like many other types of studies are preliminary steps leading to ‘real experiments’. This is very often the case, since experimental studies can lead to clearcut statements of cause and effect. These are the studies that many professional regard as the ‘proving grounds’ theory development.

Characteristics of Experimental Research Design In experimental approach, the investigator through the independent variable comes into the spotlight of science in an effort to control and minimise the effects of all variables. Barnes (1964) listed ten important characteristics of experimental research which are: 1. Research ideas are restricted by requirement that they be testable. 2. Theories and speculations are closely related to reality. 3. Simplicity in ideas and conceptualisation is the ideal. 4. Research set out to test, not to prove. 5. The concept of ‘failure’ is an archieves interference in research activity. 6. The potential value of a research project is directly related to the cogency of the questions asked. 7. The methods of research are intentionally devised to prevent the research are intentionally devised to prevent the researchers deluding himself and others. 8. Values play a legitimate and important part in research activities. 9. The method of analysis of logical deduction and statistical inferences should fit the limitations inherent in the problem being investigated. 10. The researcher courts recognition through the power of his tested ideas, not through the attractiveness of his rhetoric.

Major Steps in Experimental Design

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1. Delineate the population or universe to be studied (i.e. the set of subjects or objects that share a common observable characteristic). 2. Select a sample from the population by random sampling.

Research Design 3. By random assignment, subdivide the sample into two subsamples. 4. Specify one sub-sample, the experimental group and other the control group. 5. Before introducing the independent variable, observe and record all important characteristics of the two groups. 6. Introduce the independent variable into the experimental group but withholds it from the control group. 7. After introducing the independent variable, observe the dependent variable in both experimental and control group. 8. Compare the changes that occur in the experimental group with those that may have occurred in the experimental group with those that may have occurred in the control group. 9. Record the difference. 10. Compare these values with statistically computed values that judge the significance of the difference, and indicate whether or not the observed differences could have occurred by chance.

Types of Experimental Design The investigator planning an experiment has many experimental design option to choose. Experimental designs fall into three major categories which are: a. True or classical experimental design. b. Quasi-experimental design. c. Pre-experimental design. The most commonly used in nursing studies, are discussed as nomenclature used and definitions developed by Campbell and Stanley (1963) as follows. True or classical experimental design: There are three major designs in the true experimental design, viz. 1. Pre-test and post-test control group design 2. Solomon Four-group design 3. After/Post-test-only experimental design. Before proceeding to brief explanation of these designs, we should be aware of the use of standard notations, i.e. helpful in understanding alternative experimental designs. We will use ‘X’ to denote the experimental manipulation (treatment or intervention). ‘O’ to denote observation or measurement, and ‘R’ to denote randomisation. To denote time, we will say for example, O1 for the first observations and O2 for the second observation.

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Essentials of Nursing Research 1. Pre-test and Post-test control group design Random assignment

Experimental → Pre-test → Experimental → Post-test group treatment Control → Pre-test → —————→ Post-test group

In this design, subjects have been designed randomly to the experimental or the control group. The experimental treatment is given only to those in the experimental group, and the pre-tests and post-tests are those measurements of the dependent variable that are made before and after the experimental treatment is performed. All true experimental designs have subjects randomly assigned groups, have an experimental treatment introduced to some of the subjects and have the effects of the treatment observed. Designs vary primarily in number of observation that are made. The pre-test and post-test designs can be illustrated by using notation as follows: Before × After RO1 × O2 RO1 O2

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(OR)

RE

X1 – X

RC

C1 – C

Effect of X where, R = Randomised subjects X = Experimental treatment O = Observation occasion RE = Randomised experiment group X = Experimental treatment RC = Randomly control group The two lines notations in the design represents two separate groups. The investigator initially randomly (R) assigns subjects selected from one population into one of the two groups. The investigator then observes both groups on one occasion (O1) and subsequently administers the experimental treatment (X) to only the first group. The investigator then observes both groups again on a second occasion. This design has several advantages, i.e. i. The investigator is able to account for events occurring between time 1 and time 2 through observation of the control group. ii. It also enables the investigator to control for changes in the instrumentation, since changes or drifts in measurement should affect both groups equally. iii. Randomisation decreases selection bias and maturation.

Research Design 2. Solomon four group design: The Solomon four group design is a complex particularly useful in studies of developmental phenomena and permits the investigator to differentiate many effects.

Random assignment

Experimental → Pre → group -test Control → Pre-test group Experimental → group Control group

Experimental → treatment ……………… →

Post-test

Experimental → treatment ……………… →

Post-test

Post-test

Post-test

The diagram can be shown by notation as follows: Before × After RO1 × O2

RE

X

X´

RO1 O2

RC

C

C´

RE

–

X´´

RC

–

C´´

R × O2 R

O2

(OR)

This design employs two experimental groups and two control groups. Initially, the investigator randomly assigns subjects to the four groups. Those in the first experimental treatment, and observed again on occasion 2. Those in the experimental group 2 also receive the treatment but are observed only after the treatment, nor before. Those in control group ‘1’ are observed, on occasions 1 and 2, but they are not given the experimental treatment. Those in control group 2 are observed only on the second occasion without previous observation or treatment. The usefulness of this design rests on the assumptions that if those in experimental groups 2 were observed on occasion 1, that score would be similar to averaged scores of those in experimental and control groups. To estimate the amount of change in experimental and control groups 2, the average test scores of experimental and control groups 1 are used as baseline. This design offers several advantages and has great potential for generating information about differential sources of effect on the dependent variable. Because all four groups are studied at the same time, both the effects of events occurring between time 1 and time 2 and the maturation of subjects are controlled. One can examine the score of control groups 2 for a measure of maturation without the influence of treatment. The investigator also can compare the different in the groups.

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Essentials of Nursing Research 3. Post-test only control group design: This design, which is sometimes called after only control group designs, is composed on two randomly assigned groups, but neither of which is pre-tested or premeasured in the before period of time. The independent variable introduced into experimental group and withheld from the control group. This design can be useful in situations where it is not possible to pre-test the subjects or pre-test is non-essential. The diagrammatic representation of this design is as follows:

Random assignment

Experimental → Experimental group treatment Control → ……………… group

→ Post-test → Post-test

The diagram can be shown by using notation as Before × After R × O1 R O2

RE (OR)

–

X

RC –

C

Ouasi-experimental designs: A quasi-experimental design is one in which full experimental control, usually randomisation is not possible. The use of quasi-experimental designs requires that the researcher be aware of the points on which the results are questionable. If neither random sampling nor random assignments is used, it is not possible to generalise from the findings. A judging whether the independent variable resulted in observed differences between the experimental group and the control group requires more careful evaluation. 1. Non-equivalent control group: Design or the four celled design without use of randomisation Experimental → Pre-test → Experimental → Post-test group treatment Control group → Pre-test → Post-test O 1 × O2

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No R in

Before × after 1

X

1

–X

1

–C

–C

E

X

X

C

C

C

Difference in experimental and control group

Research Design The study subjects in this design are not randomly selected or randomly assigned. Instead, the groups are naturally assembled collectives, such as in classrooms or clinics. The researcher chooses the study subjects to be as similar as availability permits. To judge the similarity of the two groups, a pretest or pre-measurement is made in the ‘before’ time period. The more similar the scores on the pre-test, the more effective this control becomes. The independent variable is introduced into the experimental group only, after which both the experimental group and control groups are tested or measured in the “after period”. Even though the researcher not able to use random selection or assignment of study subjects, the use of control group helps the researcher determine whether or not the independent variable actually made a difference in the experiment. 2. The time series experimental design: The time series experiment design, a single group experiment comprises of series of observation in the before-time period to establish a baseline. The experimental (independent) variable is then introduced, followed by another series of observation to examine the effect of the independent variable. Before × After –––––––––––––––––––––––––––––––––––––– O1 O2 O3 O4 O5 × O6 O7 O8 O9 O 10 ––––––––––––––––––––––––––––––––––––––

E

3. The multiple times series design: Consider an excellent quasiexperimental design, the multiple time series design is similar to that one group time series experimental design, except the control group is added.

E C

–––––– O1 O2 –––––– O1 O2 ––––––

Before ––––––––– O3 O4 O5 ––––––––– O3 O4 O5 –––––––––

× After –––––––– × O6 –––––––– × O6 ––––––––

–––––––––––– O7 O8 O9 O 10 –––––––––––– O7 O8 O9 O 10 ––––––––––––

The independent variable is introduced into a series observations on the experimental group but withheld from the series of observations made on the control group. The use of the control group, the manipulation of the independent variable in the experimental group, increases the certainty with which the researcher can generalise findings.

Pre-experimental Designs 1. The one-shot case study or single case study XO

X 1 X

X = Independent variables or stimulus

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Essentials of Nursing Research In single case study, that studies at once, following a treatment or an agent presumed to cause change. Because the study design has a total absence of control, it is considered to be little value as an experiment. 2. One group pre-test and post-test design O 1 × O2

Before × After E

X

X

Here only one group is observed before and after the independent variable is introduced. Loss of the control group decreases the usefulness of the study but may be necessary in cases where it is not possible or feasible to have control groups. 3. The static group comparison design X O1 O2

Before × After E

X

X

C

C

C

The static group that has experienced the independent variable is compared with one that has not. Here the experimental group received the independent variable, but control group did not receive the independent variable.

NON-EXPERIMENTAL DESIGN 1. Historical Research Design

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Historical research is a systematic compilation of data and the critical presentations, evaluation and interpretations of facts regarding people, events, and occurrences of the past. One of the goals of the researcher using historical methodology is to shed light on the past so that it can guide present and the future. The historical method is embedded in philosophy, art and science. Philosophy means approaching in philosophy means approaching the subject under consideration by way of an individual frame of reference; art consists of contemplation, imagination, and creative interpretation and science is the discovery of facts. Historical research is the application of the scientific method of inquiry to historical problems. It is the systematic collection and critical evaluation of data relating to past occurrences. Historical research is undertaken in

Research Design order to test hypothesis or to answer questions concerning causes, effects, or trends relating to past events which may shed light on present behaviour on practices. An understanding of contemporary nursing theories, practices or issues can often be enhanced by an investigation of a defined segment of the past. Historiography is actually quite important in nursing. Particularly in this time when nurses are working to define and extend their professional roles, a knowledge of the roots of nursing has the capacity to put nursing theories and procedures into an appropriate context. History is a kind of research or special form of enquiry, uses a particular methodology to answer questions about the past. This methodological approach is referred to as ‘historiography’. Historical research is a critical investigation of events, developments and experiences of the past, the careful weighing of evidence of the validity of sources of information on the past, and the interpretation of the weighed evidence. The historical investigator, like other investigator then collects data, evaluates the data for validity and interprets the data. Actually, the historical method or historiography, differs from other scholarly activity only in its subject matter, the past, the peculiarly difficult interpretative task imposed by the elusive nature of the subject matter (Kerlinger, 1986). History, as a science is defined as a search for truth, one must at all times be aware of the many facets of the ‘truth’ and the multiplicity of witnesses to and interpretation of “the truth”. As such historian must be satisfied with the tentative nature of the research findings and accept the age old dictum that “past is the real but the truth is relevant”. Historical research provides an alternative view of the world as it was and as it is, and its shapes a vision of what it could be. It can provide a keen sense of appreciation of who and what went before, as well as a sense of awareness of nursing. Continuing journey through time. The scholarly inequity into nursing’s history can provide insight into the evolution of nursing as a profession and into determining the historical imperatives of the nurses’ role in the present delivery of health care. Historical research is viewed in three different ways: 1. Historical approach, which refers to the organisation of historical facts in support of the new concepts to be developed. 2. Historical subjects, referring to biographies of great men, monographs of places, and sketches of ideas, thoughts and trends 3. Historical technique, which refers to research that is conducted on the basis of historical records and documents. Historical method of research covers the following subdivisions: (i) historical, (ii) legal, (iii) documentary, (iv) bibliographical, (v) biographical (vi) ideational, (vii) institutional, and (viii) organisational.

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Essentials of Nursing Research

2. Survey Research Design The broader categories of non-experimental design is the survey research. Survey research is that branch of research that examines the characteristics, behaviour, attitude and intentions of a group of people by asking individuals belonging to that group (typically only a subset) to answer a series of questions. Survey research is an extremely flexible research approach and therefore, it is quite diversified with respect of populations studies, scope, content and purposes. Surveys are descriptive and exploratory in nature. There are both advantages and disadvantages of survey research. Two major advantages are that a great deal of information can be obtained from a large population in a fairly economical manner, and that survey research information can be surprisingly accurate. The disadvantage that includes is as follows: • The information obtained in a survey tends to a superficial. The breadth rather than the depth of the information is emphasised. • Conducting survey requires a great deal of expertise in a variety of research areas. The survey investigator must know sampling techniques, questionnaire construction, interviewing and data analysis to produce a reliable and valid study. • Large scale surveys can be time-consuming and costly, although the use of on-site personnel can reduce costs. The other details of advantages and disadvantages are included in later part of this subtopic. Survey research is the process of gathering current data from subjects so that new informations can be obtained. Kerlinger notes that these studies are usually called sample surveys and states that “survey research” studies large and small populations (or universal) by research selecting and studying samples chosen from the population to discover the relative incidence, distribution and interrelations of sociological and psychological variable.” The best feature of survey research is that it enables the investigators to collect current information about whatever it is that they wish to study. The word ‘survey’ is appropriate in this instance. It implies that information is being collected from a variety of subjects that resemble the total group in the characteristics being studied. Survey research is a mode of inquiry that relies heavily upon the validity of verbal reports. Surveys can serve a descriptive, explanatory, predictive or exploratory function, and some research projects concentrate on more than one of these objectives. According to the objective of survey, the survey research can be classified as follows:

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Descriptive survey: Surveys are carried out for the purpose or providing an accurate portrayal of a group of subjects with specific characteristics.

Research Design Descriptive studies usually entail the precise measurement of phenomena as they currently exist within a single group. The objectives of the descriptive survey is description only. It does not mean that they cannot be the basis of extensive implications and actions. The main purpose of this research is to describe objectively the nature of situation under study. Descriptive studies are often utilised by researcher to determine the extent or directions of attitudes or behaviours. Exploratory survey: The word ‘explore’ implies scrutinising unknown regions for the purpose of discovery. Indeed exploratory studies serve this purpose and are particularly useful during the early stages of investigating the relationship, between phenomena about which not much is known. For example, consider the human responses to new techniques of medicine or surgery. Studies are conducted to obtain more information on areas in which very little information is available. This type of survey might be conducted to determine the extent of nursing involvement in relation to a particular health problem or to identify possible hypothesis for further and more extensive study. The researcher in these types of studies moves forward with the expectation of charting new territory for research rather than with the goal of quantifying a particular variable. Exploratory indices presupposes identification of the phenomenon and its description. Ideally, these studies follow work that not only includes description of a phenomena but also includes identification of ways of measuring it. Exploratory indices provide a means of investigators to contribute to understanding about the relationship between phenomena to discover relevant corrections or differences. Explanatory survey: These are conducted to provide causal explanations or phenomena or situations. According to Warwick and Lininger, the following three conditions must be satisfied to establish a causal explanations: 1. The cause and effect must be associated with each other. 2. The cause must precede with effect, and 3. The other possible explanation of the effect should be ruled out. The kind of survey is more specific and requires a more sophisticated level of knowledge to enact. The investigators must familiarise themselves with previous studies and current literature in order to identify the causal relationships specific to the project. Explanatory surveys often involve hypothesis testing with an emphasis on the qualitative aspects of data as well as on the numbers collected. Comparative survey: Studies utilise set criteria to contrast two or more groups of designated variables. This popular type of survey has often

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Essentials of Nursing Research been used by investigators to compare two distinct groups on the basis of such qualities as knowledge level, perceptions, or attitudes. The surveys are usually very broad comparisons as a result of the presence of a multitude of variables in the situation that are not under the control of the investigator. The usual procedure consists of choosing two groups that can be expected to vary according to a definite factor. When dealing with the complexities of human subjects, it is imperative to keep in mind the enormous lack of ability to screen out other factors and construct two groups equally comparable on a limited number of items. Comparative survey is a research design that involves comparing and contrasting two or more samples on one or more variables, often at a single point of time. Comparative studies are characterised by carefully defined groups although the major effort is usually employed in selecting and retaining the instruments used to measure the intergroup differences. The usefulness of comparative studies results from the relative casel speed and accuracy with which they can be conducted by unexperienced researcher. This type of survey makes its biggest contribution to theory by generating feasible areas of further investigation and by suggesting future hypothesis for study under more controlled conditions.

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Evaluative survey: This is also a descriptive, but it has the additional dimension of one or more criteria by which some evaluative judgment will be made about the respondents either individually or as groups. This criterion exists prior to the survey and be applied as the survey progresses or it may be developed during the survey. Surveys are being used more frequently today in conjunction with other data-gathering techniques to conduct evaluation research. This type of survey is defined by Warwick and Lininger as “the assessment of the process and for consequences of deliberate and planned interventions”. Evaluative surveys are appropriate in situation in which: 1. A goal or objective has been identified. 2. A programme has been instituted to meet the goal, and 3. The results of the programme can be measured in terms of the degree in which the objective has been achieved. The term evaluation implies that the worth or merit of something being judged. Scriven views the evaluation process as the assessment of both goals and results, and describes three distinct parts of the process. • Formative evaluation is an internalised affair which is an ongoing part of the programme development to improve it while it is being created and instituted. • Summative evaluation assesses the merit of the programme after it has been developed and instituted. The summative evaluation is usually

Research Design an external process reported outside the agency developing the programme and often conducted by an external evaluator. This type of evaluation is often used for comparison or for cost analysis. • The last is termed goal free evaluation. This method is used to control bias by bringing in an evaluator who is unfamiliar with the objectives of programme and having him review the findings. This process is used to highlight unintended side effects of the programme and is thought to present a consumer viewpoint. Evaluative surveys will become more prominent in nursing as researchers strive to evaluate “nursing care given to patients, discern whether programmes are “cost-effective” and to isolate critical variables and relationships that show promise for more extensive investigation. Correlational survey: This survey collects data on more than one variable from one group of respondents with the intent of estimating the magnitude of the relationships between the variable. A correlation survey is a research design that relates multiple variables measured at a single time point in a sample from a designated population. This design enables the investigator to relate several variables to one another, all the investigators to address questions such as what factors are associated with recovery from CABG (Coronary Artery Bypass Graft) Surgery, etc.

Advantages of Survey Research Design • Data are gathered from a more natural settings. • The variable are examined as they are found in the existing social milieu. • A large amount of data can also be gathered at a fairly reasonable price. • Survey using the questionnaire are likely to cover a wide a geographical area, reach many people, ensure respondents anonymity, and require less skill to administer. • Careful pretesting of instruments and use of random sampling yields a considerable degree of representativeness. • This is the only method suitable to cover large population. Disadvantages of survey research design: It collects only self-reports, which means that recall may be selective or that the respondent may not be willing to express attitudes or beliefs on sensitive topics. • Standardisation of the questionnaire also means that the least common denominator is represented. • The respondents response rate may be low, thereby introducing bias.

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Essentials of Nursing Research • Unless the researcher uses the interview, which is more expensive the researcher is not able to observe the study subjects directly and loses the ‘feel’ of the situation. The process of survey research: The several steps to survey research are listed below: 1. Statement of the research problem. 2. Determination that the problem is appropriate for the survey approach. 3. Selection of the appropriate type of survey. 4. Identification of the objectives of the survey and the translation of these into criterion variables. 5. Determination that for the variables identified. a. Adequate techniques for data collection exist. b. Adequate techniques can be developed in time. c. Adequate techniques neither exist nor can be developed in time. 6. Interim determination of successful potential of proposed study. 7. Identification of the population of research situations or respondents needed. 8. Initial determination of the availability of a representative sample. 9. Decisions as to those aspects of survey for which representative sample can be obtained. 10. Final evaluation of success potential of survey in view of availability of adequate data collection instrument and required sample, and all potential results. Then my success potential seems reasonable. 11. Design of data collection. 12. Collection of data. 13. Preparation of report: a. Descriptive of phase b. Comparative and/or evaluative phase c. Conclusions.

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Sampling

10

Sampling

INTRODUCTION Sampling is a pretty old idea, since times immemorial people have examined a handful of grains to ascertain the quality of entire lot. A housewife examines only two or three grains of boiling rice to know whether the pot of rice is ready or not. A doctor examines a few drops of blood and draws conclusions about the blood constitution of the whole body (Blood group or counts). A businessman places orders for materials examining only a small sample of the same. A teacher may put questions to one or two students and find out whether class as whole is following the lesson. Sampling is the process of selecting representative units of a population for study in a research. It is the process of selecting a subset of a population in order to obtain information regarding a phenomenon in a way that represents the entire population. A population is an aggregate of elements showing some common set of criteria. The term ‘population’ is defined in a more general and broader sense and includes not only the common place meaning as groups or aggregate of people or living things but also aggregate of trees, animals, soil, birds, response to test items, books, buildings and the like. The population can be infinite when enumeration or listing up of all the elements. It is impossible or extremely difficult, e.g. fish in the sea, stars in the sky, or trees in the forest. Finite populations have innumerable elements such as students in school and cards in a deck. The population is the total group of individual people or things meeting the designation criteria of interest to the researcher from that sample in selected. Sampling is a smaller part of the population selected in such a way that the individual in the sample represent (as nearly as possible) the characteristics of population. Sampling is the process of selecting a sample from the target population. A target population consists of the total group of people or objects meetings the designated set of criteria of interest to the researchers. The term target population does not necessarily pertain to

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Essentials of Nursing Research

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human beings. Well-selection sampling may reflect fairly accurately the characteristics of the population. A specific value of the populations such as average of variance named “Parameter”; the corresponding value in the sample is termed as statistic. The main aims of sampling is to make an inference about an unknown parameter from a measurable sample statistic and to test a statistical hypothesis relating to population. A sample is drawn and data collected from the sample informants are analysed and on the terms of the result the hypothesis may be accepted or rejected. Sampling helps the researcher in many aspects which includes: • It reduces the time and cost of research studies. • It saves labour. • The quality of a study is often better with sampling than with a complete coverage (Census survey). • It provides much quicker results that does a census. • It is the only procedure possible, if the population is infinite. • Statistical sampling yields crucial advantage over any other way and choosing a part of population for the study. But sampling demands a thorough knowledge of sampling methods and procedures and an exercise of greater one. A complicated sampling plan may require more labour that a complete coverage. Sampling is the selection of some part of an aggregate or totality on the basis of which a judgment or inference about the aggregate or totality is made. It is process of obtaining information about an entire population by examining only a part of it. Sampling used in practice for a variety of reasons as given below— • It can save time and money. A sample study is less expensive than a census and produces results as a relatively faster speed. • It may enable more accurate measurements for a single study is generally conducted by trained and experienced researchers. • It remains the only way when population contains infinitely many members. • It remains the only choice when a test invites that destruction of the item under study. • A sample must be representative of that population. Probability sampling yields representative sample. In measurement terms, the sample must be valid. The validity of a sample depends upon its accuracy and precision. • Accuracy: It is defined as the degree to which bias is absent from the sample. Accurate or unbiased sample is one which exactly represents the population. It is free from any influence that causes any difference between sample value and population value.

Sampling • Precision: The sample must yield precise estimate. Precision is measured by the standard error or standard deviation of the sample estimates. The smaller the standard error or estimate, the higher is the precision of the sample. • Single: A good sample must be adequate in size in order to reliable. The sample should be of such size that the inferences drawn from the sample are accurate to the given level of confidence. Following are the some terminology used in sampling: 1. Population: In research, population refers to a total category of persons or objects that meets the criteria for study established by the researcher, any set of persons, objects or measurements having an observable characteristics in common. While selecting the sample, the researcher used the eligibility criteria, i.e. those characteristics that restrict the population to a homogeneous group of subjects. It may also be viewed as delimitation, examples of delimitations include the gender, age, martial status, socioeconomic status, ethnicity, level of education, age of children, health status, and diagnosis. The population criteria establishes the target population or an accessible population. The target population refers to the population that the researcher wishes to study the population about which the researcher wishes to make a generalisation, i.e. the entire set of cases about which the researcher would like to make generalisation, e.g. BSc nursing students. The accessible population refers to the aggregate of cases which conform to the designated criteria and which to accessible the researchers as a pool of subjects for the study, i.e. that aggregate must meet the criteria for inclusion in the study and that is available to the researcher/ investigator. A sample is a selected proportion of the defined population. It is a subset of the population of interest. For example, every tenth person, every third student, and so on. A sample is a set of elements that make up the population and an element is the most basic unit about which information is collected. The most common element in nursing research is individuals, but other elements such as places or objects can form the basis of a sample or population. A sampling unit is the element or set of elements used for selecting the sample. Thus, sample refers to a portion of a large population of subjects or objects. Sampling refers to the process of selecting a portion of population to represent the entire population. A sample that consists of subject units which comprise the population. In sampling terminology, the units which make up the samples and population are usually referred to as elements. Universe/Population: From a statistical point of view, the term ‘Universe’ refers to the total of the items or units in any field of inquiry,

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Essentials of Nursing Research whereas the term ‘population’ refers to the total of items about which information is desired. The attributes that are the object of study are referred to as characteristics and the units possessing them are called as elementary units. The aggregate of such units is generally described as population. Thus, all units in any field of inquiry constitute universe and all elementary units (on the basis of one characteristic or more) constitute population. Quit often, we do not find any difference between population and universe, and as such the two terms are taken as interchangeable. However, a researcher must necessarily define these terms precisely. The population or universe can be finite or infinite. The population is said to be finite if it consists of a fixed number of elements so that it is possible to enumerate it in its totality. For instance, the population of a city, the number of workers in a factory are examples of finite populations. The symbol ‘N’ is generally used to indicate how many elements (or items) are there in case of a finite population. An infinite population is that population in which it is theoretically impossible to observe all the elements. Thus, in an infinite population the number of items is infinite, i.e. we cannot have any idea about the total number of items. The number of stars in a sky, possible rolls of a pair of dice are examples of infinite population. One should remember that no truly infinite population of physical objects does actually exists in spite of the fact that many such populations appear to be very very large. From a practical consideration, we then use the term infinite population for a population that cannot be enumerated in a reasonable period of time. This way we use the theoretical concept of infinite population as an approximation of a very large finite population. 2. Sampling frame: The elementary units or the group or cluster of such units may form the basis of sampling process in which case they are called as sampling units. A list containing all such sampling units is known as sampling frame. Thus, sampling frame consists of a list of items from which the sample is to be drawn. If the population is finite and the time frame is in the present or past, then it is possible for the frame to be identical with the population. In most cases, they are not identical because it is often impossible to draw a sample directly from population. As such this frame is either constructed by a researcher for the purpose of his study or may consist of some existing list of the population. For instance, one can use telephone directory as a frame for conducting opinion survey in a city. Whatever the frame may be, it should be a good representative of the population.

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3. Sampling design: A sample design is a definite plan for obtaining a sample form the sampling frame. It refers to the technique or the procedure the researcher would adopt in selecting some sampling units from which

Sampling inferences about the population is drawn. Sampling design is determined before any data are collected. Various sampling designs have already been explained earlier in the book. 4. Statistic(s) and parameter(s): A statistic is a characteristic of a sample, whereas a parameter is a characteristic of a population. Thus, when we work out certain measures such as mean, median, mode or the like ones from samples, then they are called statistic(s) for they describe the characteristics of a sample. But when such measures describe the characteristics of a population, they are known as parameter(s). For instance, the population mean (m) is a parameter, whereas the sample mean (X) is a statistic. To obtain the estimate of a parameter from a statistic constitutes the prime objective of sampling analysis. 5. Sampling error: Sample surveys do imply the study of a small portion of the population and as such there would naturally be a certain amount of inaccuracy in the information collected. This inaccuracy may be termed as sampling error variance. In other words, sampling errors are those errors which arise on account of sampling and they generally happen to be random variations (in case of random sampling) in the sample estimates around the true population values. Sampling errors occur randomly and are equally likely to be in either direction. The magnitude of the sampling error depends upon the nature of the universe; the more homogeneous the universe, the smaller the sampling error. Sampling error is inversely related to the size of the sample, i.e. sampling error decreases as the sample size increases and vice-versa. A measure of the random sampling error can be calculated for a given sample design and size and this measure is often called the precision of the sampling plan. Sampling error is usually worked out as the product of the critical value at a certain level of significance and the standard error. As opposed to sampling errors, we may have non-sampling errors which may creep in during the process of collecting actual information and such errors occur in all surveys whether census or sample. We have no way to measure non-sampling errors. 6. Precision: Precision is the range within which the population average (or other parameter) will lie in accordance with the reliability specified in the confidence level as a percentage of the estimate + or as a numerical quantity. For instance, if the estimate is Rs 4000 and the precision desired is + 4%, then the true value will be no less than Rs 3840 and no more than Rs 4160. This is the range (Rs 3840 to 4160) within which the true answer should lie. But if we desire that the estimate should not deviate from the actual value by more than Rs 200 in either direction, in that case the range would be Rs 3800 to 4200.

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Essentials of Nursing Research 7. Confidence level and significance level: The confidence level or reliability is the expected percentage of times that the actual value will fall within the stated precision limits. Thus, if we take a confidence level of 95%, then we mean that there are 95 chances in 100 (or .95 in 1) that the sample results represent the true condition of the population within a specified precision range against 5 chances in 100 (or .50 in 1) that it does not. Precision is the range within which the answer may vary and still be acceptable; confidence level indicates the likelihood that the answer will fall within that range, and the significance level indicates the likelihood that the answer will fall outside that range. We can always remember that if the confidence level is 95%, then the significance level will be (100-95), i.e. 5%; if the confidence level is 99%, the significance level is (100-99) i.e. 1%, and so on. We should also remember that the area of normal curve within precision limits for the specified confidence level constitute the acceptance region and the area of the curve outside these limits in either direction constitutes the rejection regions. 8. Sampling distribution: We are often concerned with sampling distribution in sampling analysis. If we take certain number of samples and for each sample compute various statistical measures such as mean, standard deviation, etc. then we can find that each sample may give its own value for the statistic under consideration. All such values of a particular statistic, say mean, together with their relative frequencies will constitute the sampling distribution of the particular statistic, say mean. Accordingly, we can have sampling distribution of mean, or the sampling distribution of standard deviation or the sampling distribution of any other statistical measure. It may be noted that each item in a sampling distribution is a particular statistic of a sample. The sampling distribution tends quite closer to the normal distribution, if the number of samples is large. The significance of sampling distribution follows from the fact that the mean of a sampling distribution is the same as the mean of the universe. Thus, the mean of the sampling distribution can be taken as the mean of the universe.

ADVANTAGES AND DISADVANTAGES OF SAMPLING Advantages of Sampling The advantages of sampling are as follows:

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Economy in expenditure: If the data are collected for the entire population, cost will be very high. It is economical of cost, when the data are collected from a sample which is only a fraction of the population, i.e. sampling helps to reduce the cost in the research.

Sampling Economy in time: The use of sampling is economical of time also. Sampling is less time consuming than census technique. Tabulation, analysis, etc. also takes much less time in the case of a sample than in the case of a population. That means sampling helps greater speed in the project. Greater scope: In many fields of enquiry (For example, quality control tests) where the complete destruction of the product is involved, a cent percent test production is impossible, and often, impracticable also, but they require highly trained personnel and sophisticated equipment. Sample simplifies things and personnel with little training can collect and handle data. There is a greater scope and flexibility of studies when a sample is used. Greater accuracy: Sampling ensures completeness and a high degree of accuracy due to a limited area of operation. In dealing with a sample, the volume of work is reduced, therefore careful execution of fieldwork is possible. This processing of the data is also done more accurately, which in turn produces better results. Organisation of convenience: Sampling involves very few organisational problems. Due to small numbers, it does not require vast facilities. It is economical in respect resources. The space and equipment required for this study are very small. Intensive and exhaustive data: As the number is limited, it is possible to collect intensive and exhaustive data. Suitable in limited resources: In every society, there are more problems and less resources, particularly when the people are poor and problems uncountable. This is the method which enables the researcher to work even with limited resources. Better rapport: It is very difficult to develop rapport of the large number of people, but it is possible to develop better rapport with the respondent/ subjects.

Disadvantages of Sampling Chances of bias: Sampling may involve biased selection and thereby lead to draw erroneous conclusions, may be due to various reasons. Difficulty in getting representative supply: Selection of a truly representative sample is very difficult particularly when the phenomena under study are of a complex nature. Need for specialised knowledge: In the absence of specialised knowledge, investigator may commit serious mistakes. So it requires specialised

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Essentials of Nursing Research knowledge of sampling technique, statistical analysis and calculation of probable error. Changeability of units: The cases of the sample may be widely dispersed, since many refuse to co-operate and some may be inaccessible and sometimes the selected cases may have to be replaced by others. All these introduce a change in the stipulated subjects to be studied. Impossibility of sampling: Sometimes the universe is too small, or too heterogeneous, that, it is not possible to drive a representative sample. In such cases, supply is not required.

Characteristics of a Good Sample 1. A good sample is one, which within restrictions imposed by its size, will reproduce the characteristics of the population with the greatest possible accuracy. 2. It should be free from error due to bias or due to deliberate selection of the unit of the sample. 3. It should be free from random sampling error. 4. There should not be any substitution of originally selected unit by some other more convenient in any way. 5. It should not suffer from incomplete coverage of the units selected for the study, i.e. it should not ignore the failure in the sample in responding to the study. 6. Relatively small samples properly selected may be much more reliable than large samples poorly selected. But at the same time, it is very essential that the sample is adequate in size so that it can become more really reliable. 7. In the sample, only such units should be included, which as far as possible, are independent. 8. While constructing a sample, it is important that measurable or known probability sample technique are used. This will substantially reduce the likely discrepancies.

The Sampling Process Sampling is a process of selecting a portion of the designated population to represent the entire population or consists of seven sequential steps as follows:

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Define the population: The population that researcher wants to obtain information according to the objectives of study should be clearly demarcated and defined. The population is defined in terms of element, units

Sampling extent and time. For example, coffee drinkers is (element) household that have (sampling unit) bought coffee (extent) in the last three months (time). Specify sampling frame: It is the means of representing the elements of the population (for example, telephone book, map or city directory, etc.). Specify sampling unit: It refers to the unit for sampling in selection. The sampling unit may contain one or more elements. This step involves the task of determining that data to be collected on the sample so defined. Specify sampling method of measurement: The method by which the sampling units are to be selected is described. The methods of data collection are obviously dependent on the data to be collected. It should be collected by using the appropriate tools, devices and so on. Determine sample size: The number of elements of the population to be sampled is decided. It helps to estimate the cost of the survey and so on. Specify sampling plan: The operational procedures for selection of the sampling units is specified. It involves getting the returns back from the sampling population, supervision of the work, checking of the quality of returns, planning to handle non-responding subjects, etc. Select the sample: The office and fieldwork necessary for the selection of the sample are carried out.

Methods of Sampling Sampling methods may be classified into two generic types or approaches. (Table 10.1). I Probability sampling or Random sampling II Non-probability sampling or Non-random sampling Table 10.1: Sampling techniques/methods Probability sampling

Non-probability sampling

• • • • • • • •

• • • • • • • • • •

• •

Simple random sampling Stratified random sampling Systemic random sampling Cluster random sampling Random route sampling Area sampling Multistage and sub-sampling Random sampling with probability proportional to size Double sampling and multiphase sampling Replicated or interpenetrating sampling

Convenience or accidental sampling Purposive or judgmental sampling Quota sampling Snowball sampling Theoretical sampling Voluntary sampling Model instance sampling Expert sampling Diversity sampling Event sampling

• Time sampling

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Essentials of Nursing Research Sampling theory distinguishes between two main approaches to sampling in research as stated above. The brief explanation of the problems and non-probability sampling is as follow: Sampling strategies are generally groups into two types or methods probability sampling and non-probability sampling. Probability sampling are those in which sample elements are automatically selected by some scheme under which a particular sample of given size from a specified population has some known probability being selected. It uses some form of random selection when choosing the sample units. This type of sample enables the researchers to estimate the probability that each element of the population will be included in the sample. It is more rigorous type of sampling strategy, and it is more likely to result in a representative sample. Non-probability sampling are those in which the sample elements are arbitrarily selected by the sampler because in his judgement the elements thus chosen will most effectively represent the population. Here elements are chosen by non-random methods. The drawback of this strategy is that there is no way of estimating the probability that each element has of being included in the samples. Essentially there is no way of ensuring that every element has a chance for inclusion in the non-probability sample. Let us discuss the methods and their major types as follows:

Probability Sampling

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Probability sampling is based on the theory of probability. It is also known as random probability. The primary characteristics of probability sampling is the random selection of elements from the population. It provides a known non-zero chance of selection for each population element. Random selection occurs when each element of the population has an equal and independent chance of being included in the sample. In probability sampling, the investigator can specify for each element of the population, the probability that will be included in the sample. Usually each element has the same probability of being included in the sample, but the basic requirement is that there exists a known probability that a given element will be included. The sampling units are selected as random (by chance) and neither investigator nor the population elements have any conscious influence on what is included in the sample. In probability sampling every population has a chance of being selected, such a chance is known as probability. It yields a representation sample and hence findings of the sample survey are generalizable to the

Sampling population. The closeness of a sample to the population can be determined by estimating sampling bias or error. Through randomisation, the danger of unknown sampling bias can be minimised. Hence, probability sampling is preferable. It should be used when generalisation is the objectives of study, and a greater degree of accuracy of estimation of population parameters is required. Cost and time required for probability sampling may be large. Hence, the benefit derived from it should justify the cost. The primary characteristics of probability sampling is the random selection of elements from the population. There are four major types in use for probability sampling. The strategies are: Simple random sampling, stratified random sampling, cluster sampling, and systematic sampling. The major methods for probability sampling include: 1. simple random sampling, 2. stratified random sampling, 3. systematic random sampling, 4. cluster random sampling, and 5. random route sampling. The following discussion provides an overview of each of these sampling methods. Detailed procedures can be found in sources on more advanced research methodology. 1. Simple random sampling: It is a probability sampling procedure in which the required number of sampling units are selected at random from the population in such a manner that each population element has an equal chance (probability) of being selected for the sample. Each choice of a sampling unit must be independent of all other choices. One of the most acceptable methods for selecting a simple random sample is to use a table of random numbers, which can be either computer-generated or found in a statistics textbook. The numbers in a random-number table have been generated in such a way that there is no pattern. The same probability exists that any digit will follow any other digit, and each selection is an independent choice. To obtain a simple random sample, first list each of the population elements, then assign consecutive numbers to each of these elements. Then, referring to table of random numbers, arbitrarily start at any point in the table and proceed in any direction to identify enough tabled numbers to associate with the population elements until the desired sample has been selected. The procedure of drawing a simple random sample consists of: • Enumeration of all elements in the population. • Preparation of a list of all elements, giving them numbers in a serial order 1, 2, 3… so on, and • Drawing sample numbers by using: (a) lottery method, (b) a table of random numbers, or (c) a computer.

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The simple random sampling is suitable only for a small homogeneous population. It may yield a representative sample under the following conditions: • Where the population is a homogeneous group with reference to the specified characteristics, e.g. students in fifth standard in a boys school form a homogeneous group as regards level of education and age group; • Where the population is relatively small: and • Where a complete list of all elements is available or can be prepared. The simple random sampling is not suitable for drawing a sample from a large heterogeneous population; as it may not yield a representative sample of such population. Some advantages of simple random sampling are: • All elements in the population have an equal chance of being selected. • Of all the probability sampling techniques, simple random sampling is the easiest to apply. • It is the most simple type of probability sampling to understand. • It does not require a prior knowledge of the true composition of the population. • The amount of sampling error associated with any sample drawn can easily be computed. The simple random sampling techniques suffers from certain drawbacks. • It is often impractical, because of non-availability of population list, or of difficulty in enumerating the population. For example, it is difficult to get a current accurate list of households in a city or a list of landless rural agricultural labourers who migrate from area-to-area in search of employment or a list of households of a nomadic tribe. • The use of simple random sampling may be wasteful because we fail to use all of the known information about the population. • This technique does not ensure proportionate representation to various groups constituting the population. • The sampling error in this sampling is greater than that in other probability samples of the same size, because it is less precise than other methods. • The size of the sample required to ensure its representativeness is usually larger under this type of sampling than under other random sampling techniques. • A simple random design may be expensive in time and money. These problems have led to the development of alternative superior random sampling designs like stratified random sampling, systematic sampling, etc.

Sampling 2. Systematic or quasi random sampling: A systematic sample is formed by selecting every nth item from the universe where ‘n’ refers to the sampling interval. The sampling interval can be determined by dividing the Size of the Universe by the Size of the Sample to be chosen. For example, if we wish to draw a sample of 320 traveling expense vouchers from a universe of 32,000 vouchers, the sampling interval would be 100; that is, every 100th voucher will have to be selected. We may start the sample selection anywhere between the first and the 100th voucher. A random start is always preferable, that is, a start determined by chance, if this number is 6, the sample is composed of the numbers, 6, 106, 206, 306… In systematic sampling one can achieve greater efficiency by so arranging the units in the universe that the similarities between immediate neighbours and differences between distant neighbours increase. Thus, if the expense vouchers in the above example are arranged in order of magnitude these conditions are met and by drawing every 100th voucher a better representation of vouchers of all sizes in the sample can be achieved. 3. Stratified random sampling is a probability sampling procedure that is a variation of the simple random sample. The population is divided into two or more strata or groups with different categories of a characteristic. A simple random sample is then taken from each group. This procedure is used when the composition of the population is known with respect to some characteristic or characteristics. The variables (characteristics) chosen to stratify the population must be those that are important to the study. For example, a population of 500 human elements may be stratified on the basis of gender. Then half of the sampling units may be chosen from the female category and the other half from the male category by simple random sampling. This ensures that the sample will consist of equal allocations of males and females from each population stratum. A population may be divided into other strata or categories, such as age, educational background, occupation, ethnicity and so on, depending on their importance for the study. To ensure that the samples taken in a stratified random sample accurately reflect the composition of the population, researchers may choose to use proportional sampling. This requires that the researcher be able to identify the percentage of the population that each stratum contains. The researcher then samples the population proportionately, based on these percentages. For example, if a researcher knew that the nursing staff of an agency was comprised of 20% ANMs, 30% LHVs without a Bachelor’s degree, 46% SNs with a Bachelor’s degree, and 4% SNs with a Master’s degree, the researcher would sample the entire nursing

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Essentials of Nursing Research staff in these proportions. Twenty percent of the sample would come from the ANMs, 30% from the SNs without a bachelor’s degree, 46% from RNs with a bachelor’s degree, and 4% from SNs with a master’s degree. In many surveys the population is markedly heterogeneous. Stratified random sampling refers to a sampling design. Where the entire universe is divided into groups or strata in such a way that (i) there is as great homogeneity as possible within each stratum, and (ii) as marked a difference as possible between the strata. Sample is then taken by selecting a certain number of units from each stratum. An example would be to first classify customers according to their financial status and then to draw units from each class in order to measure customer demand for expensive and luxury items. Stratified sampling can be either proportionate, or disproportionate. In proportionate stratified sampling, the number of sample units in various strata are in the same proportion as found in the population. Thus, the larger a particular stratum, the more weight it receives in the analysis. For example, if a stratum accounts for 40% of the frame and a total sample of 100 is to be selected, then 40 sampling units should be selected from that stratum. In disproportionate sampling, the strata are represented in the total sample in a proportion other than the one with which they are found in the frame. Thus, a stratum receives a weight based upon some factor in addition to its size in the total population. There are three factors, which might be considered in establishing what is referred to as the “optimal allocation” of the sample among the strata: i. If the variability in one stratum is greater than that in the other (as measured by their standard deviations) a proportionately larger sample size may be allocated to the more carriable structure to obtain a meaningful representation of its cross-section. ii. If the cost of sampling varies from one stratum to the next, so that the sampling error can be reduced more cheaply in one stratum than in the other, the cheaper stratum may have a larger proportion of the sample size allocated to it. iii. If in the opinion of the researcher, sampling units of one stratum are more important than those of the other and need greater representation in the sample, he can allocate a larger proportion of the sample to that stratum.

a. Proportionate Stratified Sampling

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This sampling involves drawing a sample from each stratum in proportion to the latter’s share in the total population. For example, if the final year MSc nursing students of the Nursing Faculty of a university consist of the following specialisation groups:

Sampling Specialisation stream

No. of students Proportion of each stream

Community health nursing Medical-surgical nursing Maternal / Child health nursing Psychiatric nursing

40 20 30 10 100

0.4 0.2 0.3 0.1 1.0

The researcher wants to draw an overall sample of 30. Then the strata sample sizes would be: Strata Community health nursing Medical-surgical nursing Maternal and child health nursing Psychiatric nursing

Sample size 30 × 0.4 = 30 × 0.2 = 30 × 0.3 = 30 × 0.1 =

12 6 9 3

Thus, proportionate sampling gives proper representation to each stratum and its statistical efficiency is generally higher. This method is, therefore, very popular. The principal advantages of proportionate stratified sampling are: • It enhances the representativeness of the sample by giving proper representation to all subgroups in the population. • It gives higher statistical efficiency than that given by simple random sampling for a given sample size. • It is easy to carry-out this sample method. • This method gives a self-weighing sample, the population mean can be estimated simply by calculating the sample mean. The drawbacks of the proportionate stratified random sampling are: • A prior knowledge of the composition of the population and the distribution of the population characteristics are required to adopt this method. • This method is very expensive in time and money. Of course its greater efficiency may offset the additional cost. • The identification of the strata might lead to classification errors. Some elements may be included into the wrong strata. This may vitiate the interpretation of survey results.

b. Disproportionate Stratified Random Sampling This method does not give proportionate representation to strata. It necessarily involves giving overrepresentation to some strata and under representation to others. There may be several disproportionate schemes. All strata may be given equal weight, even though their shares in the total population vary. Alternatively some substrata may be given greater

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weight and others lesser weight. When is such disproportionate weighing preferable? The desirability of disproportionate sampling is usually determined by three factors, viz. (a) the sizes of strata, (b) internal variances among strata, and (c) sampling costs. The guideline suggested by Cochrane is: In a given stratum, take a larger sample if a. The stratum is larger, b. The stratum is more variable internally, and c. Sampling is cheaper in the stratum. If the elements of a stratum are more mixed or variable, then it would be sensible to take a larger sample from it in order to make it representative of the stratum. Similarly, if the cost per sampling unit is expected to be greater in some strata than in others, one could increase the costeffectiveness by taking a less proportionate sample in the costlier strata. This method of disproportionate sampling is not widely used. However, it is appropriate to use it under the following circumstances: 1. When the population contains some small but important subgroups. 2. When certain subgroups are quite heterogeneous, while others are homogeneous; and 3. When it is expected that there will be appreciable differences in the response rates of the subgroups in the population. But the above differences should be several-fold to make disproportionate sampling worthwhile. Disproportionate sampling cannot be used for population with unknown proportions of characteristics, because correct sizes of strata samples cannot be determined. The major advantages of disproportionate sampling are: • It is less time consuming compared with proportionate sampling, because the researcher is not necessarily concerned about the proportionate representativeness of his resulting sample as in the latter method. • It facilitates giving appropriate weighing to particular groups, which are small but more important. The disadvantages of disproportionate sampling are: • This method does not give each stratum proportionate representation. Hence, the resulting sample may be less representative. • This method requires a prior knowledge of the composition of the population, which is not always possible. • This method is also subject to classification errors. It is possible that the researcher may misclassify certain elements.

Sampling • Though disproportionate sampling is a means for developing an optimal. Stratification scheme, its practical feasibility is doubtful because one generally does not know the relative variability in the strata nor the relative costs. 4. Systematic sampling or fixed interval method: This method of sampling is an alternative to random sampling. It consists of taking every kth item in the population after a random start with an item from 1 to k. For example, suppose it is desired to select a sample of 20 students, from a list of 300 students, divide the population total of 300 by 20, the quotient is 15. (if there is any fraction in the quotient ignore the fraction and take the integer or whole number). Select a number at random between 1 and 15, using lottery method or a table of random numbers. Suppose the selected number is 9. Then the students numbered 9, 24 (9+15), 39 (24+15), 54 (39+15), 69, 84 … are selected as the sample. As the interval between sample units is fixed, this method is also known as fixed interval method. Systematic selection can be applied to various populations such as students in a class, houses in a street, telephone directory, customers of a bank, assembly line output in a factory, members of an association and so on. Strictly speaking, this method of sampling is not a probability sampling. It possesses characteristics of randomness and some non-probability traits. Hence, it is sometimes called a ‘pseudo-random’ sampling. Systematic random sampling: It is a probability sampling procedure in which subjects are randomly selected from the population at fixed intervals that are predetermined by the researcher. Before selecting the first element, the researcher determines how large the sample should be and decides on the size of the intervals. The first element is selected at random and subsequent elements are selected according to the intervals. Systematic random sampling is similar to random sampling in that the first population element is based on random identification. When the researcher knows the size of the population and it is not overwhelming large, the researcher may determine that a certain percentage of the population should be sampled. For example, if a population consisted of 200 nurses working in an urban hospital and a sample of 10% has been determined to be sufficient, the researcher would select the first individual’s name at random from the nursing personnel list and then count down to the tenth name on the list to select the next person. This procedure would continue until 20 individuals had been selected. Thus, the researcher, using a table of random numbers, might select as the first subject the 87th person on the nursing personnel roster–then the 97th and 107th individuals would

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Essentials of Nursing Research become subjects, and so on. If the list is exhausted before the available number of subjects have been selected, the researcher would continue to count from the beginning of the list. To ensure a completely random selection of subjects, the personnel list should be randomly ordered in the beginning to rule out biases that might be accidentally introduced if the list has been compiled in any specific order.

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5. Cluster sampling: Where the population elements are scattered over a wider are and a list of population elements is not readily available, the use of simple or stratified random sampling method would be too expensive and time-consuming. In such cases cluster sampling is usually adopted. Cluster sampling means random selection of sampling units consisting of population elements. Each such sampling unit is a cluster of population elements. Then from each selected sampling unit, a sample of population elements is drawn by either simple random selection or stratified random selection. It is a probability sampling procedure that progresses in stages from larger sampling units to smaller sampling units. Cluster random sampling is most often used in large-scale studies in which the population is geographically spread out. The sampling unit is the cluster, consisting of groups, rather than individuals, all of whom have the same characteristic(s). A cluster could consist of nursing homes, hospitals, or home health agencies. For example, if the primary sampling unit (cluster) is a group of acute care hospitals, a random sample of these could be taken; then in subsequent sampling stages, a random sample of the various nursing units in each of these hospitals could be taken; then at the next stage, a random sample could be taken that consisted of the nursing supervisors on whom the actual measurements are needed for the study. Cluster sampling has the advantage of convenience and involves less time and money than large-scale studies while retaining the advantages of probability sampling. Under this method sample is prepared by stages. The population is divided into a number of large sampling units, each of which in turn is divided into smaller units and so on. A random sample is taken of the large units at the first stage and from those selected a further random sample, i.e. the second stage is collected of the smaller units. Suppose, we want to take a sample of 5,000 households from Karnataka. At the first stage, the state may be divided into a number of districts and a few districts selected at random. At the second stage, each district may be subdivided into a number of villages and a sample of villages may be taken at random. At the third stage, 5,000 households may be selected from the villages selected at the second stage.

Sampling • Sampling list, identification, and numbering are required only for units selected in the sample at each stage and not for all the units of the population. • If sampling units at each stage are geographically defined (such as district, village, etc.) this method cut down field costs (i.e. travel). • Errors increase as the number of sampling units selected decreases. Cluster sampling consists of first selecting, at random natural groups of units (called clusters) from the universe. Then all or some of the units within each cluster are chosen to make up the sample. Cluster sampling is diametrically opposed to stratified sampling. In cluster sampling, for best results (i) the units within each cluster should be as heterogeneous as possible, and (ii) there should be as small a difference as possible between the clusters. Ideally, each cluster should be a miniature of the sampled universe. The reason for using cluster sampling is the great reduction in costs and increase in convenience. Thus, for example, in a dental survey of the fifthgrade school children in a Shimoga city, we might regard the child as the sampling unit and select a sample of children from the combined school registers for the city. But the inconvenience and cost of traveling from one randomly selected child in one school to that in another would be very large if there are a good number of schools in that city. It would be simpler, however, to take the school as the sampling unit, draw a sample of school and examine every fifth grade child in the selected schools. A sample of five schools of 100 fifth-grade boys each would very likely yield information of as much reliability as and at considerably less expenses than a simple random sample of 500 boys scattered over all the schools in the city. 6. Sequential sampling or sampling in installments: Under this method the researcher takes a very small sample in the beginning and tries to draw inference on the basis of that sample. If no clear-cut inference is possible, he adds some more units to the sample (often one at a time) and weighs the enlarged sample evidence to see if the inference can be drawn now. This is continued until a point is reached at which a clear-cut inference can be drawn within some previously chosen degree of confidence. In this way, the researcher works on the basis of a predetermined sampleplan which tells how long he should go on increasing his sample. This method has become very popular in drawing samples of destructible items (e.g. explosives) which are irretrievably lost or destroyed once they are tested for their quality. It is also used nowadays in taking decisions to accept or reject the quality of a given lot of raw material, output, accounting record, etc. An imaginary sample-plan is given in Table 10.2 to illustrate the working of this method.

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Essentials of Nursing Research Table 10.2: Sequential sample plan to determine acceptance, rejection or continued testing of a lot Number of items randomly selected for testing 2 7 19 27 30 31 40 42 54 63 65

Number of defective items Accept Reject Continue testing 0 1 2 3 4 5

2 3 4 4 5 5 6 6 6 6 6

0-1 0-2 0-3 1-3 1-4 2-4 2-5 3-5 4-5 5 -

It can be seen from this plan that the sample in the beginning consists of two items only. The plan suggests that the entire lot must be rejected if both the items of the sample are found to be defective. If, however, the number of defective items is none or one of the two items is found defective, then the testing is to continue. Similarly, the entire lot must be rejected if three items of the first seven tested are defective and if the number of defective items is anywhere from zero to two then continue testing. If no defective items are found in the first 27 items tested, the lot must be accepted. If one to three defective items are found, testing must continue. In this illustration, the sample size can grow as large as 65 items. Three characteristics of sequential sampling become evident from this illustration. 1. Sequential sampling is used in problems involving alternatives (viz. to accept or to reject the entire lot or to continue further analysis). 2. Unlike all other types of sampling, in sequential sampling the total sample size is not determined at the time sampling starts. We do not know in advance how many installments will be needed until we can arrive at a decision. 3. Each installment is selected at random; thus sequential sampling is probability sampling.

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7. Replicated or interpenetrating sampling: Replicated or interpenetrating sampling means to draw two or more independent sub-samples or replicas by some random method. Under this method, the population is first divided into as many zones as there are sampling units to be included in each subsample. For example, if we want to draw five subsamples of 10

Sampling employees each from a total of 400 employees we will divide the population into 10 zones of 40 employees each. Next, each of the five subsamples will be formed either by reading out 10 random numbers one from each zone or by reading out one random number in the first zone only and then systematically selecting every 40th unit there after. Replicated sampling has the following advantages: 1. Findings of various subsamples can be compared with each other before arriving at the main conclusion. The consistency of findings from replica-to-replica is the strongest argument for the plausibility of findings. 2. Replicated sampling provides insurance against several unforeseen mishaps that can befall a survey or some other method of research. For instance, if at some point in the enquiry it becomes necessary for the investigator to discard the data for one or two replicas he may still proceed with the analysis of the remaining replicas. A high internal consistency of findings across the remaining replicas enables the investigator to discard the faulty ones without jeopardising his conclusion. 3. Replicated sampling is particularly useful when it is not possible to study the whole sample in the allotted time or when the preliminary results are required quickly. In such situations work may be planned in interpenetrating samples and different subsamples assigned to different investigators for study to speed up the whole work. 4. When different subsamples are assigned to different investigators for study, this acts as a check on their performance. 8. Area sampling: This is an important from of cluster sampling. In larger field surveys, clusters consisting of specific geographical areas like districts, talukas, villages or blocks in a city are randomly drawn. As the geographical areas are selected as sampling units in such cases, their sampling is called area sampling. It is not a separate method of sampling, but forms part of cluster sampling. In a country like India where a state (previously known as a province) is divided into districts, districts into talukas and talukas into towns and villages, areas sampling is done on the basis of these administrative units in multistages. (See ‘Multistage Sampling’, below). Where the area covered by a study is a city, to draw a random sample of households, the following procedure may be adopted: 1. Take a map of the concerned city and lay over it a transparent sheet with a grid system of lines (i.e. horizontal and vertical lines drawn at equal intervals).

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Essentials of Nursing Research 2. The grid system divides the city into squares of equal size, say 100 areas. 3. Leave the squares occupied by non-residential business and public buildings, parks, etc. – say 30 squares. 4. Number the remaining squares in a serial order 1, 2, 3, 4, 5, … 70 in a serpentine manner. 5. Estimate the average number of households in each square on the basis of house counts in a few squares. Say the average number of households is 80. 6. If the required sample of households is, say 640, determine the number of squares to be selected by dividing this total by 80, i.e. 8 squares. 7. Select eight squares out of 80 on a simple random basis using a table of random numbers; or by adopting systematic random sampling method, i.e. every 10th (80/8=10) square with a random start. 8. Study all households in each of the sample eight squares. The total sample would be 8 × 80 = 640 or a little less or more. Where different socioeconomic class of households are found to be concentrated in specific areas of the city, it is desirable to stratify the area on an identifiable basis, then • Draw a random sample of proportionate number of areas from each strata. • Prepare a list of households in each of the selected areas. • Select randomly a proportionate number of households in each of these lists. Alternatively divide each of the selected area into smaller areas of almost equal size called segments and select randomly a proportionate number of segments in each sample area and survey all households in each of the selected segments. Area sampling invariably involves multistage sampling and subsampling.

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9. Multistage sampling: In this method, sampling is carried out in two or more stages. The population is regarded as being composed of a number of first stage sampling units. Each of them is made up of a number of second stage units and so forth. That is, at each stage, a sampling unit is a cluster of the sampling units of the subsequent stage. First, a sample of the first stage sampling units is drawn, then from each of the selected first stage sampling unit, a sample of the second stage sampling units is drawn. The procedure continues down to the final sampling units or population elements. Appropriate random sampling method is adopted at each stage. Multistage sampling is appropriate where the population is scattered over a wider geographical area and no frame or list is available for sampling.

Sampling It is also useful when a survey has to be made within a limited time and cost budget. The crucial advantages of multistage sampling are: • It results in concentration of fieldwork in compact small areas and consequently in a saving of time, labour and money. • It is more convenient, efficient and flexible than single-stage sampling. • It obviates the necessity of having a sampling frame covering the entire population. The major disadvantages of the multistage sampling is that the procedure of estimating sampling error and cost advantage is complicated. It is difficult for a non-statistician to follow this estimation procedure. Subsampling is a part of a multistage sampling process. In multi-stage sampling, the sampling in second and subsequent stage frames is called subsampling. Suppose that from a population of 40,000 households in 800 streets of a city, we want to select a sample of about 400 households. We can select a sample of 400 individual households (elements) or a sample of 8 streets (cluster). The sample of 400 elements would be scattered over the city, but the cluster sample would be confined to 8 streets. Clustering reduces survey costs, but increases the sampling error. Subsampling balances these two conflicting effects of clustering. In the above case, first a sample of say 80 streets may be drawn and from each of the selected street a 10% subsample of households may be drawn. In each of the above stages, an appropriate probability sampling-simple random/ stratified random sampling/systematic random sampling-may be adopted. 10. Sampling with probability proportionate size (PPS): The procedure of selecting clusters with probability proportional to size (PPS) is widely used. If one primary cluster has twice as large a population as another, it is given twice the chance of being selected. If the same number of persons is then selected from each of the selected clusters, the overall probability of any person will be the same. The PPS is a better method for securing a representative sample of population elements in multistage cluster sampling. The selection procedure is as follows: 1. Draw a list of clusters with their size measures; 2. Cumulate the size measures in sequences; 3. Divide the list into a certain appropriate number of equal zones/ strata with reference to cumulated measure, e.g. if the cumulative total is say 600, the list may be divided into three equal zones 1-200, 201-400, 401600; 4. Select the required equal number of sample in each zone, applying preferably systematic selection with a random start; and

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Essentials of Nursing Research 5. Draw a same fixed number of population elements from each selected cluster at random. Suppose the area of a survey is a state consisting of 20 districts. Out of them four districts are to be selected with PPS, the measure of size being population. a. List the district in some order and record the population of each together with cumulative population figures. b. Divide the cumulative total by 2; 310/2 = 155; c. Divide the list into two zones; 1-155; 156-310; d. Make a systematic random selection of two districts in each zone; e. Divide the first zone total by 2: 155/2-77. Draw a random number between 1 and 77, say, 66. The district 8th is the first sample. f. Add the interval 77 to the random number of 66 to give 143, to locate 13 as the second; g. Add the interval 77 to 143 to give 220, to locate district 17 as the third sample; and h. Add the interval 77 to 220 to give 297, to locate 20 as the fourth sample. The major advantages of PPS are: • Clusters of various sizes get proportionate representation. • PPS lead to greater precision than would a simple random sample of clusters and a constant sampling fraction at the second stage. • Equal-sized samples from each selected primary cluster are convenient for fieldwork. If one interviewer is assigned to each cluster, the interviewers have equal workloads. PPS cannot be used if the sizes of the primary sampling clusters are not known. Since in practice, primary sampling units (clusters) generally vary considerably in size, sampling with PSS is used in all multistage sampling. 11. Double (or two-phase) sampling and multi-phase sampling: Double (or two-phase) sampling “refers to the subsection of the final sample from a preselected larger sample, that provide information for improving the final selection”. When this procedure is extended to more than two phases of selection, it is then, called multi-phase sampling. This is also known as sequential sampling, as subsampling is done from a main sample in phases. Additional information from subsample of the full sample may be collected at the same time or later.

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12. Replicated or interpenetrating sampling: A real difficulty with complex sample designs like multistage stratified sampling is the laboriousness of the sampling error calculations. The case of these calculations is a factor to be taken into account in designing of a sample plan. One approach to

Sampling simplify the procedure of computing sampling errors is replicated or interpenetrating sampling, which Deming discusses in full, with a number of illustrations. Replicated or interpenetrating sampling involves selection of a certain number of subsamples rather than one full sample from a population. All the subsamples should be drawn using the same sampling technique and each is a self-contained and adequate sample of the population. Replicated or interpenetrating sampling can be used with any basic sampling technique: simple or stratified, single or multistage or single or multi-phase sampling. For example, in order to study the views of postgraduates students of a university on semester system a random sample of 300 students (out of a total population of 3,000 students distributed over different disciplines like medicine, surgery, ayush, nursing, pharmacy, etc. is to be drawn, adopting discipline-based stratified sampling. Instead of selecting one full sample of 300 students, two subsamples of 150 each, or five subsample of each may be selected. The latter procedure is replicated sampling. Whatever may be the number and size of subsamples, each sub-sample has to be an independent sample with the same sampling method, and must be a sample covering the complete population. Each subsample may be allocated to one individual investigator or a team of investigators. Sample errors estimates can be calculated for each of the subsamples, and the variation between these estimates provide a means of assessing the precision of the overall estimate. A decision to be made is the number of subsamples to be drawn. The number may vary between 4 and 10. Mahalanobis often used four replications. If it is desired to obtain simple estimates of sampling errors, more replications are desirable. For this purpose, Deming has made wide use of ten replications. The major advantages of replicated or interpenetrating sampling are: • It provides a simple means of calculating the sampling error. • It is practical. If the size of the total sample is too large to get the results ready in time, one or more of the replications can be used to get the advance results. • The replicated sample can throw light on variable non-sampling errors. If each of the subsample is interviewed by a different or set of interviewers, an estimation of inter-viewer variation can be obtained. A disadvantage of replicated sampling is that it limits the amount of stratification that can be employed. This limitation is a real drawback to the use of replicated sampling in a multistage sampling plan.

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Essentials of Nursing Research 13. Random route sampling: It is a probability sampling procedure that is useful in marketing research or other community based research in which households, businesses, or other such premises need to be sampled. In random route sampling, the interviewer randomly selects an address, usually from a sampling frame, as a starting point and then identifies subsequent addresses by a predetermined random process, such as “across the street from the first address” or “left at the corner to the next odd-numbered address” and then calls on every nth address to conduct the required number of interviews. Although random route sampling is economical in terms of time and money, it can have the disadvantage of precluding the collection of data from a sample that is truly representative. For example, in conducting a marketing survey, selecting the sample from only one particular geographic area, such as either predominately wealthy or economically deprived, may not provide a truly representative sample of the population who might be targeted for the product being evaluated.

NON-PROBABILITY SAMPLING METHODS Introduction As explained earlier, non-probability sampling does not adopt the theory of probability and it does not give a representative sample of the population. The primary methods of non-probability sampling are:

1. Convenient Sampling

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In this method, the researcher selects those units of the population in the sample which appear convenient to him or to the management of the organisation where he is conducting research. The management of the organisation may tell the researcher that certain individuals alone can be included in the sample while others can not. One important demerit of this method is that the results obtained by following this method is that the results obtained by following this method can not be generalised beyond the study’s sample. But this dose not mean that such studies are of no value. The cumulative results of many such studies of the same phenomenon by different researchers provide basis for assessing the merits of a given hypothesis. In non-probability sampling, the investigator cannot estimate the probability that each element of the population will be included in the sample. Major procedures for non-probability sampling include 1. convenience sampling, 2. quota sampling, 3. snowball sampling, 4. purposive sampling, 5. theoretical sampling, 6. voluntary sampling, 7. modal instance sampling, 8. expert sampling, 9. diversity sampling,

Sampling 10. event sampling, and 11. time sampling. The following discussion provides an overview of these. It also termed accidental sampling, is a nonprobability sampling procedure in which the sampling units are selected simply because they are available, they are in the right place at the right time that is convenient for the investigator’s purposes. For example, in an investigation of the use of an emergency care facility during the night, the investigator might select an accidental sample consisting of any person presenting to the emergency facility between midnight and 6 a.m. during a specified onemonth period. Many nursing studies use convenience sampling because of the availability of already existing population groups. This is non-probability sampling. It means selecting sample units in a just ‘hit and miss’ fashion, e.g., interviewing people whom we happen to meet. This sampling also means selecting whatever sampling units are conveniently available, e.g., a teacher may select students in his class. This method is also known as accidental sampling because the respondents whom the researcher meets accidently are included in the sample. Though convenience sampling has no status, it may be used for simple purpose such as testing ideas or gaining ideas or rough impression about a subject of interest. It lays a groundwork for a subsequent probability sampling. Sometimes it may have to be necessarily used. For example, when a population cannot be defined or a list of population is not available, there is no other alternative than to use convenient sampling.

2. Quota Sampling This is a form of convenient sampling involving selection of quota groups of accessible exampling units by traits such as sex, age, social class etc, when the population is known to consist of various categories by sex, age, religion, social class etc., in specific proportions, each investigator may be given an assignment of quota groups specified by the predetermined traits in specific proportions. He can then select accessible persons, belonging to those quota groups in the area assigned to him. “Quota Sampling is, therefore, a method of stratified sampling in which selection within strata is non-random. It is this non-random element that constitutes its greatest weakness.” Quotas are stratified by such variables as sex, age, social class and religion. It is easy to classify the accessible respondents under sex, age and religion, but it is very difficult to classify them into social categories, since social class usually involves a combination of factors such as occupation, income and caste and the interviewer’s subjective judgement and bias play some role in the social class classification of respondents.

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Essentials of Nursing Research A model of assignment given to an interviewer is shown in Table 10.3. Table 10.3: Assignment of quota Sex

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Age

Male Female

11 9

20-40 41-50 51-60 61 & above

Total

20

Total

Social class 5 8 4 3 20

Higher Middle Lower

3 10 7

Total

20

Quota sampling is a non-probability sampling procedure in which subjects are selected in such a manner that each stratum of the population is proportionately represented. To ensure that the sample does not become overloaded with subjects having certain characteristics, the investigator specifies a percentage for the inclusion of subjects in the sample so that the sample is proportionate to the characteristics of the population. For example, quota sampling may be used to ensure that a sample of males and females from certain age, ethnic, and occupational groups represents the proportions in which these characteristics occur in the population. Quota sampling is used in studies like marketing surveys, opinion polls and leadership surveys which do not aim at precision, but to get quickly some crude results. The major advantages of quota sampling are: • It is considerably less costly than probability sampling. • It is takes less time. • There is no need for a list of population. Thus, quota sampling is a suitable method of sampling a population for which no suitable frame is available. • Field work can easily be organized. Strict supervision need not be required. The method of quota sampling suffers from certain major shortcomings as: • It may not yield a precise representative sample, and it is impossible to estimate sampling error. The findings, therefore, are not generalizable to any significant extent. • Interviewers may tent to choose the most accessible persons; they may ignore slums or areas difficult to reach. Thus, they may fail to secure a representative sample within their quota groups. • Strict control of field work is difficult.

Sampling • It is difficult for sampling on more than three variable dimensions. This is because the number of categories to be selected is a multiplication of the number of values in each variable. For instances, if we want to sample proportionate number of persons by sex, social status and age and these variables consist of two, three and three categories respectively, we have to select 2 × 3 × 3 = 18 categories of respondents. • The quota of sampling is subject to a higher degree of classification error, because the investigators are likely to base their classification of respondents’ social status and economic status mostly on their impressions about them. A method of selecting a sample often employed in market and public opinion polls is that of quota sampling in which an interviewer instead of receiving a list of names and addresses to be interviewed, receives the ‘quota’ or the number of interviews which he has to conduct of persons who satisfy certain conditions about sex, age, income, etc. Thus, he may be asked to interview twenty businessmen over 50 years of age in a particular area. The interviewer can then select at his own discretion any 20 businessmen of that area who are over 50 years of age.

3. Snowball Sampling It is also known as nominated sampling, is a non-probability sampling procedure in which study subjects are asked to provide referrals to other study subjects. In this method of sampling, investigators identify individual respondents whom they believe to have pertinent information related to their study. They then ask these individuals to name (nominate) others who might be able to provide further information; these respondents, in turn, are then asked to name other potential respondents. This sampling technique is also termed network sampling or link-tracing sampling. This is the colourful name for a technique of building up a list or a sample of a special population by using an initial set of its members as informants. For example, if a researcher wants to study the problem faced by Indians through some source like Indian Embassy. Then he can ask each one of them to supply names of other Indians known to them, and continue this procedure until he gets an exhaustive list from which he can draw a sample or make a census survey. This sampling technique may also be used in socio-metric studies. For example, the members of a social group may be asked to name the persons with whom they have social contacts, each one of the persons so named may also be asked to do so, and so on. The researcher may thus get a constellation of associates and analyse it.

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4. Purposive or Judgement Sampling

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Purposive sampling, also termed judgemental sampling, is a type of nonprobability sampling in which subjects are selected because they are identified as knowledgeable regarding the subject under investigation. The investigator establishes certain criteria thought to be representative of the target population and deliberately selects subjects according to these criteria. For example, in investigating the characteristics of undergraduate nursing students most likely to succeed in graduate programmes, the investigator might ask persons who are knowledgeable regarding nursing education either to participate directly in the study or to recommend students to be selected for the study. This method means deliberate selection of sample units that conform to some pre-determined criteria. This is also known as Judgement sampling. This involves selection of cases which we judge as the most appropriate ones for the given study. It is based on the judgement of the researcher or some expert. It does not aim at securing a cross section of a population. The purposive sampling is also called the judgement sample. These terms indicate selection by design by choice, not by chance. In purposive sampling a sample is chosen which is thought to be typical of the universe with regard to the characteristics under investigation. The researcher must know about the characteristic of the universe before hand in order to be able to recognise typical items in the universe. The chance that a particular case be selected for the sample depends on the subjective judgement of the researcher. For example, a researcher may deliberately choose industrial undertakings in which quality circles are believed to be functioning successfully and undertakings in which quality circles are believed to be a total failure. The method is appropriate whom what is important is the typicality and specific relevance of the sampling units to the study and not their overall representativeness to the population. The advantages of purposive or judgement sampling are: • It is less costly and more convenient. • It guarantees inclusion of relevant elements in the sample. Probability sampling plans cannot give such guarantee. The demerits of judgement sampling are: • This does not ensure the representativeness of the sample. • This is less efficient for generalizing when compared with random sampling. • This method requires more prior extensive information about the population one studies. Without such information, it is not possible to adjudge the suitability of the sample items to be selected.

Sampling • This method does not lend itself for using inferential statistics, because, this sampling does not satisfy the underlying assumption of randomness.

5. Theoretical Sampling Theoretical sampling is a non-probability approach to sampling most often associated with qualitative research, primarily the grounded theory method (to be discussed in the next chapter). As the study data are collected, coded, and analyzed, the researcher examines the emerging conceptual categories and themes and decides on further data-collection procedures that have the potential to contribute to the developing theory. The researcher may change the focus of the research questions, the locations where the questions are asked, or the participants in the study.

6. Voluntary Sampling Voluntary sampling is a type of non-probability sampling procedure in which volunteers either offer or are actively recruited to participate in a study. A request for volunteers might be made through an international organization such as the Red Cross (for instance, for a study of couples in prenatal or neonatal classes) or through solicitation by advertisements in newspapers or journals. The use of volunteers has the potential to bias the results of a study because those individuals who did not choose to volunteer, might have provided other perspectives than those of the volunteers.

7. Modal Instance Sampling Modal instance sampling is a type nonprobability sample composed of subjects who represent the “typical case” that is constructed by the researcher for purposes of the study. The method draws its name from the mode, the most frequently occurring score or value in a set of measurements. Thus, the mode can be considered to be the typical case. For example, a researcher planning to use modal instance sampling could construct a profile of “the typical baccalaureate-prepared nurse” in a specific health care setting by using the combined qualities of age, education, and years of professional nursing experience. This information could be gathered through self-reports or by examining personnel records in the setting that was targeted for the research. In this instance, the researcher has chosen not to include other personal qualities such as gender, religion, or ethnicity. Using the modal instance technique, the researcher would then sample only those individuals who could be described as “the typical baccalaureate-prepared nurse” for purposes of the study.

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8. Expert Sampling Expert sampling is a non-probability sampling procedure in which the researcher selects study participants based on the need to ascertain how experts in a field would react to or judge the phenomena of interest for the study. The researcher determines what constitutes the expertise needed for the study. For example, a sample of nurse midwifery educators with expertise in curriculum development specific to the preparation of nurse midwives could be selected for a study proposing to determine the effectiveness of two different nurse midwifery curricula.

9. Diversity Sampling Diversity sampling, also termed heterogeneity sampling, is a nonprobability sampling procedure used when the investigation requires that subjects with a wide variety of opinions and views be included in the sample. To achieve diversity sampling, the researcher would include individuals from all segments of the population without regard for representation of persons with these opinions and views as they occur proportionately in the population. Diversity sampling is particularly useful when the researcher wants to include outliers (individuals who are a typical of those who might otherwise be sampled) to elicit a broad range of opinions or views on the variables of interest. This type of sampling could be used in a community setting by including subjects from every stratum of the community.

10. Event Sampling Event sampling is a non-probability sampling procedure in which the investigator is concerned only with sampling from those specific occurrences and/or events that are relevant to the study. For example, the research student who wrote the proposal “Compliance with Universal Precautions” would collect her data about nurses using universal precautions only when they were working with children.

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Time sampling is a non-probability sampling procedure used by researchers who are concerned with collecting data on activities that take place at specific times of the day or night. For example, a researcher who wanted to observe what was happening during meal times in an intermediate care facility would collect data only at the times when meals were being served. Both probability and non-probability sampling have a respected place in research. The important factor in determining which sampling approach to use is consistency with the research problem and the purpose of the study.

Ethical Issues in Nursing Research

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Ethical Issues in Nursing Research

A good research problem conforms to moral, ethical and legal standards of scientific inquiry. A research should have deep concern for human welfare and sensitivity for the rights of research subjects. Any research that may be harmful violates the ethical code nursing and may be illegal. In planning a research project involving human subjects, it is important to consider the ethical guidelines designed to protect your subjects. In pertinent medical, nursing and psychological experimentation using human subjects involves some element of risk, however minor and raises questions about the ethics of the process. Often in the field of research the investigator asks questions, takes notes, and pries into the mind of the subject. The situation becomes even more questionable as it relates to what is done with the information. Can the whole world be told the research findings without revealing personal and private thoughts and ideas of the subjects? The main issue does not concern the findings themselves, but what is done with them. Closely related to the issue of moral and ethics is the questions of methodology. If the researcher tells the subjects what he is doing and gains their permission, does he lose their typical behaviour? Ethics related to data gathering must answer many questions. 1. What is the risk for the subject? 2. Should the subject know the purposes for the research? 3. Should the subject know the nature of study situation? 4. What is the secondary effect of the research upon the subject? 5. Must the investigator respect the confidence of the subject? 6. What is the nature of relationship between the subject and the investigator? 7. Should the subject be allowed to see the research results?

Planning for the Protection of Subject’s Rights The conduct of research carries ethical responsibilities toward the research subjects. Sometimes the ethical responsibility to safeguard

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subject’s rights conflicts with the efficiency with which one progresses with the research; it may affect the ultimate quality of results, and in a few cases, ethical considerations may mean that a particular research design or approach is unfeasible. Nevertheless, since the ultimate goal of nursing research is to benefit the recipients of nursing care, ethical considerations safeguarding subject’s rights must always be given the highest priority. Among human subjects’ rights which must be taken into consideration are: • The right to choose whether or not to participate, and the option to withdraw without being penalised as the research continues—freedom from coercion; • The right to full information about the research, what will be expected, and the right to raise questions about the research as it progresses; • Protection from unnecessary risk or harm as a result of participating in the research project; • The right to be informed of any potential risk or harm that might be incurred as a result of participating in the research; • The right to be privacy, dignity and confidentiality; • The right to be informed about research results. When subjects are members of vulnerable groups such as minors, patients, and/or elderly people, it is particularly important to ensure that these rights are known and met. Vulnerable people may feel intimidated by authority figures and, therefore, may not assert their rights. Any research involving human subjects should be reviewed by individuals external to that particular research effort. This not only ensures that human rights will be respected, but also protects the researcher from unwittingly compromising those rights. Nurses deal with human rights issues daily, in all aspects of their professional role. Nurses may be pressured to apply their knowledge and skills in ways that are detrimental to patient and others. There is a need for increased vigilance, and a requirement to be well-informed, about how new technology and experimentation can violate human rights. Furthermore, nurses are increasingly facing complex human rights issues, arising from conflict situations within jurisdictions, political and upheaval wars. The application of human rights protection should emphasise vulnerable groups such as women, children, elderly, refugees and stigmatised groups. Nurses have an obligation to safeguard people’s health rights at all times and in all places. Health care as a right of all individuals, regardless of financial, political, geographic, racial or religious consideration. This right includes the right to choose or decline care, including the right to accept or refuse treatment or nourishments; informed consent;

Ethical Issues in Nursing Research confidentiality; and dignity including the right to die with dignity. So the obligation of nurses includes assuring that adequate care is provided within the resources available and in accordance with nursing ethics. As well, the nurse obliged to endure that patient receive approximate information prior to consenting to treatment or procedure including participation in research. As professionals nurses are accountable for their own actions in safeguarding human rights. There is need to protect human rights if amply demonstrated by research in which potentially harmful experiments were performed on elderly patients, children and sick persons. The ANA developed the Human Rights Guidelines for nurses and clinical and other researchers (19671975). The first right of human subjects is not to be harmed physically, psychologically or emotionally; other rights include self-determination, privacy, confidentiality, the right to maintain self-respect, the right to refuse to participate in research or to withdraw from participation without any penalty and the right for services. 1. The right not to be harmed has received little consideration in the past. In using the treatments that may have a temporary or permanent effect on the subjects, the researcher must take all precautions to protect their well-being. Treatments are administered under the direction of the competent professional practitioners in clinical or research facilities where effective and through precautions and safeguards may be assured. Where some risk is unavoidable the potential benefits may be sufficient to justify the research. A balance need to be achieved, with benefit out weighing risk, in such case. For example, almost all scientists would question the right of a researcher to administer drugs with unknown properties and consequences to human being before expensive tests with laboratory animals. 2. The right to self-determination includes informed voluntary consent, subjects who give voluntary consent are free from constraints and coercion of any kind. Informed consent means that the subjects have full knowledge and understanding about the research project in which they are being asked to participate. Informed consent includes providing the subjects with a full description of the following: a. The purpose of the project and its general value b. All procedures uses in research and why c. The subject part in the research including the amount of time and energy the research will take d. Any possible pain, discomfort, stress, or loss of autonomy or dignity e. How privacy, confidentiality, and anonymity will be guarded

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Essentials of Nursing Research f. The manner in which data will be used informed consent implies that promises will be kept. Here deception will be practised, the self-respect of subject will be protected, and ethical guidelines will be carefully followed. The manner in which data will be used should be explained, and the subject should give permission for such use. To allow data to be put to any other use or to fail to describe all the uses is unethical. 3. The right to privacy too in our society is a tradition of considerable importance: Ordinarily it is justifiable to observe and record behaviour that is essentially public, behaviour that others normally would be in a position to observe. It is an invasion of privacy to observe and record intimate behaviour that the subject has reason to believe is private, concealed observers, cameras, microphones or use of private correspondence without the subjects knowledge and permission are invasion of privacy. If these practices are to be employed, the researcher should explain the reasons and secure permission. This statement is not to suggest that intimate behaviour cannot be observed ethically. The sexual behaviour studies of Doctors, Nurses are based upon observation and recording of the most intimate acts, but subjects volunteer to participate with full knowledge of the purposes and procedures employed. The motivation is based upon confidence in the integrity of the researchers and the importance of scientific contributions to human welfare. 4. Confidentiality and anonymity are two processes that protect the subject best. Confidentiality is the researcher’s ability to keep data sources protected, anonymity is the researcher’s ability to keep subjects nameless. Anonymity some time prevents any longitudinal or follow-up studies. Confidentiality may be the best means of protecting subjects without damaging the research. To maintain confidentiality and anonymity pseudonyms are useful. 5. The right to maintain self-respect and dignity is associated with the right not to be harmed any way. 6. The right to refuse to participate to or to withdraw from participants without fear or recrimination is the subject’s right, even though withdrawal may damage the research project. 7. The right to services is a concern of the researcher, if the patient who comes for services is involved in research at the same time.

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8. Vulnerable subjects such as children, mentally ill, Mentally retarded and captive persons such as prisoners, men and women in the armed forces, students, the dependent poor, friends and family researcher, and employees all are vulnerable.

Ethical Issues in Nursing Research

Ethical Implications for Nursing Research Nurse researchers have an obligation to obtain informed consent from study participants; such consent constitutes an underlying ethical premise of the research processes. It recognises that only those individuals who have received sufficient information about a research study and who comprehended that information are adequately prepared to decide whether or not to participate in the study. Scientific merit of the research 1. Study of the problem or question(s) under study must be ethical. 2. The problem or question (s) must be worthwhile (e.g., significant ones for nursing). 3. The design and methods of the study must meet established scientific criteria (e.g., meet reliability and validity criteria, make optimal use of time and resources). 4. The study must be designed with accepted ethical boundaries. Consent and human subject protection and confidentiality should be followed while conducting research as follows:

Informed consent 1. Information must be provided so that subjects can make an informed and educated decision about participation, including the following: a. Nature/purpose of study. b. Purpose, extent and duration of participation. c. Type of information that is requested. d. Use of records. e. Use of information during and after study. f. Inconvenience, potential risks, and potential benefits. g. Standard treatment that may be withheld. h. Freedom to withdraw at any time without recrimination. i. How anonymity and confidentiality will be maintained. 2. Persons who are competent to consent must be free to do so without threat that they must participate to maintain benefits. (e.g., high-quality care), if not competent to give consent, it must be sought from an individual who can act as an advocate for the noncompetent person. 3. Verbal or written consent must be obtained, provided ethical considerations are observed. Who consented under what circumstances, the information provided to subjects and assurance of the right to withdraw and that no coercion was used must be documented by the investigator. 4. Other persons affected by the subject’s participation must be informed of the study and consent obtained, if necessary (e.g., staff nurse, spouse).

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Confidentiality 1. Information must be handled so that confidentiality and anonymity are maintained. 2. Information may not be used or released outside the terms of the agreement.

Protection Subjects 1. Subjects must be protected from all types of harm. 2. Potential benefits must outweigh potential risks. 3. When the well-being of the subject conflicts with the integrity of the research, a decision must be made that favours the subject.

The Research Setting

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1. The investigator must make a specific request to the agency where the research is to be conducted and provide the agency with the knowledge needed to make an informed consent about approval. 2. The agency has an obligation to provide a valid system for review. 3. All nurses have an obligation to collaborate in the research process with the investigator. 4. Investigators have an responsibility to provide adequate information to the staff members involved in or affected by the study. 5. Staff members have the right to participate or not, and should be informed if this is condition of employment in a particular agency. Although the reviewed studies have methodological limitations, they nevertheless suggest that the following approaches may increase comprehension of information for an informed consent. 1. Provide a written statement of the information needed for informed consent that is clear, brief and direct. 2. Present an amount of information for informed consent that research subject perceive to neither too little nor too much. 3. Allow research subjects a day or longer to digest information contained in the informed consent statement. 4. Be aware that individuals with lower educational and vocabulary levels may need more help in understanding information for informed consent than those with higher educational and vocabulary level. 5. Be aware that individuals who are ill or coping with other disruptive life situations may need more help in understanding information for informed consent than persons not experiencing these areas. 6. Be aware that forgetting may occur with threatening information. 7. Be aware that comprehension should be assessed independently of memory. (Note: For more details please refer Author title on ‘Nursing Research’ 2nd Edition)

Research Planning or Proposal (Protocol)

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Research Planning or Proposal (Protocol)

Research is an orderly process of inquiry that involves purposeful and systematic collection, analysis and interpretation of data (unit of information) in order to gain new knowledge or to verify already existing knowledge. Research has the ultimate goal of developing an organised body of knowledge. Research is a process. A process is a method of doing something; a process has an identified purpose and series of steps to be followed to achieve a specific goal. The purpose of the research process is to provide a guide for deriving systematic information (new knowledge) concerning phenomena of interest of the researcher. The components of the research process are the steps the researcher follows in identifying the phenomena of interest and systematically gathering, examining, and analysing these phenomena with the goal of answering the research questions. Research is an organised endeavour. It is helpful to consider the systematic steps of the research process as consisting of three sequential stages (or phases) that should answer the research question or solve the research problem. • Planning (conceptualisation of the study) • Implementation (doing the study) • Communication (reporting the study) Like any organized work, research required proper planning. Planning means deciding in advance. Planning of research means deciding the question or a problem or an issue to be studied, formulating the objectives of the study, and determining the means of achieving these objectives. Research is an intellectual process. It requires intellectual curiosity, intelligence, imagination and vision and knowledge of research methodology. To structure the planning stage of a research study both quantitative and qualitative researchers formulate a research proposal or protocol, the research proposal/protocol serves as a blue print for research project and must be completed before conducting either a quantitative or qualitative research study. The written proposal communicates the

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Essentials of Nursing Research problem being investigated and procedures that will be used in the investigations. The proposal is comparable to the blue print that the architect prepares before the bids are let and building commences. The initial draft proposal is subject to modification in the light of the analysis by the studentresearcher and his or her project guide/advisor. Because good research must be carefully planned and systematically carried out, procedures that are improvised from step to step will not suffice. A worthwhile research project in likely to result only from a well-designed proposals.

MEANING OF PROTOCOL/PROPOSAL

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Protocol is a formal or official transaction or proceeding. A research protocol, by conventions means a preliminary draft in which the information and/or the knowledge needed for the actual conduct an experiment is compiled briefly to outline the execution of a study. Sometimes instead of protocol people use the term “proposal.” Here proposal is a document prepared prior to the conduct of study that communicates to an interested party the research problem, the proposed methods and procedures for the studying the problem, the significance of the research, and when financial support is sought, how much the research will cost. Research proposal is a detailed written description of a proposed research study, sometimes called a prospectus. Research-based clinical protocol is a written document that organises and transforms research based knowledge that it can be used to direct clinical practice activities. So the significance of research proposal as given below: • A research proposal is a written summary of that the researcher intends to do, how and why it is important in nursing. • The research proposal is forward looking, as it eliminates aimless intellectual wandering and gives direction to the research work. • The research proposal describes the anticipated plan of research for the approval of the supervising profession, or committee or funding agency or university. • A well-written proposal is valuable tool for the researcher or research student, well-worth the time and effort put into its development. • The proposal anticipates as many of the elements of the research procedures as possible and provide a model that helps the students/ researcher to write the research project. • The research proposal is written during the planning phase of research, implements during the phase of data collection and analysis and described in communicating phase.

Research Planning or Proposal (Protocol) A research proposal is written for several purposes. Having to sit down and write proposal for the research study forces the researcher to think through various aspects of the study that might not otherwise have been considered. The plan can be evaluate by others, who may improve it by suggesting something that has been left out or by considering whether or not the ideas would be workable in the actual study setting. The written research proposal provides a guide to follow in carrying out the research. It saves the researcher from having to remember the many details already considered and the anticipated problems already solved. A well-thought-out proposal saves time, helps avoid mistakes, serves as a basis for writing the final report of the study, and should result in a higher-quality research study. Written research proposals are required for all academic research studies, such as thesis and dissertations, and for all research submitted for funding by various government agencies and private organisations. The preparation of a research proposal is an important step in the research process. Many institutions require that a proposal be submitted before any project is approved. This provides a basis for the evaluation of the project and gives the advisor/guide a basis for assistance during the period of his or her directions. It also provides a systematic plan of procedure for the researcher to follow. As stated earlier, planning the research project is probably the most important aspect of all. This decides the whole future of the investigation of the plan is good, all may go well. If the plan is not thought out carefully, the work may never be completed. Time employed in setting up a good plan is well spent and saves time which could be wasted in trying to patch up a bad one later. The probability that a paper with a clear image will emerge from research is determined more by how the research was conceived and planned them by how well paper is written. A clear question must be posed before the research is planned, the designs of the research plan must be adequate, and the data must be properly collected and appropriately analysed. The following information should be sorted out before drafting the research protocol or proposal. • Statement of the problem (title of the study) • Well-defined aims and objectives • Relevant literature search (review of study) • Details of study design (type of study) • Number of groups and sample size • Inclusion and exclusion criteria • Brief methodology (data collection procedure)

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Essentials of Nursing Research • Parameters to be compared and analysed • Statistical methods (significant test and level of significance) • Outcome of the research and its usefulness. A proposal/protocol must be clear, brief and precise, but it should include all the above information, otherwise it will be incomplete. The major components of the proposal may be statement of the problems and its significance, and the review of literature and hypothesis which might also includes definitions, assumptions limitations and delimitations.

Statement of the Problem and its Significance

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This is often a declarative statement but may be in question form. This attempts to focus on a stated goal gives direction to the research process. It must be limited enough in scope to make a definite conclusion possible. A problem usually implies that a controversy or difference of opinion exists. Problem can be derived from theory prior research results or personal observation and experience. Frequently, problems are based upon a significance concern and an insufficient knowledge base regarding what to do about the concern. Nursing problem become research problem which can be derived from clinical area, the literature, experience of nurse, professional and the students own interest and suggestions from the profession experts includes professors, experience nurses and faculty, nursing leaders, etc. It is important that the researcher points out how the solution to the problem or the answer to the question can influence nursing theory or practice. That is, the researcher must demonstrate why it is worth the time, effort and expense required to carryout the proposed research. Careful formulation and presentation of the implications or possible applications of knowledge help to give the project an urgency, justifying its worth. In planning stage of research study, it is customary for the investigator to state the definition, assumption and limitations for the study. • Definitions: It is important to define all unusual terms that could be misinterpreted. These definitions help to establish the frame of reference with which the researcher approaches the problem. The variables to be considered should be defined in operational terms. • Assumptions are statements of which the researcher believes to be facts but cannot verify. They are the statements based on logic or reason whose correctness or validity is taken for granted. For example, – Hospitals are for sick persons. – Pain hurts – Most people want to maintain themselves in a health state

Research Planning or Proposal (Protocol) In most studies, assumptions are implied by the investigator and need not be stated explicitly. If they are significant enough to affect the study course or its outcome, the investigator should state these assumptions explicitly so that others may evaluate their effect on the study. • Limitation of a study are restrictions identified by the researcher that may affect the outcome of a study but over which the researcher has little or no control, which meant that limitations are those conditions beyond the control of the researcher that may place restrictions on the conclusions of the study and their application to other situations. Important limitations should be anticipated in the planning stage and discussed in the report of the research to allow the reader to judge their effect on the study. Although all studies are limited in someway, limitations in quantitative studies are often related to inadequate methodology and to the use of small unrepresentative samples – in other words, samples that do not reflect the characteristics of the population from which they were drawn. These limitations limit the generalizability of quantitative studies. Often qualitative researchers cannot state the limitations for their studies during planning stage of their research. • Delimitations are the boundaries of the study.

Review of Related Literature A summary of the writings of the recognized authorities and a previous research provides evidence that the researcher is familiar with what is already known and what is still unknown and untested. Since the effective research is based upon past knowledge, this step helps to eliminate the duplication of what has been done and provides useful hypotheses and helpful suggestions for significant investigation. Citing studies that show substantial agreement and those that seem to present conflicting conclusions helps to sharpen and define understanding of existing knowledge in the problem area, provides a background for the research project, and makes the reader aware of the status of the issue. Parading a long list of annotated studies relating to the problem is ineffective and inappropriate. Only those studies that are plainly relevant, competently executed, and clearly reported should be included. Entire abstract from articles should not be given. In searching related literature, the researcher should not certain important elements as given below: • Reports of studies of closely related problems that have been investigated.

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Essentials of Nursing Research • Design of the study, including procedure employed and data gathering instrument used. • Populations that were sampled and sampling methods employed. • Variable that were defined. • Extraneous variables that could have affected the findings. • Faults that could have been avoided. • Recommendations for further research. Capitalising on the reviews of expert researchers can be fruitful in providing helpful ideas and suggested. Although review articles that summarise related studies are useful, they do not provide a satisfactory substitute for an independent search. But it is a valuable guide to defining the problem, recognizing its significance, suggesting promising datagathering devices, appropriate study design, and sources of data.

Scope of the Study The scope and dimensions of the study should be delimited with reference to the topical scope – breadth, and depth, geographical area to be covered, reference period, the type of institutions/respondents to be studied, the issues to be analysed etc. The purpose of this demarcation is to make the study in terms of the researchers aim, interest and competence and available techniques, time, finance and facilities. Research scholars are invariably ambitious, take up a vast study, not knowing the time and other requirements, and later find out difficult to complete the work within the prescribed time limit. In their anxiety to complete the work, they are forced to sacrifice its depth and quality. Therefore, it is essential to delimit the study from the stand point of manageability. Yet it should provide the researcher with an opportunity to gain a systematic experience of planning and conducting a research study and make contribution to the fund of knowledge.

Objective of the Study

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Objective refers to the short statement of outcome. The objectives refers to the questions to be answered through the study. They indicate what the researcher trying to gets from the study. The objectives way aim at description or explanation or analysis of causal relationship between variable, and indicate the expected results or outcomes of the study. They may be specified in the form of either statements or questions. The specific objectives of the study should be stated clearly. These refers to the questions to which the researcher proposes to seek answers through the study. Although there is no limit to the number of research objectives, it is desirable to limit the objectives to a reasonable number (preferably not more than five for dissertation or thesis).

Research Planning or Proposal (Protocol) What is reasonable depends upon the time limitation, resource constraints, capability etc., it is wise to pick objectives that are challenging but not impossible to achieve. The objectives may be stated as under: • To assess the knowledge of …………. • To identify the practice of …………. • To evaluate the effectiveness of …………. • To study the extent of …………. • To identify the factors which influence …………. • To examine the nature of relationship between ……. and ……… • To investigate the impact of …………. • To identify the causes of …………. • To find the association between selected variable …………. The statements of objectives should be specific and indicate the exact purpose of the study. Such precise statements give functional guidelines to the research process. The statement of objectives may be followed by a statement of the investigative question relating to each of the research objectives.

Conceptual Model Conceptual or theoretical model is a simplified systematic conceptual structure of interrelated elements in some schematic form. A model possesses five different characteristics namely, level of analysis, boundaries, specificity, construct relationship and assumptions. Conceptual model in the heart of research plan. This is where the researcher formulates and develops the structure of relationships among the variables he/she is investigating. The logical connection of the variables is delineated; the assumptions and propositions used to develop the explanatory framework are included. The entire research project rests upon the theoretical framework.

Hypothesis Hypothesis is a tentative proposition formulated for empirical testing. It is a declarative statement combining concept. It is a tentative answer to a research question. It is tentative because its veracity can be evaluated only after it has been tested empirically. In planning stage, it is appropriate to formulate a major hypothesis. This approach further clarifies the nature of the problem and the logic underlying the investigation and gives direction to the death-

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Essentials of Nursing Research gathering process. A good hypothesis has several characteristics i.e., it should be: • Reasonable. • Consistent with knowing facts or theories. • Stated in such a way that it can be tested and found to be probably true or probably false. • Stated in the simplest possible terms.

Example of Hypothesis There is a significant difference between pre- and post-test knowledge scores of mothers of under fives children on RCH services and its utilisation.

Methodology This part of the research proposal usually consists of subjects, procedures and data analysis in which following details will be given. • Definition of study subjects • Typology of the study design • Study sampling design, sampling plan method and size (number of cases) • Methods of collection of data: Inclusion and exclusion criteria • Tools for gathering data: interview schedule/questionnaire of checklists/rating scales etc. • Methods of data analysis and presentation. Here includes the parameters to be compared and analysed. Statistical techniques and methods to be used for analysing the data should be specified e.g., descriptive statistics and inferential statistics for testing hypothesis and drawing inferences.

Chapter Scheme The chapter scheme of the report/dissertation to be prepared for communicating the findings of the study to the academic community and that users should be outlined and the purposes of each chapter should be stated.

Time Schedule

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Although this time schedule may not be required by the study guide, a time schedule should be prepared so that the researcher may budget his or her time and energy effectively. Dividing the project into manageable

Research Planning or Proposal (Protocol) parts and assigning dates for their completion helps to systemize the study and minimize the natural tendency to procrastinate. If the project or study complicated a flow chart or bantt chart or time task chart may be useful in describing the sequence of events. Research projects usually involve critical time limitation and definite deadlines for filing the completed report the planning procedures with definite goals is most important dates of presentation of progress report must be specified.

Ethical Clearance In planning a research project involving human subjects, it is important to consider the ethical guidelines designed to protect subjects. In particular, medical and psychological experimentation using human subjects involves some element of risk, however, minor, and raises questions about the ethics of the process. Researchers working with humans must always remember that their subjects are real people with their own unique personalities and needs, not just numbers on a piece of paper. To this end, codes of ethics for human subjects research have been developed to ensure the protectors of the subject dignity and safety and the worthiness of research involving human subjects. So ethical clearance is essential. Any study involving human subjects require ethical clearance as per the Ethical guidelines for Biomedical Research on Human Subjects 2000, ICMR, New Delhi even if it involves of interviewing or administering a questionnaire to a person.

References References should be quoted in the text as superscripted number and listed at the end of the paper numerically. All the reference must be complete and accurate. Reference should be listed in Vancouver style or Harward style or APA style or any other standard style according to the wishes of the agency or institute or university. The references should be numbered number consecutively in the order in which they are mentioned in the text. In the text entire abstract should not be used and “et. al.” should not be used indiscriminately. When Vancouver style is used there is no need to mention the names of the author(s) and year of publication. As already stated reference must be completed accurately and listed in Vancouver style at the end of the paper numerically first come first in the text.

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I. PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1. Name of the candidate and address (in block letters) 2. Name of the institution 3. Course of study and subject 4. Date of admission to course 5. Title of the Topic

6. Brief resume of the intended work: i. Need for the study ii. Review of literature iii. Objectives of the study 7. Material and methods i. Source of data

ii. Method of collection of data (including sampling procedure, if any)

iii. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

iv. Has ethical clearance been obtained from your institution in case of iii?

II. GUIDELINES FOR PREPARING THESIS / DISSERTATION PROTOCOL

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Preparing the protocol is an initial but an important step in the thesis or dissertation work. The following is intended to help you in preparing the protocol.

Research Planning or Proposal (Protocol)

1. Title of The Topic The title should be as brief as possible but should carry as much information as required.

2. Brief Resume of the Work a. Give a brief introduction to the work you intend doing by focussing on present literature on the subject, groups in knowledge, if any and the reasons for undertaking the study. You may have to quote a few references or other studies. (About 100-200 words of introduction). b. Give the objectives of the study. The objectives usually should be more than 2 to and should relate to the points or key questions raised in introduction (about 50-100 words for objectives). c. Review the literature and give 3-5 references pertaining to the subject and work already published. It should be related to the objectives of the study.

3. Material and Methods (About 100-150 Words) Briefly explain the source from which you would collect data for the study. For example, in clinical setting, it may be patients in hospitals or in community settings or it may be households or it may be a laboratory based study. Describe the method of collection of data. For instance, it may be by interview of records or by animal experiments or by performing tests or laboratory investigations or even through some intervention. In case of human or animal study, mention the inclusion and exclusion criteria. If there are any ethical issues involved, mention them and state how you intend to overcome. If you are taking a sample, mention the sampling procedure and sample size. Thus, it is important to mention the subjects of your study parameters and the procedures.

4. References Give about 3-5 references quoted in your introduction or those related to your study. Follow the guidelines given in Annexure III for writing references.

III. GUIDELINES FOR WRITING REFERENCES The following table summarises the components of a reference and how they should be typed. Later, few examples are given for different types of references.

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Essentials of Nursing Research Different Components of Reference and Method of Typing Indentation

Overhanging first line flush with margin Second line indented five spaces

Name order

Last name first (of first author when more than one author.

Placement

End of body of report – listed alphabetically by last name of first author

Punctuation

Author Name, Title, Place of Publication, Publisher, State of Publication

Page reference

Total number of pages in book or in article

DIFFERENT TYPES OF REFERENCES Text Book Reference Single Author Basavanthappa BT, Nursing Research, Jaypee Brothers Medical Publishers, New Delhi, 1998, P. 247. Campbell, William Giles, Form and Style in Thesis Writing Boston: Houghton Millin Co., 1954, p. 4114.

Joint Authors Good, Carter V, AS Barr and Douglas E. Scales. The Methodology of Educational Research, New York: Appleton-Century Crofts Inc. 1941, p. 890.

More than three Authors Stanley, William O et al. Social Foundations of Education. New York: The Dryden Press Inc. 1956. p. 638.

Editor as Author Adhikari, Ramesh K and PT Jayawikramarajah. Ed., Essentials of Medical Education. Health Learning Materials Centre, Kathmandu. Institute of Medicine, Tribhuvan University 1996, 180 pp.

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(Note this a publication of an agency, therefore, the place of publication follows the name agency).

Research Planning or Proposal (Protocol)

A Chapter Written by an Author than Editor of the Book Srinivasa DK, “Curriculum Planning,” Chapter 19 in Medical Education – Principles and Practice. Ananthakrishna N., K.R. Sethuraman and Santhosh Kumar, Pondicherry: National Teacher Training.

Journal Articles The references are similar as for book references. Note that the name of the article is enclosed in quotation marks and name of the publication is sometimes underlined or given Italics. There are a few punctuation differences. Basavanthappa, 1999, KAP Nursing of Personnel, towards implementation of primary health care. Indian Journal Nursing and Midwifery 10: 25-32. Bhatia JC Cleland. “Obsteric morbidity in South India.” Soc. Sci Med 1996;43:1507-16.

News Paper Articles Editorial in “The Hindu,” January 30, 2007.

Thesis or Dissertation Basavanthappa BT, study the knowledge, attitude and practice of Nursing personnel towards Implementation of Primary, Health Care, unpublished Doctoral thesis, Bangalore University, Karnataka 1993, p. 247. Jampa Lopsang, A study on the Effects of 1991 Cyclone on Health Status of People and The Health Care Delivery in Karaikal (Unpublished Doctoral Dissertation, University of Pondicherry, Pondicherry 1996) p. 177.

Unpublished Material Raghuram R. Cultural Psychiatry—The Road Less Travelled, Bangalore, National Institute of Mental Health and Neurosciences, 1996, p. 14. (Mimeographed).

THE VANCOUVER STYLE OF WRITING REFERENCES References Number of references consecutively in the order in which they are mentioned in the text. Identify references in text, tables, and legends by Arabic numerals in parentheses. References cited only in tables or in legends to figures should be numbered in accordance with a sequence

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Essentials of Nursing Research established by the first identification in the text of the particular table or illustration. Use the style of the examples below, which are based on the formats used by the US National Library of Medicine in Index Medicus. The titles of journals should be abbreviated according to the style used in Index Medicus. Consult list of journals indexed in Index Medicus, published annually as a separate publication by the library and as a list in the January issue of Index Medicus. Try to avoid using abstracts as references; “unpublished observations” and “personal communications” may not be used as references, although references to written, not oral, communications may be inserted (in parentheses) in the text. Include among the references, papers accepted but not yet published; designate the journal and add “In press.” Information from manuscripts submitted but not yet accepted should be cited in the text as “unpublished observations” (in parentheses). The references must be verified by the author(s) against the original documents.

Examples of Correct Forms of References Articles in Journals

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1. Standard journal article List all authors, but if the number exceeds six give six followed by et al). You CH, Lee KY, Chey RY, Menguy R. Electrogastrographic study of patients with unexplained nausea, bloating and vomiting. Gastroenterology 1980 Aug; 79(2): 311-4. As an option, if a journal carries continuous pagination throughout a volume the month and issue number may be omitted. You CH, Lee KY, Chey RY, Menguy R. Electrogastrographic study of patients with unexplained nausea, bloating and vomiting. Gastroenterology 1980; 79: 311-4. Goale AM, Haynes AR, Owen MJ, Farrall M, James LA, Lai LY, et al. Predisposing locus for Alzheimer’s disease on chromosome 21. Lancet 1989; 1: 352-5. 2. Organisation as author The Royal Marsden Hospital Bone Marrow Transplantation Team. Failure of syngeneic bone marrow graft without preconditioning in post-hepatitis marrow aplasia. Lancet 1977; 2: 742-4. 3. No author given Coffee drinking and cancer of pancreas [editorial]. BMJ 1981; 283: 628.

Research Planning or Proposal (Protocol) 4. Article in a foreign language Massone L, Borghi S, Pestarino A, Piccini R, Gambini C. Localisations palmaires purpuriques de la dermatite herpetiforme. Ann Dermatol Venereol 1987; 114: 1545-7. 5. Volume with supplement Magni F, Rossini G, Berti F. BN-52021 protects guinea-pig from heart anaphylaxis. Pharmacol Res Commun 1988; 20 Suppl 5: 75-8. 6. Issue with supplement Gardos G, Cole JO, Haskell D, Marby D, Paine SS, Moore P. The natural history of tardive dyskinesia. J Clin Psychopharmacol 1988; 8(4 Suppl): 31S-37S. 7. Volume with part Hanly C. Metaphysics and innateness: A psychoanalytic perspective. Int J Psychoanal 1988; 69(Pt 3): 389-99. 8. Issue with part Edwards L, Meyskens F, Levine N. Effect of oral isotretinoin on dysplastic nevi. J Am Acad Dermatol 1989; 20(2 Pt 1): 257-60. 9. Issue with no volume Baumeister AA. Origins and controls of stereotyped movements. Monogr Am Assoc Ment Defic 1978; (3): 353-84. 10. No issue or volume Danoek K. Skiing in and through the history of medicine. Nord Medicinhist Arsb 1982: 86-100. 11. Pagination in Roman numerals Ronne Y. Ansvarsfall. Blood transfusion till fel patient. Vardfacket 1989; 13: XXVI-XXVII. 12. Type of article indicated as needed Spargo PM, Manners JM. DDAVP and open heart surgery [letter]. Anaesthesia 1989; 44: 363-4. 13. Articles containing retraction Shishido A. Retraction notice: Effect of platinum compounds on murine lymphocyte mitegenesis [Retraction of Alsabti EA, Ghalib ON, Salem MH. In: Jpn J Med Sci Biol 1979; 32: 53-65]. Jpn J Med Sci Biol 1980; 33: 235-7. 14. Article retracted Alsabti EA, Ghalib ON, Salem MH. Effect of platinum compounds on murine lymphocyte mitegenesis [Retraction by Shishido A. In: Jpn J Med Sci Biol 1980; 33: 235-7]. Jpn J Med Sci Biol 1979; 32: 53-65. 15. Article containing comment Piccoli A, Bossatti A. Early steroid therapy in IgA nephropathy: Still an open question [comment]. Nephron 1989; 51: 289-91. Comment on: Nephron 1988; 48: 12-7.

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Essentials of Nursing Research 16. Article commented on Kobayashi Y, Fujii K, Hiki Y, Tateno S, Kurokawa A, Kamiyama M. Steroid therapy in IgA nephropathy: A retrospective study in heavy proteinuric cases [see comments]. Nephron 1988; 48: 12-7. Comment in: Nephron 1989; 51: 289-91. 17. Article with published erratum Schofield A. The CAGE questionnaire and psychological health [published erratum appears in Br J Addict 1989; 84: 701]. Br J Addict 1988; 83: 761-4.

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18. Personal author(s) Colson JH, Armour WJ. Sports Injuries and their Treatment. 2nd rev ed., London: S Paul, 1986. 19. Editor(s), compiler as author Deiner HC, Wilkinson M. Editors. Drug-induced Headache. New York: Springer-Verlag, 1988. 20. Organisation as author and publisher Virginia Law Foundation. The medical and legal implications of AIDS. Charlottesville: The Foundation, 1987. 21. Chapter in a book Weinstein L, Swartz MN. Pathologic properties of invading microorganisms. In: Sodeman WA Jr, Sodeman WA, editors. Pathologic physiology: Mechanisms of disease. Philadelphia: Saunders, 1974: 457-72. 22. Conference proceedings Vivian VL. Editor. Child abuse and neglect. A medical community response. Proceedings of the First AMA National Conference on Child Abuse and Neglect; 1984; Mar 30-31; Chicago: American Medical Association, 1985. 23. Conference paper Harley NH. Comparing randon daughter dosimetric and risk models. In: Gamage RB, Kaye SV. Editors. Indoor air and human health. Proceedings of the Seventh Life Sciences Symposium; 1984 Oct 2931; Knoxville (TN). Chelsea (MI): Lewis 1985: 69-78. 24. Scientific or technical report Akutsu T. Total heart replacement device. Bethesda (MD): National Institutes of Health, National Heart and Lung Institute; 1974 Apr. Report No.: NIH-NHLI-69-2185-4. 25. Dissertation Youssef NM. School adjustment of children with congenital heart disease [dissertation]. Pittsburgh (PA): Univ of Pittsburgh 1988.

Research Planning or Proposal (Protocol) 26. Patent Harred JF, Knight AR, McIntyre JS. Inventors. Dow Chemical Company assignee. Epoxidation process. US Patent 3, 654, 317. 1972 Apr 4.

Other Published Material 27. Newspaper article Rensberger B, Specter B. CFCs may be destroyed by natural process. The Washington Post 1989 Aug 7; Sect A: 2(col 5).

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13

Methods of Data Collection

The word ‘data’ is a plural form of the word “datum” which means information that is systematically collected in the courses of study. The word “method” refers to the means of gathering data that are common to all sciences including “Nursing”. It is different from the word “Technique” which refers to the specific tools that are used in the given method. Data collection is not a new intervention for nurses. Nurses use all of their senses when collecting data from the patient for whom they provide care. Nurse-researcher, also have available many ways to collect information about their research subjects. The major difference between the data collected when performing patient care and the date collected for the purposes of research is that the data collection methods employed by researcher need to be objective and systematic. The method that researchers use to collect information about subjects are the identifiable and repeatable operations that define the major variables being studied. After designing an approach for the research, the statistical problem begins. Collection of data is the first step in the statistical treatment of a problem. Numerical facts are the raw materials upon which the investigator is to work just as in a manufacturing concern, the quality of a finished products depends. Inter-alia, upon the quality of the raw material, in the same manner, the validity of conclusions in a research is governed among other considerations by the quality of the data used. Assembling facts is thus a very important step and no pains should be spared to see that the data collected are accurate, reliable and thorough.

TYPES OF DATA

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The data needed for a nursing science research may be broadly classified into: (a) Data pertaining to human beings, (b) Data relating to organizations, and (c) Data pertaining to territorial areas. Personal data or data related to human beings consist of:

Methods of Data Collection 1. Demographic and socioeconomic characteristics of individuals: Age, sex, race, social class, religion, marital status, education, occupation, income, family size, location of the household, life style, etc. 2. Behavioural variables: Attitudes, opinions, awareness, knowledge, practice, intentions, etc. Organisational data consist of data relating to an organization’s origin, ownership, objectives, resources, functions, performance and growth. Territorial data are related to geophysical characteristics, resources endowment, population, occupational pattern, infrastructure, structure, degree of development, etc. of spatial divisions like villages, cities, taluks, districts, state and the nation.

NEED OF DATA The data serve as the bases or raw materials for analysis. Without an analysis of factual data, no specific inferences can be drawn on the questions under study. Inferences based on imagination or guess work cannot provide correct answers to research questions. The relevance, adequacy and reliability of data determine the quality of the findings of a study. Data form the basis for testing the hypotheses formulated in a study. Data also provide the facts and figures required for constructing measurement scales and tables, which are analysed with statistical techniques. Inferences on the results of statistical analysis and tests of significance provide the answers to research questions. Thus, the scientific process of measurements, analysis testing and inferences depends on the availability of relevant data and their accuracy. Hence, the importance of data for any research study. The search for answers to research questions is called collection of data. Data are facts, and other relevant materials, past and present, serving as bases for study and analyses. Some examples of data are: • The types of patients admitted in hospital or attended for OPD in hospital. • The items of drugs and medical supplies required for the hospital management • The quantity of each material required for a unit of output in hospital • The sex, age, social class, religion, income level of respondents in a health care recipient behaviour study • The opinions of eligible couples on birth control devices (Family Planning Survey) • The capital expenditure proposals considered by a nursing college during a year (Financial Management)

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Essentials of Nursing Research • The marks obtained by students of a BSc Nursing students in a test on a particular subject (Performances of students) • The opinions of people on voting in a general election (Opinion Poll) • The types of news read by newspaper readers (Readership Survey) • The aspirations of MSc Nursing students Nursing Leader/Educator/ Administrator.

SOURCES OF DATA The task of data collection begins after a research problem has been defined and research design/plan chalked out. While deciding about the method of data collection to be used for the study, the researcher should keep in mind two types of data, viz. primary and secondary. The primary data are those which are collected afresh and for the first time, and thus happen to be original in character. The secondary data, on the other hand, are those which have already been collected by someone else and which have already been passed through the statistical process. The researcher would have to decide which sort of data would be using (thus collecting) for his study and according he will have to select one or the other method of data collection. The methods of collecting primary and secondary data differ since primary data are to be originally collected, while in case of secondary data the nature of data collection work is merely that of compilation. The sources of data may be classified into: (a) Primary sources and (b) Secondary sources.

Primary Sources Primary sources are original sources from which the researcher directly collects data that have not been previously collected, e.g. collection of data directly by the researcher on brand awareness, brand preference, brand loyalty and other aspects of consumer behaviour from a sample of consumers by interviewing them. Primary data are first-hand information collected through various methods such as observation, interviewing, mailing, etc.

Secondary Sources

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These are sources containing data which have been collected and compiled for another purpose. The secondary sources consists of readily available compendia and already compiled statistical statements and reports whose data may be used by researcher for their studies, e.g. census reports, annual reports and financial statements of companies, statistical statements, reports of government departments, annual reports

Methods of Data Collection on currency and finance published by the Reserve Bank of India, statistical statements relating to Cooperatives and Regional Rural Banks, published by the NABARD, reports of the National Sample Survey Organisation, reports of trade associations, publications of international organizations such as UNO, IMF, World Bank, WHO, etc., Trade and financial journals, newspapers, etc. Secondary sources consists of not only published records and reports, but also unpublished records. The latter category includes various record and registers maintained by firms and organizations, e.g. accounting and financial records, personnel records, register of members, minutes of meetings, inventory records, etc. Though secondary sources are diverse and consist of all sorts of materials, they have certain common characteristics. • They are ready made and readily available, and do not require the trouble of constructing tools and administering them. • They consist of data over which a researcher has no original control over collection and classification. Both the form and the content of secondary sources are shaped by others. Clearly, this is a feature which can limit the research value of secondary sources. • Secondary sources are not limited in time and space. That is the researcher using them need not have been present when and where they were gathered.

METHODS OF COLLECTING PRIMARY DATA Primary data are directly collected by the researcher from their original sources. In this case, the researcher can collect the required data precisely according to his research needs, he can collect them when he wants them and in the form he needs them. But the collection of primary data is costly and time consuming. Yet, for several types of social science research required data are not available form secondary sources and they have to be directly gathered form the primary sources. In such cases where the available data are inappropriate, inadequate or obsolete, primary data have to be gathered. They include: Socioeconomic surveys, social anthropological studies of rural communities and tribal communities, sociological studies of social problems and social institutions, nursing research, leadership studies, opinion polls, attitudinal surveys, readership, radio listening and TV viewing surveys, knowledgeawareness practice (KAP) studies, nursing management studies, hospital management studies, etc. There are various methods of data collection. A ‘Method’ is different from a ‘Tool’. While a method refers to the way or mode of gathering data, a tool is an instrument used for the method. For example, a schedule

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Essentials of Nursing Research is used for interviewing. The important methods are: (a) observation, (b) interviewing, (c) mail survey, (d) experimentation, (e) simulation, and (f) projective technique. To collect primary data during the course of doing experiments in an experimental research but in case we do research of the descriptive type and perform surveys, whether sample surveys or census surveys, then we can obtain primary data either through observation or through direct communication with respondents in one form or another or through personal interviews. This, in other words, means that there are several methods of collecting primary data, particularly in surveys and descriptive researches. Important ones are: (i) observation method, (ii) interview method, (iii) through questionnaires, (iv) through schedules and (v) other methods which include (a) warranty cards, (b) distributor audits, (c) pantry audits, (d) consumer panels, (e) using mechanical devices; (f) through projective techniques, (g) depth interviews, and (h) content analysis. Observations involves gathering of data relating to the selected research by viewing and or listening. Interviewing involves face-to-face conversation between the investigator and the respondent. Mailing is used for collecting data by getting questionnaires completed by respondents. Experimentation involves a study of independent variables under controlled conditions. Experiments may be conducted in a laboratory or in field in a natural setting. Simulation involves creation of an artificial situation similar to the actual life situation. Projective methods aim at drawing inferences on the characteristics of respondents by presenting to them stimuli. Even method has its advantages and disadvantages.

Selection of Methods of Data Collection

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Methods of data collection should be selected for a proposed research project is one of the questions to be considered while designing the research plan. One or more methods has/have to be chosen. The choice of a method depends upon the following factors: 1. The nature of the study of the subject-matter: If it is a study of opinions/ preferences of persons, interviewing or mailing may be appropriate depending on the educational level of the respondents. On the other hand, an impact study may call for experimentation; and a study of behavioural pattern may require observation. 2. The unit of enquiry: The unit of enquiry may be an individual, household institution or community. To collect data from households, interviewing is preferable. Data from institutions may be collected by mail survey and studies on communities call for observational method.

Methods of Data Collection 3. The size and spread of the sample: If the sample is small and the area covered is compact interviewing may be preferable, but a large sample scattered over a wider area may require mailing. 4. Scale of the survey: A large scale may require mailing or interviewing through trained investigators. 5. The educational level of respondents: For a simple survey among educated persons concerned with the subject-matter of study, a mail survey may be appropriate. But for a survey of less educated/illiterate persons like industrial workers, slum dwellers, rural people, interviewing is the only suitable method. 6. The type and depth of information to be collected: For collection of general, simple, factual and non-emotional data, interviewing or mailing is appropriate. For an indepth survey of personal experiences and sensitive issues, in-depth interview is essential. For collection of data on behaviour, culture, customs, life style, etc. observational method is required. 7. The availability of skilled and trained manpower: In this case, even for a large general survey entailing many complicated questions, interviewing can be adopted. 8. The rate of accuracy and representative nature of the data required: Interviewing is the most appropriate method for collecting accurate data from a representative sample of population. Interviewing can achieve a higher response rate. A researcher can select one or more of the methods keeping in view the above factors. No method is universal. Each method’s unique features should be compared with the needs and conditions of the study and thus the choice of the methods should be decided.

Evaluation of Data Collection Methods The appropriateness of a method of data collection may be evaluated on the basis of the following criteria: • The efficiency, i.e. the speed and cost of data collection • Data quality and adequacy, i.e. response rate, accuracy and objectivity • Naturalness of setting • Anonymity • Interviewer supervision • Control of context and question order • Ability to use visual aids • Potential for controlling variables • Dependence on respondent’s reading and writing ability.

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1. OBSERVATION AS A METHOD OF DATA COLLECTION

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Observation also plays a major role in formulating and testing hypothesis in nursing sciences. Nurse scientists observe the behaviour of nursing institutions. In a sense, all nursing research begins and ends with observation. A researcher silently watching a city council or a trade union committee or quality circle or a departmental meeting or a conference of politicians or others picks up hints that help him to formulate new hypothesis. He can test them through further observation and study. Observation becomes scientific, when it (a) serves a formulated research purpose, (b) is planned deliberately, (c) is recorded systematically, and (d) is subjected to checks and controls on validity and reliability. Validity refers to the extent to which the recorded observations accurately reflect the construct they are intended to measure. Validity is assessed by examining how well the observations agree with alternative measures of the same construct. Reliability entails consistency and freedom from measurement error. This is usually assessed in terms of (a) the extent to which two or more independent observers agree in their ratings of the same event; (b) the repeatability of observations over-time by means of test-retest comparisons. The observation method is the most commonly used method specially in studies relating to behavioural sciences. In a way we all observe things around us, but this sort of observation is not scientific observation. Observation becomes a scientific tool and the method of data collection for the researcher, when it serves a formulated research purpose; is systematically planned and recorded and is subjected to checks and controls on validity and reliability. Under the observation method, the information is sought by way of investigator’s own direct observation without asking from the respondent. The main advantage of this method is that subjective bias is eliminated, if observation is done accurately. Secondly, the information obtained under this method relates to what is currently happening; it is not complicated by either the past behaviour of future intentions or attitudes. Thirdly, this method is independent of respondents’ willingness to respond and as such is relatively less demanding of active cooperation on the part of respondents as happens to be the case in the interview or the questionnaire method. This method is particularly suitable in studies which deal with subjects (i.e. respondents) who are not capable of giving verbal reports of their feelings for one reason or the other.

Methods of Data Collection

Characteristics of Observation Observations as a method of data collection has certain characteristics. • It is both a physical and mental activity. The observing eye ‘catches’ many things which are slighted, but attention is focused on data that are pertinent to the given study. • Observation is selective. A researcher does not observed anything and everything, but selects the range of things to be observed on the basis of the nature, scope and objectives of his study. • Observation is purposive and not casual. It is made for the specific purpose of noting things relevant to the study. • It captures the natural social context in which persons’ behaviour occurs. • It grasps the significant events and occurrences that affect social relations of the participants. • Observation should be exact and be based on standardized tools of research such as observation schedule, social-metric scale, etc. and precision instruments, if any.

Types of Observation Observation may be classified in different ways. With references to investigator’s role, it may be classified into (a) participant observation, and (b) non-participant observation. In terms of mode of observation, it may be classified into (c) direct observation and (d) indirect observation. With reference to the rigor of the system adopted, observation is classified into (e) controlled observation, and (f) uncontrolled observation. a. Participant observation: In this observation, the observer is a part of the phenomenon or group which is observed and he acts as both an observer and a participant. For example, a study of tribal customs by an anthropologist by taking part in tribal activities like folk dance. The persons who are observed should not be aware of the researcher’s purpose. Then only their behaviour will be ‘natural.’ The concealment of research objective and research’s identity is justified on the ground that it makes it possible to study certain aspects of the group’s culture which are not revealed to outsiders. b. Non-participant observation: In this method, the observer stands apart and does not participate in the phenomenon observed. Naturally, there is no emotional involvement on the part of the observer. This method calls for skill in recording observations in an unnoticed manner. c. Direct observation: This means observation of an event personally by the observer when it takes place. This method is flexible and allows the observer to see and record subtle aspects of events and behaviour as they occur. He is also free to shift places, change the focus of the

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Essentials of Nursing Research observation. A limitation of this method is that the observer’s perception circuit may not be able to cover all relevant events when the latter move quickly, resulting in the incompleteness of the observation. d. Indirect observation: This does not involve the physical presence of the observer, and the recording is done by mechanical, photographic or electronic devices, e.g. recording customer and employee movements by a special motion picture camera mounted in a department of a large store. This method is less flexible than direct observation, but it is less biasing and less erratic in recording accuracy. It also provides a permanent record for an analysis of different aspects of the event. e. Controlled observation: This involves standardization of observational techniques and exercise of maximum control over extrinsic and intrinsic variables by adopting experimental design and systematically recording observations. Controlled observation is carried out either in the laboratory or in the field. It is typified by clear and explicit decisions on what, how and when to observe. It is primarily used for inferring causality, and testing causal hypothesis. f. Uncontrolled observation: This does not involve control over extrinsic and intrinsic variables. It is primarily used for descriptive research. Participant observation is a typical uncontrolled one.

Planning Observation

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The use of observation method requires proper planning as given below: • The researcher should carefully examine the relevance of observation method to the data needs of the selected study. • Researcher must identify the specific investigative questions which call for use of observation method. These determine the data to be collected. • Researcher must decide the observation content, viz. specific conditions, events and activities that have to be observed for the required data. The observation content should include the relevant variables. • For each variable chosen, the operational definition should be specified. • The observation setting, the subjects to observed, the timing and mode of observation, recording, procedure, recording instruments to be used, and other details of the task should be determined. • Observers should be selected and trained. The persons to be selected must have sufficient concentration powers, strong memory power

Methods of Data Collection

•

• • •

and unobtrusive nature. Selected persons should be imparted both theoretical and practical training. The conditions of effective observation include the following: Observations must be done under conditions which will permit accurate results. The observer must be in vantage point to see clearly the objects to be observed. The distance and the light must be satisfactory. The mechanical devices used must be in good working conditions and operated by skilled persons. Observation must cover a sufficient number of representative samples of the cases. Recording should be accurate and complete. The accuracy and completeness of recorded results must be checked. A certain number of cases can be observed again by another observer/ another set of mechanical devices, as the case may be. If it is feasible, two separate observers and sets of instruments may be used in all or some of original observations. The results could then be compared to determine their accuracy and completeness.

Planning and Conducting Experiments It is easy to conceive ideas, but difficult to translate the ideas into a workable, credible, meaningful set of experimental operations. This to a great extent depends upon the researcher’s knowledge, imagination and intelligence. Yet the general procedure in experimentation may be outlined. • Determine the hypothesis to be tested and the independent and dependent variable involved in it. • Operationalize the variables by identifying their measurable dimensions. • Select the type of experimental plan. The types of experimental design based on types of control may be classified into: (1) one group plan, using the same group as experimental and control group and measuring it before and after experimental treatment, (2) matched groups plan, consisting of two identical group, one to be used as control group and another as experimental group, with (a) Post-test only measurement or (b) pretest-post-test measurements. • Choose the setting. The setting may be field or laboratory • Make the experimental conditions as nearly the same as the expected real life conditions. This is essential in order to make the findings reliable. • Make a record of pre-experimental conditions. • Introduce appropriate methods for controlling extraneous variables that are not manipulated in the experiment. These methods are: Removing the variable: An extraneous variable may be eliminated completely. For example, observer distraction may be removed by

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Essentials of Nursing Research separating the observer by a one-way glass partition. Some variables may be eliminated by selecting cases with uniform characteristics, e.g. using only male subjects removing sex as a variable. Matching cases: Selecting control and experimental groups with identical characteristics. By this all variables are kept constant. Balancing cases: This means assigning subjects to experimental and control groups in such as way that the means and the variances of the groups are as nearly equal as possible. Randomisation: This involves pure chance selection and assignment of subjects to experimental and control groups. This method eliminates systematic bias and minimizes the effect of extraneous variables. Analysis of covariance: This is a statistical method of eliminating initial differences on several variables between the experimental and control groups. Pretest mean scores are used as covariates. • Apply the experimental treatment and record observations and measurements using appropriate measurement devices. If feasible, repeat the tests several times in order to insure the accuracy of results. • Analyse the results, using appropriate statistical devices. • Interpret the results, giving consideration to all possible extraneous conditions. No possible cause should be overlooked, as unforeseen conditions might influence the results. The applications of experimental method are discussed under Laboratory Experiment, and Field Experiment, below. Experimentation has some specific advantages and disadvantages. Advantages includes: • Its power to determine causal relationships variables surpasses that of all other methods. The influence of extraneous variables can be more effectively controlled in this method. • The element of human errors is reduced to the minimum. • In this method better conditions for conducting experiments may be created, than is possible in other methods. • Experimentation yields generally exact measurements can be repeated for verifying results.

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Disadvantages includes: • It is difficult to establish comparable control and experimental groups. • The scope for experimentation with human beings is extremely limited. • Experiment is often difficult to design, tends to be expensive and timeconsuming.

Methods of Data Collection • It is artificial to some extent and may lack realism. • Experimentation can be used only in studies of the present but not in studies relating to past or future. • It is of no use in determining opinions, movies and intentions of persons. • The results observed may not be the true effects of the experimental treatment, but may be artificial, i.e. effects of some extraneous variable. For instance, an experimenter may unwillingly influence his subjects to behave in ways that confirm the hypothesis, particularly if the subjects want to please the experimenter. Laboratory experiment is especially vulnerable to such artificialities when subjects know they are being studied and want to create a good impression.

a. Laboratory Experiment An experiment can be conducted either in a laboratory or in a real-life setting. A laboratory experiment is an investigation conducted in a setting created specifically for the purpose. The researcher manipulates an independent variable and studies its effect on a dependent variable, keeping other variables constant. In experimental methods the investigator tests the hypothesis about a cause and effect relationship by manipulating the independent variable under controlled conditions. In these methods the key word is central. The purpose of laboratory experiments are: (1) to discover casual relations under uncontaminated conditions, reduce the discovered relations to functional form y = f(x) and make predictions on the basis of the functions; (2) to test the predictions derived from theory and other researches; and (3) to refine theories. This method is useful not only in physical sciences research, but also in social sciences research. Eventhough experimentation on a social science problem has special difficulties, it can be used for a variety of studies such as voting behaviour, leadership style, learning process, effectiveness of advertising media, effect of package on sales, influence of incentive schemes on labour productivity and so on. Laboratory method has several merits which includes: • The chief merit of experiment method is the possibility of securing relatively complete control over extraneous factors. • The experimenter can manipulate one or more variable and study its or their impact on a dependent variable. • The experimenter in most cases can achieve a high degree of specificity on operationalising the variables. • An experiment yields precise results and it is replicable.

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Essentials of Nursing Research The laboratory experimental method is not free from drawbacks they are: • The greatest weakness of this method is probably the lack of strength of independent variables. As the laboratory situation is artificial, the effects of experimental manipulations are usually weak. • This method is highly structured, thus limiting flexibility. • The result cannot be simply generalized to real life situations, because in the latter, various extraneous, forces operate. Thus, an experimental method lacks external validity. Nevertheless, the contributions of experimental method to theory building are so great that this method is one of man’s greatest achievements.

b. Field Experiment

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This is an experiment conducted in a real life situation in which the experimenter manipulates an independent variable in order to test a hypothesis. Compared with laboratory experiment, a field experiment incorporates less control. As it is difficult to foresee and control extraneous factors in a field experiment, its result is subject to large uncontrolled variation. This method is well-suited to both testing of theory and finding solutions to practical social problems. It has been used for studying a variety of social action programmes such as, improving the quality of work life in assembly-lines, post offices and insurance companies and banks, the learning process in educational institutions and training centres; changing group productivity; changing organisation culture; changing superior-subordinate relationship in organisation; overcoming resistance to change through participative approach; changing attitude through social contract; changing food habits; improving the effectiveness of mass education; testing new products in markets; determining best procedures or techniques for tasks; and so on. “Anyone who wishes to take effective social action in any setting can improve upon the uncontrolled, try out of new methods by the application of more scientific experimental procedures. Through careful measurements, better theorizing, the use of control groups, and other aspects of improved experimental design, the practical problems of social action can be solved with greater certainty, with greater accuracy, and sometimes with greater efficiency than through common-sense trial-and-error methods.” The field experiment will be more successful if preceded by a field study which gives a more thorough knowledge of the setting and thus enables the experimenter to manipulated and control his variable more effectively. For example, in a field experiment in a factory, Coch and French

Methods of Data Collection manipulated participation of workers in planning and studied its effect on various dependent variables – production, resignations and aggression. The broad hypothesis tested was that resistance to change can be overcome by increased participation in decision or processes that lead to change. Factory workers were divided into three groups. The members of the control group did not participate in any of the discussions or decision in different degrees: Total participation and participation by representation. The results supported the hypothesis. Field experimental method has some unique virtues. • The variables in a field experiment usually have a stronger effect than those of a laboratory experiment, as the field situation is real. Realism increases with strength of the variables. • The field experiment permits a more unequivocal determination of causal relations, while a mere non-experimental field study reveals only a correlation. • This method is particularly appropriate for studying methods of social influence, social processes and social changes in real life settings. • As the field experiment deals with the total life situation, it is wellsuited for studying complex syndromes and social processes where the inter-relationships among many analytical variables are involved. The field experimental method is not free from limitations. • The major limitations of this method is the practical difficulty involved in the manipulation of independent variables and randomisation in many field situations. • Another weakness inherent in this method is lack of precision. Precise measurement in realistic situation is not so possible as in a laboratory setting. • A field experiment is a very difficult process, as it calls for social skills and good contacts on the part of the experimenter and also it is a timeconsuming process. Unless the organisation where it has to be conducted and the subjects cooperate, it is not possible to conduct it.

Validity of Experimentation An experiment should achieve two types of validity internal and external validity. When the effects of extraneous variables are eliminated and the observed effects on dependent variable can be ascribed solely to the effect to experimented dependent variables, then the experiment has internal validity. This is generally achieved in a laboratory experiments, because in it extraneous variables are controlled. The extent to which the results of an experiment can be generalized to other settings is known as external validity. The contribution of an experiment to the body of knowledge depends upon is external validity.

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It is very difficult to achieve cent percent validity in an experiment, because there are various threats to validity. Campbell and Stanley list twelve threats to validity. 1. Maturation: This means the effects of time. Between the pretest and the post-test, the subjects undergo various changes such as fatigue, boredom, growth or intellectual maturation which may influence their performance and so the difference between the pre-test and post-test measurements of their performance cannot be ascribed to the effect of experimental variables only. This source of invalidity is eliminated/minimized by before-after design with control group, for the control group also experiences the effects of time. 2. History: Other extraneous events may occur during experimentation and thus influence the results. These may be events that occur in the political, economic or cultural life of the people under study or other minor events such as illness of a subject, disruption in the experiment of an interruption from any unwanted source. The influence of this source of invalidity is greater in a field experiment than in laboratory experiment. 3. Testing: It is impossible that the experience gained in the pre-test may result in an increase in the post-test performance. This testing effect is confounded with the effect of experimental variable. The before-after design with control group guards against this source of invalidity also. 4. Instrumentation: If the tests of instruments used for measurement are not accurate or consistent, or if observers become more experienced or careless, the results will be vitiated. 5. Statistical regression: Those who scored highest on a pre-test are likely to score relatively lower on a re-test, whereas subjects who score lowest in the pre-test are likely to score higher on a re-test. Thus, their average score in re-test may be closer to the overall population average. This is merely a statistical illusion. Failure to recognize this effect may lead the researcher to arrive at erroneous conclusion on the results. 6. Differential selection: Selection bias arises when the experimental and control groups are not as identical as possible. Techniques like random selection of subjects and matching may minimize the selection bias. 7. Experimental mortality: This refers to loss of subject due to dropout, migration, etc. This is more likely in a long-term experiment, and affects the comparability of pre-test and post-test results. The remedy is to omit the pre-test scores of subjects who did not take the post-test.

Methods of Data Collection 8. Selection-maturation, selection-history or selection-testing interaction: These interactions between selection and other factors arise when the effect of the other factors differs between the groups selected. 9. Reactive effect of testing: The pre-test may affect the responsiveness of the experimental group of the treatment. For example, pre-test measuring of knowledge about Denmark may sensitize the subject; as a result, they may be more receptive to the information given out in a film about Denmark, which is the treatment under study. 10. Reactive effect of experimental arrangements: The knowledge of participation in an experiment may introduce bias in favour of the experimental group. This reactive effect is popularly known as the “Hawthrone effect”, since its importance was clearly demonstrated in the famous studies conducted by Prof. Elton Mayo and his associates at the Hawthrone plant of Western Electric Company in Chicago during early 1930s. In this enquiry into the relationship between physical work conditions and productivity, the output of a group of workers under various conditions was measured. They were treated differently and they knew they were the subjects of the experiments. When light intensity was increased, the workers output increased; but when the intensity of light was reduced, there was no reduction in their output, because of the reactive effect of experimental arrangements. 11. Multi-treatment interference: In some experiment like medical experiments several types of treatments are arrived at successively on the same subject. At each stage, the residual effect of the previous treatment would interact with the effect of the next one. 12. Contamination: This is a type of bias which arises when the researcher has some previous knowledge about the subjects involved in an experiment. This may affect the objectivity of his judgement. The researcher should be aware of the above threats and take appropriate measures like matching, randomisation, etc., to minimise their effect and arrive at conclusions, keeping in view the limitations.

3. SIMULATION AS A METHOD OF DATA COLLECTION Simulation is one of the forms of observational methods. It is a process of conducting experiments on a symbolic model representing a phenomenon. Abelson defines simulation as “the exercise of a flexible limitation of process and outcomes for the purpose of clarifying or explaining the underlying mechanisms involved”. It is a symbolic abstraction, simplification and substitution for some referent system. In other words, simulation is a theoretical model of the elements, relations and processes

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Essentials of Nursing Research which symbolize some referent system, e.g. the flow of money in the economic system may be simulated in an operating model consisting of a set of pipes through which liquid moves. Simulation is thus a technique of performing sampling experiments on the model of the systems. The experiments are done on the model instead of on the real system, because the latter would be too inconvenient and expensive. Like laboratory experiment, in simulation study also the setting is deliberately structured to mirror important dimensions of some naturally occurring system. The only difference between these two is that whereas in a laboratory experiment, the system being studied is more generic (e.g. a formal organisation) in a simulation it is specific (e.g. Poison). Advantages of simulation • There is greater realism in the setting • There is greater amount of control over external sources of variance • The researcher enjoys greater ability to manipulate independent variables • There is higher participant involvement. Disadvantages of simulation may be that this method is expensive and the high degree of participant involvement increase the risk of subjects being psychologically harmed in the course of study. • The process of simulation includes the following: - The process or system to be simulated is identified. - The purposes of this simulation is decided. It may be to ‘clarify’ or ‘explain’ the process. - On the basis of the available information on the process or system– its components and the set of conditions assumed to operate in and between the components– a mathematical model is developed. - Several sets of input data to be used are collected. Inputs may be samples of actual data or synthetic data based on the general characteristics of real input data. - The type of simulation– computer simulation or man simulation or man-computer simulation to be uses is determined. - The simulation is operated with the various sets of input data, and the results are analysed to determine the best solution.

Simulation vs Experimentation

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A real-life experiment may be too costly or may not be possible because of practical difficult or of the complexities of the phenomenon. For example, the search for an optimal approach to the problem of inventory issue and replenishment through experimentation would disrupt operations for a certain period of time and also would be very costly; phenomena, like

Methods of Data Collection macro-sociological situations or business systems are so complex, that it would not be possible to manipulate independent variables, and to control extraneous variable in real-life experiments on them. Such difficulties do not arise in simulation because it experiments with models and can artificially manipulate variables. Further, an experiment can extrapolate to, at best a few variables, whereas simulation, particularly computer simulation may often handle many variables including interpersonal and interpersonal processes. Simulation, unlike experiments, is best suited to the study of a system with set of inter-related and interdependent sub-components.

Types of Simulation There are three types of simulation, viz., (a) man simulations, (b) computer simulations and (c) man-computer simulations. Man simulation: This is a game played by people in a laboratory setting to simulate people in real world. For example, number of individuals are divided into groups that are placed in a laboratory room. Each group is instructed to imagine that it represents the government of a particular nation. Simulated international situations involving treaties, threats, wars and the like are then played out by the groups. No gaming model can serve as a universal model for all games. Each model is unique. The size of the group is important factor. The size may be two persons, three persons or more than three persons. Other important dimensions are information level (whether individuals have perfect information or not), and perceived goal motivation-no common interest and purely competitive or partly competitive and partly cooperative. Computer simulation: This is an operational model programmed to generate a sequence of interactions. This requires precise definitions, storing of large amounts of data on the system to be analysed and programming of the analysis. For example, two or more sets of ratios relating to liquidity, profitability and operational efficiency may be fed into a discriminant function analysis in order to find out which set of variables has a better power to predict the financial health of an enterprise. Man-computer simulation: In this type of simulation, persons play the role of decision-makers, while the computer is responsive to players’ activities. In this game, the computer must be provided with a script. “The script lists the messages conveyed to the player. Two kinds of messages are involved. One is simple response to the players’ actions. The other is instruction to the player as to the appropriate way he can respond to the computer.”

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Essentials of Nursing Research The successive runs of a simulation should give similar results. Then it is said to be reliable. This is rarely a problem in computer simulation, but it may be a problem in games. The reliability in games requires that the physical equipment should not be cumbersome, the rules should be clear, simple and complete and the game should not overtax the player’s span of attention. Validity refers to the generalizability of the findings of the simulation. This depends on the degree of correspondence between the operating model and its reference system. Simulation is applicable to various categories of problems; behavioural and social problems, e.g. population dynamics; group behaviour; social conflicts. • Political problems, e.g. predication of voting in elections; cold war conflicts; international political situations; international counteractions to specific actions like diplomatic protest, sanctions, etc. study of revolutions. • Economic problems, e.g. study of economics under conditions of recession and inflation; developmental planning strategies; balance of payment policies; economic forecasting; urban traffic system design; water resources development; flood control system; national manpower planning. • Business problems, e.g. determination of proper order quantities; production scheduling, designing complex distribution system; waiting line problems in transport services; maintenance scheduling in factories, airlines, bus service; assembly line scheduling in consumer behaviour prediction; financial forecasting; introduction of a new product; control system. • War strategies and tactics.

4. NON-EXPERIMENTATIONAL METHODS OF DATA COLLECTION Non-experimental methods are so called because in them the investigator does not control or change any aspect of the situation under study as in the case of experiment, but simply describes what naturally occurs. These methods do not always aim at testing hypothesis. Their object may sometimes simply be to describe a known phenomenon. Commonly used methods of non-experiments are field methods and library methods including field study, sample survey and case study.

Field Methods

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Field study: Any systematic study which aims at discovering the relations and interactions among variables or testing hypothesis in natural live

Methods of Data Collection situations like, communities, schools, factories, organizations, and institutions and which is ex post facto in nature is a ‘field study.’ The essential factor which distinguishes a field study from a field experiment is the design of research. Though both types of studies are carried out in the natural field setting, a field experiment involves actual manipulation of independent variables by the experimenter in order to find out causal relations with the dependent variables whereas in the field out study the researcher has no control whatsoever over the independent variable. Instead, he relies self-reports of subjects for determining the extent to which they have received some treatment and for assigning independent variables values to them. Since data in a field study are collected at only one point in time, only correlational or cross-sectional analysis of the data are possible. Field study serves several purposes, i.e. exploratory, descriptive and hypothesis testing: (i) Exploratory field study has its goal, the gaining of familiarity with a system to enable the researcher to define a research problem or develop hypothesis about some processes associated with the system, (ii) descriptive field study has its objective, the description of a system which may include measurement of a number of characteristics of the system or recording the frequency of certain system occurrences. A field study may also aim at testing some hypothesis. Advantages of field studies are that this method is very much realistic since it is conducted in the real world situations and data on a larger number of variables can be obtained from the subjects. The field study is not free from limitations as follows: • The cooperation of organization is often difficult to obtain • Since these studies are expost facto in which independent variables are not manipulated causal inferences cannot be drawn • Data are likely to contain unknown sampling biases • Measurement is not as precise as in the laboratory because of the influence of confounding variables • The ‘dross rate’ or proportion of irrelevant data may be high in field studies. Sample survey: It is also a form of ex post facto research in which researcher simply collects data about certain sociological or psychological characteristics of a sample that represents a known population in natural setting. In fact, the researcher is interested in knowing something about the whole population. But rarely does he study the whole population. He only studies sample drawn from populations. The data are sought directly from respondents by some systematic technique such as interviewing questionnaire and observation. If the researcher suspects that confounding influences may be present in the data obtained from survey,

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Essentials of Nursing Research then the potentially confounding variables may be measured and statistical techniques used to control theses effects. The purpose of sample survey are exploring the existence of some phenomenon, describing the phenomenon and testing hypothesis. In addition, sample surveys are uses to predict future conditions, to evaluate social programmed and to develop social indicators, e.g. consumer price index. Advantages of sample survey • Use of a large representative sample in survey reduces problems of sample bias and allows the researcher to generalize his results to the parent population • Data collection can take place in any setting. It is assumed that respondents replies generally remain uninfluenced by the setting in which they are given • Data are obtained directly from respondents • A variety of data collection techniques can be used alone or in combination • If a mail questionnaire is used to collect data, the cost of collection per respondents is relatively low as compared to direct contact • Surveys often yield information that suggests new hypotheses. Limitations of sample survey • There is generally initial resistance to being interviewed either because the respondent does not wish to be bothered or because the suspects some trap. If mail questionnaire are used to collect data, the proportions of returned questionnaire is often low • There are possibilities of the information being shallow or biased. Biases can be both deliberate and non-deliberate • Use of standardized response formats in many sample surveys forces respondent to subscribe to statements they do not fully endorse • Most surveys ‘one shot’ studies • It does not involve manipulation of independent variables. As a result cause and effect relationship between variables cannot be established.

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Case study: The case study is a method of intensively exploring and analysing the life of a single social unit-be that unit, a person, a family, institution culture group or even an entire community. In this method no attempt is made to exercise experimental or statistical control and phenomena relating to the unit are studies in natural settings. The researcher has considerable discretion in gathering information from a variety of sources such as personal documents diaries, autobiographies, letters, confessions, records in office files, interviews and so on.

Methods of Data Collection The researcher must, however, carefully evaluates these sources in terms of the motives, biases and prejudices of the respondents and are recorders, their opportunities to know the recorded facts and their ability to describe their intimate personal experiences. This method is useful in the following cases: • To present evidence on what the researcher considers to be a rare, remarkable or a typical instance of some phenomena • To exemplify or illustrate a concept that would be difficult to describe using solely abstract theoretical language • To demonstrate the use of a technique • To establish a pool of data that may be useful at a future point in time • To challenge the existing theory with the help of case study evidence • To serve as an inductive or hypothesis generating vehicle. Advantages of case study • It is very intensive in nature. It aims at studying everything about few units than several units • In this method data collection is flexible because a researcher is completely free to approach the problem from any angle he desires • In this method, data are collected in natural settings • This method is useful for generating hypothesis for later full scale studies • It is less expensive than other methods. This method is also not free from limitation. Limitations of case study method • It lacks internal validity, i.e. the findings of case study generally do not lend themselves to comparison because in the absence of any common research design, different researchers with different levels of memory, perception and judgement collects analyse and interpret the same data differently • It cannot serve as base for generalization, because in the case study on unit of a defence population studies • A case study is generally non-statistical in its analysis. There may be possibilities of subject to varying interpretations • Causal inferences from a case study data are impossible since there is no manipulation (IV) and control (CV) • Case studies are more time consuming than other methods.

Library Methods The place of library is designing a research study particularly a historical one and in serving as a method of data collection can hardly be

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Essentials of Nursing Research overemphasized. In order to be able to effectively use a library, a researcher should be well familiar with its two major sections, viz. library catalogue and reference material and periodical. Library catalogue is a device to help the use or locate the required reading materials in the library. Catalogues may be available according to the title of the book or according to the name of the author or both. Researcher should have some knowledge about either author or the title in order to locate desired publication. Reference material and periodicals, indices, encyclopedias, yearbooks, bibliographies and other literature. Researcher should be aware of and how to locate and get the required information.

Sources of Data Collection Data is a factual information systematically collected in the course of study. The sources, a researcher should tap for collection of data for a research study vary with his interests and the type of study. However, these can be classified as documentary sources, field sources and historical sources. Primary sources: Which provide data gathered at first hand, the responsibility and promulgation remaining under the same authority that originally gathered their data from primary sources may be gathered by participant observation, personal interview, conferences, correspondence questionnaire and other devices.

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Secondary sources: Which provide data that has been transcribed or compiled from original sources and of which the promulgating authority is different from that which controlled the collection of data at first hand. For example, the census of India is generally cited as the primary source whereas the health statistics on India based on census of India. Whether primary or secondary may be gathered by private of public authority. Usually, the secondary sources must be scrutinised carefully by the scientific workers. Their reliability for research work can be determined only by reference to the primary source which should be cited in notes or bibliography so that any one who desires to make himself responsible for the facts can refer to the original source. At times, discrepancies which appear in different secondary sources can be settled from the original source. The records and reports of official bodies refer for the most part, the primary sources of data, but it should not be taken for granted that official reports always supply primary sources materials. The person examining these data should enquire into the sources of such data.

Methods of Data Collection Field sources: Include living persons who have a fund of knowledge about or have been in intimate contact with social conditions and changes over a considerable period of time. These persons are in a position to describe not only the existing state of affairs but also the observable trends and significant milestones in a social process. These people are regarded as a personal sources or direct sources. If discretion is used in their selection, various professionals, businessmen, old people can be utilised as a source of information. Each person supplying information may often serve as check on the other until the account is reliably reconstructed. Field sources also include conditions, environment, and events that are observable and measurable, such as sanitary conditions, humility, childbirth. Most survey studies and all experimental studies were field sources for data collection. Historical sources: Include a combination of primary, secondary and field sources. These consist of documents and various historical resources to which the historian himself has access. Collecting data implies sorting out the materials (documents, letters, articrafts) that provide the historical evidence for the research in two main categories; primary source data and secondary source data. Data considered to be primary sources are those events that the author/observer directly witnessed. Secondary sources are those data that the author/observer did not directly witness but instead reported from the observation of others. The priority for the historiographer in collecting primary sources whenever possible, since first hand evidence is considered more credible. Unobtrusive measures: In using unobtrusive measures to collect data, the researcher decides what needs to be measured and then determines how to measure it without direct intervention. A time-honoured way to measure the most popular exhibits in a museum would be to determine the dirtiest display cases at the end of the day; this is done on the assumption that the more people who touch or press their noses against a display case, the dirtier it will be. Over a period of time, certain exhibits would show the most consistent usage. Unobtrusive measures might be used in a study designed to measure anxiety levels of patients by observing the wear and tear on magazines placed in waiting rooms–perhaps more anxiety is exhibited in the office of a dentist than in the office of a dermatologist. Unobtrusive measures can also be used to collect data when people are unaware that they are being studied, such as installing hidden hardware for bedroom “bugging” to study sexual behaviour (Powers & Knapp, 1995). Such research raises serious ethical concerns regarding informed consent and the right privacy.

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Essentials of Nursing Research Self-report scales: In relation to data collection, a scale is a self-report measure that consists of a series of items designed to measure the attributes being investigated. The subject is presented with the items and responds to each item on the scale provided. Self-report scales are usually designed to be summated, i.e. each response can be given a value and the responses for the entire scale can then be totaled to obtain a single score. Four types of self-report scales will be discussed: rating scales, Likert scales, semantic differential scales, and visual analog scales. i. A rating scale is a type of data-collection instrument that allows the respondents to place their responses, such as feelings or attitudes, on a scale that has a range of potential responses. For example: • How would you rate the nursing care in this hospital? Very Good 1,2,3,4,5 Very Poor (Please check the appropriate blank) The number of response options on rating scales may vary considerably. Although five options occur most frequently, and this appears to be the minimum acceptable number, six, seven, or even eight options can also be presented.

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ii. The Likert scale is a commonly used self-report measure that is designed primarily to measure attitudes. A Likert scale consists of a series of statements, each of which has a number of possible responses, such as strongly agree, agree, uncertain, disagree, strongly disagree. Although five responses is typical, up to seven responses may be provided. There is a definite advantage in using scales that have an even number of responses; these are called forced-choice scales. When given an odd number of choices, subjects may respond to the middle choice and thus appear to be neutral, choosing neither high nor low ratings. If a scale has an even number of options, however, the subject must respond with a high or low ranking or rating. Given the previous question, the evennumbered forced-choice rating scale compels the respondent to either like or dislike the nursing care: • The nursing care in this hospital is: • Very Good …………… Very poor • The scale might similarly have been written as a Likert scale. • The nursing care in this hospital is very good. Very strongly agree, strongly agree, agree, disagree, strongly disagree, very strongly disagree. In this instance, the respondent would probably be asked to circle the appropriate response. Often, adequate statistical analysis cannot be done if the sample size is small. Forced-choice scales allow for the collapsing of cells (categories

Methods of Data Collection of data), for dichotomization, or for bringing cells together in statistically valid groups. Neutral responses might otherwise have to be discarded or divided, giving an unclear picture of the respondents’ feeling or attitudes. iii.The semantic differential scale is used most often to elicit the attitude and beliefs of respondents. The scale consists of a listing of bipolar adjectives with a five-to seven point scale between them that may describe a setting, object, profession, or any other variable of interest. For example, a researcher who wanted to determine how people from different cultural and ethnic backgrounds perceive hospitals might construct the following scale: Below is a checklist of words that describe a hospital. Please place a check mark in the space that best shows how you feel about hospitals. Be sure to place a check mark on each line. Good …………… Bad Busy …………… Quiet Warm…………… Cold Clean …………… Dirty Analytical techniques specifically designed for semantic differential scales would then be applied to the data to determine whether different subjects perceive the hospital setting in different ways. Walker and Sofaer (1998) developed a 12-item, 5-point semantic differential scale in their study of psychological distress in patients attending pain clinics. The scale was validated by factor analysis and its reliability was obtained by the test-retest method. They asked subjects to mark the box that “represents how you feel Most Often these days”. For example: Calm …………… Irritable Happy …………… Sad iv. The visual analog scale (VAS) is a self-report paper and pencil scale that consists of a straight line that has the extreme limits of the variable being measured at each end of the line. The straight line may be either vertical or horizontal. The scale is designed to have the respondent indicate a point on the line that indicates where his or her pain is most like (analogous to) the intensity of the specific attribute being measured. The VAS has proven to be a useful research tool to measure such subjective experiences as pain and anxiety reported by subjects in a clinical setting. Following is an example of a horizontal VAS that could be used to measure fatigue No fatigue |———————————| Fatigue as bad as it could possibly become

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Essentials of Nursing Research The subject would be asked to select a point along the line that best expresses the intensity of his or her fatigue and to place a mark through the line at that point.

5. INTERVIEWING AS A METHOD OF DATA COLLECTION Interviewing is one of the prominent methods of data collection. It may be defined as a two-way systematic conversation between an investigator and an informant, initiated for obtaining information relevant to a specific study. It involves not only convolves not only conversation, but also leaning from the respondent’s gestures, facial expressions and pauses, and his environment. Interviewing requires face to face contact or contact over telephone and calls for interviewing skills. It is done by using a structured schedule or an unstructured guide. Interviewing may be used either as a main method or as a supplementary one in studied of persons. Interviewing is the only suitable method for gathering information from illiterate or less educated respondents. It is useful for collecting a wide range of data from factual demographic data to highly personal and intimate information relating to a person’s opinions, attitudes, values, beliefs, past experience and future intentions. When qualitative information is required or probing is necessary to draw out fully, then interviewing is required. Where the area covered for the survey is a compact, or when a sufficient number of qualified interviewers are available, personal interview is feasible. Interview is often superior to other data-gathering methods. People are usually more willing to talk than to write. Once rapport is established, even confidential information may be obtained. It permits probing into the context and reasons for answers to questions. Interview can add flesh to statistical information. It enables the investigator to grasp the behavioural context of the data furnished by the respondents. It permits the investigator to seek clarifications and brings to the forefront those question, that for one reason or another, respondents do not want to answer. There are several real merits and demerits of interview.

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• The greatest value of this method is the depth and detail of information that can be secured. When used with a well-conceived schedule, an interview can obtain a great deal of information. If far exceeds mail survey in amount and quality of data that can be secured.

Methods of Data Collection • The interviewer can do more to improve the percentage of responses and the quality of information received than other method. He can note the conditions of the interview situation, and adopt appropriate approaches to overcome such problems as the respondent’s unwillingness, incorrect understanding of question, suspicion, etc. • The interviewer can gather other supplemental information like economic level, living conditions, etc. Through observation of the respondent’s environment. • The interviewer can use special scoring devices, visual materials and like in order to improve the quality of interviewing. • The accuracy and dependability of the answers given by the respondent can be checked by observation and probing. • Interview is flexible and adaptable to individual situations. Even more control can be exercised over the interview situation.

Demerits of Interviewing • Interviewing is not free limitations. Its greatest drawback is that it is costly, both in money and time. • The interview results are often adversely affected by interviewer’s mode of asking questions and interactions, and incorrect recording and also be the respondent’s faulty perception, faulty memory, inability to articulate, etc. • Certain types of personal and financial information may be refused in face-to-face interviews. Such information might be supplied more willingly on mail questionnaires, especially if they are to be unsigned. • Interview poses the problem of recording information obtained from the respondents. No foolproof system is available. Note taking is invariably distracting to both the respondents and the interview and affects the thread of the conversation. • Interview calls for highly skilled interviewers. The availability of such persons is limited and the training of interviewers is often a long costly process.

Characteristics of Interviewing Interviewing as a method of data collection has certain characteristics. They are: • The participants, the interviewer and the respondent are strangers. Hence, the investigator has to get himself introduced to the respondent in an appropriate manner. • The relationship between the participants is a transitory one. It has a fixed beginning and termination points. The interview proper is a fleeting, momentary experience for them.

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Essentials of Nursing Research • Interview is not a mere casual conversational exchange, but a conversation with a specific purpose, viz. obtaining information relevant to a study. • Interview is a mode of obtaining verbal answers to questions put verbally. • The interaction between the interviewer and the respondent need not necessarily be on a face-to-face basis, because interview can be conducted over the telephone also. • Although interview is usually a conversation between two persons, it need not be limited to a single respondent. It can also be conducted with a group of persons, such as family members, or a group of children or a group of customers, depending on the requirements of the study. • Interview is an interactional process. The interaction between the interviewer and the respondent depends upon how they perceive each other. The respondent reacts to the interviewer’s appearance, behaviour, gestures, facial expression and intonation, his perception of the thrust of the questions and his own personal needs. As far as possible, the interviewer should try to be closer to the socio-economic level of the respondents. Moreover, he should realize that his respondents are under no obligation to extend response. He should, therefore, be tactful and be alert to such reactions of the respondents as lame-excuse, suspicion, reluctance or indifference, and deal with them suitably. He should not also argue or dispute. He should rather maintain an impartial and objective attitude. • Information furnished by the respondent in the interview is recorded by the investigator. This poses a problem of seeing that recording does not interfere with the tempo of conversation. • Interviewing is not a standardized process like that of a chemical technician; it is rather a flexible psychological process. The implication of this feature is that the interviewer cannot apply unvarying standardised technique, because he is dealing with respondents with varying motives and diverse perceptions. The extent of his success as an interviewer is very largely dependent upon his insight and skill in dealing with varying socio-psychological situations.

Requirements of Successful Interview

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The requirements or conditions necessary for successful interview are: 1. Data availability: The needed information should be available with the respondent. He should be able to conceptualise it in terms useful to the study, and be capable of communicating it.

Methods of Data Collection 2. Role perception: The respondent should understand his role and know what is required of him. He should know what is a relevant answer and how complete it should be. He can learn much of this from the interviewer’s introduction, explanations and questioning procedure. 3. The interviewer should also know his role. He should establish a permissive atmosphere and encourage frank and free conversation. He should not affect the interview situation through subjective attitude, argumentation, etc. 4. Respondent’s motivation: The respondent should be willing to respond and give accurate answer. This depends partly on the interviewer’s approach and skill. The interview has interest in it for the purpose of his research, but the respondent has no personal interest in it. Therefore, the interviewer should establish a friendly relationship with the respondent, and create in him interest in the subject-matter of the study. The interviewer should try to reduce the effect of demotivating factors like desire to get on with other activities, embarrassment at ignorance, dislike of the interview content, suspicious about the interviewer, and fear of consequences. He should also try to build up the effect of motivation factors like curiosity, loneliness, politeness, sense of duty, respect of the research agency and liking for the interviewer. The above requirement reminds that the interview is an interactional process. The investigator should keep this in mind and take care to see that his appearance and behaviour do not distort the interview situation.

Types of Interviews The interview method of collecting data involves presentation of oralverbal stimuli and reply in terms of oral-verbal responses. This method can be used through personal interviews and, if possible, through telephone interviews. 1. Personal interviews: Personal interview method requires a person known as the interviewer asking questions generally in a face-to-face contact to the other person or persons. (At times the interviewee may also ask certain questions and the interviewer responds to these, but usually the interviewer initiated the interview and collects the information). This sort of interview may be in the form of direct personal investigation or it may be indirect oral investigation. In the case of direct personal investigation the interviewer has to collect the information personally from the sources concerned. He has to be on the spot and has to meet people from whom data have to be collected. This method is particularly suitable for intensive investigations. But in certain cases it may not be

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Essentials of Nursing Research possible or worthwhile to contact directly the persons concerned or on account of the extensive scope of enquiry, the direct personal investigation technique may not be used. In such cases an indirect oral examination can be conducted under which the interviewer has to cross-examine other persons who are supposed to have knowledge about the problem under investigation and the information, obtained is recorded. Most of the commissions and committees appointed by government to carry on investigations make use of this method. The interviews may be classified into: (a) structured or directive interview, (b) unstructured or non-directive interview, (c) focused interview, (d) clinical interview, and (e) depth interview. 2. Structured or directive interview: This is an interview made with a detailed standardized schedule. The same questions are put to all the respondents and in the same order. Each question is asked in the same way in each interview, promoting measurement reliability. This type of interview is used for large-scale formalized surveys. This interview has certain advantages. First, data from one interview to the next one are easily comparable. Second, recording and coding data do not pose any problem, and greater precision is achieved. Lastly, attention is not diverted to extraneous, irrelevant and time-consuming conversation. However, this type of interview suffers from some limitations. First, it tends to lose the spontaneity of natural conversation. Second, the way in which the interview is structured may be such that the respondent’s views are minimised and the investigator’s own biases regarding the problem under study are inadvertently introduced. Lastly, the scope for exploration is limited.

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3. Unstructured or non-directive interview: This is the least structured one. The interviewer encourages the respondent to talk freely about a given topic with a minimum of prompting or guidance. In this type of interview, a detailed pre-planned schedule is not used. Only a broad interview guide is used. The interviewer avoids channeling the interview directions. Instead, he develops a very permissive atmosphere. Questions are not standardized and not ordered in a particular way. This interviewing is more useful in case studies rather than in surveys. It is particularly useful in exploratory research where the lines of investigation are not clearly defined. It is also useful for gathering information on sensitive topics such as divorce, social discrimination, class conflict, generation gap, drug-addition, etc. it provides opportunity to explore the various aspects of the problem in an unrestricted manner.

Methods of Data Collection This type of interview has certain special advantages. It can closely approximate the spontaneity of a natural conversation. It is less prone to interviewer’s bias. It provides greater opportunity to explore the problem in an unrestricted manner. Though the unstructured interview is a potent research instrument, it is not free from limitations. • One of its major limitations is that the data obtained from one interview is not comparable to the data from the next. Hence, it is not suitable for surveys. • Time may be wasted in unproductive conversations. By not focusing on one or another facet of a problem, the investigator may run the risk of being led up blindly. • As there is no particular order or sequence in this interview, the classification of responses and coding may require more time. • This type of informal interviewing calls for greater skill than the formal survey interview. The method of collecting information through personal interviews is usually carried out in a structured way. As such we call the interviews as structured interviews. Such interviews involve the use of a set of predetermined questions and of highly standardised techniques of recording. Thus, the interviewer in a structured interview follows a rigid procedure laid down, asking questions in a form and order prescribed. As against, the unstructured interviews are characterised by a flexibility of approach to questioning. Unstructured interviews do not follow a system of predetermined question and standardized techniques of recording information. In a non-structured interview, the interviewer is allowed much greater freedom to ask, in care of need, supplementary question or at times he may omit certain question if the situation so requires. He way even changes the sequence of questions. He has relatively greater freedom while recoding the responses to include some aspects and exclude others. But this sort of flexibility results in lack of comparability of one interview with another and the analysis of unstructured responses becomes much more difficult and time-consuming than that of the structured responses obtained in case of structured interviews. Unstructured interviews also demand deep knowledge and greater skill on the part of the interviewer. Unstructured interview, however, happens to be the central technique of collecting information in case of exploratory or formulative research studies. But in case of descriptive studies, we quite often use the technique of structured interview because of its being more economical, providing a safe basis of generalisation and required relatively lesser skill on the part of the interviewer.

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Essentials of Nursing Research 4. Focused interview: This is a semi-structured interview where the investigator attempts of focus the discussion on the actual effects of a given experience to which the respondents have been exposed. It takes place with the respondents known to have involved in a particular experience, e.g. seeing a particular film, viewing a particular programmed on TV, involved in a train/bus accident, etc. The situation is analysed prior to the interview. An interview guide specifying topics relating to the research hypothesis is used. The interview is focused on the subjective experiences of the respondent, i.e. his attitudes, and emotional responses regarding the situation under study. • The focused interview permits the interviewer to obtain details of personal reactions, specific emotions and the like. • This type of interview is free from the inflexibility of formal methods, yet gives the interview a set from and insures adequate coverage of all the relevant topics. • The respondent is asked for certain information, yet he has plenty of opportunity to present his views. • The interviewer is also free to choose the sequence of questions and determine the extent of probing. 5. Clinical interview: This is similar to the focused interview but with a subtle difference. While the focused interview is concerned with the effects of a specific experience, clinical interview is concerned with broad underlying feelings or motivations or with the course of the individual’s life experiences. The ‘Personal history’ interview used in social casework, prison administration, psychiatric clinics and in individual life history research is the most common type of clinical interview. The specific aspects of the individual’s life history to be covered by the interview are determined with reference to the purpose of the study and the respondent is encouraged to talk freely about them.

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6. Depth interview: This is an intensive and searching interview aiming at studying the respondent’s opinion, emotions or convictions on the basis of a interview guide. This requires much more training inter-personal skills than structured interviewing. This deliberately aims to elicit unconscious as well as extremely personal feelings and emotions. This is generally a lengthy procedure designed to encourage free expression of affectively charged information. It requires probing. Depth interviews are those interviews that are designed to discover underlying motives and desired and are often used in motivational research. Such interviews are held to explore needs, desires and feelings of respondents. In other words, they aim to elicit unconscious as also

Methods of Data Collection other types of material relating especially to personality dynamics and motivations. As such, depth interviews require great skill on the part of the interviewer and at the same time involve considerable time. Unless the researcher has specialised training, depth interviewing should not be attempted. Depth interview may be projective in nature or it may be a nonprojective interview. The difference lies in the nature of the questions asked. Indirect questions on seemingly irrelevant subjects provide information that can be related to the informant’s behaviour or attitude towards the subjects under study. Thus, for instance, the informant may be asked on his frequency of air travel and he might again be asked at a latter stage to narrate his opinion concerning the feelings of relatives of some other man who gets killed in an airplane accidents. Reluctance to fly can then be related to replies to questions of the latter nature. If the depth interview involves questions of such type, the same may be treated as projective depth interview. But in order to be useful, depth interviews do not necessarily have to be projective in nature; even non-projective depth interviews can reveal important aspects of psycho-social situation for understanding the attitudes of people. The interviewer should totally avoid advising or showing disagreement. Of course, he should use encouraging expressions like “un-huh” or “I see” to motivate the respondent to continue narration. Sometimes the depth interviewer has to face the problem of affection, i.e. the respondent may hide expressing affective feelings. The interviewer should handle such situation with great care.

6. PANEL METHOD OF DATA COLLECTION The panel method is a method of data collection, by which data is collected form the same sample respondents at intervals either by mail of by personal interview. This is uses for longitudinal studies on economic conditions, expenditure pattern, consumer behaviour, recreational pattern, effectiveness of advertising, voting behaviour, and so on. The period over which the panel members are contacted for information may spread over several months or years. The time interval at which they are contacted repeatedly may be 10 or 15 days, or one or two months depending on the nature of the study and the memory span of the respondents. The basic characteristic of the panel method is successive collection of data on the same items from the same persons over a period of time. The type of information to be collected should be such facts that can be accurately and completely furnished by the respondent without any reservation.

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Essentials of Nursing Research The number of item should be as few as possible so that they could be furnished within a few minutes, especially when mail survey is adopted. The average amount of time that a panel member has to spend each time for reporting can be determined in a pilot study. The panel method requires carefully selected and well-trained field workers and effective supervision over their work.

Need for Panel Study When sample respondents – particularly households or individuals are contacted once only, they may not be able to recall exactly what have occurred during a longer time period, say a year because their memory span is short. Therefore, they will not be able to give correct information on such facts as cash inflow, source-wise income, expenditure pattern, purchases, savings, recreation pattern and so on. But when they are contacted successively at short intervals of 10 or 15 days, they would to to able to give accurate information on happenings between two successive contacts, as the time span is short well within the memory span. In this way, data are collected repeatedly at intervals, and computations for the required period like a year can be easily made and the data so collected will be more reliable were collected. On the completion of the entire field work, annual data were compiled from the ten-day long data.

Types of Panel

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The panel may be static or dynamic. A static or continuous panel is one in which the membership remains the same throughout the life of the panel, except for the members who drop out. The dropouts are not replaced. The static panel is appropriate when the purpose is to study changes in a given group of persons over a period of time. The main drawbacks of the static are: 1. Due to dropouts, it ceases to be representative of the original universe after a time. 2. The size of the reporting panel may become too small for satisfactory results. In a dynamic panel, to keep the panel representative of the current population in the area covered by the universe, replacement are found for the members who droop out. A dynamic panel may also able a rotating one, in which members are systematically replaced at specified time intervals. The dynamic panel is most useful when it is important to keep the panel representative of the population at all times. The main problem connected with its use is the cost and difficulty of recruiting new members to replace the dropouts.

Methods of Data Collection

Advantages of Panel Method • This method facilitates collection of more accurate data for longitudinal studies than any other method, because under this method event or action is reported soon after its occurrence. • This method makes it possible to have before-after designs for fieldbased studies. For example, the effect of public relations or advertising campaigns or welfare measures can be measures by collecting data before, during and after the campaign. • The panel method offers a good way of studying trends in events, behaviour or attitudes. For example, a panel enables a market researcher to study how brand preferences change from month-to-month; it enables an economics researcher to study how employment, income and expenditure of agricultural labourers change from month-to-month; a political scientist can study the shifts in inclinations of voters and the causative influential factors during an election; it is possible to find out how the constituency of the various economy and social strata of society changes through time; and so on. • A panel study also provides evidence on the casual relationship between variables. For example, a cross-sectional study of employees may show an association between their attitude to their jobs and their positions in the organisation, but it does not indicate which came first—favourable attitude or promotion. A panel study can provide data for finding an answer to this question. • If facilitates depth interviewing, because panel members become well acquainted with the field workers and will be willing to allow probing interviews.

Limitations of Panel Method The major limitations or problems of the panel method are: • This method is very expensive. The selection of panel members, the payment of premiums, periodic visits of investigators and supervisors, and the costs involved in replacing dropouts, all add to the expenditures. • It is often difficult to set up a representative panel and to keep it representative. Many persons may be unwilling to participate in a panel study. In the course of the study, there may be frequent dropouts. The dropouts may be replaced by persons with similar characteristics. But there is no guarantee that the emerging panel would be a representative one. • A real danger with the panel method is “panel conditioning”, i.e., the risk that repeated interviews may sensitise the panel members and they become untypical as a result of being on the panel. For example,

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Essentials of Nursing Research the members of a panel study of political opinions may try to appear consistent in the views they express on consecutive occasions. In such cases, the panel becomes untypical of the population it was selected to represent. One possible safeguard to panel conditioning is to give members of a panel only a limited panel life and then to replace them with persons taken randomly from a reserve list. • The quality of reporting may tend to decline due to decreasing interest after a panel has been in operation for some time. Cheating by panel members or investigators may be a problem in some cases.

7. MAIL SURVEY AS A METHOD OF DATA COLLECTION

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The mail survey is another method of collecting primary data. This method involves sending questionnaires to the respondents with a request to complete them and return them by post. This can be used in the case of educated respondents only. The mail questionnaires should be simple so that the respondents can easily understand the questions and answers them. It should preferably contain mostly closed-end multiple choice questions so that it could be completed within a few minutes. The distinctive feature of the mail survey is that the questionnaire is self-administered by the respondents themselves and the responses are recorded by them, and not by the investigator as in the case of personal interview method. It does not involve face-to-face conversation between the investigator and the respondent. Communication is carried out only in writing and this requires more cooperation from the respondents than does verbal communication. This method of data collection is quite popular, particularly in case of big enquiries. It is being adopted by private individuals, research workers, private and public organisations and even by governments. In this method a questionnaire is sent (usually by post) to the person concerned with a request to answer the questions and return the questionnaire. A questionnaire consists of a number of questions printed or typed in a definite order on a form or set of forms. The questionnaire is mailed to respondents who are expected to read and understand the questions and write down the reply in the space meant for the purpose in the questionnaire itself. The respondents have to answer the questions on their own. The method of collecting data by mailing the questionnaires to respondents is most extensively employed in various economic and business surveys. The merits claimed on behalf of this method are as follows: 1. There is low cost even when the universe is large and is widely spread geographically.

Methods of Data Collection 2. It is free from the bias of the interviewer; answers are in respondent’s own words. 3. Respondents have adequate time to give well thoughtout answers. 4. Respondents, who are not easily approachable, can also reached conveniently. 5. Large samples can be made use of and thus the results can be made more dependable and reliable. The main demerits of this systems can also be listed here: 1. Low rate of return of the duly filled in questionnaires; bias due to noresponse is often indeterminate. 2. It can be used only when respondents are educated and cooperating. 3. The control over questionnaire may be lost once it is sent. 4. There is inbuilt inflexibility because of the difficulty of amending the approach once questionnaires have been dispatched. 5. There is also the possibility of ambiguous replies or omission of replies altogether to certain questions; interpretation of omissions is difficult. 6. It is difficult to know whether willing respondents are truly representative. 7. This method is likely to be the slowest of all.

Procedure The researcher should prepare a mailing list of the selected respondents by collecting the addresses from the telephone directory of the association or organisation to which they belong. A covering letter should accompany a copy of the questionnaire. It must explain to the respondent the purpose of the study and the importance of his cooperation to the success of the project. Anonymity may be assured. Dear respondent, May we ask you a favour that takes only a few minutes of your time? We are conducting a study of Corporate Planning in Public and Private Sector Hospitals in India with a view to knowing the status of their functioning in the state of Karnataka. We solicit your cooperation in completing the enclosed questionnaire. Your reply will be kept strictly confidential, of course, and the result of the study will be shown in statistical form only. At your earliest convenience, please return the completed questionnaire in the enclosed self-addressed stamped envelope. We thank you for your cooperation. Sincerely yours. Dr BTB

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Essentials of Nursing Research In this covering letter the sponsor’s identity may be revealed. However, when such information may bias the results, it is not desirable to reveal it. In the later case, a disguised organisation named may be used. A self-addressed stamped envelope should be enclosed in the covering letter. After a few days from the date of mailing the questionnaires to the respondents, the researcher can expect the return of completed ones from them. The progress in return may be watched and at the appropriate stage follow-up efforts can be made.

Alternative Modes of Sending Questionnaires There are some alternative methods of distributing questionnaires to the respondents. They are: (1) personal delivery, (2) attaching questionnaires to a product, (3) advertising questionnaire in a newspaper of magazine, and (4) news-stand inserts. Personal delivery: The researcher or his assistant may delivery the questionnaires to the potential respondents with a request to complete them at their convenience. After a day or two he can collect the completed questionnaires from them. Often referred to as the self-administered questionnaire method, it combines the advantages of the personal interview and the mail survey. Alternatively, the questionnaires may be delivered in person and the completed questionnaires may be returned by mail by the respondents. Attaching questionnaires to a product: A firm test-marketing a product may attach a questionnaire to a product and request the buyer to complete it and mail it back to the firm. The respondent is usually rewarded by gift or a discount coupon. Advertising the questionnaire: The questionnaire with the instructions for completion may be advertised on a page of a magazine or in a section of newspapers. The potential respondent completes it tears is our and mails it to the advertiser. For example, the committee on Banks Customer Service used this method for collecting information from the customers of commercial bands in India. This method may be useful for large-scale on topics of common interest.

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News-stand inserts: This method involves inserting the covering letter, questionnaire and self-addressed reply-paid envelope into a random sample of news-stand copies of a newspaper or magazine. The response rate in mail surveys is generally very low. More so in developing countries like India. Certain techniques have to be adopted to increase the response rate. They are:

Methods of Data Collection 1. Quality printing: The questionnaire may be neatly printed in quality light coloured paper so as to attract the attention of the respondent. 2. Covering letter: The covering letter should be couched in a pleasant style so as to attract and hole the interest of the respondent. It must anticipate objections and answer them briefly. It is desirable to address the respondent by name. 3. Advance information: Advance information can be provided to potential respondents by a telephone call or advance notice in the newsletter of the concerned organisation or be a letter. Such preliminary contact with potential respondents is more successful than follow-up efforts. 4. Incentives: Money, stamps for collection and other incentives are also used to induce respondents to complete and return mail questionnaires. 5. Follow-up-contacts: In the case of respondents belonging to an organisation, they may be approached through some one in that organisation known to the researcher. 6. Larger sample size: A larger sample may be drawn than the estimated sample size. For example, if the required sample size is 1000, a sample of 1500 may be drawn. This may help the researcher to secure in effective sample size closer to the required size. Advantages of Mail Surveys • They are less costly than personal interviews, as cost of mailing is the same throughout the country, irrespective of distances. • They can cover extensive geographical areas. • Mailing is useful in contacting persons such as senior business executives who are difficult to reach in any other way. • The respondents can complete the questionnaires at their conveniences. • Mail surveys, being more impersonal, provide more anonymity than personal interviews. • Mail surveys are totally free from the interviewers bias, as there is no personal contact between the respondents and the investigator. • Certain personal and economic data may be given more accurately in an unsigned mail questionnaire. Disadvantages of Mail Surveys • The scope for mail surveys is very limited in a country like India where the percentage of literacy is very low. • The response rate of mail surveys is low. Hence, the resulting sample will not be a representative one. • It is also difficult to determine the degree of representativeness of a sample obtained by mail.

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Essentials of Nursing Research • The causes for inadequate and non-responses cannot be known, and no probing is possible. • Information on the personal characteristics of the respondent and his environment cannot be secured. • Respondents may not cooperative if the mail questionnaire is long or complex. • Several returned questionnaires may contain unanswered questions and incomplete responses. Before using this method, it is always advisable to conduct ‘pilot study’ (Pilot Survey) for testing the questionnaires. In a big enquiry the significance of pilot survey is felt very much. Pilot survey is infact the replica and rehearsal of the main survey. Such a survey, being conducted by experts, brings to the light the weaknesses (if any) of the questionnaires and also of the survey techniques. From the experience gained in this way, improvement can be effected.

8. PROJECTIVE TECHNIQUES OF DATA COLLECTION

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The direct methods of data collection, viz. personal interview, telephone interview and mail survey rely on respondent’s own report of their behaviour, beliefs, attitudes, etc. But respondents may be unwilling to discuss controversial issues or to reveal intimate information about themselves or may be reluctant to express their true views fearing that they are generally disapproved. In order to overcome these limitations, indirect methods have been developed. Projective techniques are such indirect methods. They became popular during 1950s as a part of motivation research. Projective techniques involve presentation of ambiguous stimuli to the respondents for interpretation. In doing so, the respondents reveal their inner characteristics. The stimuli may be a picture, a photograph, an inkblot or an incomplete sentence. The basic assumption of projective techniques is that a person projects his own thoughts, ideas and attributes when the perceives and responds to ambiguous or unstructured stimulus materials. Thus, a person’s unconscious operations of the mind are brought to a conscious level in a disguised and projected form, and the person projects his inner characteristics. Projective techniques can help to overcome some of the following psychological barriers: • The barrier of unawareness: People are often unaware of their motives and attitudes. For example, a lonely woman may keep cats as some kind of substitute for children, but also might be unaware of such need.

Methods of Data Collection • The barrier of irrationality: Our society places a high premium on sensible, rational and logical behaviour. Most of us tend to rationalize. We invent logical reasons for actions whose origins are far from rational. • The barrier of inadmissibility: We find it difficult to admit our failure to meet social norms or expectations. • The barrier of self-incrimination: It concerns those aspects of behaviour and feelings that might lower the respondent’s self-esteem such as communal prejudice, superstition, etc. • The barrier of politeness: People often prefer not so say negative or critical views. They tend to say ‘all right’ for everything. Whenever the pilot study shows the existence of the above barriers with respect to the problem under study, then the use of projective technique should be considered. The commonly used approaches in projective technique are: • Association: “Say-the-first-thing comes into your mind” approach is based on the assumption that a fast response to a stimulus word, picture or question will be less ‘guarded’ and therefore more ‘revealing of underlying attitudes and motives. • Fantasy: The respondent is asked to guess or tell a story or discuss a picture in imaginary terms. In doing this he is likely to reveal his own attitudes and experiences. • Ambiguous stimuli: Whenever a subject is asked to respond to a relatively ambiguous stimulus, he will reveal something about himself when making his response. • Conceptualizing: The way a respondent names, orders or groups things may reflect his attitudes. All these approaches rely on spontaneity or interpretation, and on ambiguity in the stimulus. They should be as non-directive as possible so as not to bias the responses. They also require a certain amount of interpretation on the part of the researcher. The influence may very from observer to observer. Thus, projective methods lack objectivity and the reliability and validity are rather shaky. Yet they yield best results when interpreted by tainted psychologists, in terms of some pre-established psychological conceptualisation. In fact, projective tests serve as a major tool for understanding human personality, and for measuring achievement motivation as well. “If we have to penetrate deeper, below the level of conscious awareness or being the individual’s social facade, then indirect projective techniques have to be used.”

Types of Projective Techniques Projective techniques may be divided into three broad categories: (a) visual projective techniques, (b) verbal projective techniques, and (c) expressive techniques.

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Essentials of Nursing Research a. Visual projective techniques involve use of visual (pictorial) stimuli. They include: (1) Rorschach tests, (2) Thematic apperception test (TAT), (3) Rosenzwiegh Test, (4) Picture frustration test, and (5) Holtzman inkblot test (HIT). b. Verbal techniques involve use of words both for stimulus and for response. They consist of (1) Word Association Test, (2) Sentence Completion Test and (3) Story Completion Test. c. Expressive techniques: The subject is required to form some sort of product out of the given material. But the emphasis is on the manner in which he does the work and not on the end product. “The subject expresses his needs, desires, emotions and motives through working with, manipulating and interacting with materials, including other persons, in a manner of style that uniquely expresses his personality.” The principal expressive methods are: (1) play, (2) drawing, (3) finger painting, and (4) role playing.

10. SOCIOMETRY USED AS DATA COLLECTION Sociometry is “a method of discovering, describing and evaluating social status, structure, and development through measuring extent of acceptance or rejection between individuals in groups.” Franz defines sociometry as “a method used for the discovery and manipulation of social configurations by measuring the attractions and repulsions between individuals in a group.” it is a means for studying the choice, communication and interaction patterns of individuals in a group. It is concerned with attractions and repulsions between individuals in a group. In this method, a person is asked to choose one or more persons according to specified criteria, in order to find out the person or persons with whom he will like to associate. Helen Jennings describes sociometry “as a means of presenting simply and graphically the entire structure of relations existing at a given time among members of a given group. The major lines of communication, or the pattern of attraction and rejection in its full scope, are made readily comprehensive at a glance.” The basic principles and techniques of sociometry were first embodied in a volume entitled who shall survive? By JL Moreno, first published in 1934. An enlarged revised edition of this book published in 1953 covers the history, theory, terminology, techniques, bibliography and applications of sociometery.

Sociometry Test

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The basic technique in sociometry is the “sociomteric test”. This is a test under which each member of a group is asked to choose from all other

Methods of Data Collection members those with whom he prefers to associated in a specific situation. The situation must be a real one to the group under study, e.g. ‘group study.’ ‘play,’ ‘classroom seating’ for students of a public school. A specific number of choices, say two or three to the allowed is determined with reference to the size of the group, and different levels of preferences are designated to reach choice. Suppose we desire to find out the likings and dislikings of persons in a workgroup consisting of 8 persons. Each person is asked to select 3 persons in order or preference with whom he will like to work on a group assignment. The levels of choices are designated as; the first choice by the number 1, the second by 2, and the third by 3. The result may be tabulated as under (Table 13.1): Table 13.1: Sociometric choices in a group of 8 persons Chosen A Choser

A B C D E F G H

B

2

C

D

E

F

3

1 3

2

1 3

1 3

2 3

G

H

2 2 1

1

1st choice

–

3

2

2nd choice

1

1

–

1

3rd choice

1

1

2

Total

2

2

5

3

1 3 2 1 2

1

1

1

3

2

1

The requirements of the sociometric test are: 1. The limits of the group should be indicated to the subjects. 2. The number of choice allowed should be specific and it depends on the size of the group tested. 3. Each subject should be permitted to make his choices and rejections privately without the presence of the other members of the group. 4. A specific criterion for choice should be used, with reference to the functional activity of the group. 5. Different levels of preference should be designated for each choice. Types of choice: Sociometric choice may mean ‘choice of persons,’ ‘choice of lines of communication,’ or ‘choice of lines of influence’.

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Essentials of Nursing Research Scoring sociometric choices: One method is to count the number of times an individual is chosen, disregarding the order of choice. This is the most simple method and is widely used. The main drawback of this method is that it is insensitive, for it does not distinguish between first and third choice. Another method is to score the order of choices: say, 3 points to first choice, two to second choice, and one point to third choice. The weakness of this scoring plan is that it treats the difference between a third choice and no choice as identical to the difference between first and second choices, and that between second and third choices. A third plan is to use a rating scale. Each subject may be asked to rate each one of the other members in a five point scale: 4, 3, 2, 1, 0. In this scale 4 means “ would like to work with him very much,” and O means “would not want to work with him at all,” and other numbers representing intermediate degrees of liking to work with him. The results of a sociometric test may be augmented by personal interviews in order to discover motivation for attraction and rejection— sympathy, fear, anger, jealousy, etc.

11. CONTENT ANALYSIS

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Content analysis is a research technique for making inferences by objectively and systematically identifying specified characteristics of contents of documents. This is method of data collection and analysis. This is used for gathering data from archival records, documents, newspapers, diaries, letters, minutes of meetings and the like. The content of the written materials serves as a basis of inference. The analysis is made objectively and systematically. Objectivity refers to making analysis on the basis of explicit rules which enable different researchers to obtain the same results from the same documents. Systematic analysis refers to making inclusion or exclusion of content according to consistently applied criteria of selection; only materials relevant to research’s hypothesis are examined. Content analysis, as a method of studying communications was developed in the United States as a branch of social psychology known as ‘Communications research’. Content analysis can be applied to available materials such as letters, diaries, newspaper articles and editorials, etc. and to materials like stories or essays especially produced for a particular research problem. Content-analysis consists of analysing the contents of documentary materials such as books, magazines, newspaper and the contents of all verbal materials which can be either spoken or printed. Content-analysis prior to 1940s was mostly quantitative analysis of documentary materials

Methods of Data Collection concerning certain characteristics that can be identified and counted. But since 1950s content-analysis is mostly qualitative analysis concerning the general import or message of the existing documents. “The difference is somewhat like that between a casual interview and depth interviewing.” Bernard Berelson’s name is often associated with, the latter type of content-analysis. “Content-analysis is measurement through proportion…. Content analysis measures pervasiveness and that is sometimes an index of the intensity of the force”. The analysis of content is a central activity whenever one is concerned with the study of the nature of the verbal materials. A review of research in any area, for instance, involves the analysis of the contents of research articles that have been published. The analysis may be at a relatively simple level or may be a subtle one. It is at a simple level when we pursue it on the basis of certain characteristics of the document or verbal materials that can be identified and counted (such as on the basis of major scientific concepts in a book). It is a subtle level when researcher makes a study of the attitude; say of the press towards education by feature writers.

Procedure Significant content analysis begins with some systematic problem which requires specific data from content analysis. The researcher must conceptualise the variables that are relevant to his problem. The procedure of content analysis involves certain steps. The first step is to define the universe of content that is to be analysed, e.g. the editorials of newspapers on the subject-matter of the problem (say ‘sati’) under study; the publications of an author; the issues of a newspaper for a given period. If the volume of materials to be examined is too large, a representative sample of documents may be selected for analysis. The second step is to specify the content characteristics to be measured. On the basis of these characteristics, the universe is divided into categories. Before discussing the general procedures for categorisation, it is necessary to specify the major units of analysis or recording units and to differentiate recording units from context units. The recording unit is the smallest elements of content in which the appearance of a reference is counted. The context unit is a larger body of the content that may be examined in characterising a recording unit. For example, the recording unit may be a single term; but in order to note whether the term is treated favourably or unfavourably, one has to consider the entire sentence in which the term appears. The sentence is the context unit.

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Essentials of Nursing Research

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Recording units: Five major recording units are frequently used in content analysis. They are: words (terms), themes, characters, paragraphs and items. The world is the smallest unit. The words are counted and a list of frequencies of selected words is prepared. For example, Lasswell in a study on propaganda detection, reports that the Moscow News frequently used twenty-seven key political terms (bourgeois, class struggle, red army, the people, revolution, etc.) during 1938-39. The theme is a proposition about something. It is usually in the form of a sentence, clause or passage. Themes are most frequently employed in the study of propaganda, attitudes, images and values. The character is an individual in a literary production. This is used as a unit in analysing stories for studying the traits of characters appearing in them. The paragraph as a unit of analysis is rarely used because of difficulties in classifying various things discussed in it. The item is the whole document. It may be an entire article, a book or a speech. The third step in content analysis is categorisation. Categorisation is an important part of content analysis, because it reflects the purposed of the study and spells out the variables of the hypothesis to be tested. Eventually, recording units are classified and coded into categories. For example, projective stories written by children in response to a picture may be categorized into ‘creative’ or ‘non-creative.’ Categories must relate to the research objectives and be exhaustive and mutually exclusive. Exhaustiveness ensure that every recording unit relevant to the study can be classified. Mutual exclusivity means that no recording unit can be included in more than one category. The indicators or criteria for classifying recording units into respective categories should be explicitly specified. This enables replication, which is an essential requirement of objectivity. The last step in content analysis is to quantify the materials in any appropriate form. One form of quantification is counting the number of objects in each category. A second form of quantification is raking. Judges can be asked to rank the objects according to a specified criterion. The next form of quantification is rating scale. This is generally employed in quantifying attitudes, and values. For example, the degree of creativity may be rated as ‘very high, high, average, low, very low.’ Content analysis is used for various purposes such as: (a) To analyse their attributes, antecedents or effects; (b) To infer personality traits of speakers from logical and cognitive characteristics of their verbal communications; (c) To infer aspects of culture and cultural change from contents of literatures; (d) To understand the role of the mass media in

Methods of Data Collection molding public opinion on occasions like general election; (e) To study newspapers stand towards current issues like Sati, terrorism in Punjab, India’s peace-keeping force’s role in Sri Lanka, etc; (f) To determine the philosophy of saints like Sri Ramakrishna, Swami Vivekananda of Sri Aurobindo and of great national leaders like Mahatma Gandhi, Gopal Krishna Gokhale or Jawaharlal Nehru; (g) To determine themes and values of novels and short stories; (h) To determine sociocultural life in ancient times from classical literatures; (i) To measure behaviour variables like need, values, attitudes, authoritarianism, creativity and so on through an analysis of both available materials and deliberately created materials of projective kind; (j) To study the propaganda techniques adopted by propagandists to influence the public; (k) To identify the literary style, concepts or beliefs of a writer, e.g. Mahatma Gandhiji’s concept of trusteeship; (l) To explain the possible causal factors related to some outcome or action or event, e.g. the influence of editorials upon the action of the parliament on an economic legislation; and so on. Content analysis of available materials should not be used indiscriminately. If a researcher can gather data directly through interviewing, mailing or projective techniques, so much the better. If there is no such possibility, then available materials can be used.

12. DELPHI TECHNIQUE OF DATA COLLECTION A data-gathering technique that has become popular with researchers is known as the Delphi technique. Named after the famous Oracle of Apollo at Delphi in ancient Greece, the process attempts to predict what will be important to the surveyed group in the future. The Delphi technique consists of identifying a group of experts or persons concerned with a certain area or program. Their concerns about their area or programme are elicited and ranked. Once a total list of concerns has been acquired, it is given to the experts, who are asked to rank the items on the list in order of importance. The responses are again tallied by the researcher and sent back to the same panel, with response totals given. The panel members are then asked to rerank their responses on the basis of the total responses and their peer’s evaluations. The researcher can then focus on those items considered the most important by the experts. For example, a researcher could use the Delphi technique to examine nurse’s concerns in a community health agency by sending the following questions to all, or a sample, of the staff nurses: We are attempting to determine the future goals for patient care in a community setting. Please list at least five of your major concerns about nursing service as it is currently practiced in a community setting.

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Each of the respondents then has an opportunity to express concerns and predictions about the future of nursing care in the community. After the first round of responses is returned, the researcher lists each comment-with similar comments organised into a single topic and a questionnaire is developed. The same respondents are used in all rounds of questioning, so a letter like the following might be sent to the initial respondents. Several weeks ago, you were asked to list your major concerns about the patient care in your community. As a result of your responses and those of your peers, we have been able to develop the following list of concerns. We would now like you to rate these concerns on a scale of 1 to 5, with 1 being of little importance and 5 being of great importance. 1. Patient loads are too large for adequate care to be given. 2. Patients are unable to get additional care from other community agencies. After the subjects respond to this questionnaire, the researcher then calculates how each response was evaluated by determining the percentages of the total responses in each category. For instance, the group sampled on the question concerning patient loads might have responded 60% 5’s, 20% 4’s and 20% 3’s. Another survey is then sent to the respondents with a latter that night read like this: You and your colleagues have responded to a series of questions concerning nursing care in your community. Each of you was asked to rank a list of questions as to their importance. Based on your responses, the questions were rated by the percentages in the categories which you see below. Please rate the questions as to their importance again, based on your own beliefs and your knowledge of your peer’s responses. At this point, the subjects may also be supplied with their own previous responses. The subjects then respond and rate the questions as to their relative importance. The researcher re-evaluates the scale and determines which items are now considered the most important by the respondents. The researcher then identifies the main areas of concern and makes recommendations. The Delphi technique has the advantage of identifying the major concerns and recommendations of a specific group and may provide the potential for alleviating these concerns. It can also help an organization to focus on and take direction toward the future. Goossen and associates (1997) contacted an international panel of 36 experts and used a three-round Delphi process to gain consensus on criteria that would be useful in the application of information policy and information systems in nursing.

Methods of Data Collection

13. ETHOLOGIC TECHNIQUE OF DATA COLLECTION It is the observation and measurement of behaviours in animals. A number of researchers have used ethologic techniques to study human behaviours and interactions. Often using films or videotapes to record interactions between individuals and groups of individuals. Proxemics is the study of body language, such as facial expressions. Proximity to one another, touch, and gestures, all of which can be analysed to determine patterns of behaviour accompanying various tasks. When individuals from different cultures meet, they may have difficulty in communicating because of their backgrounds. For example, Americans often become uncomfortable when people from other countries or cultures approach and engage them in conversation. The person may be felt to be standing too close, and this makes the American nervous because his or her “body space” is being invaded. The other person is also uncomfortable and feels that the American is being standoffish. Both individuals are right. Data collection in proxemics requires that the researcher observe and/ or film or videotape situations to collect instances of the activities being analysed. The researcher uses a pre-established data-gathering instrument, often a structured checklist, to determine the type and frequency of the activities being measured. For example, if the researcher is interested in facial expression during a conversation, data related to smiles, frowns, grimaces, or other expressions associated with the conversations would be recorded. The data are analysed by counting the occurrences of the behaviours that the researcher is interested in.

14. SECONDARY DATA COLLECTION The secondary data may be used in three ways by a researcher. First, some specific information from secondary sources may be used for reference purpose. For example, the general statistical information in the number of cooperative credit societies in the country, their coverage of villages, their capital structure, volume of business etc., may be taken from published reports and quoted as background information in a study on the evaluation of performance of cooperative credit societies in a selected district/state. Second, secondary data may be used as benchmarks against which the findings of a research may be tested e.g., the findings of a local or regional survey may be compared with the national averages; the performance indicators of a particular bank may be tested against the corresponding indicators of the banking industry as a whole; and so on. Finally, secondary data may be used as the sole source of information for a research project. Such studies as securities, market behaviour,

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Essentials of Nursing Research financial analysis of companies. Trends in credit allocation in commercial banks, sociological studies on crimes, historical studies, and the like depend primarily on secondary data. Year books, statistical reports of government departments, report of public organizations of Bureau of Public Enterprises, Census Reports etc., serve as major data sources for such research studies.

Advantages Secondary sources have some advantages: 1. Secondary data, if available can be secured quickly and cheaply. Once their source of documents and reports are located, collection of data is just a matter of desk work. Even the tediousness of copying that data from the source can now be avoided, thanks to xeroxing facilities. 2. Wider geographical area and longer reference period may be covered without much cost. Thus, the use of secondary data extends the researcher’s space and time reach. 3. The use of secondary data broadens the data base from which scientific generalizations can be made. This is especially so when data from several environmental and cultural settings are required for the study. 4. The use of secondary data enables a researcher to verify the findings based on primary data. It readily meets the need for additional empirical support. The researcher need not await till the time when additional primary data can be collected.

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The use of secondary data has its own limitations: 1. The most important limitation is the available data may not meet our specific needs. The definitions adopted by those who collected those data may be different; units of measure may not match; and time periods may also be different. 2. The available data may not be as accurate as desired. To assess their accuracy we need to known-how the data were collected. 3. The secondary data are not up-to-date and become obsolete when they appear in print, because of time lag in producing them. For example, population census data are published two or three years later after compilation, and no new figures will be available for another ten years. 4. Finally, information about the whereabouts of sources may not be available to all social scientists. Even if the location of the source is known, the accessibility depends primarily on proximity. For example, most of the unpublished official records and compilations are located in the capital city, and they are not within the easy reach of researchers based in far off places.

Methods of Data Collection

15. CASE STUDY METHOD OF DATA COLLECTION The case study method is a very popular form of qualitative analysis and involves a careful and complete observation of a social unit, be that unit a person, a family, an institution, a cultural group or even the entire community. It is a method of study in depth rather than breadth. The case study places more emphasis on the full analysis of a limited number of events or conditions and their interrelations. The case study deals with the processes that take place and their interrelationship. Thus, case study is essentially an intensive investigation of the particular unit under consideration. The object of the case study method is to locate the factors that amount for the behaviour patterns of the given units as an integrated totality. According to H. Odum, “The case study method is a technique by which individual factor whether it be an institution or just an episode in the life of an individual or a group is analysed in its relationship to any other in the group.” Thus, a fairly exhaustive study of a person (as to what he does and has done, what he thinks he does and had done and what he expects to do and says he ought to do) or group is called a life or case history. Burgess has used the words “the social microscope” for the case study method.” Pauline V. Young describes case study as “a comprehensive study of a social unit be that unit a person, a group, a social institution, a district or a community.” In brief, we can say that case study method is a form of qualitative analysis where in careful and complete observation of an individual or a situation or an institution is done; efforts are made to study each and every aspect of the concerning unit in minute details and then from case data generalizations and inferences are drawn. Characteristics: The important characteristics of the case study method are as under: 1. Under this method the researcher can take one single social unit or more of such units for his study purpose; he may even take a situation to study the same comprehensively. 2. Here the selected unit is studied intensively, i.e. it is studied in minute details. Generally, the study extends over a long period of time to ascertain the natural history of the unit so as to obtain enough information for drawing correct inferences. 3. In the context of this method we make complete study of the social unit covering all facets. Through this method we try to understand the complex of factors that are operative within a social unit as an integrated totality. 4. Under this method the approach happens to be qualitative and not quantitative. Mere quantitative information is not collected. Every

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Essentials of Nursing Research possible effort is made to collect information concerning all aspects of life. As such, case study deepens our perception and gives us a clear insight into life. For instance, under this method we not only study how many crimes a man has done but shall peep into the factors that forced him to commit crimes when we are making a case study of a man as a criminal. The objective of the study may be to suggest ways to reform the criminal. 5. In respect of the method an effort is made to know the mutual interrelationship of casual factors. 6. Under case study method the behaviour pattern of the concerning unit is studied directly and not by an indirect and abstract approach. 7. Case study method results in fruitful hypotheses along with the data which may be helpful in testing them, and thus it enables the generalized knowledge to get richer and richer. In its absence, generalised social science may be handicapped. The case study method is a widely used systematic field research technique in sociology these days. The credit for introducing this method to the field of social investigation goes to Frederic Le Play who used it as a hand-maiden to statistics in his study of family budgets. Herbert Spencer was the first to use case material in his comparative study of different cultures. Dr. William Healy resorted to this method in his study to juvenile delinquency, and considered it as a better method over and above the mere use of statistical data. Similarly, anthropologists, historians, novelists and dramatists have used this method concerning problems pertaining to their areas of interests. Even management experts use case study methods for getting clues to several management problems. In brief, case study method is being used in several disciplines. Not only this, its use is increasing day-by-day. The case study method is based on several assumptions. The important assumptions may be listed as follows: i. The assumption of uniformity in the basic human nature in spite of the fact that human behaviour may vary according to situations. ii. The assumption of studying the natural history of the unit concerned. iii. The assumption of comprehensive study of the unit concerned.

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Major phases: Major phases involved in case study are as follows: i. Recognition and determination of the status of the phenomenon to be investigated or the unit of attention. ii. Collection of data, examination and history of the given phenomenon. iii. Diagnosis and identification of causal factors as a basis for remedial or developmental treatment.

Methods of Data Collection iv. Application of remedial measures i.e., treatment and therapy (this phase is often characterised as case work). v. Follow-up programme to determine electiveness of the treatment applied. Advantages: There are several advantages of the case study method that follow from the various characteristics outlined above. Mention may be made here of the important advantages. i. Being an exhaustive study of a social unit, the case study method enables us to understand fully the behaviour pattern of the concerned unit. In the words of Charles Horton Cooley, “case study deepens our perception and gives us a clearer insight into life…. It gets at behaviour directly and not by an indirect and abstract approach.” ii. Through case study a researcher can obtain a real and enlightened record of personal experiences which would reveal man’s inner striving, tensions and motivations that drive him to action along with the forces that direct him to adopt a certain pattern of behaviour. iii. This method enables the researcher to trace out the natural history of the social unit and its relationship with the social factors and the forces involved in its surrounding environment. iv. It helps in formulating relevant hypotheses along with the data which may be helpful in testing them. Case studies, thus, enable the generalised knowledge to get richer and richer. v. The method facilitates intensive study of social units which is generally not possible if we use either the observation method or the method of collecting information through schedules. This is the reason why case study method is being frequently used, particularly in social researches. vi. Information collected under the case study method helps a lot to the researcher in the task of constructing the appropriate questionnaire or schedule for the said task requires thorough knowledge of the concerning universe. vii. The researcher can use one or more of the several research methods under the case study method depending upon the prevalent circumstances. In other words, the use of different methods such as depth interviews, questionnaires, documents, study reports of individuals, letters, and the like is possible under case study method. viii. Case study method has proved beneficial in determining the nature of units to be studied along with the nature of the universe. This is the reason why at times the case study methods are alternatively known as “mode of organising data.”

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Essentials of Nursing Research ix. This method is means to well understand the past of a social unit because of its emphasis of historical analysis. Besides, it is also a technique to suggest measures for improvement in the context of the present environment of the concerned social units. x. Case studies constitute the perfect type of sociological material as they represent a real record of personal experiences which very often escape the attention of most of the skilled researchers using other techniques. xi. Case study method enhances the experience of the researcher and this in turn increases his analysing ability and skill. xii. This method makes possible the study of social changes. On account of the minute study of the different facets of a social unit, the researcher can well understand the social change then and now. This also facilitates the drawing of inferences and helps in maintaining the continuity of the research process. In fact, it may be considered the gateway to and at the same time the final destination of abstract knowledge. xiii. Case study techniques are indispensable for therapeutic and administrative purpose. They are also of immense value in taking decisions regarding several management problems. Case data are quite useful for diagnosis, therapy and other practical case problems.

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Limitations: Important limitations of the case study method may as well be highlighted. i. Case situations are seldom comparable and as such the information gathered in case studies is often not comparable. Since the subject under case study tells history in this own words, logical concepts and units of scientific classification have to be read into it or out of it by the investigator. ii. Read Bain does not consider the case data as significant scientific data since they do not provide knowledge of the “impersonal, universal, non-ethical, non-practical, repetitive aspects of phenomena.” Real information is often not collected because the subjectivity of the researcher does enter in the collection of information in a case study. iii. The danger of false generalisation is always there in view of the fact that no set rules are followed in collection of the information and only few units are studied. iv. It consumes more time and requires lot of expenditure. More time is needed under case study method since one studies the natural history cycles of social units and that too minutely.

Methods of Data Collection v. The case data are often vitiated because the subject, according to Read Bain, may write what he thinks the investigator wants; and the greater the rapport, the more subjective the whole process is. vi. Case study method is based on several assumptions which may not be very realistic at times, and as such the usefulness of case data is always subject to doubt. vii. Case study method can be used only in a limited sphere; it is not possible to use it in case of a big society. Sampling also is not possible under a case study method. viii. Response of the investigator is an important limitation of the case study method. He often thinks that he has full knowledge of the unit and can himself answer about it. In case the same is not true, then consequences follow. In fact, this is more the fault of the researcher rather than that of the case method. Despite the above stated limitations, we find that case studies are being undertaken in several disciplines, particularly in sociology, as a tool of scientific research in view of the several advantages indicated earlier. Most of the limitations can be removed if researchers are always conscious of these and are well-trained in the modern methods of collecting case data and in the scientific techniques of assembling, classifying and processing the same. Besides, case studies, in modern times, can be conducted in such a manner that the data are amenable to quantification and statistical treatment. Possible, this is also the reason why case studies are becoming popular day-by-day.

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Techniques of Data Collection

As stated earlier, “data” is a plural of “datum” which means ‘information’ that is systematically collected in the course of a study. Here data is a fact which is an observable and measurable phenomenon. Phenomena is any fact, circumstance or experience that is apparent to the senses and that can be systematically/ scientifically described or appraised. Data collection techniques are described as being both objective and systematic. Here ‘Objective’ means that data must not influenced by anyone who collects data. Whereas systematic means that the data must be collected in the same way by everyone who is involved in the collection procedure. The data collection methods of a study provide the operational definitions of the relevant variable. Variable is a phenomenon or attribute that needs to be measured. It is something which varies e.g., height, weight, body temperature, educational attainment. Most phenomena, characteristics, concepts or things have in common a capacity to vary or in other words, to have more than one number that describes them. Operationalisation is the process of translating the concepts that are of interest to a researcher into observable and measurable phenomena. Operational definition translates the conceptual definition into behaviours or verbalisations that can be measured for the study.

TYPES OF TOOLS

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The various techniques of data gathering involve the use of appropriate recording forms. These are called tools or instruments of data collection. They consist of: • Observation schedule or observationnaire • Interview guide • Interview schedule • Mailed questionnaire • Rating scale • Check list • Opinionnaire

Techniques of Data Collection • Document schedule/data sheet • Schedule for institutions • Inventories. Each of the above tools is used for a specific method of data gathering: Observation schedule for observation method, interview schedule and interview guide for interviewing, questionnaire and opionionnaire for mail survey, and so on. The tools of data collection translate the research objectives into specific questions/items, the responses to which will provide the data required to achieve the research objectives. In order to achieve this purpose, each question/item must convey to the respondent the idea or group of ideas required by the research objectives, and each item must obtain a response which can be analyzed for fulfilling the research objectives. Information gathered through the tools provide descriptions of characteristics of individuals, institutions or other phenomena under study. The characteristics may help to explain differences in behavioural pattern and performance of objects under study. Information gathered through the tools serve another purpose also. It is useful for measuring the various variables pertaining to the study. The variables and their interrelationships are analysed for testing the hypothesis or for exploring the content areas set by the research objectives. A brief description of the various tools of data collection is given below.

MEASUREMENT AS A TECHNIQUE OF DATA COLLECTION Measurement is central to the process of obtaining data. How and how well, the measurement in research project are made as critical in determining whether the project will be success. The term ‘measure’ means to ascertain the dimensions, quantity or capacity of, to mark off, usually with reference to some units of measurement. Measurement is the assignment of numbers to object or events according to rules. Measurement consists of a set of rules for assigning numerical values to objects to represent varying degrees of some attributes being measured. The purpose is to measure these attributes quantitatively.

Approaches Measurement In conducting Nursing Research, investigators measure many types of phenomena. To achieve an understanding of human responses in health

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Essentials of Nursing Research and illness, nurses study people’s thoughts, feelings, attitudes, experiences, sensations, skills, behaviours and physiological functions. To study the variety of phenomena the investigators use several different approaches to measurements including norm-referenced measurement and criterion-referenced measure. Norm-referenced Measurement Approach: It is technique appropriate for evaluating the performance of an individual relative to some other individuals in a group. Norm-referenced measurement permits meaning to be assigned to scores through comparing one participant’s performance to the performance of others i.e., through reference to a group norm. Normreferenced measurements are appropriate when the investigator is interested in evaluating the performance of an individual relative to other individuals in group. Standardised tests are one type of norm-referenced measures. For example, MMP Inventory (Minnesota Multiphasic Personality Inventory), TSC (Tennesse self-concept) tests of personality SAT (Scholastic Aptitude Test, Stanford-Binet test and Wechster Intelligence test of Intelligence, etc. These tests have been developed after years of testing. The reliability and validity data are established for use with many different groups of population. Criterion-referenced Approach: Criterion-referenced measures are techniques appropriate for determining whether or not an individual has acquired a set of behaviours or mastered a specific risk. These measures allow the investigator to determine whether the subject has reached a certain specific performance criterion or has mastered a specific task. It is an either, or, pass-fail approach in which a specific set of target behaviours (or items sampling a content area) are designated and when these are mastered the subject is considered proficient in that area. This approach enjoys popularity among those charged with assessing. For example, clinical skills among Nursing Students.

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It is not difficult to understand certain measurements used in physical sciences such as length, height, weight, but it is very difficult to understand the measurements of such characteristics of individuals and groups as intelligence, aggressiveness and anxiety and such others. Therefore, the measurement process constitutes the operational definition of concepts, specifying the nature of attributes and existence of phenomena under study, and giving numerical expression. As stated earlier, measurement in the assignment of some numerical value to objects or events to represent the kind or amount of some

Techniques of Data Collection characteristics of those objects or events. Measurement as used in this context includes qualitative measurements in which objects are assigned to categories that represent the kind characteristics they possess and that are mutually exclusive and exhaustive. So the measurement can be defined quantitatively and qualitatively as follows: Quantitative measurement is the assignment of numerical values to objects or events to represent this kind or amount of characteristic of those objects or events. The function that assigns each member of one set of objects to some value of another set is sometimes referred to as the “rule of correspondence.” The function takes the form of F = (X, Y), where, X is any object or Y is some numerical. Measurement is quantitatively oriented activity assumes that characteristics of objects or events exist in some amount. The rule of correspondence is used to determine whether the characteristic is there and in what quantity is present. For example, number of admissions, discharges and deaths in a year according to type of disease or condition. Qualitative Measurement is a process of classification that involves assigning objects to categories (i.e. distributing phenomena into classes) that represent variation of the concept being studied. The characteristics of classification system described (Kerlinger, 1986) as follows: • The classification system should be natural or relevant. • The set of categories should be exhaustive. • The individual categories should be mutually exclusive or disjoint. • The category system should be derived from and should develop a principle or ordering. • The individual categories should be formulated on the same level of abstraction or discourse. • The classification system should be useful. • The classification system should be constructable. For example, Nursing diagnosis, Medical diagnosis, Agewise classification, Sexwise classification etc.

Levels of Measurement Levels of measurement refer to the classification of measurement according to whether the obtained scores reflect a category (quality) or a numerical value (quantity). The fair levels of measurement are nominal, ordinal, interval and ratio. 1. Nominal measurement involves the assignment of number to represent categories or classes of things. In other words, it is used to classify objects or events into categories. It refers to the simple classification of

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Essentials of Nursing Research objects or item into discrete groups which do not bear any magnitude relationships to one another. Magnitude is the quantum or quantity in which the attribute exists in various instances of the phenomena. Here the numbers have no quantitative value and used only on labels. They cannot be ordered or added. Examples of nominal measurements can be used to categorise a sample on such information as gender, hair colour, marital status, religious application, caste, blood type, etc. For example, Gender 1. Male 2. Female, Caste: 1=SC; 2=ST; 3=others. The statistics applicable in this measurement are mode. Modal percentage, range, frequency distribution. 2. Ordinal measurement is the form of measurement which requires that objects can be rank ordered on some operationally defined characteristic. On ordinal scale measures, numbers represent ordering of magnitude on the same attribute. A number is assigned to represent membership in a mutually exclusive and exhaustive category, as in nominal measurement, but this number can also be ordered according to the amount of the attribute possessed. Ranking does not imply that intervals between scale categories are equal, only that one is less than two, which is less than three and so on. Ordinal measurement is used to show relative ranking of objects or events. The numbers assigned to each category can be compared and a member of a higher category. It reflects only magnitude and does not equal intervals or an absolute zero point. An ordinal data are limited in the amount of mathematical manipulation possible. The statistics applicable are mode, median, range, percentile semiquartile range, frequently distribution, rank order correlation and other nonparametrics associated with rank order. 3. Interval measurements show ranking of events or objects on a scale with equal intervals between the numbers. The interval scale possesses two out of three important requirements of a good measurement scale i.e., magnitude and equal intervals but lacks the real or absolute zero point. Equal intervals denote that the magnitude of the attribute represented by a unit of measurement on the scale is equal, regardless of where on the scale the unit falls (e.g. scale) whereas absolute zero point is a value that indicates that a zero quantity of the attribute exists at that point or nothing at all of the attribute being measured exists. The statistics applicable here are mode, median, mean, range percentile, semiquartile range, standard deviation.

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4. Ratio level measurements have all the three attributes, magnitude, equal intervals and absolute zero point, meaning an absolute absence of the phenomenon. Thus, magnitude from zero to some point on the scale is known. Examples, of ratio level data are height, weight, pulse, and

Techniques of Data Collection blood pressure. All types of statistical procedure are applicable in ratio level measurement.

Measurement Scale and Indices Scales are devised for measuring variables in social science research. During the past few decades, thousands of scales have been designed by researchers in sociology, psychology, education, psychiatry, medicine, nursing, ethics, behavioural science, economics, administration and other fields. Indices and scales are often used interchangeably to refer to all sorts of measures, absolute or relative, single or composite, simple or elaborate. “Scaling” refers to the procedure by which numbers or scores assigned to the various degrees of opinions, attitude and other concepts.

Scales Classification Scales may be classified in many ways” in terms of (a) subject matter, (b) scaling methods or techniques, (c) scale function, (d) levels of measurement, and (e) number of dimensions. However, there is no widely accepted system of classification. Subject Matter: Scales are designed to measure (1) attitude, (2) social distance, (3) socioeconomic status, and (4) other variables. Scaling Techniques: In terms of techniques, scales may be classified into (a) arbitrary scales, (b) judgement scales, (c) ‘item analysis’ scales, (d) rating scales, (f) cumulative scales, and (g) factorial scales. Scale Functions: Scales may have either predictive powers or reproductivity. Scales which have powers to predict an external criterion are Predictive Scales. Aptitude tests and prediction of marital adjustment are examples of this type of scale. Reproductive scales are designed to arrange sets of data in such fashion that if the research is given a single score, he can reproduce all items in the scale. Louis Guttman has designed scales of this type. Levels of Measurement: In terms of this property, scales may be classified as nominal, ordinal, interval or ratio scales. Number of Dimensions: Scales are either unidimensional or multidimensional. Unidimensional scale measures only one attribute of the respondent or object e.g., attitude, opinion, job satisfaction, durability and so on. Most of the scales used in research are of this type. Multidimensional scale measures several dimensions of an object.

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Common Types of Measurements Used in Nursing There are four types of measurement that are used in as data collection methods. 1. Physiological measurements. 2. Biological measurements. 3. Psychological measurements. 4. Sociological measurements. Physiological Measurement: It is the use of specialised equipment to determine physical and biological status of subjects. In everyday practice, nurses collect physiological data about patients such as their temperature, pulse rate, and blood pressure. So this type of measurement is particularly suited in the study of several types of nursing problems. Human physiological functions generally are viewed according to the body systems and cellular and subcellular subsystems. Human health status is at least particularly assessed by observing separate components of such systems and making judgement about the normalcy of their function. These systems are commonly studied separately to explain what and how factors act on or affect the system (input or stimuli) to charge function (output or response). The selection of system for study can then occur on several levels as follows: • Integrated behaviours such as sleeping or eating that involve interaction of individuals with their external environment • Organ systems such as cardiovascular system • Particular organ (e.g., liver, kidney etc.) • Particular tissue or cell types (e.g., epithelial tissue or RBCs) • Subcellular organells (e.g., mitochondrion) • Intercellular molecules (e.g., deoxyribonuclease) Biological events tend to be in low energy outputs range and exhibit intraindividual variability, as well as temporal and circumstantial variability. For this reason, data are collected on large number of subjects to develop norms for comparison. The physical quantity, characteristic or condition that is to be measured in a system or subsystem is called the “measured.”

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Biological Measurement: In biological system measures may take various energy forms that must be converted into a form that is detectable and quantiable to the researcher. Transduction refers to converting one form of energy to another form, the instruments that do this is called ‘transducers.’ In the process of measurement biophysical and biochemical events are transduced into a form that can be interpreted and usually quantified by the using instrument, that act as input transducer, signal

Techniques of Data Collection modifiers, (amplifiers) and output transducers. The events may be externally accessed. Factors that influence accessibility of devices for human monitoring are: • Any measuring device be preferably non-invasive • The presence of the transducer does not interfere with the phenomenon being measured • Any energy imparted by the device is not harmful, and • The device reproduces the event in a form that is accurate, precise, specific and sensitive to very small changes in the event of interest.

Measuring Biological and Physiologic Responses By its very nature, nursing research lends itself to the measurement of numerous biological and physiologic responses of research subjects. Measuring devices, ranging from the fever thermometer and sphygmomanometer to the electroencephalogram, the electrocardiogram, and magnetic resonance imaging can all be used to collect useful research data. Blood chemistries, microbiological samples, and tissue samples may also provide valuable sources of data. Clark (1997) obtained a portion of the data for her study by measuring bone-mineral density of the femoral neck and lumbar spine in a small sample of alcoholic women who were identified as either having multiple eating disorders or not having an eating disorder. She collected information by using a Lunar DPXL dualenergy densitometer that was operated by a licensed nuclear medicine technician. The results of her study indicated that women with eating disorders had a significantly greater median bone-mineral density than those without eating disorders. As in all research dealing with human subjects, researchers have the ethical responsibility to explain the purpose of any measurement device that is used and to obtain the informed consent of the subjects. Biophysical Measurement: The measurement of biophysical events usually convert some physical changes into electronic changes e.g., body temperature, pressure, muscle tension. The biophysical phenomena are generally measured in three steps as follows: 1. Usually a nonelectrical signal is converted into an electrical one. This is done by an input transducer. 2. After being sensed by a transducer, the event of interest will be modified or processed, it often will be amplified so that it can be quantified. 3. The signal then is displayed in some form of output by the output transducers. The biological signals that are sensed by the input transducer can take several forms including displacement (velocity or acceleration) flow,

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Essentials of Nursing Research pressure, force and torque, sound, electricity and magnetism, temperature, humidity, time and frequency, nuclear and penetrating radiations, chemical reaction or concentrations, properties of materials and impedence. The transducer senses the event usually converts it into an electrical or mechanical (displacement or pressure) signal . Example of input transducer are magnetic flowmeter or ultrasonic flowmeter and spirometers, mercury column of thermometer, electrodes, electrochemicals and electromagnets etc. Example, of output transducers are meter on weighing scale, oscilloscopes, polygraphs.

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Biochemical Measurements: The measurements of biochemical events usually involve the conversion of chemical events into physical events, which may be sensed electronically or in a variety of other ways. Biochemical functions are assayed by procedures that involve binding to or incorporating a physically detectable molecules into tissue or cells, measuring the constituents of body fluids, provoking a chemical reaction so that the constituent is detectable through a change in colour or optical density of separating various components in a mixture. Assay means a method for physically detecting the presence of a substance. Common types of assays include radioactive uptake or incorporation, competitive binding assays are a special type, spectrophotometric fluorometric, colormetric, chromatographic or electrophoretic assays. Physiological measurement are those methods that use technical instruments to collect data about patients physical, chemical, microbiological or anatomical status. Such instruments are particularly suited to the study of the effectiveness of nursing care and the ways to improve the provision of nursing care. For example: 1. The physiological measurement such as temperature, volume, pressure, electrical measures are used in the studies of Sharma (1977), Parkasamma (1981), Erickson (1980), Neal (1968). 2. The chemical measurements like hormone levels, sugar urea, HB%, potassium levels etc. used in the studies of Dutta (1985), Reichert (1980), Verhonica (1961). 3. Microbial measurements like bacterial counts, and identification used in the studies of Asha Sharma (1977). 4. Anatomical and cytological measurements such as X-rays, tissuebiopsies, tomography, CT scan etc. (Sharma 1977 used X-ray in their study). Physiological measurements can also be classified as in vivo and in vitro. In vivo measurements are those which are performed directly within or on living organism themselves. Blood flow determination through radiographs, IVP cholecytography angiogram, etc. An in vitro

Techniques of Data Collection measurement by contract is performed outside the organism of the body, e.g., serum sodium, potassium, blood urea etc. Physiological measurements are objective, precise and sensitive. However, they may be very expensive and they may distort the variable of interest. Psychological Measurement: It mainly makes use of psychological tests and inventories. Psychological test is in instrument designed to measure a sample of certain aspects of human behaviour. These tests yield objective and standardised description of behaviour. These inventories are known as scales. ‘Scale’ is a set of symbols or numerals constructed so that the symbols or numerals can be assigned by rule to characteristics of individuals to whom the scale is applied. The assignment of the symbols are numerals indicated by the individual possession of characteristics, the scale is supposed to measure. Scale scores permit comparison between individuals regarding the phenomenon of interest. Scales are composite measures of a phenomenon that consists of several items that have logical or empirical relationship to one another. Scaling is the process of assigning a score to a subject to place her or him in a continuum relative to the phenomenon being studied. Scales used to measure psychosocial construct, are comprised of a stem statement relating to the attitude or other phenomenon being rated, a series of scale steps and anchors defining the scale steps. Stem is a statement of the attitude or other phenomena to be rated on a scale. For example, there is a person very close to me to reveal my personal matters. Scale steps are series like 1, 2, 3, 4, 5, 6, 7 are examples of anchors. We strongly agree to strongly disagree. In short, the scale steps are increments on the scale, denoted by number, that remind subjects to the meanings of the scale steps and facilitate data entry and analysis for investigator. The anchors define the scale steps and are usually specified at the beginning of the scale and in some cases for each item.

Types of Scales Used in Nursing Scales have been developed to measure intelligence, aptitude, achievement, personality, attitudes and values. Most of the scaling techniques used in contemporary nursing research were developed originally to measure attitudes or sentiments and they include summated scales, cumulative scales and the semantic differential scale. 1. Summated Rating Scale: A summated rating scale contains a set of scales each of which express some attitude or value. The measurement of attitudes consist of statements designed to assess feeling of an individual

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Essentials of Nursing Research towards work, place, group, objects, programme, policies, etc. The subjects task us to respond with varying degrees of intensity on scale ranging between two extremes such as ‘strongly agree’ to “strongly disagree.” In other words, an individual reacts to these statements verbally expressing approval or disapproval, agreement or disagreement to the items on the scale. These reactions purport to measure a person’s position on controversial issues or problems. Here the scores of all scales are summed or summed and averaged to yield each individual score. An example of summated scale is the Likert scale named after Renis Likert (1932) who developed it as a measurement device. It consists of several statements expressing view points on a topic. Respondents indicate the degree to which they agree or disagree with each statement. The Likert scale usually contain as few as hour or five scales. It is scored by summing the numerical values attached to the scale anchors. Positive and negative items are scored differently and compared and concluded accordingly to know the findings . 2. Cumulative scales consist of item constructed so that the person who agrees with item two also agree with item, one but, not necessarily with item three. Cumulative scale construction requires developing a number of items of increasing intensity, regarding some construct, usually, an attitude. They contain a homogenous set of items, that is, they are related to only one construct. Moreover, cumulative scales are hierarchical, i.e., they contain items reflecting increasing intensity. An example of a cumulative scale is the type initially developed by Louis Guttman (1949). Participants (typically four or five items) representing a hierarchy. Individuals who endorse items that are higher in intensity should also endorse items of lower intensity.

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3. The semantic differential scale is designed to measure attitudes toward concepts along dimensions, such as evaluation, potency, and activity. Initially developed by Osgood, Suc and Jannebaumle (1957), the semantic differentials scale require the respondent to rate a concept in several S-5-50, 9-point scales anchored by bipolar adjectives such as kind-cruel, fast-slow, good-bad, and successful-unsuccessful. For example, Important –------------Unimportant Passive –------------Active Good –------------Bad Fair –------------Unfair Strong –------------Weak The items are scored similarly to items on a Likert scale, taking into account the direction of positive and negative bipolar-adjective pairs. In

Techniques of Data Collection addition to comparing respondent’s scores for ranging various groups of respondent’s score. 4. Visual analog scales represent a type of measurement technique designed to obtain interval-level data. Instead of requiring respondents to select a point on a Likert scale, the visual analog scale requires respondents to indicate a point on a linear scale that reflects the intensity of their feelings, opinions or beliefs. Usually, the respondent is instructed to read the items and place an X on the scale opposite the question at point that best shows their intensity of feeling. Commonly, a 100 mm line is used for the scale with two anchor words to describe the end points of the scale. Scale values are obtained by measuring the point on line. For example, • How much pain are you feeling?……………………… None Excruciating • Are you able to work at your usual tasks? …………………………………………………….. Not Normal for at all me • Are you able to obtain sexual satisfaction? …………………………………………………….. Not Normal for at all me • How good is your quality of life? ……………………………………………………………. Extremely Excellent poor 5. Magnitude estimation scale is a measurement technique based on recent advances in psychophysics. Stevans (1957) first used the method by asking people to assign numbers to represent levels of light intensity, sound and heaviness. He found that people produced a series of ratio scales that were related in curvilinear way to the corresponding physical stimuli. Magnitude estimation requires participants to match numbers, lengths of lines of pressure of handgrips to stimuli. The response modalities that could be used with magnitude estimation technique include the brightness of light, intensity of sound, and strength of grip etc. The other psychological test or inventories used for psychological measurement as follows. a. Personality tests • California psychological inventory for normal individual • Sixteen personality factor questionnaire for normal individual • Edward personality preference inventory for normal individual

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• Minnesota multiphasic personality inventory for normal individual • Projective techniques TAT • IPAT anxiety scale/selfconcept scale etc. b. Aptitude • Scholastic aptitude test • General aptitude test battery c. Intelligence • Stanford binet test • Wechsler intelligence test d. Achievement • Test for English as a foreign language e. Projective Test • Thematic appreciation test (TAT) • Roshach inkblot test (RIBT). The projective instrument enables a subject to project his internal feelings, attitudes, needs, values or wishes to an external object. The organisation and reaction to unstructured stimuli reflect the individual needs, motives, attitudes and values etc. Projects may be accomplished by many techniques. i. Association (TAT, RIBT) ii. Completion (verbal) i.e., verbal completion, word association and expressive methods. Word association is used to detect impaired thought process, creativity, interest, internal conflicts. In completion, the individual is supplied with a set of incomplete sentences and asked to complete them in any desired manner. For example, - I must enjoy……… - My ambition is ……… - Expressive methods are to encourage self-expression like role playing, play technique, drawing, painting etc. - Sociological measurement: It includes the use of scales like social distance scale, socio-economic status scale (SES urbanKuppuswamy, SES-Rural-Udai Prakash) and sociometry. - Sociometry is a method used for the discovery and manipulation of social configurations by measuring the attractions and repulsions between individuals in a group at some point in time. The basic technique is sociometry. The sociometric test consists in having each member of a group choose from all other members those with whom he prefers to live, eat, work or otherwise associate in specific situation. Sociometric studies reveal that certain persons are chosen for all situations, but frequently entirely different individuals are preferred for each type of activity.

Techniques of Data Collection

OBSERVATION AS A TECHNIQUE OF DATA COLLECTION ‘Observation’ term indicates on the abstract concrete continuum, a property that is a directly observable, empirical reference. An observation study is that asks questions about overt behaviours or events and then answers those questions by having human observers record those behaviours or events over a period of time or series of occurrences. It is one of the basic and oldest research methods to gather data. Observation stops being a norm part of daily life and becomes research method if it is systematically planned and recorded and when both observation and recording are checked for their validity and reliability. It is a technique for collecting all the data or acquiring information through occurrences that can be observed through senses with or without mechanical devices. It involves interpretations of phenomena in the environment. It is a two part process i.e., (i) observer (someone is observing) and (ii) the observed (there is something to observe). It is through observation that hypotheses are suggested i.e., by observing natural phenomena in the systematic way drawing conclusions, predicting what will happen and developing theory to explain why it is happening. Observation is primarily centered around naturalistic conditions, termed as field research, i.e. observation occurs in the natural environment of subject. Laboratory or analog setting is when target behaviours are observed in environments, different from the environment in which the behaviour occurs. It is usually occurring in a clinic or laboratory setting especially equipped for unobtrusive visual and auditory monitoring need. Observation is one of the methods of collecting data, in which researcher scientifically watches and records pertinent information. The best and most important reasons for doing observational study is that research question or hypothesis requires data that can be produced best through observation. It is particularly suited as a data collection method in complex research situation, that are best viewed as total entities and that are difficult to measure in parts, such as studies, dealing with the nursing process, parent-child interactions, or group processes. In addition, observational methods can be the best way to operationalise some variables of interest in nursing research studies, particularly individual characteristics and conditions, such as traints and symptoms, verbal and nonverbal communication behaviours, activities and skill attainment and environmental characteristics. Scientific observation places a great deal of emphasis on the objective and systematic nature of the operation. Here the investigator is not merely looking at what is happening, but rather is watching with a trained eye for certain specific events. To be scientific observations must fulfil the following conditions:

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Essentials of Nursing Research • The observations undertaken are consistent with the study’s specific objectives • There is standardised and systematic plan for the observation and the recording of data • All of the observations are checked and controlled • The observations are checked and controlled • The observations are related to the scientific concepts and theories. Thus, scientific observation requires preplanning systematic recording, controlling the observation and relationship to scientific theory.

Observers and their Role As stated earlier, there should be observer in observational process. Observing is an important skill, takes lot of practice. In observation, the observer should possess certain qualities of good observer. It is believed that a good observer should be capable of sustained attention and vigilance on the observation situation. An observer who is able to cope with a stimulating environment without confusion usually will find it easier to make the systematic observations required during the research observations. The ability to attend to details is another important characteristics of an observer because the observer will be required to make note of details of behaviour. Each observer comes to research scene with personal biases and theoretical commitments. An observer must be able to recognise those biases and commitments and be able to achieve detachment and distance whereas observed behaviour is in conflict with personal values. And the observer must be highly motivated and must be analytical and introspective because the research findings will be only as stable and reflective of the behaviour as are the observers record. If feasible more observers should be selected than are actually needed. Observational methods can be distinguished by the role of the observer. This role is determined by the amount of interaction between the observer and those being observed. Each of the following four basic types of observational role is distinguishable by the amount of concealment or intervention implemented by the observer: 1. Concealment without intervention. 2. Concealment with intervention. 3. No concealment without intervention. 4. No concealment with intervention. Concealment refers to whether the subjects know that they are being observed and intervention deals with whether the observer provokes actions from those who are being observed.

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Concealment without Intervention: Here the observer makes the observation from the periphery of the social setting in such a way that he

Techniques of Data Collection is present but does not interact with others. This is also called ‘Lurking.’ The observer does not make his intensions known to the group, nor does he make any effort to participate. By Lurking the observer is often able to gather treat deal of information but when the observer is not nearby, there is difficulty in hearing which can lead to misunderstanding. The question of human rights may arise from lack of dignity in the collection of data where the observed are neither aware of the observer or being observed. In this case, the researcher watches the subjects without their knowledge of the observation, but she or he does not provoke them into action. Often, such concealed observations use hidden television cameras, audiotapes or one-way mirrors. Concealment without intervention often used in observational studies in children. Such studies allow for the observation of children’s natural behaviour and often are used in developmental research. Concealment with Intervention: Here the researcher observes the behaviour of the people in their natural setting, where the observed are unaware of being observed, but, since observer’s presence usually alters the behaviour of the subjects, he may adopt a passive role. He observes and records observation with minimum intervention. The problem of behaviour distortion with presence of observers is known as ‘reactive measurement effect,’ or more simply reactivity, the Hawthrone effect, or the distortion created when the subjects change behaviour because they are being observed. To minimise the problem of reactivity, observer can carry out his observation without the subject’s knowledge through concealment. For example, researcher may monitor patient’s conversation to determine content by means of call system located at the nurses’ station. Concealed observation with intervention involves staging a situation and observing behaviours that are evoked in the subjects as a result of interventions). No Concealment without Intervention: This approach is extremely valuable in nursing research intervention studies. In many field experiments, where the researcher is interested in observing the effects of specific intervention introduced for scientific purposes, the subjects here are aware of their participation in the study. Prakasamma (1981) in her study observed the effect of Pranayama on lung function in patients with pleural effusion by using this approach. No concealment without intervention are commonly used for observational studies in which the researcher obtains informed consent from the subjects to be observed and then simply observes his or her behaviour.

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Essentials of Nursing Research No Concealment with Intervention: Here, the observer makes no attempt to alter the social setting that is being studied at the same time does not make the observation covertly. The observer is a part of the social setting. The subjects are aware of researchers’ presence but may or may not be aware of his underlying motive. This approach offers more depth of information. No concealment with intervention is employed when the researcher is observing the effects of some intervention introduced for scientific purposes. Because the subjects know that they are participating in a research study, there are few problems with ethical concerns but reactivity is a problem with this type of study.

Phenomena Amenable to Observation The following are the phenomena which are important for observation in nursing research: Characteristics and Conditions of Individuals: Variety of information about people’s attributes and status can be gathered by direct observation. Physiological conditions and characteristic that can be observed either through sense or aided by observation apparatus e.g., X-ray examination, spirometer readings. Prakasamma (1981) studied the effect of yoga on lung function of patients with pleural effusion. Using spirometer she made several readings of FVC, FEV, MVV, X-ray chest was used to see lung expansion before giving treatment. Sharma (1977) used measurement of chest expansion and X-ray films in postoperative patients to see the lung expansion. Verbal Communication Behaviour: Commonly observed behaviour is linguistic behaviour, content and structure of people’s conversation, entire process of social interaction e.g., Robert F Bales (1950) interaction process analysis, Flanders’s interaction analysis. Vatsa (1978) and Madan Lal (1980) studied interaction pattern between teachers and students in clinical setting using Flander’s interaction analysis category system. Abraham (1986) observed interaction pattern between nurses and rooming in mothers of hospitalised children adopting Bale’s interaction process analysis.

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Nonverbal Communication Behaviour: Nonverbal communication includes facial expressions, touch, posture, gesture, body movements, extra-linguistic behaviour like the manner in which the people speak, loudness, continuity, of the speech. Nirula (1978) observed relationship of patient and personnel in a psychiatric setting with relation to perception of such gestures initiated by doctors and nurses while interacting with psychiatric patients.

Techniques of Data Collection Activities: Apart from the behaviour that communicates overt state of an individual, there are many actions that are amenable to observation. Actions that serve as an index of health status, physical and emotional functioning are particularly important. Study of activities also indicate type of nursing function a nurse performs e.g., Dube (1975), Bhan (1978), Dhaulta (1975), Idicula (1966), Ranga (1966), adopted Darlysheri’s activity schedule to study the activities of nursing personnel working in different units of the hospital at different places in India. Ranga (1966), and Idicula (1966), conducted their studies adopting the pattern suggested by Ferguson. Skill Attainment and Performance: Attainment of nursing skills are manifested behaviourally which can be observed by direct observation. Procedures of aseptic technique were observed by several student researchers in the Raj Kumari, Amrit Kaur College of Nursing, New Delhi, such as catheterization technique by Philip Sircar (1976) injection technique by Pushpavathamma (1971) and perineal toilet by Champa Dutta (1977). Environmental Characteristics: Number of environmental attributes e.g., noise levels, cleanliness etc. have profound effect on individual’s behaviour. Observation of these environmental attributes are important to help plan health education interventions for individuals in community, schools etc. Jaya Samantha in her study has collected observation data from school’s environment including, noise, dust, ventilation, odour, water supply, mosquito breeding area etc.

Units of Observation In selecting behaviours, attributes or situations to be observed, the researcher must make a decision concerning what constitutes a unit. There are two basic approaches.

Molar Approach Observation of large units of behaviour and treating them as a whole e.g., study of psychiatric patients swings in verbal and nonverbal behaviour on one hand and passive behaviour on the other hand.

Molecular Approach Observation of small and highly specific behavior e.g., observation of each movement, gesture, action, and treating each action separately or perhaps breaking in further into smaller units.

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Observational Methods Unstructured Observation: Here, the attempt is made to provide as complete and non-selective a description as possible of an event or behaviours observed. The following techniques are used as unstructured method of observation: Participant observation: It is a technique where research participates in the functioning of the social group that is under investigation. The researcher attempts not to interject her own views and meaning into the social situation under observation. The researcher also attempts to minimise observer imposed meanings to the data collected. Observer usually keeps two types of records. Logs and field notes:Logs is a record of event and conversations and is usually maintained a daily basis by field worker. Field notes: Field notes may include daily log but tend to be much broader, more analytic, and include more interpretation than mere listing of occurrences. Field notes represent participant observer’s effort to record, inform, and also to synthesise and understand the data. It is essential to record observation while the researcher is still in the process of collecting information because of memory failure. Keuffner (1973) while doing her doctoral studies on identifying general patterns and sequence of behaviour in a selected number of severely burned, isolated children aged six to ten years to maintained her filed notes soon after making observations in hospital. Anecdotes focus on behaviour of particular interest. Anecdote typically selects specific kind of events and behaviours for observation before hand. The observer objectively, and accurately records the observation. Anecdotes can be of scientific value if they are prepared in an illustrative fashion. Unstructured observation method provides rich and deep understanding of human behaviour. Observer gets a chance to get inside a particular group and participate as one among them. How effectively observer establishes his relationship with the group members/subjects, and uses his observation skills, determine the richness of this method. Observer’s lias and observer’s influence are prominent difficulties. Memory distortions represent another possible source of inaccuracy.

Structured Observation

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When appropriate is an excellent method of data collection. Many more subjects can be observed in much less time. Structured observation

Techniques of Data Collection involves indication of presence or absence of prespecified behaviour or attributes. The following are commonly used tools in structured observation: Checklists: It is a tool used for structured observation where phenomena are recorded by putting a tally against a particular behaviour, event or characteristic depending upon its presence or absence. When developing a checklist researcher must list all the expected behaviours related to the variable being measured, so that all relevant behaviours in the subjects will correctly be identified. Sometimes, a pilot study can be done with a few subjects to get an idea of the kinds of behaviours one can expect. Two basic formats of observation checklist contain: Sign system: In sign system one lists categories of behaviours that may or may not be manifested by the subjects. The observer watch for instances of the behaviours on the list and puts a check off beside the appropriate behaviour when it occurs. The observer does not classify all the behaviours or characteristics of the individuals being observed but rather identifies the occurrence and frequency of particular behaviour. The patient centered nursing care time study conducted by College of Nursing (RAK) and TNAI (1966) used 16 broad nursing care activities which were coded 1 to 16. The examples of behaviour under each nursing tasks were given in the guide. The observer did a continuous observation of the nursing activities giving the time of starting and time of finishing. The observer identified not only the occurrence and frequency of behaviour but also the time taken for the behaviour to occur. Analysis of ongoing and discrete elements of behaviour (Polit 1983): Here the observer places behaviours in only one category for each unit of behaviour, such as a sentence in a conversation, or to a time interval. For Joseph (1976) and Abraham (1986) constructed a category system based on Bales ‘interaction analysis and listed categories such as ‘unfriendly,’ ‘showing tension,’ and ‘disagrees’ under social and emotional area negative. The observer was required to classify every subject’s verbal interaction to the social and emotional area negatives in terms of one of these three categories along with the code number of speaker and to whom the communication was addressed. Soedown and Fitzpa-rick (1976) reported a study where they used an observational system for analysing motor activity of children. The observer was expected to record the body positions and movements (as per the behaviour list) occurring within a fifteen second period. This refers to record of unit of behaviour according to a time interval.

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Essentials of Nursing Research Rating scales: Structured observation can also be rated in term of qualitative points along a descriptive continuum. The ratings usually are quantified during the subsequent analysis of the observation data. Here either the observer is required to make ratings of behaviours or events at frequent intervals throughout the observational period or he may make use of rating scale to summarise an entire event or transaction after the observation is completed where a more descriptive method has been used for maintaining observation record.

Category System

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The most common method used in structured observation is construction of category system to which observed behaviours or characteristics can be assigned. In category system an attempt is made to designate in a systematic or quantitative fashion the qualitative behaviour and events transpiring within the observation setting. In the development of category system important requirements are: • Careful and explicit definition of behaviours and characteristics to be observed • Referent behaviour should be mutually exclusive. For example, In the Patient Centered Nursing Care-Time Study, broad nursing activity categories were developed with clear definition of referent behaviours i.e., based on the components of nursing care prepared by Virginia Henderson (1960). Nursing activity No. 2 and 3 states as ‘Helping patient with respiration,’ ‘Helping patient with eating and drinking.’ • Developing a system of coding. The simplest fashion is one involving a single phenomena that can be coded in dichotomous fashion as either present or absent e.g., Bales (1950) for observing verbal behaviour in small groups contain twelve categories under four areas as ‘shows solidarity,’ ‘shows tension release,’ ‘agrees’ and so on • Generality system––meaning its application to a wide variety of research situations • Pilot run of constructed category system to assess its suitability for the intended study • Developing, refining and retesting of a new category system. a. I have copied the way the people dress on TV. b. I have made things after they have been shown on TV. c. I have purchased a particular brand after seeing its advertisement on TV. d. I have gone to an art gallery after seeing it on TV. And so on. Inventories can be constructed with various purposes in mind or to test particular hypothesis. They invariably form part of a questionnaire/ schedule.

Techniques of Data Collection

Advantages and Disadvantages of Observational Methods Advantages • Observation is an important technique in studying human behaviour specially where interventions are used • Observation techniques are relatively inexpensive to employ • The researcher is not dependent on subjects who consent to answer. All subjects are potential respondents • Subjects usually available unlike questionnaire where one is dependent on return of mailed questionnaire • It lends itself to the use of recording equipments • It allows view of complete situation firsthand and include sequence of events • The instrument is quite simple to develop as compared to a lengthy questionnaire • The observation technique can be stopped or begun at any time • Observation may be recorded at the time they occur, eliminating bias because of recall • One can make use of assistants to carry out observations • Provides depth and variety of information.

Disadvantages • Accurate prediction of a situation (Time and Duration) or events to be observed is unlikely. Therefore, it is difficult to be present to observe key events • Observation and interpretation is a demanding task requiring attention, sensation, perception and conception • Lack of consent to being observed • Interviewing selected subjects may provide more information economically, than waiting for the spontaneous occurrence of the situation • The presence of an observer gives the subject a quality normally absent • Data is vulnerable to many distortions and biases • Observed events are subjected to researchers cultural background and personal interpretations • Use of recording devices are expensive. Lighting requirement and Lens limitation cause technical problems • Extensive training is necessary if assistant observers are used • Observer may get involved in the situation which can cause threats to the objectivity of the data collected

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Essentials of Nursing Research • Especially rating scales are susceptible to two distinct types of errors i.e., error of linency-tendency of observer to rate harshly • ‘Halo effects’ tendency of the rates to be influenced by one characteristic in rating other nonrelated characteristics.

QUESTIONING AND INTERVIEWS AS TECHNIQUE OF DATA COLLECTION Meaning

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Interviews are a method of data collection where a data collector questions a subject verbally. Interviews may be face to face or telephone encounter with a research subject to obtain specific and systematic information about a given phenomenon. Interviews include special situations such as focus groups, play interviews, role playing and ethnographic interviews. A questionnaire is a paper and pencil instrument that a research subject is asked to complete. It is designed to gather data from individuals about knowledge, attitudes, beliefs and feelings, questionnaire comprises of a series of questions prepared by the researcher that are annexed and filled in by all the respondents. Opinionnaire comprises of a series of questions that may be referred to matters of opinions to be answered by the respondents. Questionnaires include techniques that do not require direct interaction between the investigator and the respondent, such as Q-sort and Delphi technique. Computer technology makes it possible to administer a questionnaire via computer. The respondent’s computer terminal displays questions that the respondent answers by keying his/ her response into the terminal. The actual questions used to achieve the research purpose may be identical in an interview guide and on a questionnaire. The method of administration differentiates an interview from a questionnaire (Table 14.11). A guide to interview or questionnaire will be referred to as ‘schedule.’ Interviews and the questionnaires are useful instruments in nursing research because they allow the investigator to question research, subjects about facts ideas, behaviours, preferences, problems, feelings, attitudes and so forth. Survey research relies almost entirely on questioning subjects with either interviews or questionnaires, but these methods of data collection can also be used in other types of research. No matter what type of study is conducted, the purpose of questioning subjects is to seek information. This information may be either direct interest such as the subject’s age or indirect interest such as when the researcher uses a combination of items to estimate to what degree the respondent has some trait or characteristics e.g., intelligence. When the items of indirect interest are combined to obtain an overall

Techniques of Data Collection Table 14.11: Difference between an interview schedule and questionnaire Interview schedule

Questionnaire

It is filled in by the interviewer and is never mailed to the respondents. The presence of the interviewer enlivens the atmosphere.

It is filled in by the respondent himself and usually mailed to him. It therefore lacks personal touch

It is generally used where the survey to be conducted of a relatively small geographical area.

It is generally used where the field of enquiry is large. Questionnaires can be mailed to distant places at a little extra cost.

Its use involves greater expenditure of time and money. It can be used even where the respondents are illiterates because the investigator can explain to them at any point on the spot.

Much time and money are saved in its use. It cannot be used where the respondents are illiterate. Even literate respondents leave several entries incomplete.

In it the wording is not in the form of questions.

In it the wording is in the form of questions.

In its designing the convenience of the investigator in handling it in the field should be the main consideration.

In its designing, knowledge, convenience and mood of the respondent should be the main consideration.

scene, the measurement tool is called ‘Scale.” For example, Attitude scale, Intelligence scale. Plan for Scoring It is essential to plan that scoring technique in order to examine the type of data and the possible statistical computation. Ultimately, the choice of question type would depend largely upon the subject matter of the study verbal ability of the respondents and amount of time available. Construction of Schedules Schedule will be used to refer to both questionnaires and interview schedules. The design of a useful schedule normally involves extensive planning, consultation with colleagues or advisers, pretesting and revising. While constructing a research schedule, the investigator / researcher need to keep in mind the following points for consideration: 1. The form of the schedule. 2. The form of the question. 3. The question content.

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Essentials of Nursing Research 4. 5. 6. 7. 8.

The The The The The

question wording. response alternatives. question sequence. schedule format. introduction and instructions.

Summary of Characteristics of a Good Schedule/Questionnaire

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The construction and use of schedules and questionnaires has been discussed at length in this and the preceding chapter. A summary of the main characteristics of a good schedule/questionnaire is given below: 1. It asks for and obtains all the information required for achieving the research objectives. 2. It contains questions relevant to the study and does not include any irrelevant and unimportant questions. 3. It does not aim at obtaining any information which can be more accurately and effectively obtained by other data-gathering methods like observation. 4. It contains no questions that are unclear, ambiguous, double, leading, loaded or uninformative, and long. 5. It contains no open-ended or discussion questions unless they are absolutely necessary. 6. It does not contain questions which are beyond the memory span of respondents. 7. It contains questions that can be answered as quickly and easily as possible. 8. It avoids unwarranted presumptions about the respondents. 9. It does not restrict the choices of answers so as to bias or distort replies to be given. 10. Choices to closed questions are adequate, reasonable, unidimensional and logically consistent. 11. Each question is limited to a single idea or single reference. 12. No embarrassing questions are given without providing an opportunity to explain. 13. Appropriate balance between personalization and indirect form is maintained. 14. Filter questions are used wherever necessary. 15. Topics and questions are arranged in a logical and psychological sequence that is natural and easy for the respondent. 16. Transition between one section and another is smooth. 17. Inter-related questions are so positioned as to avoid context effects. 18. Questions seeking ‘reasons for’ are based on reason analysis. 19. Questions and alternative answer choices are properly coded.

Techniques of Data Collection 20. Design requirements like margin, spacing etc., are taken care of. 21. Appropriate introduction and instructions are included. 22. The instrument has been adequately pretested and revised so as to be a satisfactory tool for the particular survey. In conducting research in nursing usually following points to be considered while constructions of questionnaire or observationnaire. Form of the Schedule: Standardised or tightly structured schedules consist of a set of items in which the wording of both the question and the alternative responses is predetermined. When structured interviews or questionnaires are used, all subjects are asked to respond to exactly the same questions, in exactly the same order and have the same set of options for their responses. The purpose of such a high degree of structure is to ensure comparability of responses. In totally unstructured interview schedule, the researcher does not specify in advance either the questions or the alternative response. Unstructured interview schedules have a number of potential difficulties, particularly in terms of making comparison between subjects, but there are number of research situations in which the flexibility of this approach is a distinct disadvantage. Unstructured interview schedule is very useful, when a new area of research is being explored. In general, questionnaires tend to be more standardised that interview schedules. I feel structured schedules with questionnaire of useful for descriptive evaluated survey. Form of the question: There are two categories of questions such as open-ended and closed-ended (or fixed alternatives). Open-ended items allow subject to respond to the question in their own words. In questionnaires the respondent is asked to give written reply to open-ended items and, therefore, adequate space must be provided to allow the expressions of opinions. Close-ended questions offer respondents a number of alternative replies form which the subjects must choose the one that most closely approximate the ‘right’ answer. The alternatives may range from the simple yes-no variety to rather complex expression of opinions or behaviour. Questionnaire construction, may be easy but analyse it very problematic and time consuming. The procedure that is normally followed is the development of categories and the assignment of the open ended response to those categories. That is researcher essentially transforms the open responses to a fixed category in a post-hoc fashion, so that tabulation can be made. This classification process takes considerable

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Essentials of Nursing Research time and skill. Furthermore, since the ultimate classification decision lies in the hands of the researcher rather than the respondent there is the possibility of inappropriate categorisation caused by misinterpretation of the responses or an inadequate classification systems. Close-ended items are difficult to construct but easy to administer and especially to analyse. Here the researcher needs only to tabulate the number of responses to each alternative in order to gain some understanding concerning what the sample as a whole thinks about an issue. Sometimes, the meaning of the questions can be clarified through reference to explicit options. Similarly, the provision of alternatives identifies to the respondent the researcher’s frame of reference. Generally close-ended items are more efficient than open-ended questions in the sense that a respondent is normally able to complete more close-ended items than open-ended questions in a given amount of time. The major draw back of close-ended questions lies in the possibility of the researcher neglecting or overlooking some potentially important responses. And also there are no chances for respondents to express their views. Question Contents: The content of the questions will naturally be guided by the aims and needs of the researcher. Questioning is useful for obtaining following information. • Facts about the respondents • Facts about the persons known to the respondent • Facts about events and conditions known to the respondent • Beliefs about what the facts are • Attitude, feelings and opinions of the respondents • Reasons for or influences on specified attitude, feelings, opinions or behaviour • Level of knowledge about policies, practices, conditions or situations • Intentions or statements about future actions. Question Wording: The researcher has to face the most difficult aspects of constructing a schedule in the actual wording of the questions and for close-ended items, the wording of alternative responses. While constructing the schedules/questions, the following consideration should be borne in mind:

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1. Clarity a. Clarity in your own mind the information which you are trying to obtain. If you are unclear about exactly what you want to find out, you can hardly expect respondents to guess your intentions b. Avoid long sentences or phrases. Simple sentence structures are the easiest to comprehend

Techniques of Data Collection c. Avoid ‘double-barrelled’ questions which contain two distinct ideas or concepts d. Avoid technical terms if more common terms are equally appropriate particularly if the respondents are lay persons e. Try to state your questions in the affirmative rather than negative. 2. Ability of Respondents to Reply or Give Information a. Language: Try to use words that are simple enough for the least educated respondents in your sample. b. Level of information: It should not be assumed that respondents will always be aware of, or informed about, issues or questions in which you are interested. c. Memory: You should not take for granted, that respondents will be able to remember events, situations, or previous activities and feelings with a high degree of accuracy. 3. Bias Bias can enter into an instrument in a number of subtle ways, however, and some techniques are useful in minimizing any biases, which the researcher might inadvertently introduce themselves. a. Avoid leading questions that suggest a particular kind of answer b. Avoid identifying a position or attitude with a prestigious person age or group c. Avoid words that are emotionally loaded and that automatically suggest a favourable or unfavourable response, regardless of the real content of the question d. State a range of alternatives within the question itself when possible e. Try to counterbalance the ‘slant’ of questions when the strategy suggested about is not possible. 4. Handling Sensitive or Personal Information In any event the researcher must strive to be courteous, considerate, and sensitive to the needs and rights of research participants. There are really no rules or general guidelines to facilitate the research planner in this regard. Judgement and discretion need to be exercised in the formulation of each question. The following concepts might be kept in mind: a. Consider how objectionable the question wording might be to the respondent and try to develop less objectionable alternatives b. For questions that deal with socially unacceptable behaviour or attitudes, the researcher can usually elicit more frankness if the schedule creates an atmosphere of permissiveness or nonjudgement c. Impersonal wording of a question is often useful in minimising embarrassment and encouraging honesty

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Essentials of Nursing Research d. Politeness and encouragement help to motivate a respondent to cooperate. Response to alternatives: A few general consideration to be kept in mind are: • Coverage of alternatives i.e., responses should be adequately encompass all of the significant alternatives • Overlapping responses should be avoided. The alternatives should be mutually exclusive • Ordering responses there should be some underlying rationale for the order in which alternatives are presented to the respondents • Response length the response alternative should not be too lengthy since it is inefficient and cumbersome for the subjects to read detailed replies. Question sequence (order): In organisation of the schedule, the researcher must plan on the questioning sequence (order of questions) and the schedule format. Some thought should be given to the sequencing of the questions so as to arrive at an order that is psychologically meaningful to the respondents and encourages them to answer all questions. The order in which questions are asked can affect the responses as well as overall data collection activity. Responses given by subjects will tend to be more accurate and representative of the sample when certain principles are followed: • Every item in a questionnaire should relate to the topic under study • Items should be organised into units. There should be progression from one type of items to another and one group to another • General questions should lead to specific ones • General questions should not influence others • Personal background information such as age, education, status, marital status e.g., is usually included in the questionnaire either in the beginning or end. Schedule format (Lay-out): The way a questionnaire or interview schedule is laid may affect response rate and the accuracy of the responses given. Formats that are easy to follow and pleasing to the eye are usually completed by the respondents.

Introduction and Instructions

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1. Questionnaires/interview schedules are not complete without an introduction. Subjects have the right to know the purpose of the study and why they are being questioned. Each schedule must be prefaced by some introductory comments regarding the nature and purpose of

Techniques of Data Collection

2. 3. 4. 5.

the study. For self-administered questionnaires, it is also essential to incorporate clear instructions on the schedule itself, indicating how the respondent is to answer questions. Directions for completion of items should be efficient and unambiguous so that respondents understand what the researcher wants. Interview schedules require directions for the interviewer completing the form. Confidentiality and anonymity should be assured. Personal data e.g., age, sex, education etc. Backward data e.g., family income, father ’s occupation, living environment, etc. Content knowledge, opinion, belief, attitude, practice etc. Acknowledging participation.

Writing Good Questions 1. Use the words that are simple, direct and familiar to all. Tailor the words of questions to your respondents, e.g. when sending a questionnaire to general public, you might talk about “companies that sell medicine,” for physician respondents “pharmaceutical companies” would be more appropriate. 2. Question should be as clear and specific as possible. Confusing item: “Is the quality or nursing care better than it used to be?” Better Item: “Is the quality of nursing care better now than it was five years ago?” 3. Define or qualify the terms that can easily be misinterpreted. Not clear: What is the value of your house? The term value is not clear. Clear: What is the present market value of your house? 4. Avoid double barrelled questions. For example, Do you favour or oppose closing of acute and chronic hospital beds? Better Item • Do you favour or oppose closing of acute hospital beds in Delhi? • Do you favour or oppose closing of chronic hospital beds in Delhi? 5. Beware of double negatives. Two negatives in a sentence are confusing and respondent is not sure how to answer. For example, “Are you against not allowing nurse to strike?” Better Item: “Are you against allowing nurses to strike?” 6. Underline a word if you wish to indicate special emphasis e.g., should all schools offer a modern foreign language?

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Essentials of Nursing Research 7. Avoid questions that are leading or suggest the answer that is expected. For example, “You do not approve of strikes, do you?” Suggest that the respondents should answer no. 8. Be sure that the alternatives are enough and appropriate for the intended respondents. Why is that nurses do not want to work at hospital X? a. The pay is too low b. The working conditions are unpleasant. Additional responses should be included, since the real reason may have to do with their feelings towards administrative personnel, hospital policies, lack of inservice education etc. 9. Personal question: If a very personal question is being asked, some reason should be given as to why answer is needed. Otherwise, the respondent is apt to omit the item, give a vague answer or lie. 10. Problem words: Some words present problems because they are confusing, one of these are “you.” “How many patients did you care for last week?”

Administration of Questionnaire Questionnaire and interview schedule require different skills and different consideration in their administration. Self-administered: This type of questionnaires can be distributed in number of ways. The most convenient procedure is to administer questionnaire to a group of respondents who complete the instrument at the same time. This approach has the advantage of maximising the return and allowing researcher to clarify any possible misunderstandings about the instrument. Mailing distribution: Questionnaires are often mailed to the respondents. The basic method for data collection through mail in transmission of a questionnaire, accompanied by a letter of explanation and a return envelope. The respondent then completes the questionnaire and mails back to the researcher. Advantage: Large cross-section of population widely scattered can be covered. Disadvantage: Some items may need clarification, completion rare tends to be low.

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Monitoring return: Researcher should undertake a careful recording of methodological data. As completed questionnaires are returned each should be perused and assigned an identification number serially.

Techniques of Data Collection Acceptable response rate: The response rate can be affected by the manner in which the questionnaire was designed and mailed. It is essential to keep the lapse rate as low as possible. A response rate of at least 50 percent is adequate for analysis and reporting. A response rate of at least 60 percent is good and of 70 percent of more is very good. Follow-up mailing: Properly timed follow-up mailings provide additional stimuli for responding. In practice, three mailings (one original and two follow-ups) seem the most efficient. Timings of follow up mailing is also important. It is experienced that two to three weeks is a reasonable space between mailings. Methods of dealing with non-response: The physical appearance of questionnaire can influence its appeal, so some thought should be given to layout, quality and colour of paper and typographic quality of instrument. Unless non-response is confined to a small proportion of the whole sample, the results cannot claim any general validity. The methods of dealing with non-response are sending follow-up letter (s), making telephone calls and personal visits. (Das, 1986; Bhaduri and Prakashamma, 1984).

Interviews Types of Interview Standardised (structured): Interviewers are not permitted to change the specific wordings of the interview schedule questions. (Das, 1986; Majumdar, 1983; Yalayya swami; 1979). Nonstandardised (unstructured): Interviewers have complete freedom to develop each interview in the most appropriate manner of the situation. Semistandardised (semistructured): Interviewers may be required to ask a number of questions, but beyond these they are free to probe as they choose. (Das, 1986; Sarojini, 1981, Suvarna, 1982). Focused: The focused interview is much like the nonstandardised type in that no specific questions are asked of all the respondents. Special attention can be given to specific topics or ideas. Nondirective: In this type of interview, the subject is allowed an opportunity to relate personal feelings without fear of disapproval.

General Rules for Interviewing Fix-up the appointment Interviewer should fix up the date and time of interview with the subject/interviewee ahead of time. This would save time of the interviewer.

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Essentials of Nursing Research Appearance and demeanor : As a general rule, the interviewer should dress in a fashion fairly familiar to that of the people she will be interviewing. In demeanor, the interviewer should be pleasant and communicate a genuine interest in getting to know the respondent without appearing to be a spy. She must be relaxed and friendly without going too casual or clinging. Familiarity with interview schedule/questionnaire: The questionnaire/ interview schedule must be studied carefully, question by question and interviewer must practise reading it aloud. The interviewer must be able to read the items to respondents without error, without stumbling over the words and phrases and in natural conversation. Of course, the interviewer should not attempt to memorise the questionnaire. Follow question wording carefully : Question wordings should be followed exactly as phrased. All the effort will be wasted if interviewers rephrase questions in their own words. Slight change in the wording of a question may lead a respondent to answer “Yes” rather than “No.” Record responses exactly : No attempt should be made to summarise, paraphrase or correct bad grammar of the responses given by the subjects particularly for open ended questions. The response should be written down exactly as given. Probing the responses: Probes are frequently required in eliciting responses to open-ended questions so that responses will be sufficiently informative for analytical purposes. It is imperative that probes be completely neutral. The probe must not in any way affect the nature of the subsequent response.

Training the Interviewer In the interview situation there may be one or more persons doing the interview. If more than one researcher is involved training of other interviewers is required. The amount of time required for such training will depend on the scope and nature of survey and the relative experience of the interviewers.

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General instructions: The interviewer training should begin with some general comments about the nature of survey and its ultimate purpose. Generally speaking if interviewers understand why the survey is being conducted and can see that it is an important undertaking, they will be more diligent and careful in their work.

Techniques of Data Collection Studying the questionnaire and specification: Interviewers and the researcher should then go through the entire questionnaire step by step and all possible ambiguities should be discussed. The examination of questionnaire should simultaneously involve an examination of the specifications. Practice Interviews in class: Series of practice interviews should be conducted in the class. Since these interviews serve as a model for the interviewers, they should be conducted in precise accord with the previous general and specific instructions. Practice Interviews in the field: Interviewers should, then, be assigned to practise interviews in the field. This part of the training should be exactly like the real thing. The interviewers should be given exactly the same materials they will use in final survey.

Conducting the Interview (Practical Application) Interviews can be conducted by face to face meeting, telephonically or videorecording. If possible interview should be conducted in a quite peace atmosphere. The subject should be seated in a comfortable position and should be told before hand approximately how many minutes the interview will take. Recording of responses should be done simultaneously. In recording answers in which the subject talks very rapidly, it is impossible for interviewer to record in long hand. In this case it may be feasible to use a taperecorder/videorecording with the permission of subjects. Experience of writing in short hand is useful. Semantics: Language is used in all interviews, but not every word has the same meaning for every person. It is important, therefore, that most comprehensible questions be formulated. Questions must be so constructed that they may be tallied, coded and analysed as accurately as possible. In interviewing, the researcher must ask these questions in a similar fashion throughout the data gathering process. Rapport: The art of establishing rapport, or putting interviewee at ease, is really not difficult. It is important that the interviewers begin by identifying themselves and by giving reason for research. They should ask permission to interview, create a friendly and pleasant atmosphere for the subjects. Interviewees should be promised confidentiality, told that their frank opinions are needed and that their responses will be anonymous. They should not pressure the individual to answer e.g., if the subjects do not want to answer embarrassing questions, they should be told they need not answer unless they wish to do so. If such questions

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Essentials of Nursing Research are left until late in the interview, after a rapport has been established, it is usually easier for the interviewee to answer them.

Problems of Interview 1. An interview is an effective tool for obtaining opinions, attitudes, value and perceived behaviour. However, it is usually an effective procedure for obtaining actual behaviour patterns. 2. Some interviewees may have faulty memories and either cannot remember a certain fact or guess what seems to be a reasonable answer. 3. Subjects may be or may give answers to representative of a group rather than their own ideas. 4. The presence of interviewer may influence the subjects so that they answer questions differently than they would if filling a questionnaire. 5. Not every one in a chosen sample may be available for an interview; thus the response rate is less than anticipated. 6. Some of the interviewees may not be qualified to answer certain questions. They may also be prejudices to the point that their answers are strongly biased. 7. The interviewer may become so concerned with the mechanics of using an interview schedule or guide that non-verbal cues are overlooked. 8. Time is lost when interviewer has to record the interviewee’s responses. Some of these problems are similar in questionnaires.

Ethical Implications Scientists do make a distinctive contribution to society in development of knowledge and informed application of that knowledge. But, when human beings are used as subjects in research investigations, as is generally the case in nursing research, great care must be exercised in assuring that rights of those human beings are protected. ANA states that in health care practices, the need for protection of human rights is of most importance. The term ‘human rights’ refers to three rights. 1. Right to freedom from intrinsic risk of injury 2. Right to privacy and dignity 3. Right to anonymity.

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Questionable practices involving research participants: Kidder and Judd state the questionable practices encountered in science research may be grouped into ten categories as follows: 1. Involving people in research without their knowledge or consent. 2. Coercing people to participate.

Techniques of Data Collection 3. Withholding from the participant the true nature of the research. 4. Deceiving the participant. 5. Leading the participants to commit acts that diminish their selfrespect. 6. Violating the right to self-determination–research on behaviour control and character change. 7. Exposing the participant to physical or mental stress. 8. Invading the privacy of the participant. 9. Withholding benefits from participants in control groups. 10. Failing to treat participants fairly and to show them consideration and respect. ICMR guidelines on ethical considerations involved in human subjects give the following directions: • That the rights and welfare of human subjects on whom experiments are carried out are adequately protected • That the risks to an individual are outweighed by potential benefits to him or to society or by the importance of the knowledge to be gained • That informed consent is obtained from the individual by method that are appropriate and adequate • That the clinical investigation on human subjects is carried out by an investigator who has the requisite background and competence to carry out such research, and • That the investigator has a framework for obtaining advice, support and assistance from his peers before embarking on a particular clinical research programme. (ICMR, policy statement on ethical considerations involved in research on human subjects, 1980, for details see chapter on ethical Issues). Knowledge about the changing scope of nursing responsibility and emerging ethical issues affecting all practitioners in health care today is necessary for a professional nursing practice that accepts accountability for protection of human rights or consumers. Ethics in research is continually preplexing concern, since ethical demands often conflicts with scientific requirements. The researcher need to develop great sensitivity to ethical considerations.

RECORDS OF EXISTING DATA AS A TECHNIQUE OF DATA COLLECTION The use of records and available data sometimes is considered to be primarily the province of historical research, but hospital records, care plans, and existing data sources, such as census, are frequently used for collecting information. Existing data sources for necessary research

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Essentials of Nursing Research include public records, personal health records investigator generated data basis associated with earlier studies, national data bases, and mass media. Records or existing data, that are collected from existing materials, such as hospital records, historical documents, or videotapes are used to answer research questions in a new manner. There are many advantages of using existing data. Because the data are available, the investigator does not spend much time and money in collecting the data. Moreover, existing data enables the investigator to trace patterns overtime. Data bases such as the large national databases offer the advantage of a large sample size and broad geographical area. The use of available data may save the researcher considerable time and money when conducting a study. This data collection methods reduces the problems with both reactivity and ethical concerns. The disadvantages of using available data / existing data include missing data, omission of needed data, idiosyncratic methods of recording, poor quality of documents, inconsistency in definition between the investigator’s proposed study and the existing data, and adequacy of the methods used to collect the initial data. However, records and available data are subject to problems of availability authenticity and accuracy.

Testing of Measurement Tools Measuring of nursing phenomena is a major challenge concern of nursing researchers. Because many new constructs are relevant in nursing theory, and few established measuring instruments are available to the researcher, investigators frequently face the challenge of developing instruments. Reliability and validity are great concern whether an investigator chooses to use an available instrument or must develop an appropriate measurement tool. Unless measurement tools validity and reliability reflect the concepts of the theory being tested, conclusion drawn from empirical phase of the study will be invalid and will not advance the development of nursing theory. Thus, after developing the tool/instrument, it is must that investigator should establish the reliability and validity of that tool. Reliability is the proportion of accuracy to inaccuracy in measurement. Validity refers to an instrument or test actually testing what it is supposed to test. Observed scores that are derived from a set of items consist of true scores plus error. The error may be either chance error or random or it may be what is known as systematic error. Validity is concerned with the systematic error, whereas reliability is concerned with random error.

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Random errors are unsystematic in the nature and are a result of a transient state in the subject, in the context of the study, or in the administration of

Techniques of Data Collection the instrument. For example, in the measurement of temperature, fluctuation in the room, thermometer placement, and person’s attempting to talk, despite the fact that the person’s true body temperature remains stable over several occasions of measurement. Systematic error or construct error is measurement error that is attributable to relatively stable characteristics of the study, population that may bias that behaviour and/or cause incorrect instrument calibration. For example, level of education, socioeconomic status, social desirability, response set, or other characteristics may influence the validity of the instrument by altering measurement of the ‘true’ responses in a systematic way.

Validity Validity refers to whether a measurement instrument accurately measures what it is supposed to measure. When an instrument is valid, it truly reflects the concept, it is supposed to measure. There are three kinds of validity that vary according to the kind of information provided and the purpose of the investigations are: • Content validity. • Criterion validity. • Construct validity.

Content Validity Content validity refers to the adequacy of the sampling of the domain being studies i.e., it represents the universe of content or the domain of a given construct. The universe content provides the framework and basis for formulating items that will adequately represent the content. When an investigator is developing a tool and issues of content validity arise, the concern is whether the measurement tool and the items it contains are representative of the content domain the researcher intends to measure. The researcher begins by defining the concept and identifying the dimensions that are the components of the concept. Those items that reflect the concept and its dimensions are formulated. After formulation, the items are submitted to a panel of judges/experts, who know about the concepts by requesting to indicate their agreement with the scope of the items and the extent to which the items reflect the concept under consideration. A subtype of content validity is face validity and consensual. Face validity refers to rudimentary type of validity that verified basically that the instrument gives the appearance of measuring concepts. In which the colleagues or subjects can give their opinion about instrument. Consensual validity is a process by which a panel of experts judges the validity.

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Criterion Validity Criterion validity represents the relationship between one measure and another measure of the same phenomena. It indicates so what degree the subject’s performance on the measurement tool and the subjects’ actual behaviour are related. The criterion is usually second measure, which assists the same concept under study. This approach to validation represents a challenge in nursing, because of the newness of some concepts and the lack of instruments to measure them. There are two forms of criterion validity concurrent and predictive. Concurrent validity, refers to the degree of correlation of two measures of the same concept administered at the same time. A high correlation coefficient indicates agreement between the two measures. Predictive validity refers to the degree of correlation between the measure of the concept and some future measure of the same concept. Because of the passage of time, the correlation coefficients are likely to be somewhat lower for predictive validation studies. Both types of validity are estimated with simple correlation coefficients.

Construct Validity Construct validity is based on the extent to which a test measures a theoretical construct or trait. It involves attempting to validate a body of theory underlying the measure and testing hypothesised relationship. The major focus of construct validity is on the abstract concept that is being measured and its relationships to other concepts. Construct validation is a cyclical process that unites psychometric procedures with theory development. Constructs are specified and then interrelated with others in empirical testing. Empirical testing confirms of fails to confirm the relationship that would be predicted among concepts. It is a complex process, often involves several studies. Two strategies for assessing construct validity include convergent and divergent approaches. Convergent validity: It refers to a search for other measures of the construct. When two or more tools that theoretically measure the same construct are identified, they are both administered to the same subject. A correlational analysis is performed. If the measures are positively correlated, convergent validity is said to be supported.

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Divergent validity: It searchers further instruments that measure the opposite of the contruct. It refers to the ability to differentiate the construct from others that may be similar. If the divergent measure is negatively related to other measures, validity of the measure is strengthened.

Techniques of Data Collection A specific method of assessing convergent and divergent validity is that multitrait-multimethod approach (Campbell and Fiske 1959). For example, anxiety could be measured by: • Administering the State-Trait anxiety inventory • Recording blood pressure readings • Asking subjects about Indian feelings • Observing the subject behaviour.

Reliability Reliability refers to the accuracy or inaccuracy rate in measurement device. Reliable people are people whose behaviour can be relied on to be consistent and predictable. Reliability is defined as the extent to which instrument yields the same results on repeated measures. Reliability is then concerned with consistency, accuracy, precision, stability, equivalence and homogeneity. The three main attributes of a reliable scale are stability, homogeneity and equivalence. The stability of an instrument refers to the instrument’s ability to produce the same results with repeated testing. The homogeneity of an instrument mean that all the items in a tool measure the same concepts or characteristic. An instrument is said to exhibit equivalence of the tool produces the same results when equivalent or parallel instruments or procedures are used. The tests that are used to estimate stability are test-retest and parallel or alternative form. Homogeneity can be assessed by using one of four methods, item-total correlations, split-half reliability, Kuder-Richardson (KR-20) coefficient or Cronbachs alpha. And there are two methods to test-equivalence. They are interrater reliability and alternate parallel form. (The Details of these test are studied in statistics).

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Pilot Study

Pilot study is the study carried out at the end of the planning phase of research, in order to explore and test the research elements. Pilot studies, although not an absolute requirement, are frequently worthwhile. A pilot study is a miniature version of the planned research, searcher to identify and correct problems which could affect the research process. It is important that the phases of the pilot study be carried out as carefully as the actual research. It is also important that the sample for the pilot study be as representative of the entire research sample as possible; ideally the pilot sample should be selected at random form the research sample. The pilot study is a small scale dress rehearsal that proceeds as if it were the actual study, except for the fact, that subjects who will participate in the actual study are not used. However, they may be selected at this point. The pilot study is a small preliminary investigation of the same general character as the major study, which is designed to acquaint the researcher with problems that can be corrected in preparation for the large research projects or is done to provide the researcher with an opportunity to try out the procedures for collecting data. During the pilot study the instrument is going through a pretest, although the instrument’s content is expected to be in final form by this stage. The primary objective of the pilot study is to test as many elements of the research proposal as possible, in order to correct any part that does not work well. For example, the pilot study tests whether the variable defined by operational definition are actually observable and measurable. It is difficult to plan a major study or project without adequate knowledge of its subject matter, the population it is to cover, their level of knowledge and understanding and the like. What are the issues involved? What are the concepts associated with the subject matter? How can they be operationalized? What method of study is appropriate? How long the

Pilot Study study will take? How much money it will cost? These and other related questions call for a good deal of knowledge of the subject matter of the study and its dimensions. In order to gain such pre-knowledge of the subject matter of an extensive study, a preliminary investigation is conducted. This is called a pilot study. A pilot study is a “small scale replica” of the main study. It is the rehearsal of the main study. It covers the entire process of research: Preparation of a broad plan of the study, construction of tools, collection of data, processing and analysis of data and report writing.

Purpose of a Pilot Study A pilot study fulfils one or more of the following purposes: • It provides a better knowledge of the problem under study and its dimensions. • It provides guidance on conceptualization – identification and operationalization of concepts relating to the study. • It assists in discovering the nature of relationship between variables and in formulating hypothesis. • It shows the nature of the population to be surveyed and the variability within it. This is of importance in determining an efficient sample design. • A pilot study shows whether the available sampling frame from which sampling is to be drawn is adequate, complete accurate, up-to-date and convenient. • It provides data on the relative suitability of alternative methods of collection of data – observation, mailing, interviewing – their relative cost, accuracy and response rates to make a sensible choice. • It shows the adequacy of the tool for data collection. • It also helps in discovering mechanical problems relating to interviews/ mailing. • It assists in developing better approaches to target population – as regards introduction, rapport etc. • It provides information for structuring questions with alternative answers. • It helps the researcher to develop an appropriate plan of analysis. • It enables the researcher to identify field problems to be encountered and suggests remedial approaches. • It provides information for estimating the probable cost and duration of the main study and of its various stages. • Above all, it helps the researcher to determine whether or not a more substantial study is warranted. In the light of the results of the pilot study, the researcher will be able to take a pragmatic view on the main study’s potentialities and feasibility.

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The size, scope and design of the pilot study is a matter of convenience, time and money. It should be large enough to fulfill the above functions and the sample should be of a comparable structure to that of the main study. It should be designed so as to ensure a testing of alternative methods of data collection, ordering the questions, wording and the like. It should succeed in disclosing the significant difficulties to be guarded against. In the light of the outcome of the pilot study, if it is found that the main study is worth undertaking, then it is adequately designed on the basis of the results of the pilot study and the lessons drawn from its experience. The time and effort to conduct a pilot study is well worth it. Pitfalls and errors that may prove costly in the actual study may be identified and avoided. Thus, the purpose of the pilot study is two fold: Firstly to make improvements in the research project, and secondly to detect problems that must be eradicated before the major study is attempted. Actually, every research study should serve as a pilot study in anticipation of larger study. The pilot study should be only large enough to be representative of the sample, which might in some cases be ten percent of the anticipated (people) sample size. This number would give some indication of the major problems that will arise in the research study. It is very important that information discussed during the pilot study or pretest is kept confidential. Subjects in the major study should not be contacted ahead of time, since neither the procedure nor the items should be discussed with them. The purpose and hypothesis of the study should be kept confidential until the appropriate time for announcement. Any publication of the purpose, nature or methods of pilot study may bias the major study. Pretesting of instrument also carried in the pilot study. While a pilot study is a full-fledged miniature study of a problem, pretest is a trial test of a specific aspect of the study such as method of data collection or data collection instrument—interview schedule, mailed questionnaire of measurement scale. An instrument of data collection is designed with reference to the data requirements of the study. But it cannot be perfected purely on the basis of a critical scrutiny by the designer and other researchers. It should be empirically tested. As emphatically pointed by Goode and Hatt, “No amount of thinking, no matter how logical the mind or brilliant the insight, is likely to take the place of careful empirical checking”. Hence, pretesting of a draft instrument is indispensable. Pretesting means trial administration of the instrument to a sample of respondents before finalising it.

Pilot Study Pretesting has several purpose: 1. to test whether the instrument would elicit responses required to achieve the research objectives, 2. to test whether the content of the instrument is relevant and adequate, 3. to test whether wording of questions is clear and suited to the understanding of the respondents, 4. to test the other qualitative aspects of the instrument like question structure and question sequence, and 5. to develop appropriate procedure for administering the instrument with reference to field conditions. Pretesting is the process of measuring the effectiveness of the instrument used to gather data. After the research tool is completed it must be tested on subjects who meet the criterion for the study sample. This is called pre-testing. Instrument and scales are likewise tested to determine if each actually measures what the researcher intends it to measure. It is important that all steps in a pilot study be carried through because it is only by completing the full procedures that weaknesses can be identified. A thorough methodologist will tabulate the data in order to detect problem areas that are hidden. Perhaps, the data are not giving the responses expected. Poorly worded items, ambiguous answers, a rather high proportion of respondents who refuse to be interviewed or to return questionnaires and marginal comments all point to corrections that should be made before the research tool is in the major study. For example, if questionnaire is used, the pilot study reveals any problems the respondents have with either the instructions or the wording. If an interview schedule is used; the pilot study answers many questions, including the following: • Is proper place available for the interview? • How much time is needed to ask all the questions? • Is more than one interviewer needed? • Are they properly trained? • Do the subjects understand the wording of questions? The cost factor must be kept in a mind and may be a determining feature of pilot study. A monetary consideration is also involved in the interviewing process. Often beginning research students work in order to finance their education, leaving a minimal amount of time available for interviewing. The fear of failure should not force the conscientious researcher to return to the library to pretest his instrument and to conduct pilot studies in the field until he has an effective tool. The major advantages of pilot study are as follows: 1. It tells about the completeness, accuracy, and convenience of the sampling frame from which it is proposed to select the sample.

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2. It unfolds the variability (with regard to the subject under investigation) within the population to the surveyed/studies. This is of importance in determining the size of the sample. 3. It helps in bringing out the inadequacies of the draft questionnaire. It throws light on several difficulties. 4. It shows how effective the training has been in ridding the interviewers of their prejudices and in motivating them, what are the deficiencies of training curricula, staff incentives etc. 5. It helps in distinguishing the serious type of interviewers from the cheat. It also helps in finding out the type of person ‘most likely’ to be a good interviewer in the study. 6. It allays interviewers’ fears about overtly sensitive questions and builds their self-confidence. They learn to respect the local culture. 7. It tests interviewers’ stamina to work under conditions, of personal discomfort, stress and fatigue. 8. It tests the efficiency of the survey organisation in the field, including type of supervision and instructions. 9. It helps in identifying the need for different kinds of equipment and vehicles, which are necessary during project. 10. It provides data for making estimates of time and costs for completing various phases of the project and shows way to effect savings. A pilot study is the whole study operation in miniature. It is a careful empirical checking of all phases of the study from the collection of data to their tabulation and analysis. In testing the directions of hypothesized relationships, the pilot study should be submitted to the same type of data analysis as expected for the main study. At least, basic measures of central tendency and dispersion should be obtained to determine whether hypotheses are holding up as expected for major independent/dependent variable relationships. The scale of pilot study will depend on the available resources of time, money and personnel, but it should be a large enough to permit in initial analysis of the adequacy of the questionnaire and of the training, instructions and supervision of interviewer, under field conditions. A pilot study is thus a sort of “dress rehearsal” which reveals to the planners and interviewers the weaknesses and teaches them are correct way of doing their job. They come to know about several things. For example, interviewers learn whom should they approach, in the town or village to explain themselves. What should they say and not say. What is too much and what is too little explanation, what assurances can or cannot be given, how can factionalism or disputes be handled before the study is jeopardized in the community; how should interviewers dress and which kind of behavior they must avoid and so on. In short, the pilot study is a

Pilot Study preview of how will interviewers perform, respondents behave, and procedures in work place.

Pretest Procedure A broad guideline is suggested below for pretesting of an instrument. The first testing of a draft instrument can be done among one’s colleagues in order to find out its shortcomings. After this “in-house” testing, it should be revised and tested in the field. The instrument may be administered to 15 to 20 sample respondents drawn from the universe relating to the planned survey. They may be interviewed or copies of the instruments mailed to them, depending on the method selected for data collection. Test mailings are useful, but it is quicker to use a substitute procedure. That is, copies of the draft questionnaires may be handed over to a few respondents with a request to complete them. The researcher may meet them later and request them to comment on question clarity and other aspects of the questionnaire. This appeal for advice may elicit their cooperation, and the researcher can get constructive suggestions for revising the questionnaire. Whatever be the mode of pretesting, it is important to conduct the field test under actual field conditions. The pretest responses should be carefully examined and analysed in order to identify the weaknesses of the instrument. The researcher should look for signs or indicators of weaknesses. As pointed by Goode and Hatt, the signs may include: 1. lack of order in the answer which may be caused by a poor conceptualization; 2. “all-or-none” responses i.e., questions eliciting mere stereotyped responses; 3. a high proportion of “don’t know” or “don’t understand” answers, which indicate that the questions are improperly drawn or vague or a bad sampling design has been used; 4. a great number of qualifications or irrelevant comments, indicating the inadequate listing of alternative answers; 5. a high proportion of refusals to answer indicating out of context of the question or poor transition from one subject area to another; 6. inconsistencies in answers, 7. problem of space and the like. Necessary corrections, deletions, additions and changes in question wording and sequences should be made to eliminate the imperfections discovered. Often, several pretesting with different sets of new respondents are required until a workable instrument is achieved. The importance of ‘restrevise’ retest cycle’ needs no emphasis. Any failure to take this step will lead to poor research results. Testing is the hallmark of a scientific research.

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Data Analysis and Interpretation

Analysis is a process which enters into research in one form or another from the very beginning. It may be fair to say that research consists, in general, of two larger steps—the gathering data, and analysis of these data, but no amount of analysis can validly extract from the data factors which are not present. The analysis and interpretation of data involves the objective material in the possession of the researcher and his subjective reactions and desire to derive from the data the inherent meanings in that relation to the problem. To avoid making conclusions or interpretations from insufficient or invalid data, the final analysis must be anticipated in detail, when plans are being made for collecting information. The problem should be analysed in detail to see that what data are necessary in its solution and to be assured that the method used will provide definite answers. The researcher must determine whether or not the factors chosen for study will satisfy all the conditions of the problem and if the sources to be used will provide the requisite data. The discovery of order in the phenomenon of nature notwithstanding their complexity and apparent confusion is rendered possible by the process of analysis and synthesis which are foundation stone of all scientific method. The data, after collection, has to be processed and analysed in accordance with the outline drawn for the purpose at the time of developing the research plan. This is essential for a scientific study and for ensuring that we have all relevant data for making coding, classification and tabulation of collected data so that they are amenable to analysis. The term analysis refers to the computation of certain measures along with searching for patterns of relationships that exist among data-groups. Thus, “in the process of analysis, relationships or differences supporting or conflicting with original or new hypotheses should be subjected to statistical tests of significance to determine with what validity, data can be said to indicate any conclusions.” Some experts still do not like to make difference between processing and analysis. They opine that

Data Analysis and Interpretation analysis of data in a general way involves a number of closely related operations which are performed with the purpose of summarising the collected data and organising these in such a manner that they answer the research question(s). We, however, shall prefer to observe the difference between the two terms as stated here in order to understand their implications more clearly. Data in the real world often comes with a large quantum and in a variety of formats that any meaningful interpretation of data cannot be achieved straightaway. Nursing researches to be very specific, draw conclusions using both primary and secondary data. To arrive at a meaningful interpretation on the research hypothesis, the researcher has to prepare his data for this purpose. This preparation involves the identification of data structures, the coding of data and the grouping of data for preliminary research interpretation. This data preparation for research analysis is termed as processing of data. Further selection of tools for analysis would to a large extent depend on the results of this data processing. Data processing is an intermediary stage of work between data collection and data interpretation. The data gathered in the form of questionnaires/interview schedules/field notes/data sheets is mostly in the form of a large volume of research variables. The research variables recognised age a result of the preliminary research plan, which also sets out the data processing methods beforehand. Processing of data requires advance planning and this planning may cover such aspects as identification of variables, hypothetical relationship among the variables and the tentative research hypotheses. The various steps in processing of data may be stated as: a. Identifying the data structures b. Editing the data c. Classifying the data d. Transcriptions of data e. Coding f. Tabulation of data. After carefully collecting data from the study of subjects, the investigator can begin a series of important processes to prepare the data for analysis. The collected data may be adequate, valid and reliable to any extent, it does not serve any worthwhile purpose unless it is carefully edited, systematically classified, and tabulated, scientifically analysed, intelligently interpreted and rationally concluded. The process of data analysis, interpretation and generalisation involves a number of steps. The researcher is faced with the task of organising the individual pieces of information, so that the meaning is

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Essentials of Nursing Research clear. The mass of data collected through a use of various reliable and valid tools is yet but raw. It needs to be systematised and organised, i.e. edited, classified and tabulated before it can serve any worthwhile purpose.

1. Identifying the Data Structure In the data preparation step, the data are prepared in a data format, which allows the analyst to use modern analysis software such as SAS or SPSS. The major criterion in this is to define the data structure. A data structure is a dynamic collection of related variables and can be conveniently represented as a graph whose nodes are labelled by variables. The data structure also defines and states the preliminary relationship between variables/groups of variables that have been preplanned by the researcher. Most data structures can be graphically presented to give clarity as to the framed research hypotheses. A simple structure could be a linear structure, in which one variable leads to the other and finally to the resultant end variable. The identification of the nodal points and the relationships among the nodes, could sometimes be a complex task than estimated. When the task is complex, which involves several types of instruments being collected for the same research question, the procedure for drawing the data structure would involve a series of steps. In several intermediate steps, the heterogeneous data structures of the individual data sets can be harmonised to a common standard and the separate data sets are then integrated into a single data set. However, the clear definition of such data structures would help in the further processing of data.

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The next step in the processing of data is editing of the data instruments. Editing is a process of checking to detect and correct errors and omissions. Editing implies the checking of the gathered data for accuracy, utility and completeness. In other words, editing means to look for and remove any errors, incompleteness or inconsistency in the data. If the raw data are erroneous, incomplete or inconsistent, these deficiencies will be carried through all subsequent stages of processing and will greatly distort the result of any enquiry. Therefore, at this stage certain questions are specified for cent percent editing because they are known to be especially troublesome or particularly critical to study objectives. The job of editor or the project director is to see that none of these questions has been skipped, all answers have been recorded and all replies are internally

Data Analysis and Interpretation consistent with each other. For example, the name is consistent with sex, age with martial status and the number of children born and so on. Further, he should see, that there are no “do not know” “cannot be remembered” or “refused to answer” responses and that all the responses have been legibly recorded and not merely scribbled by the interviewer to hide his language deficiency. In all such cases, the editor or project director should immediately refer back the error or omission to the field for necessary correction. But for some reason if this is not possible, he should take his own decision and should apply it uniformly and consistently to all such cases in future. Documented editing and testing of the data at the time of data recording is done considering the following questions in mind: • Do the filters agree or are the data inconsistent? • Have “missing values” been set to standardised values, which are the same for all research questions? • Have variable descriptions been specified? • Have labels for variable names and value labels been defined and written? All editing and cleaning steps are documented so that the redefinition of variables or later analytical modification requirements could be easily incorporated into the data sets. Data editing is also a requisite before the analysis of data is carried out. This ensures that the data is complete in all respect for subjecting them to further analysis. Some of the usual check list questions that can be had by a researcher for editing data sets before analysis would be: • Is the coding frame complete? • Is the documentary material sufficient for the methodological description of the study? • Is the storage medium readable and reliable? • Has the correct data set been framed? • Is the number of cases correct? • Are there differences between questionnaire, coding frame and data? • Are there undefined and so-called “wild codes” or duplicate cases? • Comparison of the first counting of the data with the original documents of the researcher. The editing step checks for the completeness, accuracy and uniformity of the data set created by the researcher. a. Completeness: The first step of editing is to check whether there is an answer to all the questions/variables set out in the data set. If there were any omission, the researcher sometimes would be able to deduce the correct answer from other related data on the same instrument. If this is possible, the data set has to be rewritten on the basis of the new

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Essentials of Nursing Research information. For example, the approximate family income can be inferred from other answers to probes such as occupation of family members, sources of income, approximate spending and saving and borrowing habits of family members, etc. If the information is vital and has been found to be incomplete, then the researcher can take the step of contacting the respondent personally again and solicit the requisite data again. If none of these steps could be resorted to, the marking of the data as “missing” must be resorted to. b. Accuracy: Apart from checking for omissions, the accuracy of each recorded answer should be checked. A random check process can be applied to trace the errors at this step. Consistency in response can also be checked at this step. The cross verification to a few related responses would help in checking for consistency in responses. The reliability of the data set would heavily depend on this step of error correction. While clear inconsistencies should be rectified in the data sets, fake responses should be dropped from the data sets.

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c. Uniformity: In editing data sets, another keen look out should be for any lack of uniformity in interpretation of questions and instructions by the data recorders. For instance, the responses towards a specific feeling could have been queried from a positive as well as a negative angle. While interpreting the answers, care should be taken so as to record the answer as a “positive question” response or as “negative question” response. In all, uniformity checks for consistency in coding throughout the questionnaire/interview schedule response/data set. The final point in the editing of data sets is to maintain a log of all corrections that have been carried out at this stage. The documentation of these corrections help the researcher to retain the original data set. Editing of data is a process of examining the collected raw data (specially in surveys) to detect errors and omissions and to correct these when possible. As a matter of fact, editing involves a careful scrutiny of the completed questionnaires and/or schedules. Editing is done to assume that the data are accurate, consistent with other facts gathered, uniformly entered, as completed as possible and have been well arranged to facilitate coding and tabulation. With regard to points or stages at which editing should be done, one can talk of field editing and central editing. Field editing consists in the review of the reporting forms by the investigator for completing (translating or rewriting) what the latter has written in abbreviated and/or in illegible form at the time of recording the respondent’s responses. This type of editing is necessary in view of the fact that individual writing styles often the interview, preferably on the very day or on the next day.

Data Analysis and Interpretation While doing field editing, the investigator must restrain himself and must not correct errors of omission by simply guessing what the informant would have said if the question had been asked. Central editing should take place when all forms or schedules have been completed and returned to the office. This type of editing implies that all forms should get a thorough editing by a single editor in a small study and by a team of editors in case of a large inquiry. Editor(s) may correct the obvious errors such as an entry in the wrong place, entry recorded in months when it should have been recorded in weeks, and the like. In case of inappropriate missing replies, the editor can sometimes determine the proper answer by reviewing the other information in the schedule. At times, the respondent can be contacted for clarification. The editor must strike out the answer if the same is inappropriate and he has no basis for determining the correct answer or the response. In such a case an editing entry of ‘no answer’ is called for. All the wrong replies, which are quite obvious, must be dropped from the final results, especially in the context of mail surveys. Editors must keep in view several points while performing their work: (a) They should be familiar with instructions given to the interviewers and coders as well as with the editing instructions supplied to them for the purpose. (b) While crossing out an original entry for one reason or another, they should just draw a single line on it so that the same may remain legible. (c) They must make entries (if any) in the form in some distinctive colour and that too in a standardised form. (d) They should initial all answers which they change or supply. (e) Editor’s initials and the date of editing should be placed on each completed form or schedule.

3. Classification of Data When open-ended responses have been received, classification is necessary to code the response. For instance, the income of the responded could be an open-ended question. From all responses, a suitable classification can be arrived at. A classification method should meet certain requirements or should be guided by certain rules. First, classification should be linked to the theory and the aim of the particular study. The objectives of the study will determine the dimensions chosen for coding. The categorisation should meet the information required to test the hypotheses or investigative questions. Second, the scheme of classification should be exhaustive. That is, there must be a category for every response. For example, the classification of marital status into three category viz., “married,” “single,” and “divorced” is not exhaustive, because responses like “widower” or “separated” cannot be fitted into the scheme. Here, an open-ended

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Essentials of Nursing Research question will be the best mode of getting the response. From the responses collected, the researcher can fit a meaningful and theoretically supportive classification. The inclusion of the classification “others” tends to fill in the cluttered, but few responses from the data sheets. But “others” categorisation has to be carefully used by the researcher. However, the “other” categorisation tends to defeat the very purpose of classification, which is designed to distinguish between observations in terms of the properties under study. The classification “others” will be very useful when a minority of respondents in the data set give varying answers. For instance, the reading habits of newspapers may be surveyed. The 95 respondents out of 100 could be easily classified into 5 large reading groups while the 5 respondents could have given a unique answer. These given answers rather than being separately considered could be clubbed under the “others” heading for meaningful interpretation of respondents’ reading habits. Third, the categories must also be mutually exhaustive so that each case is classified only once. This requirement is violated when some of the categories overlap or different dimensions are mixed up. The number of categorisation for a specific question/observation at the coding stage should be maximum permissible. Since, reducing the categorisation at the analysis level would be easier than splitting an already classified group of responses. However, the number of categories is limited by the number of cases and the anticipated statistical analysis that are to be used on the observation. Most research studies result in a large volume of raw data which must be reduced into homogeneous groups if we are to get meaningful relationships. This fact necessitates classification of data which happens to be the process of arranging data in groups or classes on the basis of common characteristics. Data having a common characteristic are placed in one class and in this way the entire data get divided into a number of groups or classes. Classification can be of one of the following two types, depending upon the nature of the phenomenon involved:

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a. Classification according to attributes: As stated above, data are classified on the basis of common characteristics which can either be descriptive (such as literacy, sex, honesty, etc), or numerical (such as weight, height, income, etc). Descriptive characteristics refer to qualitative phenomenon which cannot be measured quantitatively, only their presence or absence in an individual item can be noticed. Data obtained this way on the basis of certain attributes are known as statistics of attributes and their classification is said to be classification according to attributes.

Data Analysis and Interpretation Such classification can be simple classification or manifold classification. In simple classification we consider only one attribute and divide the universe into two classes— one class consisting of items possessing the given attribute and the other class consisting of items which do not possess the given attribute. But in manifold classification we consider two or more attributes simultaneously, and divide that data into a number of classes (total number of classes of final order is given by 2,’ where n=number of attributes considered). Whenever data are classified according to attributes, the researcher must see that the attributes are defined in such a manner that there is least possibility of any doubt/ambiguity concerning the said attributes. b. Classification according to class-intervals: Unlike descriptive characteristics, the numerical characteristics refer to quantitative phenomenon which can be measured through some statistical units. Data relating to income, production, age, weight, etc. come under this category. Such data are known as statistics of variable and are classified on the basis of class intervals. For instance, persons whose incomes, are say within Rs 201 to Rs 400 can form one group, those whose incomes are within Rs 401 to Rs 600 can form another group and so on. In this way the entire data may be divided into a number of groups or classes or what are usually called, ‘class-intervals.’ Each group of class-interval, thus, has an upper limit as well as a lower limit which are known as class limits. The difference between the two class limits is known as class magnitude. We may have classes with equal class magnitudes or with unequal class magnitudes. The number of items which fall in a given class is known as the frequency of the given class. All the classes or groups, with their respective frequencies taken together and put in the form of a table, are described as group frequency distribution or simply frequency distribution. Classifying refers to the dividing up of the data into different categories, classification or sub-headings for use. After the data have been properly edited, they need to be arranged in homogeneous groups on the basis of their characteristics. When data are classified on the basis of qualities and attributes which are incapable of quantitative measurement, the classification is said to be according to attributes and when the data are classified on the basis of quantitative measurement, the classification is said to be according to class intervals. The two operations which help in classification of voluminous survey data are transcription and coding. Classes of the final order are those classes developed on the basis of ‘n’ attributes considered. For example, if attributes A and B are studied and their presence is denoted by A and B respectively and absence by a

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Essentials of Nursing Research and b respectively, then we have four classes of final order viz., class AB, class Ab, class aB, and class ab.

4. Transcriptions of Data When the observations collected by the researcher are not very large, the simple inferences that can be drawn from the observations can be transferred to a data sheet, which is a summary of all responses on all observations from a research instrument. The main aim of transition is minimisation. It contains 120 responses and the observations have been collected from 200 respondents to prepare a simple summary of one response from all 200 observations would require a shuffling of 200 pages. The process is quite tedious if several summary tables are to be prepared from the instrument. The transcription process helps in the presentation of all responses and observations on data sheets, which can help the researcher to arrive at preliminary conclusions as to the nature of the sample collected etc. Transcription is, hence, an intermediary process between data coding and data tabulation.

Methods of Transcription

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The researcher may adopt a manual or computerized transcription. Long work sheets, sorting cards or sorting strips could be used by the researcher to manually transcript the responses. The computerized transcription could be done using a data base package such as spreadsheets, text files or other data bases. The main requisite for a transcription process is the preparation of the data sheets where observations are the rows of the data base and the responses/variables are the columns of the data sheet. Each variable should be given a label so that long questions can be covered under the label names. The label names are thus the links to specific questions in the research instrument. For instance, opinion on consumer satisfaction could be identified through a number of statements (say 10). The data sheet does not contain the details of the statement, but gives a link to the question in the research instrument through variable labels. In this instance the variable names could be given as CS1, CS2, CS3, CS4, CS5, CS6, CS7, CS8, CS9 and CS10. The label CS indicating Consumer Satisfaction and the number 1 to 10 indicates the statements measuring consumer satisfaction. Once the labelling process has been gone through for all the responses in the research instrument, the transcription of the responses is done.

Data Analysis and Interpretation

5. Coding Coding refers to the process of assigning numerals or other symbols to answers so that responses can be put into a limited number of categories or classes. Such classes should be appropriate to the research problem under consideration. They must also possess the characteristic of exhaustiveness (i.e. there must be a class for every data item) and also that of mutual exclusively with means that a specific answer can be placed in only one cell in a given category set. Another rule to be observed is that of unidimensionality by which, it meant that every class is defined in terms of only one concept. Coding is necessary for efficient analysis and through it the several replies may be reduced to a small number of classes which contain the critical information required for analysis. Coding decisions should usually be taken at the designing stage of the questionnaire. This makes it possible to precode the questionnaire choices and which, in turn, is helpful for computer tabulation as one can straight forward key punch from the original questionnaires. But in case of hand coding some standard method may be used. One such standard method is to code in the margin with a coloured pencil. The other method can be to transcribe the data from the questionnaire to a coding sheet. Whatever method is adopted, one should see that coding errors are altogether eliminated or reduced to the minimum level. The edited data are then subject to codification and classification. Coding process assigns numerals or other symbols to the several responses of the data set. It is, therefore, a pre-requisite to prepare a coding scheme for the data set. The recording of the data is done on the basis of this coding scheme. The coding sheet needs to be prepared carefully if the data recording is not done by the researcher, but is outsourced to a data entry firm or individual. In order to enter the data in the same perspective, as the researcher would like to view it, the data coding sheet is to be prepared first and a copy of the data coding sheet should be given to the outsourcer to help in the data entry procedure. Sometimes, the researcher might not be able to code the data from the primary instrument itself. He may need to classify the responses and then code them. For this purpose, classification of data is also necessary at the data entry stage. Data analysis is the processes by which the researcher summarises and describes data and, if possible, makes inferences from the study sample to the population from which the sample was drawn. Using descriptive statistics enables the researcher to summarise and describe data. Using inferential statistics allows the researcher to estimate the probability that findings from the study sample may be generalised to the target population.

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Essentials of Nursing Research Guidelines for Coding Questionnaire. Following are some important guidelines which should be borne in mind while coding questionnaires: 1. Codes should be mutually exclusive: In other words one code should be specific to only one kind of information so that a given response falls in only one category. 2. Set of categories should be collectively exhaustive so that all responses could be classified in one or the other category. Generally speaking for closed ended or fixed alternative questions the researcher is able to anticipate all possible responses but it is difficult to anticipate all possible responses for open ended or free response questions. Thus, a miscellaneous category should be created for recoding unanticipated responses, which do not fit any other precoded category. These responses should be recorded verbatim. 3. Separate categories should be created for recording ‘non-response’ and ‘no knowledge’ responses. Non-response means ‘won’t answer’ (refusal), and no knowledge means can’t answer (ignorance). A separate analysis of these categories may be important and meaningful in many cases. 4. Intercoder and intracoder agreement tests should be conducted throughout the entire coding process to check its reliability. Intercoder agreement means the degree to which any coder will classify and code any given response in the same way that any other coder will classify and code the response. Inter coder agreement means the degree to which any coder will classify and code any given response in the same way that any other coder will classify and code the response. Intracoder agreement means the degree to which the same coder will code the same response in the same way at different points in time. 5. To help ensure that responses are being coded systematically, a senior person should be appointed as head of the coding team. This person should be familiar with all conceptual and operational aspects of the survey and be entirely conversant with the coding process. He should be responsible for decisions whenever there is doubt as to how an item should be coded. In this way, whatever bias will creep into the data, it will be from a constant source.

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Tabulation can be done manually or through the computer. The choice depends upon the size and type of study, cost considerations, time pressures and the availability of software packages. Manual tabulation is suitable for small and simple studies.

Data Analysis and Interpretation Tabulation of data is the process of arranging the material in a concise and logical order. The classification procedure that forms categories and groups commonly begins before the data are gathered but seldom actually completed until all data have been collected. Following this process, the data may be organised in various ways, constructing an array of the material is a common way. An array is a list of the observations in which the data are ranked from lowest to highest. For example, if the observations have been collected on the ages of persons in the sample, there may be a number of different ages in the age category that may be ordered by listing each one from the youngest to the oldest: 18, 19, 20, 21, 22, 24, 29, 29, and so on. Thus, the array organises data in a form that may be easily described and summarised. The next essential process is to count the number of cases that belong to the various categories. The result of such a count is called a frequency (designated by the letter f). The frequency tells how often a characteristic occurs, such as age “20” or sex “female.” At times, a frequency count is the only kind of quantitative data that is possible to obtain. At other times, it is the first step towards a more complicated analysis of the observations. A frequency distribution indicates how certain characteristics are spread across different locations or categories. For example, if we wish to know how age is distributed among males in the sample– how many men are under 21 years of age, how many are between 21 and 40, between 41 and 60, between 61 and 80, and between 81 and 100, a count of the men in each age group will give the frequency distribution, which may then be depicted by a figure, chart, or table. To make a frequency distribution, it is necessary first to establish the set of categories into which the data will be grouped. The categories must be exhaustive, mutually exclusive, homogeneous, logical, and consistent. All of the categories must be of the same size, spanning the same number of units of measurement. The categories of age for adult males noted above span 20 years each, beginning at 21 years of age, a faulty universal definition of adulthood in western society. Groups of scores (weights, ages, lengths, etc.) placed into categories of particular units are called class intervals (designated by the lower case letter i). Class is the category, such as “age,” while interval is the standard size of each category (20 years in the example above). Frequency distributions using class intervals are helpful to analyze ordinal and interval data, which may then be depicted in a table or a graph.

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The rules and procedures in constructing statistical tables are not entirely standardised, but there are certain generally accepted principles and usages which should be adhered to closely: 1. Every table should have a title. The title should represent a succinct description of the contents of the table, and should make the table intelligible without reference to the text. The title should be clear, concise, and adequate and should answer the questions what? Where? and When? The title should always be placed above the body of the table. 2. Every table should be identified by a number to facilitate easy reference. The number may be either arabic or roman, and it can be centered above the title or placed on the first line of the title. 3. The captions or column headings and the stubs or row headings of the table should be clear and brief. 4. Any explanatory footnotes concerning the table itself are placed directly beneath the table, and in order to obviate any possible confusion with the textual footnotes such reference symbols as the asterisk (*), dagger (†), double dagger (‡), and section mark (§) should be used. 5. If the data in a series of tables have been obtained from different sources, it is ordinarily advisable to indicate the specific sources in an inconspicuous place just below the table. 6. In order to emphasize the relative significance of certain categories, different kinds of type, spacing, and indentation can be used. 7. Leaders are generally used to guide the eye from the stubs to the first column, except where the column is set so closely that no guide is required. 8. It is important that all column figures be properly aligned. Decimal points and plus-minus signs should also be in perfect alignment. 9. Usually the columns are separated from one another by lines. Lines of this kind bring out the relations of the data more clearly and make the table more readable and attractive. Lines are always drawn at the top and bottom of the table and below the captions. It is not at all necessary to draw lines along the sides of the table. 10. Sometimes the columns are numbered to facilitate reference. 11. Miscellaneous and exceptional items are generally placed in the last row of the table. 12. Since it may be found very confusing to read a long table when all the rows or lines are single spaced it is a common practice to group the stubs, as these sideheads are called. Generally, grouping of stubs by fives or fours is very satisfactory. 13. Abbreviations should be avoided whenever possible and ditto marks should not be used in a statistical table.

Data Analysis and Interpretation 14. The actual arrangement of the major classes in the table depends on the facts and relationships that are to be emphasized. It should always be kept in mind, however, that a statistical table should be made as logical, clear, accurate, and simple as possible. 15. Columns and rows which are to be compared with one another should be brought close together. 16. Totals can be placed either at the top or at the bottom. It might be pointed out in this connection that the most conspicuous part of a table is the upper left-hand corner. 17. The arrangement of the categories in a table may be chronological, geographical, alphabetical, or according to magnitude. Chronological series may read from top to bottom or from bottom to top, or left to right or right to left, depending on the emphasis or importance of the data in the series. With the exception of time series, categories as a rule should be arranged according to magnitude. If the order of importance has no particular significance, geographical order may be employed. Alphabetical arrangement is used much more frequently in general purpose than in special purpose tables. After the data have been tabulated, the next step is to arrange at least part of them in statistical tables. Statistical tables have been referred to as the “shorthand of statistics.” No matter what type of statistical problem one is investigating, there will almost invariably be a need for tables. It is, therefore, of extreme importance for the student of social research to have a thorough understanding of table construction. The advantages of presenting statistical data in tabular form are so obvious as to make extended comment unnecessary. It might, however, be pointed out that: (1) Statistical tables conserve space and reduce explanatory and descriptive statements to a minimum; (2) The visualization of relations and the process of comparison is greatly facilitated by tables; (3) Tabulated data can be more easily remembered than data which are not Tabulated; (4) A tabular arrangement facilitates the summation of items and the detection of errors and omissions; and (5) Statistical tables provide a basis for computations.

Plan for Data Analysis and Interpretation A research study is no better than the quality of the analysis. Plans for the interpretation of data must be made prior to the collection process and should include the formats to be used in the presentation of the data. The method used in analysing the data is a prime factor in the interpretive process. Meaningful interpretation of research findings hinges on correct analysis of data.

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Essentials of Nursing Research When planning data analysis, the researcher must recognize that many correct ways exist to analyse data. The investigator begins by considering the study’s purposes as they relate to research design and the question the study attempts to answer regarding levels, distributions, contrasts or association between concepts. Specification of how each concept was measured and the precise research questions or hypotheses precede specification of the necessary data analysis. Sample characteristics such as size and distribution of the values of the key variables need to be specified before selecting the analytical strategy. And the implication of the most likely patterns of results need to be considered before the analysis of the data can begin. Planning data analysis requires the investigator to consider the domain of descriptive and inferential statistics. These statistical procedures are used to give organisation the meaning of data. Procedures that allow researchers to describe and summarise data are know as descriptive statistics. Procedures that allow researchers to estimate how reliably they can make predictions and generalize finding based on the data are known as ‘inferential statistics.’ In other words, descriptive statistics summarise information about a sample, whereas inferential statistics allow the researcher to make conclusions that extend beyond the sample studied to the population of interest.

Descriptive Statistics

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Descriptive statistical techniques reduce data manageable proportions by summarising them, and they also describe various characteristics of data under study. Descriptive techniques include measures of central tendency, such as mode, median, means and measures of variability, such as model percentage, range, and standard deviation; and some correlation techniques, such as scatter plots. Measures of central tendency describe the average member of the sample. Percentages are especially valuable for comparing two quantities. Ratios are useful in numerical comparison also. Data, to be meaningful, must be placed in an orderly fashion. The measures of central tendency and standard scores all provide valuable arrangements. Descriptive statistics may be presented in several ways in a research report. Prose descriptions should always be reinforced with visual arrangements of the data in tables, graphs or charts. Whatever the method of presentation, the report should give the reader a clear and orderly picture of research results. The other techniques for descriptive data are measurement scales. Nominal scales place data in mutually exclusive categories, such as male and females. Ordinal scales are on ordering of categories; interval scales

Data Analysis and Interpretation make use of measurement between classes; and Ratio scales have an absolute zero point and are mathematically manipulatable (The detail of these measurement scales is explained in the last chapter). Descriptive statistics provide precise, standard ways to summarise, understand and communicate complex information. An important aim of the researcher is to be able to make generalisation from the results of a single study sample, which requires that the descriptive presentation of the data be systematic and objective. Frequency distribution: It is one of the methods used to describe data. It is one of the most basic ways of organising data. A frequency distribution is a systematic way to list a series of observations of a variable. This is done by listing the categories of the scale and then tabulating the frequency of each occurrence. In a frequency distribution the number of times each event occurs is counted or the data are grouped and the frequency of each group is reported. The frequency distribution presents data in tabular or graphic form and allows for the calculation or observations of characteristics of the distribution of the data including skewness, symmetry, modality and kurtosis. • In nonsymmetrical distributions the degree and direction of the pull of the peak off centre are described as ‘SKEW’. • In speaking of modality, the number of peaks is described as unimodal, bimodal or multimodal. • The relative spread of data is described by “Kurtosis”. Each characteristic of the frequency distribution is independent. Measures of central tendency: As stated earlier there are three measures of central tendency, i.e., mode, median and mean. These measures are characteristic representatives of a group and have value for description and comparison. Measures of central tendency describe to average member of sample. 1. The most appearing value is the mode i.e., in the most frequent score. It is quickly determined and is not affected by extreme scores; but it cannot be used for algebraic manipulation. The frequency distribution is bimodal when two modes appear in the clusters of observations or values. 2. The median is a point (not a score) in which half the number of values are above it and half are below it, i.e. it is the middle score. It is easy to calculate and is a useful approximate measure of the average. The median is seldom affected by extreme scores; however, it cannot be handled algebraically.

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Essentials of Nursing Research 3. The mean is the arithmetic average of the scores. This is computed by adding the scores and dividing the sum by the total number of scores. The mean is the most accurate and reliable of the three measures and suitable for mathematical manipulation; however, it is influenced by extreme scores. The mean is the most stable and useful of the measures of central tendency and with the standard deviation it forms the basis for many of the inferential statistics. The normal distribution: The concept of normal distribution is theoretical one, based on the observation of data from repeated measures of interval or ratio level group themselves about a midpoint in a distribution in a manner that closely approximates the ‘normal’ curve. The normal curve is resulting from the distribution of a large number of scores. It beings and ends at a low point where there are few extreme scores and rises in a centre where more scores cluster. In the normal curve, the mode, the median, and the mean all occur at the highest point of the curve. These three measures of central tendency also divide the normal probability curve into two equal parts, the left called the negative side and the right called the positive side. Theoretically, all populations, if large enough, approach the normal probability curve. Frequency distributions with a cluster of units at one end have either a negative or positive skew.

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Measures of variability: Dispersion of measures of variability is concerned with the spread of data. Variability measures answer the question “Is the sample homogeneous or heterogeneous. Is the sample similar or different” as with measures of central tendency, the various measures of variability are specific kinds of measurements and types of distribution are modal percentage range, semiquartile range, percentile, standard deviations, and standard scores of Z score. 1. Model percentage is the percent of the cases in the mode. It is used with nominal data and is the percentage of cases in the mode. A high modal percentage is indicative of decreased variability. 2. The range is the simplest but most unstable measures of variability. The ranges reflect differences between the highest and lowest scores. 3. The semiquartile range indicates the range of the middle 50 percent of the scores. It is more stable than the range, since it is less likely to by changed by a single extreme score. 4. Percentile represents the percentage of cases given score exceeds. 5. Standard deviation is the most stable and useful measure of variability. It is a measure of dispersion and is an average of all deviations from the mean. The standard deviation being of an algebraic in nature, can be combined and used for a composition of the data. It derived its

Data Analysis and Interpretation place as the master measure of variability. It is derived from the concept of the normal curve. In the normal curve, sample scores and means of large number of samples group themselves around the midpoint in the distribution, with a fixed percentage of the scores falling within given distance of the mean. This tendency of means to approximate the normal curve is called the sample distribution of the means. 6. Standard scores are units of the standard deviations. A standard score is the distance of any score or value from the means of the distribution, expressed in standard deviation units. It is possible to compare standard score or units. The Z score (Sigma) is the device used in expressing the standard score, i.e., a Z score in the standard deviation converted to standard units.

Inferential Statistics Inferential statistics combine mathematical processes and logic that allows researchers to test hypotheses about a population using data obtained from probability samples. Inferential statistics enables to go beyond the immediate description of the results of individual research studies in ways that provide the best possible bases for clinical practice or further research. Its main purpose is to provide probabilistic guidelines for the inferences beyond the present set of data. So the statistical inference if generally used for two purposes; to estimate the probability that statistics found in the sample accurately reflect the population parameter, and to test hypotheses about a population. This means an inferential statistics uses the sample finding as the basis to infer or extend the characteristics to the total population. The most commonly used purpose of inferential statistics in hypothesis testing is statistical hypothesis testing allows researcher to make objective decisions about the outcome of their study. As stated in earlier chapter, there were two types of hypothesis. The scientific or research hypothesis is that which the researcher believes will be the outcome of the study. The null hypothesis, which is the hypothesis that actually can be tested by statistical methods would state that there is no difference between the groups. Inferential statistics uses the null hypothesis for testing the validity of a scientific hypothesis in sample data. The null hypothesis states that there is no actual relationship between the variables and that any observed relationship or difference is merely a function of chance fluctuation in sampling. The other purpose of the inferential statistics is to provide probabilistic guidelines for inference beyond the present set of data. The probability of an event is the event’s long run relative frequency in repeated trials under similar conditions. Statistical probability is based on the concepts

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Essentials of Nursing Research of sampling error. Sampling error is a tendency for statistics to fluctuate from one sample to another. There are two types of errors in statistical inference i.e., type I error and type II error. Type I error occurs when the researcher rejects a null hypothesis that is actually true. Type II error occurs when the researcher accepts a null hypothesis that is actually false. The researcher controls the risk of making a type I error by setting the alpha level, or level of significance. Unfortunately, reducing the risk of a type I error by reducing the level of significance increases the risk of making a type II error. Tests of statistical significance: It may be parametric or nonparametric. Parametric tests of significance have three attributes i.e., (i) they involve the estimation of at least one parameter, (ii) they require measurements on at least an interval state, and (iii) they involve certain assumptions about the variable being studied. These assumptions usually include that the variable is normally distributed in the overall population. Whereas the nonparametric tests of significance are not based on the estimation of population parameter, so that they involve less restrictive assumptions about the underlying distribution. Nonparametric tests usually are applied when the variables have been measured on a nominal or ordinal scale. Thus, the test that is used depends on the level of measurement of variables in question and the type of hypothesis being studies. Basically these statistical tests are two types of hypothesis: 1. That there is difference between groups i.e., test of difference 2. That there is a relationship between two or more variables i.e., test of relationship or association. Tables 16.1 and 16.2 show the tests of difference and tests of association. The nonparametric and parametric according to their levels of measurement. Accordingly the commonly used parametric and nonparametric statistical tests include those that of tests for differences between means such as the ‘t’ test and ANOVA, and those that of difference in proportion, such as the Chi-square test. The tests that examine data for the presence of relationships include the Pearson r, the sign test, the Wilcoxon matched pairs, signed ranks test, and multiple regression and also an advanced statistical procedures include path analysis, LISREL and factor analyses.

Interpretation of Data

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By interpretation of data we mean the task of drawing conclusions or inferences and of explaining their significance, after careful analysis of the colleted data. The interpretation of research data cannot be considered in the abstract. In view of the diversity of research methods used in education,

Data Analysis and Interpretation Table 16.1: Tests of difference Level of measurement Nonparametric Nominal Ordinal

Parametric Interval or Ratio

One group

Two groups Related Independent

More than two groups

Chi-squire

Chi-square Fisher exact Probability Sign test ‘Wilcoxon matched pairs Signed rank

Chi-square

Chi-square

Chi-square Median test Mann-whitney

Chi-square

‘Correlated

Independent ANOVA

‘ANOVA ‘ANCOVA ‘MANCOVA

Kolmogrov Smirnov

Correlated ‘ANOVA (repeated reason)

ANOVA–analysis of variance, ANCOVA–analysis of covariance and MANCOVA– multiple analysis of covariance. Table 16.2: Tests of association Levels of measurement Nonparametric Normal Ordinal Parametric Interval or Ratio

Two variables

More than two variables

Phi coefficient Point-biserial –Kendall tau –Spearman rho

Contingency coefficient

Pearsons

–Descriminant function Analysis Multiple regression Path analysis Canonical correlations.

and the corresponding diversity of data they seek, the interpretation of such data is best considered within context of each method. The analysis and interpretation of historical data. For example, best viewed in the light of historical method, its objectives and its limitations. The process of interpretation is essentially one of stating that what the findings show. The findings of the study are the results, conclusions, interpretations, recommendations, generalisations, implications, future research and nursing practice. Interpreting the findings of a study involves a search for their meaning in relation to the problem, conceptual framework, purpose and all the research decisions made in developing and implementing the empirical phase of the study.

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Essentials of Nursing Research The interpretation of findings is an extremely important aspect of conducting a study. Interpreting the results of a study requires confrontation with three types of validity i.e., explanatory validity, ecological validity and methodological validity. Explanatory validity refers to that which the concept is chosen to account for that study findings to do so. This required examination of alternative, equally plausible explanation for the findings. Ecological validity refers to the extent to which the sample of observations in the study represents the substantive domain, the adequacy of the relationships between the study design and substance being studied. Methodological validity refers to the degree of which the findings are a function of a set of methods used to test the theory. Interpretation is by no means a mechanical process. It calls for critical examination of the results of one’s analysis in the light of all the limitations of his data gathering. It is a very important step in the total procedure of research. It is important to recognise that errors can be made in the interpretation just as that can in any of other steps of the scientific method and the specific errors to be guarded against vary with the different research methods. This step is purely subjective and many errors are made at this point. If, however, one is careful and critical of his own thinking, he should be able to make satisfactory interpretations. The following are among the more common errors of interpretation which need to be avoided: Failure to see the problem in proper perspective: Sometimes, investigator may have an inadequate grasp of the problem in its broad sense and too close a focus in its immediate aspect. Failure to appreciate the relevance of various elements: The investigator may fail to see the relevance of the various elements of the situation due to an inadequate grasp of the problem, too rigid a mind set or even a lack of imagination. This may cause the investigator to overlook the operation of a significant factor. Consequently, the outcomes of the study are attributed to the wrong antecedent. Failure to recognise limitations in the research evidence: These limitations may be of many types of such a nonrepresentativeness in sampling, biases in the data, inadequacies in the research design, defective, data gathering instrument and inaccurate analysis. Faulty inferences on the basis of inadequate data. Errors in the use of various tools of analysis like mean, median, mode, percentage.

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Faulty generalisations on the basis of incorrect and unrepresentative sample.

Data Analysis and Interpretation Misinterpretation due to unstudied factors: A given result is composed of many factors. It is not produced simply by a single factor. One’s conclusions are always limited to the factors studied, and the cautious person will not draw generalisations which involve factors and conditions which he has only assumed. Ignoring selective factors: In investigations where a selective group is made the subject of a study or where a selective factor is operating on the situation studied one is likely to reach unwarranted conclusions if one ignores the selective factors. Difficulties of interpretative evaluation Inappropriate comparisons Inadequate Attention to Individual Cases: Many times the results of experiments in social research may not on the whole support the hypothesis. On this basis alone the researcher should not reject the hypothesis. His effort should be to delve deep into his data and pay more attention to individual cases.

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17

Communicating Nursing Research

Research is a public enterprise. Wherever an individual undertakes a research project, the commitment includes the responsibility to communicate the completed project to others. Communicating the findings of research to others is a usual link in the research process. The accumulation of new scientific knowledge is essential to guide nursing practice, nursing education and nursing administration. Knowledge development is a cumulative process shared by the entire body of nursing professionals. Dissemination of research serves scientific, professional and public functions. Through communications of research processes and outcomes among scientists ideas are generated, developed, tested and refined. Thus, all investigators have the responsibility to contribute to this process by disseminating their research to others for dialogue, debate, and evaluation. Research can be disseminated to audience (i.e. nursing practitioners, nurse educators and nurse administrators and nurse researchers) through two major methods, verbal and written.

Verbal Reports

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The most rapid means of disseminating one’s research is to discuss it during formal or informal professional meetings, public lectures or interviews with media. Researcher typically elects to present scientific papers at research or clinical conferences. Because these presentations are usually ten to thirty minutes, indepth discussion of an entire project rarely is possible. However, conference participants often can ask the investigator more about the project. The contents of such presentation can be targeted to the audience in attendance and might focus on conceptual or methodological issues, selected research findings, or implications for practice. The opportunity for dialogue with the audience can stimulate the researchers thinking and help refine ideas before publication.

Communicating Nursing Research Many professional meetings now include the ‘poster sessions’ format for presentation of research. This format combines verbal and written communication as the researcher prepares a visual display, highlighting elements of the research but usually also is present to talk informally to interested observers. The poster format is ideal for sharing information about research in progress and for stimulating idea to exchange among peers. The novice researcher can also use it as a nonintimidating format for dissemination. The main disadvantage of this method is that only the audience at the presentation directly benefit from the knowledge, and time constraints usually limits depth or scope of content.

Written Reports Written reports of research offer the advantages of permanence and potential for reaching a wider audience. The major disadvantage of written reports is the time involved in their preparation and publication. Almost all research projects include preparation of final report as a requirement of either the academic programme (e.g., thesis, dissertation) or the funding agency; written progress reports throughout the project might also be made. Preparation of a written report of scholarly work for first publication in a Journal or Book is the most common method for dissemination of nursing research. This method allows specific audiences to be targeted according to the journals usual readership (e.g. nurse scientists, practitioners, in the special field, the public) and allows dissemination to national and international audiences. The review and publication schedules of most professional journals, however, involve long intervals between article submission and eventual publication. Publishing a book based on a research project takes even longer, involving more preparation time because of greater length and a longer production phase. Books or monographs allow indepth reports of an entire research project. Journal articles are briefer but can describe either an entire project, including conceptualisation, methods and results or focus on selected aspects. Also, brief reports, technical notes, or abstracts or research are published by a variety of journals. Short abstracts (e.g. one to two pages) of research presented at professional meetings often are compiled and distributed as conference proceedings to attenders and sometimes to others on request. These written reports reach a smaller audience but often allow more rapid dissemination because of shortened production time. The abstracts, however, usually do not meet prereview criteria for ‘publication’ and thus may not fulfil the researchers’ reward or recognition goals.

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WRITING THE RESEARCH REPORT Writing the research report is the highlight of the research project. The research task is not completed until the report has been written. A research report is the ultimate output of the research process. A good research report should posses following characteristics: • Conciseness–Lack of redundancy, conciseness saves the readers’ time and forces the writer to refine his ideas • Clarity–Lucidity of expression, clarity helps the reader to understand the points being made • Honesty–Freedom from fraud. Honesty is necessary to maintain the respect of the reader and the integrity of the author • Completeness–Full details. Completeness results in a full report, thus enabling the reader to evaluate the study • Accuracy–Quality of being precise and free of error. Accuracy is necessary to maintain the integrity of the author in the eyes of the reader.

Guidelines for Writing Research Report

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There are certain important guidelines to be followed while writing a research report as follows: 1. Develop your thinking: There is a high positive correlation between good thinking and effective writing. Research is not merely the accumulation, evaluation and assimilation of facts, it is a process of rebuilding facts into a meaningful whole. This demands patient, deep and alert thinking, which alone results in clear writing of the report. 2. Divide your narration into paragraphs and use of informative headlines whenever necessary. Paragraphing is an important feature of any report. It serves to break the test into readable units. It groups sentences around one central thought or idea. Linking one paragraph to another is an essential technique for maintaining continuity. 3. Use present tense and active voice: Results of research should be valid in the present. Otherwise, there is no use in presenting them. 4. Minimise the use of technical language or jargon: Most disciplines are criticised for their use of technical jargon. They stress here; that the range of possible readers can be increased by use of simple straightforward language. Clarity, conciseness, and simplicity are critical attributes of any kind of good writing. But they are particularly important in technical writing. A technical vocabulary may be an important facilitator of communicating among those who share it, but, may serve as a barrier when communicating with others. If there is a popular word that is equivalent to a technical one, the popular word

Communicating Nursing Research should be used. It is more important that the report avoids the use of jargon. 5. Use visual aids in the form of tables and figures to illustrate the principal findings of the study. It is important that such illustrations be used to emphasize points made in the text rather than to replace them. 6. Be objective: The report should be unbiased and objective justified by facts. As a general rule, long excerpts from works of others should be avoided. Too many quotations or references of other writers either creates an impression of showmanship or that the researcher has done very little work of his own. All references to the thoughts and works of others should, however, be properly acknowledged in, the footnotes. Otherwise, the writer would be considered guilty of plagiarism. 7. Treat data confidentiality: Confidentiality is not an issue if individuals have voluntarily provided data, with full awareness that these will be revealed to others. But where the researcher has promised to the respondents to, protect that anonymity, the same should be written in such away, as to preclude the possibility of respondents identification. 8. Revise and rewrite: Revising is part of writing. Few writers are so expert that they can produce what they are on the first try. Quite often, the writer will discover, on examining the completed work that there are serious flaws’ in the arrangement of material calling for transpositions or the work needs to be shortened or faulty sentences need to be restructured, and so on. This should not dishearten the report writer. He should remember that this is a common occurrence in all writings and even among the best writers. The report should normally go through three drafts. The first draft should aim at making the report as comprehensive and full of facts as possible. The second should aim at improving the language, form, style of the report and the final draft should aim at making the reports authoritative’ by checking its footnotes, references, bibliography etc. Revision of the first draft should be done after some gap. This will increase the degree of objectivity towards one’s own work. Author’s involvement, with the writing, which is just completed, makes it difficult for him to see it with a detachment which is a prerequisite’ for objectivity. The gap of time should not be too long, because it might slacken authors’ concentration on the topic.

FORMAT OF THE RESEARCH REPORT The report of a researcher not only serves to record and communicate the procedure and the results but it also fulfils an important function in the process of research. In the act of writing, if it is so well done, the research

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Essentials of Nursing Research worker refines his thinking and the detailed record facilitates, the critical testing of the work done. If he is interested in communicating his work to others, the report must be well written in order to fulfill that purpose effectively. The research report is a written or spoken communication that informs an audience about the research finding and procedures. The researcher draws relevant material from the work, which he or she relays to an audience, beginning with problem and ending with conclusion and recommendations. There is no set outline that can be used in preparing all research reports. The most appropriate form and contents of a particular report, should be determined by the nature of the intended audience. Some research units or institutions have designed an official manual, or have established their own style manual, to which their theses or dissertation must conform. The researcher should find out which manual has been adopted officially by his institution or departments. Although research reports may vary considerably in scope of treatment they are expected to follow a similar pattern of style and form that have been conventional in academic circles. The matters of style and format are based on the principles of clarity of organisation and presentation and it is essential that the researcher be familiar with them. If he is to communicate his ideas effectively. A research report usually follows fairly standardised pattern. The following outlines research report or format were established in some institutions as follows:

Format 1

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1. Introduction a. Importance of the general problem b. Specific problem. 2. Research statement a. Statement of what the researcher studied and how b. Definitions of concepts/variable c. Hypothesis, if any d. Objectives of the study: purposes e. Ethical implications of the research. 3. Review of the literature a. Review of related and competing theories b. Review of relevant research c. Specification of theory and research used in the study d. Review of observations to formulate theory if applicable. 4. Research design a. Description of the particular design used

Communicating Nursing Research

5.

6.

7.

8.

9.

10. 11.

b. Description of the control used if any c. Discussion of the validity and reliability of the design Sampling a. Description of the target population i. Discussion of how the sample was drawn, sample size response rate ii. Discussion of bias if any. Methodology a. Description of the method of data collection used b. Description of categories, instruments, scales, operational definitions c. Discussion of the reliability and validity of methods, instruments. Pilot study a. Description of findings b. Subsequent revisions. Analysis and interpretation of data a. Description of statistics used and how the data was analysed b. Summary of data in graphs and tables, with narrative explanation c. Interpretation of findings. Conclusion a. Implication of findings for nursing b. Recommendations, suggestions for future research. Bibliography and appendices Abstract.

Format 2 1. Title page 2. Certificates of approval a. Certificate from the guide b. Declaration of the author candidate 3. Acknowledgements/Dedications 4. Introduction 5. Review of literature 6. Materials and methods 7. Observations 8. Discussion 9. Summary, conclusion 10. Recommendations 11. Limitations a. Glossary/abbreviations b. Bibliography c. Appendices.

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Essentials of Nursing Research

Contents of the Format Whatever the format, the research uses, he/she should maintain proper sequence in his/her presentation. The following outline presents the usual sequence of various sections.

Preliminary Sections or Front Matter 1. 2. 3. 4. 5. 6. 7.

Title page Approval sheet Acknowledgement (if any) Preface or foreword Table of contents. List of tables (if any) List of figures (if any).

Main Body of the Report 1. Introduction a. Statement of the problem b. Significance of the problem c. Purpose of the study d. Assumptions and delimitations e. Definition of important terms f. Statement of hypothesis g. Assumption underlying hypothesis 2. Review of related literature or analysis of previous research 3. Design of the study a. Procedures used b. Methods of gathering data c. Description of data gathering instrument 4. Presentation and analysis of data a. Text b. Tables c. Figures 5. Summary and conclusions a. Brief restatement of the problem and procedures b. Description of procedures used, c. Principal findings and conclusions d. Recommendations for further research

Reference Section

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1. Bibliography

Communicating Nursing Research 2. Appendix 3. Index, if any. The first step toward preparing a report should be the preparation of an outline of its major divisions and then subdivisions in the form of headings and subheadings of proposed chapters, sections or even paragraph. This outline would guide the researcher in arranging the material at his disposal in an orderly manner as it sets down the design of the report.

Preliminary Section 1 Title page: The first page of the report is the title page. It should indicate the purpose of the research, its completion date, for whom it was conducted and by whom. If the research is of a confidential in nature, this should be stated along with a list of individuals who should be allowed to see it. Usually the title page includes the following: a. The name of the topic or the title of the study: All the items in the title page are centered between the margin of the page and no terminal punctuation is used. For example, topic may be written as follows: A Study of Knowledge, Attitude and Practice of Nursing Personnel towards Implementation of Primary Health Care. The title should be concise and should indicate clearly the purposes of the study. The title should be presented in capital letters, but only the initial letters of principal words are capitalised in other items. If the title is beyond one line, it is double spaced and placed in an inverted triangle. For example: Training Needs Assessment of Nursing Personnel working in a rural Area In One of the Districts of Karnataka With a View to Identify Training Programme Content for Inservice Education b. Full name of the candidate and his previous academic background. For example, By Bedavatti Thukkappa Basavanthappa M.N. (Delhi)

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Essentials of Nursing Research c. Name the Faculty/Dept and Institution to which the report is submitted. For example, Department of Nursing Govt. College of Nursing, Bengaluru-560002 or Department of Preventive and Social Medicine Bangalore Medical College Bengaluru-56000 d. Mention the degree for which the report is presented. For example, A Thesis Submitted for the Award of Doctor of Philosophy Degree in Nursing under Faculty of Medicine Bangalore University e. The date of presentation Example: 7-10-1993. 2. Approval sheet: If the institution requires an approved sheet, a page of the dissertation/ thesis allots space for the necessary certificate and the signature of the supervisor/advisor or the chairman/the member of the committee or Head of the Department of concerned. For dissertation the certificate will be as follows:

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Certified that this is the bonafide work of BT Basavanthappa at the Rajkumari Amrit Kaur College of Nursing Submitted in partial fulfilment of the requirements for the degree of Master in Nursing from the University of Delhi Roll No. 4802 sd/Masters in Nursing Dr. (Mrs) Aparna Bhaduri (Semester IV) M.N., Ed. D., R.N.R.M. Practical Paper IV Prof. and Head of Nursing RAK College of Nursing New Delhi New Delhi May 1988

Communicating Nursing Research For thesis, certificate will be according to the concerned university. It can be certified by the Guide/Guides of Ph.D. candidate. The format is as follows: Department of Preventive and Social Medicine Bangalore Medical College, Bengaluru CERTIFICATE This is to certify that the thesis entitled “A study of Knowledge, Attitude and Practice of Nursing Personnel Towards Implementation of Primary Health Care” submitted by Shri B.T. Basavanthappa for the award of “Doctor of Philosophy Degree in Community Health Nursing under the Faculty of Medicine is a record of bonafide research work carried out by him under my direct supervision and guidance and that it has not formed the basis for the award of any degree or diploma prior to this date. sd/Guide Dr. (Mrs) Manjula. K. Vasundhra MD. FIPHA, FIAPSM ICDS Consultant Prof. and Head of the Department of Preventive and Social Medicine, Bangalore Medical College, Bengaluru-560 002 In some universities before getting approval from the Guide or Committee the Candidates are expected to give declaration about his thesis as follows. DECLARATION I hereby declare that the study presented in this thesis entitled “A Study of Knowledge, Attitude, and Practice of Nursing Personnel towards Implementation of Primary Health Care” has been carried out by me under the direct supervision and guidance of my guide Dr. (Mrs) Manjula K. Vasundhra, Professor and Head of the Department of Preventive and Social Medicine, Bangalore, Medical College, Bengaluru. This thesis is being submitted for the Award of Ph. D. Degree in Community Health Nursing under the Faculty of Medicine to the Bangalore University in the Year 1993. I also declare that the thesis of no part of this study have been submitted to any other university for the award of any degree or diploma of this university or any other university. sd/Bengaluru BT Basavanthappa

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Essentials of Nursing Research 3. Acknowledgements: The acknowledgement page is largely a matter of courtesy. The investigator acknowledges the guidance and assurance he has received in carrying out study. It conveys indebtedness for the professional, academic and administrative assistance received by him. Good taste calls for acknowledgements to be expressed in a simple and restrained language. 4. Preface or foreword: Sometimes preface or foreword, one or two pages long follows the acknowledgement page, containing some initial remarks and perhaps a brief statement of the scope, aim and general character of the research. 5. Table of contents: The table of contents indicates the organisation of the report by listing the various chapters and their page numbers. It occupies a separate page or pages, give the readers birds eye view of the report and enables them to locate quickly each section of it. It includes in it the chapter headings, the major subdivisions of the chapter and sometimes the topics within the subdivisions. The chapter titles are usually typed in capital letters and the subdivision headings in small letters with the Initial letter of the principal words capitalised. All the titles and headings appear in the exact words and order as they do in the report, and each is followed by correct page citation. 6. List of tables and figures: If the report contains a large number of tables and figures, these can be listed following table of contents. They form a part of the report that lists are given on separate pages. The full titles of figures and tables worded exactly as they appear in the text are presented with the corresponding numbers and page locations. All the pages in the preliminary section are numbered at the centre of the bottom margin with lower case Roman numerals (i, ii, iii, iv…). Main body of the report: The body of the report contains a number of divisions. 1. Introduction: The purpose of the introduction is to discuss the background of the research project. It usually includes a statement of the factors leading up to the choice of the problem, the purpose of the study, the value and significance attached to the problem by the researcher as a contribution to nursing and any information to express the sincerity of the researcher in his selection/choice.

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Statement of the problem: A statement and elucidation of the problem sometimes follows a part of the introduction. If the problem is stated in a clear cut and logical manner, the consumer or reader is able to get a sufficiently clear insight into the study from every beginning. This section presents the problem area in a social context.

Communicating Nursing Research Significance of the problem: The background of the problem under study is thoroughly provided in the first pages of the chapter of introduction. After stating the problem, justifications of its study is developed by giving its significance and importance. Purpose/objectives of the study: The importance of the investigation will be further highlighted by enlisting purposes and objectives of the study. This section consists of a statement of the objectives of the research project. If the research has been done at the behest of arty organisation then this section also contains a statement of the frame of reference which was given to the researcher at the inception of the study. This section tells just what the investigator investigates. Assumptions and delimitation: Any technical assumptions behind this research project will also be clearly stated. The exact area the investigator is supposed to cover must be well demarcated. The sources of informations selected and that nature and delimitations should be mentioned and justified. Every study has flaws. This should be done not to show humility or one’s technical competence, but rather to prevent the reader from taking too much or too little from the findings. Limitations are equally important to underline the scope of further research. The limitation section should deal with the question of bias and nonresponse. The reader should be told about the sources and types of biases, their probable reasons and effects. There should also be an analysis of the number, characteristics and reasons of nonresponse and substitutions. The reader should be told how these are related to differences in culture, demographic characteristics, distances and modes of transport, terrain, climate, callback attempt and motivational efforts to interviewer. Definition of important terms: Operational definition of the terms that are essential to the study or are used in a restricted or unusual manner, so that the reader may understand the concepts employed. Any term used in the hypothesis that may have more than a single definition should be included here to avoid any misunderstandings. It gives the reader a clear concept, of the scope of the study and the precise explanation offered for the problem. Hypothesis or research questions: Here the investigator gives the hypothesis or research question that he has formulated for the purpose of collecting further evidence for the verification of the same. Assumption underlying the hypothesis: The hypothesis/ hypotheses are formulated only after some experience and evidence. Any assumption underlying the same or restrictions placed on the same are also stated in

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Essentials of Nursing Research order to build essential justification of the same. The hypothesis should be explicit. It may be stated in either Null form or the Working form. The Null hypothesis form does not suggest the end results, whereas working hypothesis predicts the anticipated results. Example Working hypothesis: The higher the educational attainments the higher the annual income. Working hypothesis: There is no relationship between higher education and annual income.

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Review of the literature: The importance of searching the literature can be very complete and summarised in a few pages. Previous research studies are abstracted, and significant writings of authorities in the area under study are reviewed. This part of the report provides a background for development of the present study and rings the reader up-to-date. Since further research based upon everything that is known about a problem this section gives evidence of the investigator’s knowledge of the field. Communicating a review of the literature involves consideration of the review content, organisation of the content, and style. Studies that are particularly relevant to the current work can be discussed in detail, with specific information about the conceptual methodological and analytical approaches included in that discussion. Usually, the information is paraphrased from the original sources, but in some instances, verbatim quotations are included. Most important is inclusion of the investigator’s interpretation of the earlier work and its relationship to the current study. Initially organising the review into an outline is helpful. Creating an outline of major concepts areas or major relationships that have special relevance to the current study allows the investigator to insert material on each study or theoretical paper at an appropriate point in the review. In some instances historical organisation, proceeding from earliest to most contemporary work, is quite effective in illustrating the progression of scientific thought. In other instances organisation according to specific conceptual or theoretical position is more appropriate. The style for presenting the result of a literature review and analysis will vary according to the style requirement for courses, Journals, theses and dissertations, and grant proposals. However, each of these style requires documentations of the citations that support the statement that the researcher makes. For example, references pertinent to the statement follows the statement as illustrated throughout this text.

Communicating Nursing Research 2. Methodology: A description of methodology tells the reader about the technical aspects of the study. It explains the design of the study in detail. The size and selection of the sample, the variables and controls employed; the sources of data, the tools; and methods of gathering data, the reliability of the instruments selected or constructed and the statistical procedures used in the analysis are carefully described. This section gives an accurate detailed description of how the work was done. 3. Presentation and analysis of data: The data analysis and interpretation may be presented in separate chapters or may be integrated and presented in one or more chapters. This is the heart of the research report. Sometimes separate chapters are developed to the tabulation, analysis and the interpretation of data. The arrangement depends on the quantity of information one has to convey to the development of the study. Analysis and interpretation of data have to be done through the media of text, tables and figures. Author (1993) placed the analysis and interpretation of data in two chapters titled as Observation and Discussion. 4. Summary and conclusions: This section may be quite short in comparison to the body of the report. It is probably the most difficult section of report to write. It is perhaps the most difficult part to prepare. This is because the researcher must distill the essential from a technical research effort and present them in a style which catches the imagination of the reader. The summary includes brief restatement of the problem, description of procedures used, major findings and conclusions and recommendations for further research. After a brief statement of the problem and a description of the procedures used in the investigation and conclusions are presented. The procedures are used, the design of the study, methods of research employed, the techniques and tools used for data collection, treatment of data, the method of analysis and interpretation of data and all other steps are described briefly in order to enlighten the reader in this respect. The final unit of the report usually contains the major findings of the study, the conclusions the investigator had arrived at and the generalisation he has formulated. In stating the conclusions, the researcher must indicate what his contribution has been to his field of study. Negative as well as positive results should find a place in the conclusions. Recommendation of the further research may be appropriate in concluding this part of the report to indicate promising side problems that have been uncovered and to suggest areas or problems for further investigations. The recommendation consists of statements which have implications for the policy and decision maker.

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Essentials of Nursing Research The summary and conclusion chapter is the most widely read part of a study because it recapitulates the information that has been presented in the previous sections of the report. Most readers scan the summary first to obtain an overview of the problem to determine the usefulness of the study to them. Reference section: This section includes bibliography, appendix and index. 1. Bibliography: A bibliography is a list of sources used in the report. It contains the list of authors cited alphabetically by last names. The bibliography should give a clear, complete description of the sources that were used while preparing a list. Some bibliographies classify entries under headings such as books, periodicals, newspapers, reports public documents and miscellaneous, but most of them arrange items in a simple alphabetised list. The following samples/format presents a simple and feasible writing style of bibliography. Format for a book: Surname of author, give name or two initials, title taken from title page (underlined), edition, if more than one, volume, if more than one, place of publication; publishers, date on title page or copyright date. For example: • Park J.E. and K. Park. Textbook of Preventive and Social Medicine, XI edn., Jabalpur (India), M/s Banarsidas Bhanot, 1986. • Trecle, Eleanor Walters et al “Element of Research in Nursing,” Saint Louis; The C.V. Mosby Company, 1973. • Basavanthappa B.T. “Community Health Nursing” First edn, Jaypee Brothers Medical Publishers, New Delhi. 1997. Format for periodicals (articles): Surname of the author, given name or two initials “Title of the Article,” Name of periodical (underlined), volume of Periodical (month, day, year) beginning page. Huque, Hasmath, “Continuing Education for Health Personnel.” The nursing journal of India vol. LXX No. 10, October, 1979 pp. 261-63. Format for a newspaper: Name of the paper (underlined), month, day, year, section of the paper (by author and title are given, they precede name of paper). Ordinarily newspaper items are not listed in the bibliography but they are cited in footnotes. For example: Editorial-The Indian Express, June 6, 1996.

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Communicating Nursing Research 2. Format for unpublished material (Speeches, Letters, Mimeographed materials etc.) Surname of author, given name or initials, “Titles of Material” Nature of material and where it is available or was presented, date, e.g. Basavanthappa BT “Training Needs and Assessment of Nursing Personnel working in rural Area in one of the Districts of Karnataka with a view to Identify Training Programme content for Inservice Education” unpublished, Master Theses, Delhi University, 1988. Pyle, David F “Voluntary Agency/Managed Projects Delivering an Integrated Package of Health, Nutrition, Population Services. The Maharastra Experience” Paper prepared for the Ford Foundation, New Delhi, 1979 (Mimeographed). 3. Format for a Thesis or Dissertation. Surname of author, given name or initials “Title of Material” Nature of material, where it was available or was presented. Example, Basavanthappa BT. “A Study of Knowledge, Attitude, and Practice of Nursing Personnel Towards Implementation of Primary Health Care” Ph.D. Thesis, Bangalore University 1994 or presented at V Conference of Nursing, Research Society of India held at Bangaluru Nov. 1995. Appendix: An appendix if included, follows the bibliography. It is the final section of the report. Items that will appeal to only a few readers or that may be needed only for occasional reference should be confined to an appendix. Details of the sampling plan, detailed statistical tables; copies of questionnaires, employed in the study, correspondence from letters and similar items generally belong to this section. The pages of the appendix are numbered in consecutive order similar to the other sections of the report. Index: If a study is complex, of major importance or to be published in book, or monograph form, it is ideal to prepare an alphabetised index, which follows the appendix.

Style of Writing The research report should be presented in a style that is creative, clear and concise. Although the phraseology should be dignified and straight forward, it need not be dull or pedantic. Even the most profound ideas can best be explained in simple language and short, coherent sentences. Slang, or hackneyed phrases and folksy style should be avoided. Since objectivity is the primary goal, there should be no element of exhortation or persuasion. The research report should describe and explain rather than try to convince.

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Essentials of Nursing Research In the interest of objectivity, the personal pronouns, I, we, you, my, own and us should not be used. These personal pronouns can be avoided by the use of such expressions as the investigator or the researcher. Only the last names of cited authorities are used. Titles such as Professor, Dr., Mr. and Dean are omitted. The past tense should be used in describing research procedures that have been completed. Abbreviations may be used in footnotes, tables, beginning a sentence should always be spelled out. Fractions, round numbers and numbers under 100 should be spelled out, except when they are combined. Use one half, but 4½ or 4.5 percent is spelled out except in tables and figures. Use Arabic numerals with percent, unless they being a sentence. In numbers with more than three digits, commas should point off thousands or millions. Ordinarily standard statistical formulae are not presented in the research report, nor are computations included. If a rather unusual formula is used in the analysis it is appropriate to include it. The ordinary rules of correct usage should prevail. Research workers who have difficulty in written expression should have a competent friend proofread their copy for correct usage before they type the final manuscript. Inability to write correctly is a serious limitation. Carelessness is an even greater fault. Effective research report writing is not an easy task. Good reports are not written hurriedly. Even skillful and experienced writers revise many times before they submit a manuscript for publication. To avoid making unnecessary, time consuming revisions of your report, you should study the report format and style manual recommended by your guide. Several style manuals are available to choose from if you are specifically granted the right to select your own. After adopting, a style manual, you must adhere to it throughout the report.

Organisation

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Mastering the methods of reporting is important, for an outstanding scientific investigation is of little value if the findings are not communicated effectively to others. An analysis of the style employed in educational periodicals ends with the recommendation that educational writing be done in a straight forward, business-like manner suited to technical publications. Obviously, school workers and writers in education should seek to employ a vocabulary as exact and uniform as that used by practitioners in medicine or law. A number of specific factual studies the range of terminology employed in education are available. Of course, space is not available to present a glossary of educational terms, which

Communicating Nursing Research seems unnecessary in view of the several dictionaries devoted to this purpose. Spewing a disordered jumble of raw facts into a report not only fails to convey information to the reader but also suggests that you have not grasped the significance of your materials. Only through arduous intellectual effort can you organise facts so that they deliver the precise ideas you have in mind.

Proportion and Emphasis To achieve proper proportion and emphasis in report, you keep revising your outline until you have placed all topics of equal importance on the same level. You refrain from stating main ideas in a few sentences and elaborating upon minor points. When revising a report, you delete words and sentences that give too much weight to minor topics and add supporting evidence and illustrations to expand underdeveloped major topics. It is done by placing topic sentences where they quickly capture the reader’s attention, put key words or phrases at the beginning or end of sentences and utilise numbers or italics to signal that statements are important.

Unity and Clarity To create unity and clarity in your report, you select homogeneous items from your notes, state the ideas in coherent sentences, place these sentences in a logical sequence, and weave them into paragraphs that in turn are logically related. To ensure’ the flow of the manuscript, you examine paragraphs and chapters to determine whether like ideas have been placed together and whether one idea leads naturally to the next.

Other Style Problems It is also essential to follow the rules and conventions in the use of abbreviations, capital letters and quotation marks. The use of abbreviations should be avoided in the text of the report. Even in the footnotes, the bibliography and the tables, only a few abbreviations are not considered appropriate. The rules for correct capitalisation should be followed meticulously. Capitals should not be used in words just for emphasis but only when they add to clarity and are warranted by the rules of rhetoric. In general, the modem practice is to economise on capitals. The proper use of quotations needs consideration. Direct quotations are often used by report writers to support their own arguments, to lend prestige of outside authority and colour of a variety of expression. But using such quotations in excess, may be considered a limitation.

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Tables

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Tables are a popular illustrative device for presenting the data in a more effective manner than a mere verbal presentation. Maps, charts, diagrams, graphs and tables are useful illustrative devices, but should be used judiciously. Tables that are accurately compiled, properly arranged, easily read and correctly interpreted may convey information more effectively than many paragraphs of written description. Through the use of a table, you may help readers spot important details, see relationships, get a concise overview of the findings, or graphs the significance of data much more quickly and easily than through many pages of prose explanation. A table is a systematic method of presenting statistical data in vertical columns and horizontal rows, according to some classification of subject matter. Good tables are relatively simple, concentrating on a limited number of ideas. It is often advisable to use several tables rather than to include too many details in a single one. . If a table is large enough to occupy more than a half page, it should be placed on a page by itself, carefully centred for a balanced effect. If it is short, occupying less than a half page it may be placed on the page with textual material, preferably following as closely as possible the textual discussion that relates to it. Tables should not exceed the page size of the manuscript. Large tables should be reduced to manuscript page size by photostating or some other process of reproduction. Tables that are too wide for the page may be turned sidewise. The word table is centered between the page margins and typed in capital letters, followed by the table number in capital letters, followed by the table number in’ capital Roman numerals. Tables are numbered consecutively throughout the entire report or thesis, including those tables that may be placed in the appendix. The caption or title is placed two spaces below the word table, and arranged in inverted pyramid form. No terminal punctuation is used. The main title should be brief, clearly indicating the nature of the data presented. The top of the table is placed three spaces below the last line of the title. Column headings or box heads, should be clearly labeled, describing the nature and units of measure of the data listed. Such terms as number, percent, and frequency may be abbreviated by the use of No. % and if numbers are short-ebbed by the omission of zeroes, that fact should be mentioned in the subtitle. The stub, or label, for the rows should be clear and concise, parallel in grammatical structure and if possible, no longer than two lines. Numerical data are usually arranged in descending order of magnitude or frequency, so that comparisons by position can be noted readily. If

Communicating Nursing Research there are several columns in the table, the first column to the left is arranged in descending order. Lines of tabular data are single spaced. Rulings or lines are used only if they facilitate the reading of the table. Few horizontal lines are needed. Vertical lines at left and right margins are omitted. Decimal points should always be aligned in the column. When no data are available for a particular cell, indicate the lack by a dash, rather than by a zero. Double horizontal lines are placed at the top of the table separating it from the title. A horizontal line is also placed at the bottom to separate the table from the material which follows three spaces below. When footnotes are needed to explain items in the table, small Arabic letters are used. Table footnotes are placed just below the tables rather than at the bottom of the page.

Figures A figure is a device that presents statistical data in graphic form. The term figure is applied to a wide variety of graphs, charts, maps, sketches, diagrams and drawings. When skilfully used, figures present aspects of data in a visualised form that may be clearly and easily understood. Some ideas may be communicated more effectively by figures than by written or tabular presentations. Figures should not be intended as substitutes for textual description, but included to emphasize certain significant relationships. . Characteristics of good figures: Many of the qualities of good figures are enlisted below: 1. The title should clearly describe the nature of the data presented. 2. Figures should be simple enough to convey a clear idea, and should be understandable without the aid of textual description. 3. Numerical data upon which the figure is based should be presented in an accompanying table, if they are not included in the figure itself. 4. The figures should not suffer from oversimplication, misrepresentation or distortion. 5. Figures should be used sparingly. 6. Figures that occupy more than a half-page should be placed on a separate page. 7. Figures should follow, not precede, the related textual discussion. 8. Figures are referred to by number, never as “the figure above” or “the figure below.” 9. Figures are numbered with Arabic rather than Roman numerals. 10. The title of the figure is placed below rather than above it.

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Essentials of Nursing Research Types of figures: The commonest forms of figures used in reports are line graphs, bar graphs, pie charts, area or volume charts, pictorial charts, maps, diagrams of a apparatus, and photographs. Some of them are being described below. The line graph: The line graph is useful in showing change in data relationships over a period of time. The horizontal axis usually measures the independent variable, the vertical axis the measured characteristic. The figure formed by the lines connecting the point is known as frequency polygon. The bar graph: The bar graph may be arranged either horizontally or vertically. It represents data by bars of equal width, drawn to scale length. The numerical data may be lettered within the bar or outside it. In bar graphs the bars are usually used to compare components at a particular time. Vertical bars are used when making comparisons at different times. The circle or pie chart: This type of chart shows the division of a unit into its component parts. It is frequently used to explain how a unit of government distributes its share of the revenue, how an individual spends his salary, or any other type of simple percentage distribution. The radius is drawn vertically, and components are arranged in a clockwise direction in descending order of magnitude. The proportion of data is indicated by the, number of degrees in each segment of the 360° circle. Maps: When geographic location of identification is important, maps may be used. Identification may be made by the use of dots circles or other symbols and density or characteristics of areas represented by shading or cross-hatching.

Quotations Laymen often joke about a too large number of quotations and footnotes found in research reports. Pasting too many quotations into an authorityladen text does not create an acceptable research report. Strings of these passages reveal that you are little beyond the note-taking stage of your work. A research report is a creative effort, a synthesis of what you have read, observed, thought and mentally ordered into new patterns rather than a mere compilation of other people’s work. You may use quotations but use them sparingly and purposively.

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Arts and quoting: If you paraphrase rather than quote materials, your discussion moves more directly and forcefully towards your objective. When you cannot rephrase a law, formula, or idea as concisely, accurately or effectively as the original author has phrased it, you use a direct

Communicating Nursing Research quotation. Whenever possible you select a short quotation and plant it in your own sentence. To avoid introducing quotations repeatedly with Mr. Singh says, “you place the introductory phrase within or at the end of the quotation.” Mechanics of quoting: The rules for presenting short and long direct quotations differ. A short quotation is enclosed in quotation marks, double-spaced, and incorporated in the paragraph. A quotation that appears within a short quotation is enclosed in single quotation marks. The Arabic reference numeral to the foot-note is typed half a space above and after the phrase or sentence quoted, and after the punctuation mark it comes at the end of the sentence. Long quotations four or more typewritten lines are usually set of in separate single spaced paragraphs that are indented in their entirety, and no quotation marks are necessary. Quotations within long quotations are set off by full quotation marks. Exceptionally long quotations may be placed in the appendix. A quotation that occurs in a footnote is single spaced, enclosed in quotation marks, and indented in paragraph style. There is need to check for accuracy when duplicating quoted material. Some other items of mechanics are like this. If the first word of a quotation is grammatically linked to what precedes it in the sentence the word is not capitalised even though it was capitalised in the original sentence. Only one punctuation mark accompanies the terminal quotation marks: • A period or comma is placed inside closing quotation marks. • A colon or semicolon is placed outside quotation marks. • An interrogation or exclamation point is placed inside if it belongs to the quoted matter and outside if it is a part of the whole sentence.

Footnotes Footnotes serve various purposes. 1. Some give source references for direct quotations or paraphrased material. 2. Some provide cross references to materials appearing in other parts of the report. 3. Some indicate sources that contain substantiating evidence, and 4. Some explain or elaborate upon a point in the textual discussion. The last type should be kept to a minimum. Many editors insist that if something is important enough to be said, it should be placed in the report. Footnotes enable writers to substantiate their presentation by citations of other authorities, to give credit to sources of material that they have quoted or paraphrased and to provide the reader with specific sources

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Essentials of Nursing Research that he may use to verify the authenticity and accuracy of material used. Occasionally, these are also used to present explanatory statements that, although important, would interfere with the logic and continuity of textual material. In serving their various purposes, footnotes are very useful devices. They should be used sparingly, however, and never included for the mere purpose of scholarly appearance. Citation of footnotes: Several methods of inserting footnotes have been devised. The traditional procedure is to place at the bottom of the page all footnotes for citations appearing on that page. The footnotes are separated from text by a short line-twenty spaces-drawn from the left margin one space below the written discussion. Beneath this line, a double space is left before the first note is typed, the footnotes are single-spaced with double spaces between them. Each footnote is indented as in a paragraph and preceded by a superscript numeral that corresponds to the reference numeral used in the textual material. The first word of the footnote follows the reference superscript numeral; no punctuation or space is necessary. If the textual material consists of tables, mathematical materials or formulas; an asterisk or some other non-numerical symbol is selected to identify a footnote. The writer either numbers footnotes, consecutively throughout the report or begins a new on each page or in each chapter, depending upon the institutional requirements. If a report is to be published, authors may employ either methods of inserting footnotes to facilitate the work of the typesetter. They may place the footnote immediately following the textual reference on the page and separate this source information from the rest of the paragraph by typing unbroken lines above and below it. To conserve space and to cut printing costs, some publishers prefer to have a coded reference to a source placed immediately after and in alignment with a direct quotation. A bibliographical code like (12; 24-25) may be employed. Many research journals use an author and date of publication, i.e. Smith, (1978). If an investigator uses the author date method, he can omit or add references to a bibliography at any time without remembering all the entries and making the necessary changes throughout the text. This method of citation is especially applicable for materials appearing in research journals where no quoted materials appear. In another procedure all the citations are placed on one page at the end of the chapter. Each institution or department usually specifies the type of footnote citation permitted or recommended.

Abbreviations in Footnotes

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To save time and space, full bibliographical information is presented in the footnotes the first time that a reference is made to a source thereafter,

Communicating Nursing Research abbreviations are used to identify it. In consecutive footnote reference the abbreviation IBID (Latin, the same) may be used. If the page reference is different, the new page citation follows: 5 Fred N Kerlinger. Foundations of Behavioral Research (New York; Hold, Rinehart and Winston, 1973) p.217. 6 Ibid (indicates the same page as previous reference). 7 Ibid, p.230 (same work, but a different page). When references to the same work occur within a page or two, op cit (Latin, the work cited) may be used, always with surname of the author reference. Op cit is used when another reference intervenes. 4 Clinton I. chase, Elementary Statistical Procedures (New York McGrawHill Book Co., 1967), 15. 6 Chase opcit 30. 7 Philip H. DuBois, An Introduction to Psychological Statistics (New York: Harper & Row, 1965), 20. When a second but non-consecutive reference follows, referring to the same work and the same page previously cited, loc cit may be used. Again the author’s surname must be included. For Example, Du Bois, loc cit (This reference is to page 20). In addition to the symbols above, the student should be aware of the accepted standard abbreviations.

Bibliography As stated earlier, the bibliography should give a clear complete description of the sources that were used while preparing the report. Some bibliographies classify entries under headings such as books, periodicals, newspapers, reports, public documents, and miscellaneous but most of them arrange items in a single alphabetised list. It is better to use the latter method and number the items consecutively. Style of citing: Items are usually listed alphabetically by author’s surnames but a chronological arrangement is used in some studies. When the author’s name is not given, the work is listed under the name of the school system, institution, or agency that prepared the report. When no clue of authorship is available, the work is listed under the first important word of the title. To make the author’s name stand out, the first line of each entry is typed flush with the margin and the remaining lines are indented. Double spacing or single spacing with double spaces between entries is used. Aids for citing: If you form the habit early in an investigation using the same style for like items on your bibliography cards, rechecking each item on every para for accuracy and completeness, and consulting a

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Essentials of Nursing Research style manual when uncertain about how to write an entry, you will experience little difficulty in compiling a bibliography for your research report. The following general rules will help to remove some of the common difficulties. 1. When two or more works by the same author are listed, an unbroken line about six spaces in length, followed by a comma, is sometimes substituted for his name after the first entry. The titles of his works are alphabetised under his name. Publications of which he is co-author follow those of which he is sole author. 2. If a book has two or three authors, the second and third authors’ names are written in the normal order. If there are more than three authors, the name of the first is given, followed by “et al” or “and others.” 3. An editor or compiler is indicated by placing the proper abbreviation in the parenthesis following the name. 4. When identifying the place of publication, the name of the city is sufficient, if it is well known, otherwise the name of the complete address is added. Citing of footnotes: The above mentioned bibliographical style is also used for footnotes, except that the regular paragraph indention rather than the underhung style is employed and the exact page of the quotation is given. But some institutions require further changes in footnotes, they stipulate that the author’s given name must appear first and some recommend a different form for the punctuation and placement of items. Some of the illustrations for footnotes are as under: Jacques Barzun and Henry F. Graff. The Modem Researcher (New York; Harcourt Brace Jovanovich, 1977), p.171. Claire Selltiz et al, Research Methods in Social Relations (New York); Hold, Rinehart and Winsoon, 1959), p.77. Rienard B Banta “New Harmony,” Encyclopaedia Britannica (1968) 16: 305. J. Hartt Walsh, “Education in 2,000 AD,” Nation’s Schools 57 (April 1956), 47-51. Comparative features of bibliography and footnote forms are depicted in Table 17.1.

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When the manuscript is divided into chapters, each chapter begins a new page. The word CHAPTER is capitalised, followed by a capitalised Roman numeral, centered and placed four spaces lower than the usual top line of the text. The chapter title is centred and capitalised, a double space below the heading.

Communicating Nursing Research Table 17.1: A comparison of bibliography and footnote form Comparative features

Bibliography

Footnote

Indentation

Overhanging-first line flush with margin, second line indented five spaces

Regular paragraph

Name order

Last name first (of first author when more than one authors)

First name first

Placement

End of body of report listed alphabetically by last name of the first author Author’s name title place of publication publisher, date of publication

Bottom of page with superscript

Punctuation

Page reference 414 pp (total number of pages in book or in article.

Author, title (place of publication; publisher date of publication) p.p (specific page location of reference)

Textual material follows three spaces below the title. A major division of a chapter or of a short term paper is introduced with a centred Head written in full capitals. Textual materials that follow are placed three spaces below the centred head. A subdivision of the section of the part of the discussion under the centred Head is introduced by a free standing side HEAD flush with the left margin. For further subdivision of the discussion, a paragraph side head is used, with the usual paragraph indention.

Centre Head (Full Capitals) • Side Head (major words capitalised) • Paragraph side head (only initial letter of first word capitalised).

Pagination Page numbers are assigned to each page of the research paper or report. The title page or the initial page of a section (chapter, major subdivision, bibliography or appendix) does not have a page number typed on it, but a number is allowed for it-in the series. Page numbers are placed in the upper right hand comer, one inch below the top of the page and aligned with the right margin. Page numbers of the Preliminary Section of the manuscript use small or lowercase Roman numerals (i, ii, iii) beginning with the title page and ending with the last page preceding the main body of the paper. The page containing Chapter 1 is page 1, but has no number typed on it. However, the next

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Essentials of Nursing Research page is page 2. The bibliography and appendix are numbered serially and consecutively, following the last chapter. Since correct pagination depends upon the final edited copy, assigning page numbers should be the final step before putting the manuscript into the binder or folder. Preliminary page numbers can be lightly penciled in and changed if additions, deletions or corrections are made.

Preparation of the Report When preparing a report you will adopt the patterns of working that are most suitable for you. But acquiring some knowledge of how others have solved common writing, revising and typing problems may help you improve your system.

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Drafting and revising the report: Author, title (place of some parts of a report, such as the review of the literature, may be written fairly early in an investigation, but most of the writing is done after the hypothesis has been tested. You collect data and organise them into tables, graphs or some other form that brings out relationships. You classify your notes and place them in the order that they appear in your outline. Then, while examining the data and notes, you write paragraphs of explanation and interpretation for each section of the report, compose transitional statements or paragraphs that lead the reader from one point to the next, and draft the conclusions. Even at this state of your work, you may reorder points in the outline to achieve a more logical presentation. Thus, in all but the final copy of a report, you should type each paragraph on a separate page so that sufficient room is left to make corrections or revisions. By doing so, you may rewrite materials, add paragraphs, or shift items from one section of the report to another without retyping entire pages. Writing is an arduous work. The prolonged process of composing, reordering, adding, deleting, and polishing is taxing. Successful writers redraft their reports, many times before they are satisfied with the results, and their faculty advisers or editors may make many additional suggestions for improvement. Revising a report usually consumes many more hours than writing the original draft. A beginner has much to learn before he or she can write effectively. You may make better progress if you form the following work habits: 1. Set aside regular hours for writing and observe your schedule faithfully. 2. Choose an environment that is conducive to work and make certain that the necessary reference books, dictionaries, and files are at hand. 3. To overcome the difficulty of getting started at each writing session, stop writing early each day and spend a few minutes organising materials and listing the things to do the following day.

Communicating Nursing Research 4. After working for a few days, set the draft aside and return later to read it critically. 5. Since items in a report, do not have to be written in a consecutive order, compose a rough draft of a section whenever sufficient insight into the materials has been gained. 6. Concentrate on communicating information when writing. Do not let minor problems interrupt the flow of thought and block progress, skip over them and return later to find the proper word, devise a draft transition, check a fact or insert an illustration. 7. When bogged down in a particular paragraph or section of a report, read the preceding materials and the outline to retain perspective. 8. Ask colleagues to read the report and point out any gaps, weaknesses, or ideas that are not clearly communicated. 9. Allot generous amounts of time for making unhurried, thorough revisions.

Typing the Report Many students type their own research reports. Anyone with reasonable proficiency and a willingness to learn proper procedures can do an acceptable job. Typographical standards for the thesis or dissertation are more exacting. Strikeovers, crossovers, insertions and erasures are not permitted. Therefore, only typists with great proficiency should attempt to prepare thesis or dissertation copy. Although the expense of professional typing may seem high, the saving of time and excessive effort usually makes this arrangement the wiser choice. It is the writer’s responsibility to present manuscript material to the professional typist in proper form. Except for minor typographical matters, the correction of major errors is not the responsibility of the typist. After the material is received from the typist, the student should proofread it carefully before it is turned in. Before typing the final draft of a report, you read the manuscript critically, searching for inaccurate statements, omissions and inconsistencies. After making an exacting examination to locate errors in quotations, footnotes, tables, figures, paragraphing, sentence structure, headings, mathematics, spelling, style, proper names, or bibliography, you mark the copy to provide the typist with the necessary directions. The time spent in checking the above detail is well-invested, for ultimately you alone, and not the typist, are held responsible for the contents of the report. When typing any draft of an investigation, you should make carbon copies. The second copy is valuable if you lose the first one. Filing the

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Essentials of Nursing Research duplicate and first copies in separate places gives added protection against loss through fire and other means. Good quality of bone 8th by 11 inches in size, of 13 to 16 pound weight, should be used for the original and first carbon copy of the thesis or dissertation. A lighter paper may be used for additional copies. For the term paper, any bond paper is acceptable. Only one side of the sheet is typewritten manuscript. Pica type, with ten spaces to the inch, is preferred to elite, which has twelve. The type must be clean, and a medium-inked black ribbon should be used. Medium weight, black carbon paper should be used for the copies. Carbon paper should be replaced often enough to ensure clear and even copies. Special symbols not available on the typewriter key board should be carefully inserted, using black India ink. To facilitate the proper placement of copy on the page, a guide sheet may be constructed, showing the proper margins, the centre of the copy portion and the number of lines from the top and bottom margins. This sheet should be ruled in black ink and placed beneath the first sheet so that the markings show through. The right margin should be one inch, the top margin 1½ inches, the bottom margin 1½ inches and the left margin 1½ inches. Textual material should be double spaced. Long lists of materials may be single spaced. Paragraphs should be indented seven spaces for pica type, nine for elite. Words should not be divided at the end of the line, unless completing them would definitely interfere with the margin. A few spaces runover is preferable. In dividing words, consult a dictionary for correct syllabication. Direct quotations, not over three typewritten lines in length, are included in the text and are enclosed in quotation marks. Quotations of more than three lines are set off from the text in a single-spaced paragraph and indented four spaces from both left and right margins without quotation marks. Original paragraph indentations are retained. The superscript is originally placed at the end of the sentence of quoted material. Where several references are mentioned, in one sentence, the superscript is placed after each name reference (Harry1, Jones2, and Smith3, reported their findings).

Presentation of Research Report in Professional Meetings

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Presentation at professional meetings can be in two forms: (1) Paper session (2) Poster session. The paper sessions involve oral presentation whereas poster sessions are visual presentation followed by oral presentation or vice versa. The emphasis of both methods is on methods

Communicating Nursing Research and results. The privilege of presenting at a professional meeting is usually granted by a programme committee, that reviews abstracts of presentations submitted by potential presenters. A carefully developed abstract, therefore, is the first step toward presenting at a meeting. This abstract is written before the actual paper. These abstracts vary considerably. It is important to follow directions for the submission carefully, and if possible, secure the assistance of a successful applicant in reviewing the abstract. Papers and posters at professional meetings help the researcher/presenter to become known. They also help the presenters know researcher’s working in his area and provide an excellent opportunity to have his work critiqued prior to journal submission. Strengths and weaknesses that the presenter might have missed can be incorporated into his articles as a result. As stated above, oral presentations are referred to in papers. That is because they are usually written out and read to the audience by the author or a designate. They generally include some kind of visual presentation like slides or handouts. This is often the first version of what eventually becomes a journal article. Questions and comments from the audience help clarify points and are often incorporated into the paper. Sometimes, various versions (with different titles) are presented at a number of professional meetings. Each with different audiences who have interest in research. This is an excellent way to meet people and establish co-operative relationships with other professional working in related area. The conference committee usually establishes time limits, and groups presented according to similarity of topics. Sometimes, it requests minor changes in presenter’s approach or format (e.g. change of paper to part of seminar or panel discussion presentation). The committee also designates a session chairperson who introduces speakers and keeps time. When presenter used the allotted time he will be interrupted and asked to stop. Therefore, the presenter wants a lengthy question and answer period after his presentation, make his remarks short enough. The reverse is also true. Traditionally papers have been written. This allows their presentation by others. When the author for instance, cannot afford travel expenses or is otherwise occupied. It also allows publication in the proceeding of a conference, so that those unable to attend can learn the latest developments and news. It also helps when the authors are nervous. Nevertheless, some particularly gifted or relaxed speakers prefer to speak extemporaneously, using only an outline on note cards to guide them. Even better, some speakers use a series of slides and transparencies as guides. These presentations are usually mere fun to attend, and if an

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Essentials of Nursing Research actual paper does not have to be provided for proceedings, it may be, authors preferred method of presen-tation. Poster sessions are becoming more popular. They allow many researchers to present them in a relatively short period of time. The poster itself varies in size, depending on programme committee negotiations with the hotel or building staff in which the meetings are held. At large meetings, a portable bulletin boards is provided. However, it is usually safer to have assembled presenter display on a large poster board prior to the session. Sometimes, however, this must be transported in parts if large distances are to be travelled to get to the meeting. Typically, the poster session lasts an hour and is held in a large hall/room that has been filled with rows of bulletin boards. The researcher stands in front of the poster informally and talks about the research with viewers who walk by. Sometimes, a handout with an abstract or table is distributed by the researcher. Posters may be presented as a shortened version of a paper; however, rather than consisting of just typed pages, the presentation is enhanced by the use of colour in graphs, tables, charts, and pictures. The material needs to be readable from a distance of several feet. Viewers have usually been given a list of the posters, titles and authors, each of which is numbered in some systematic way. This is an excellent, nonthreatening way to share presenter/researcher results and meet other people interested in author’s topic area. Begin by attending poster sessions or meetings where the author presents/intends to present. Study the poster presentations, that seem most successful even taking notes, and emulate them.

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Critiquing Research Report

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Critiquing Research Report

Critical appraisal of completed research is an important part of the development of nursing theory, because, critique allows the researcher to move beyond a general descriptive account of the research study to careful, systematic judgement of the study’s worth. “A research critique reflects a penetrating analysis of a study in which judicious and constructive comments have been made about a piece of work (Leininger 1968).” The research critique provides an appraisal of completed research that helps the investigator evaluate the favourable and less favourable aspects of the study. The critical view of the study may be different from the investigator’s and may open new vistas for considering alternative hypothesis and exploring assumption underlying the study. The research critique can facilitate the scientific potential of the research. The research critique is also important to the person using the research in deciding how the study findings best can be applied to nursing practice. The critic of completed research has a very special role in that he or she is looking beyond the surface description of the study to an appraisal of the study’s to an appraisal of the study’s worth. The critic is expected to: • Maintain an objective attitude • Emphasize an advisory role • Provide constructive criticism • Assess the general features, strengths and weakness of the study • Make summary appraisals and recommendations. Nurses should be able to evaluate analytically reports of health care research in order to judge the applicability of the findings of their practice. A knowledgeable consumer is able to identify weaknesses as well as strengths of published research reports. Education onself to be such a consumer is a continuous process. Each reader is different with different experiences, interests and degrees of expertise. Reports, too, vary widely with respect to subject, methodology, statistical treatment of data.

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Essentials of Nursing Research Although this situation precludes a step-by-step checklist by which to evaluate every research report, it does not preclude some helpful guidelines. By knowing what, in general, each section of research report should contain, and, by mentally asking oneself a number of questions as one reads a report and/or upon completion of that reading, the reader can draw some conclusions about the value and validity of the study. The research evaluator checklists presented on the following pages help to make a research or evaluation as follows:

Research Report evaluation Checklist No. 1 Research Questions 1. What is the researcher trying to find out? 2. What are the kind of relationships being examined? (causal or correlational) 3. Are there any hypothesis being tested? Do they evolve naturally from the literature review and theoretical framework if any? Rationale and Significance of the study 1. What is the purpose of the study? 2. Why is the researcher considering this research question? 3. Will the answer meet the so-what test? 4. Have similar studies been conducted? Does the researcher appear to have a good command of related literature?

Methodology How is the researcher answering the research question (or gathering evidence to prove or disprove a hypothesis)? Consider the following: a. Variable • Just what are the characteristics, traits, elements, actions, responses, and so forth that are being studied? • What are their constitutive definitions (Le. definitions using words)? • Can any variables be modified or manipulated by the researcher?

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b. Operational definitions of variables. • How is a measure, value or category level given to, each of the research variables described above? Is multimodal measurement used? • What are the reliability and validity of this number? What additional instrument credentialing is needed? • What kind of number if it (e.g., Frequency count for each category, rank or score)?

Critiquing Research Report • If this is a new measure, was it adequately pretested? • How was the instrument developed and with what target populations? Are accuracy and precision concerns? c. Sampling • Who are the subjects and how were they selected? (random, stratified random, convenience sampling) • From what study population, does this sample come? Were they prelisted? • How many subjects were solicited? How many actually participated? Is the sample size adequate? Did anyone refuse to participate? • How were the rights of human subjects protected? • What constituted informed consent? d. Research design • Is this study longitudinal, cross-sectional or retrospective? • What type of study is this? (e.g., Comparative, correlational experimental or a combination of these) • As subjects randomly assigned to groups? If not, how are they assigned? Is there a central group? Are intact groups used? Is there a comparison group? How is equalency of groups argued? • What relationships between variables if any are being examined? • What threats to internal, construct, and external validity are inherent in the design? Which ones are controlled? • Are blind, double-blind, or placebo techniques used? e. Procedure • How is the research design implemented? What methods, are used to gather date? Where? When? • Who is gathering the data and what are the subjects told? f. Data analysis • How is the accuracy of the data verified? Is the scoring scheme, if any apparent? • How are missing data handled? • How are cutting points established? Do they seem reasonable? • What summary statistical tests are given (i.e., frequency, measures for control, tending and dispersions)? • What is the level of significance (alpha)? • What statistical tests are computed? Are they appropriate to the research design and type of operational definition? • Are there threats to statistical conclusion validity? • Was power analysis performed for null findings?

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Essentials of Nursing Research g. • • •

Rival hypothesis What confounding or intervening variables were present? Did the researcher make control for them? How? Were any not controlled?

Results (Findings) 1. What are the ‘facts and figures’ as a result of this study? 2. Do tables and graphs adequately summarize the results?

Interpretations and Conclusions 1. Are the results statistical tests interpreted correctly? 2. How does the researcher explain the results of this study? 3. Are there any implied or stated basic assumptions that might affect the results and conclusions? 4. What are the limitations of the study? 5. Are there any confounding variables present that might affect interpretation of results and conclusions? 6. What conclusions are drawn? Are they justified? 7. To what target population are results generalised? Is this appropriate? 8. Are suggestions made for further research, including replications? 9. What suggestions are made for implementation of the results?

Critique 1. What do you think of this study? 2. What are its strengths and weaknesses? 3. How could this study be improved? What changes could be made in design or operationalisation of replications in order to enhance construct validity? 4. Where do we go from here?

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Glossary

Glossary

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Abstract: A concise summary of a study that communicates the essential information about the study. Accidental sampling: See convenience sampling. Action research: A research approach in which researchers pursue action and research outcomes at the same time. Alpha error: See type I error. Alternate forms reliability: Method of determining reliability in which at least two different forms of an instrument are administered to the same individuals and the scores are then correlated. Also called equivalent forms reliability. Analysis of covariance: (ANCOVA) Parametric statistical test to determine the differences between the means of two or more groups by removing the effects of one or more confounding variables. Analysis of variance: (ANOVA) Parametric statistical test to determine the differences between the means of two or more groups. Anonymity: Protection of the rights of study subjects so that their identity is not disclosed and their responses are not linked to them. Applied research: Research conducted to generate new knowledge that can be immediately applied to solve practical problems directly related to clinical practice. Assumption: A statement based on logic or reason whose correctness or validity is taken for granted. Attrition Loss of subjects during a research study. A consideration related to internal validity in experimental studies. Auditability: In qualitative research, asks the question, “Can another individual follow the documentation of data collection and analysis that led up to the conclusions of the researcher?” Audit trail: In qualitative research, used in connection with auditability; refers to the systematic process by which an investigator records all activities that are related to the investigation so that an outside individual can examine the data and draw independent conclusions. Basic research: Research concerned primarily with establishing new knowledge and developing and refining theories rather than being immediately applied to practical problems. Beta error: See type II error.

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Essentials of Nursing Research Blind study: See single-blind study and double-blind study. Broad-range theories: “Systematic constructions of the nature of nursing, the mission of nursing, and the goals of nursing care” (Meleis, 1997, p. 18). Broadrange theories in nursing deal with the scope, philosophy, and general characteristics of nursing (also called grand theories). Case study: Intensive and in-depth investigation of a single unit of study. CD-ROM: Compact disk-read only memory. Chi-squared: (χ2) A statistical technique used to determine whether observed frequencies differ from expected frequencies. Also known as chi square. CINAHL: (Cumulative Index to Nursing and Allied Health Literature) A data base available either in print or on CD-ROM or on-line. Cluster random sampling: A probability sampling procedure that progresses in stages from larger sampling units to smaller sampling units. Also called multistage sampling. Cohort: A group of persons who share a common characteristic, such as age, occupation, or a delineated area of residence. Compact disk-read-only memory: See CD-ROM. Complex hypothesis: A statement of the predicted relationship between three (or more) variables. Concept: An idea or complex mental formulation of a specific phenomenon. Conceptual framework: Discussion of the relationship of concepts that underlie the study problem and support the rationale (reason) for conducting the study. Concurrent validity: A measure of how well an instrument correlates with another instrument that is known to be valid; a type of criterion-related validity. Confidentiality: Protection of research subjects so that the researcher will safeguard not only their identities but also their responses from public disclosure. Confirmability: In qualitative research, the trustworthiness of the findings as an indicator of the extent to which the researcher conducted the investigation in a rigorous manner. Confounding variable: Variable outside the purpose of the study that could influence the study’s results. Sometimes called extraneous variable or intervening variable. Constant comparative method: Characteristic of the grounded theory method in which data collection and data analysis occur simultaneously so that all the data being collected are compared to all the data previously collected in order to determine their importance and position in the hierarchy of data analysis.

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Construct: An abstract phenomenon that is deliberately invented (constructed) by researchers for scientific purposes.

Glossary Construct validity: An approach for establishing the validity of a quantitative measuring instrument that represents the degree to which a measuring instrument measures specific hypothetical trait or construct, such as intelligence. Content analysis: (1) In qualitative research, a process to analyze the content of qualitative information gathered from the study participants by “categorizing the observations into themes and concepts emerging from the data,” (2) In quantitative research, “a method to make inferences based on systematic, objective, and statistical analyses of written text or oral communication and documentation” (Doordan. 1998, p. 47). Content validity: An approach for establishing the validity of a quantitative measuring instrument that determines the extent to which the instrument represents the phenomena under study. Continuous data: Data that can be located at some point along a continuum or scale and are characterized by fractional values of a whole unit. Control: Process of eliminating or reducing the influence of confounding variables that could interfere with the findings of a research investigation. Control group: The group in which the experimental treatment is not introduced. Convenience sampling: Non-probability sampling procedure in which the sampling units are selected because they are available to the investigator at the time of data collection; also called accidental sampling. Correlation coefficient: The number that represents the strength of the quantifiable relationship between two or more variables. Correlation: The strength of the quantifiable relationship between two or more variables. Correlational research design: Non-experimental quantitative research design that measures the relationship between two or more variables. Credibility: In qualitative research, asks the question, “Are the reported findings true?” Criterion variable: See dependent variable. Criterion-related validity: An approach for establishing the validity of a quantitative measuring instrument. Refers to the relationship of the measuring instrument to some already known external criterion or other valid instrument. The term includes both concurrent validity and predictive validity. Cross-sectional research design: A research design in which data are collected from subjects at one point in time. Data: Units of information (singular: datum). Debrief: To provide subjects of the study with information about the study after the study has been concluded.

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Essentials of Nursing Research Deductive reasoning: Method of reasoning that moves from the general to the specific. Delphi technique: A research methodology for predicting or emphasizing the main concerns of a group. Demographic variable: A characteristic or attribute of a study subject, such as age, gender, marital status, ethnicity, educational level, employment status, and family income. Dependent variable: The variable that changes as the independent variable is manipulated by the researcher; sometimes called the criterion variable. Descriptive research: Non-experimental research designed to discover new meaning and to provide new knowledge when there is very little known about a phenomenon of interest. Descriptive statistics: Statistics used to describe and summarize data. Diffusion: The process of spreading an innovation through a social system. Direct: definition Definition of a term taken from a dictionary. Directional hypothesis: A hypothesis that specifics the predicted relationship between the independent variable (or variables) and the dependent variable (or variables). Discrete data: Data that exist only in distinct units expressed as whole numbers that are pre-else and definite; 6 beds, 5 hospitals, 6 patients (not 6-1/2 beds, 52/3 hospitals, 6-1/4 patients). Diversity sampling: A non-probability sampling procedure used when the investigation requires that subjects with a wide variety of opinions and views be included in the sample. Also called heterogeneity sampling. Double-blind study: Research design technique in which neither the subjects nor those who collect that data know which subjects are in the experimental group and which subjects are in the control group. Emic: In ethnographic research, the interpretation of the data from an insider’s point of view. Empirical evidence: Data gathered to generate new knowledge. It must be rooted in objective reality and gathered directly or indirectly through the human senses. Empirical generalization: A principle derived from empirical evidence. Empiricism: A characteristic of the scientific method in which evidence gathered to generate new knowledge must be rooted in objective reality and must be gathered directly or indirectly through the five human senses.

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Equivalent forms reliability: See alternate forms reliability.

Glossary Ethnographic research: Qualitative research approach for in-depth investigation of a culture or subculture in which data related to the members of the culture are collected, analyzed, and described. Ethnomethodology: Literally, “people’s methods.” A qualitative research approach that attempts to understand how people see, describe, and explain the world in which they live. Ethnomethodology focuses on the tacitly held knowledge that people use to function in a familiar situation. Ethnonursing: A term unique to nursing, used by Madeline Leininger in connection with her theory of culture care diversity and universality. Ethnoscience: A qualitative research approach that analyzes the language used by a study’s participants in order to determine how things are connected or recognized as belonging to the same categories. Ethology: The observation and measurement of behaviors in animals. Etic: In ethnographic research, the interpretation of data as an outsider looking in. Event sampling: A non-probability sampling procedure in which the investigator is concerned only with sampling from those specific occurrences and/or events that are relevant to the study. Evidence-based practice: Professional practice based on the use of wellestablished research findings as well as other valid and relevant evidence. Ex post facto research design: See retrospective research design. Experimental group: The group in which the experimental treatment is introduced. Experimental research design: Quantitative research design in which the independent variable(s) is manipulated by the researcher, subjects are randomly assigned to groups, and the experiment is conducted under controlled conditions. Experimenter effect: Consideration related to internal validity in experimental studies. Experimenters can unconsciously bias subjects by the tone of their voice, facial expressions, or other behavioral mannerisms. Expert sampling: A non-probability sampling procedure in which the researcher selects study participants based on the need to ascertain how experts in a field would react to or judge the phenomena of interest for the study. Exploratory study: Study conducted when relatively little is known about the phenomenon. Sometimes called a pilot study. External criticism: The evaluation of the validity of a historical data source. External validity: The ability to generalize the results of the study. Extraneous variable: See confounding variable.

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Essentials of Nursing Research Face validity: A sub-type of content validity that is determined by inspection of the items to see whether the instrument contains important items that measure the variables being studied. Fatigue: Consideration related to internal validity in experimental studies. Subjects or researchers can become tired, bored, or inattentive during the course of an experiment, thus affecting the results of the study. Fittingness: See transferability. Focus group research design: A method that allows the researcher to examine the points of view of a number of individuals in a group as they share their opinions/concerns about a topic. Usually consists of a small number of individuals who share a common bond. Friedman two-way analysis of variance by ranks: Non-parametric statistical test using ordinal-level data to determine whether related samples have come 2 from the same population by determining mean ranks. Symbolized by χr . Generalizability: A characteristic of the scientific method in which information from a sample of a population can be said to be representative of the entire population from which it was drawn. The findings from the sample of a specific study can then be inferred to the entire population. Generalization: See generalizability. Grand theories: See broad-range theories. Grounded theory research: A qualitative research approach that uses inductive reasoning to generate the theoretical underpinnings of the research by “grounding” or basing the theory in the data being collected. H: See Kruskal- Wallis one-way analysis of variance by ranks. Hawthorne effect: Consideration related to external validity in experimental studies; the psychological reactions to the presence of the investigator or to special treatment during a research study, which may alter the responses of the subjects. Heterogeneity sampling: See diversity sampling. Historical factors: Consideration related to internal validity in experimental studies. If an experiment is carried out over a period of time, factors that are extraneous to the experiment, such as maturation or increased knowledge on the part of the subjects, may affect responses. Historical research: Qualitative research approach that deals with what has happened in the past and how these events affect the present. Ho: See null hypothesis.

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Human subjects review board: See institutional review board.

Glossary Hypothesis A statement of the predicted relationship between two or more variables in a research study; an educated or calculated guess by the researcher (plural: hypotheses). Independent variable: The variable that is purposely manipulated or changed by the researcher; also called the manipulated variable. Inductive reasoning: Method of reasoning that moves from the specific to the general. Inferential statistics: Statistical tests used to make inferences (generalizations) to the larger population from which the sample was drawn. Informed consent: Voluntary agreement by a study subject to participate in a research study after being fully informed about the study. Innovation: Change perceived as new, such as new ideas or methods. Institutional review board (IRB): A committee appointed by an agency to review proposed research and monitor ongoing research within the agency to ensure protection of the rights of subjects participating in a research study. Also called human subjects review board. Internal criticism: Evaluation of the reliability (authenticity and consistency) of what is stated in a historical document. Internal validity: In an experimental study, refers to whether or not manipulating the independent variable(s) really docs make a significant difference on the dependent variable. Internet: An international electronic network that allows computers to communicate regardless of where the machines are located. Interrater reliability: Method for determining reliability in which the strength of agreement between the observations made by two or more observers is determined. Also called interobserver reliability. Intervening variable: See confounding variable. Interval data: Data based on a scale that has equal intervals but has no absolute zero starting point. Interview: Verbal questioning of respondents by the investigator in order to collect data. Requires interaction between people. IRB: See institutional review board. Isolated research: Research that is not linked to the theory development process. Judgment sampling: See purposive sampling. Key informants: Individuals who are willing to participate in a study and whose positions or roles in a society or institution place them in a position to know what is really taking place. Kinesics: The study of physical activity exhibited by individuals.

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Essentials of Nursing Research Kruskal-Wallis one-way analysis of variance by ranks (H): A non-parametric statistical test that ranks ordinal-level data to determine whether independent samples were drawn from the same continuous population. Likert scale: A self-report measure in which each statement usually has five possible responses, such as strongly agree, agree, uncertain, disagree, strongly disagree. Five responses are typical, but up to seven responses may be provided. Limitation: Restriction identified by the researcher that may affect the outcome of a study but over which the researcher has little or no control. Link-tracing sampling: See snowball sampling. Longitudinal research design: A research design in which data are collected from the same subjects at different points in time. Manipulated variable: See independent variable. Mann-Whitney U: Non-parametric statistical test that uses ordinal data (ranks) to determine whether two independent samples have been drawn from the same population. Mean: The arithmetic average. Measures of central tendency: See mean, median, mode, standard deviation. Median: The number that divides the sample in half so that 50% of the sample falls above the median and 50% falls below the median. Meta-analysis: A synthesis of the findings of many separate investigations relating to the same general phenomena. Microtheories: See narrow-range theories. Middle-range theories: Theories that have a narrower focus than broad-range theories. “Middle- range theories are more precise than grand theories and focus on developing theoretical statements to answer questions about nursing” (Marriner-Tomey & Alligood, 1998, p. 11). Also called midrange theories. Modal instance sampling: Type of non-probability sampling procedure that identifies subjects who represent the typical case that is constructed by the researcher for purposes of the study. Mode: The most frequently occurring score or number value. Model: A symbolic representation of reality used to demonstrate the interrelationships among a set of concepts or phenomena that cannot be directly observed but that do represent reality.

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Mortality threat: Loss of study subjects; a consideration related to internal validity in experimental studies, especially when the dropout rate is much different between the experimental and the control groups.

Glossary Multiple analysis of variance (MANOVA): Parametric statistical test to determine interaction effects between two or more independent variables and two or more dependent variables. Multistage Sampling: See cluster random sampling. N See population. n See sample. Narrow-range theories: Theories that deal with a limited range of discrete phenomena or concern to a discipline; also called microtheories. Naturalistic paradigm: An approach to scientific inquiry in which reality is subjective as mentally constructed by individuals. Network sampling: See snowball sampling. Nominal data: Data that can be separated into only two mutually exclusive categories. Nominated sampling: See snowball sampling. Non-directional hypothesis: A hypothesis that predicts a relationship between the independent and dependent variables but does not specify the direction or the relationship. Non-parametric statistics: Inferential statistics that do not require the same rigorous assumptions as parametric statistics. Non-parametric statistics are most often used when samples are small and/or when the data are measured on the nominal or ordinal scales. Non-probability sampling: Sampling approach in which the investigator cannot estimate the probability that each clement of the population will be included in the sample, or even that it has some chance of being included. Normal curve: A theoretical bell-shaped curve with most measurements clustered about the centre and a few measurements at the extreme ends. Null hypothesis (Ho): See statistical hypothesis. Nursing research: Research conducted to answer questions or to find solutions to problems that fall within the specific domain of nursing. Observation: Watching and noting actions and reactions. Odd/even reliability: See split-half reliability. Operational definition: The researcher’s definition of a term that provides a description of the method for studying the concept by citing the necessary operations (manipulations and observations) to be used. Opinionnaire: A questionnaire designed to elicit data about a subject’s opinions. Order: A characteristic of the scientific method that uses a series of systematic steps: (1) identification of a problem to be investigated; (2) precise definition,

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Essentials of Nursing Research measurement, and quantification of the phenomena related to the research problem; (3) collection and analysis of data (information) that bears on the solution to the problem; and (4) formulation of conclusions regarding the problem being investigated. Ordinal data: Data that are ordered but for which there is no zero starting point; the intervals between individual datum are not equal. Big, bigger and biggest are ordinal data, p: In inferential statistics, the symbol p stands for probability. Paradigm: “A way of looking at the world or perspective on phenomena that presents a set of interrelated philosophical assumptions about the world. The perspective guides research and practice” (Doordan, 1998, p. 91). Parametric statistics: Inferential statistics that assume a normal distribution of the variables and the use of interval or ratio measures. Participant observation: Observation technique in which the observer becomes a participant in the situation being observed. Used in ethnographic research. Pearson r: Pearson product-moment correlation coefficient. A parametric correlation statistic. Percentile rank: Descriptive statistic indicating the point below which a percentage or scores occurs. Phenomena: Facts or events that can be observed and scientifically described because they are known through the senses rather than by thought or intuition (singular: phenomenon). Phenomenology: Research approach based on the philosophy of phenomenology, which proposes to understand the whole human being through “the lived experience.” Pilot study: A small-scale version of the actual study conducted with the purpose of testing and potentially refining the research plan. Sometimes called an exploratory study. Population: The total group of individual people or things meeting the designated criteria of interest to the researcher. Typically shown as N. Also known as the target population. Positivist-empiricist paradigm: See positivist paradigm. Power analysis: A statistical procedure that allows the researcher to estimate how large a sample should be in order to determine the likelihood of accepting a null hypothesis that should actually be rejected or determining that a relationship does not exist between variables when a relationship actually does exist.

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Predictive validity: The ability of an instrument to predict an individual’s behavior in the future; a type of criterion-related validity.

Glossary Pretest: (1) The process of testing the effectiveness of a measuring instrument in gathering appropriate data. (2) In an experimental study, the datacollection procedure before the experimental phase of the study. Primary source: First-hand information obtained from original material; not interpretive or hearsay information. Principle of beneficence: Ethical principle that requires that a researcher should do no harm to the individual or, if risks cannot be avoided, that the benefits of research should be maximized while the possible harm should be minimized. Principle of justice: Ethical principle that requires that subjects be treated in a fair and equitable manner and that the resulting benefits of research must be equitably applied to all members of society rather than just to those who can afford them. Principle of respect for human dignity: Ethical principle that requires that individuals be treated as autonomous agents who are capable of self-determination that allows them voluntarily to take part in activities that may harm them when they are made fully aware of the potential dangers of such activities. Probability sampling: Sampling approach in which the investigator can specify, for each population element, the probability that it will be included in the sample– that is, there is a known probability or each element being included in the sample. Problem solving process: A process to find an immediate solution to a practical problem in an actual setting. Projective test: Psychological test that requires the subject to project a meaning into essentially ambiguous or meaningless materials. Proportional sampling: A sampling technique that requires that the researcher be able to identify the percentage of the population that each stratum contains. The researcher then samples the population proportionately, based on these percentages. Proposition: A statement of a relationship between two or more concepts in a theory. Prospective research design: A non-experimental research design that identifies the independent variable(s) in the present and looks to the future to identify potential effect(s) (the dependent variable). Protocol: See research-based clinical protocol. Proxemics: The study of body language, such as facial expressions, proximity to one another, touch, and gestures, all of which can be analyzed to determine patterns of behavior accompanying various tasks. Purposive sampling: Non-probability sampling procedure in which subjects are selected because they are identified as knowledgeable regarding the subject under investigation. Also called judgmental sampling.

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Essentials of Nursing Research Qualitative data: Data characterized by words rather than numbers. Qualitative research: A research method in which the investigator seeks to identify the qualitative (non-numerical) aspects of the phenomenon under study from the participant’s viewpoint in order to interpret the meaning of the totality of the phenomenon. Usually conducted in the natural setting. Quantitative data: Data characterized by numbers. Quantitative research: A research method in which the study variables are preselected and defined by the investigator and the data are collected and quantified (that is, translated into numbers), then statistically analyzed, often with a view to establishing cause-and-effect relationships among the variables. Quasi-experimental research design: Quantitative research design in which there is always manipulation of the independent variable(s) and control measures are employed, but the other element of a true experiment, random assignment of subjects, is absent. Questionnaire: A paper and pencil data-collection instrument that is completed by the study subjects. Quota sampling: Non-probability sampling procedure in which study subjects are selected in such a manner that each stratum of the population is proportionately represented. r: See Pearson r. rs: See Spearman’s rho. Random route sampling: A probability sampling procedure that is useful in conducting research when the investigator intends to conduct interviews in households, businesses, or other such premises that need to be sampled. Random sampling :Selection of subjects based on chance alone. Also see simple random sampling or stratified random sampling. Randomization: Random assignment of subjects to the groups in an experimental study on the basis of chance alone. Range: The difference between the lowest and the highest score on measuring instrument; the high score minus the low score. Rating scale: A type of data collection instrument designed to allow respondents to place their responses on a scale that has a range of potential responses. Ratio data: Data based on a scale that has equal intervals and an absolute zero starting point.

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Refereed Journal A journal that uses the process of having three or more experts independently review and judge the merits of a manuscript before acceptance for publication.

Glossary Regression toward the mean: Consideration related to internal validity in experimental studies; the tendency for changes in scores of individuals when given the same test several times to come closer to the mean scores of the group. Reliability: (1) In quantitative research, the stability of a measuring instrument over time. (2) In qualitative research, “the measure of the extent to which random variation may have influenced stability and consistency of results” (Morse and Field, 1995, p. 243). Replication: Repeating a study using the same methods in order to determine whether the results will be the same as or similar to the original study. Research: An orderly process of inquiry that involves purposeful and systematic collection, analysis, and interpretation of data (units of information) in order to gain new knowledge or to verify already existing knowledge. Research critique: An objective and critical evaluation of the strengths and weaknesses of an entire research study. Research design: The overall plan for a research study. Research hypothesis: Method of stating a hypothesis so that it specifies the relationship between the variables that the researcher expects as the study’s outcome. Research process: A guide for deriving systematic information (new knowledge) concerning the phenomena of interest to the researcher. Research proposal: A detailed written description of a proposed research study; sometimes called a prospectus. Research utilization (RU): A systematic process by which the scientifically valid results of research are transferred for use in practice. Research-based clinical protocol: A written document that organizes and transforms research- based knowledge so that it can be used to direct clinical practice activities. Research-based document: A written document that transforms research-based knowledge so that it can be used in practice. Retrospective research design: A nonexperimental research design in which changes in the independent variable have already occurred before the research due to the natural course of events. Also called ex post facto research design. Risk-benefit ratio: Anticipated benefits to subjects should outweigh the risks to the subjects, and knowledge to be gained should be of sufficient importance to merit any risks to which subjects might be subjected. Sample: A smaller part of the population selected in such a way that the individuals in the sample represent (as nearly as possible) the characteristics of the population. Typically shown as n.

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Essentials of Nursing Research Sampling frame: The list of all of the members of the population from which the sample is taken. Sampling: Process of selecting a sample from the target population. Science: A unified body of systematized knowledge concerned with specific subject matter obtained by establishing and organizing facts, principles, and methods. Scientific merit: The degree to which the study is both methodologically and conceptually sound. Scientific method: “An orderly, systematic, controlled approach to obtaining precise empirical information and testing ideas” (Doordan, 1998, p. 112). Secondary data analysis: A research technique in which the investigator uses existing data either to design research studies to answer new questions or to test new hypotheses, or to reinterpret the existing data. Secondary source: An interpretive or hearsay source of data. Self-report: A subject’s response to a survey instrument, such as a questionnaire or interview. Semantic differential scale: A scale consisting of a listing of bipolar adjectives with a five to seven point scale between them that may describe a setting, object, profession, or any other variable of interest. Serendipitous findings: Important and unexpected discovery of significant results in a research study not related to the purpose of the study. Simple hypothesis: A statement of the predicted relationship between two variables–that is, a single independent variable and a single dependent variable. Simple random sampling: A probability sampling procedure in which the required number of sampling units is selected at random from the population in such a manner that each population element has an equal chance (probability) of being selected for the sample. Single-blind study: Design technique for achieving control in a research study carried out in either of two ways: (1) The study subjects know whether they are in the experimental or control group, but the data collectors do not know; (2) the data collectors know whether subjects are in the experimental or control group, but the subjects do not know. Snowball sampling: A non-probability sampling procedure in which study subjects are asked to provide referrals to other study subjects. Also called nominated sampling or network sampling. Sociometric technique: A quantitative research technique used to determine social interaction and leadership patterns within a group.

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Spearman’s rho (rs): A non-parametric measure of correlation.

Glossary Split-half reliability: Method for determining reliability in which responses to a measuring instrument are divided in half, scored separately, and then correlated. Also called odd-even reliability. Standard deviation: The general indicator of the dispersion or spread of scores from the mean. Standard score: A number reflecting the distance that an individual score is from the mean in standard deviation units. Reported as z, Z, or T. Statistical hypothesis: A statement of no statistically significant difference or relationship between the variables of a study. Also called the null hypothesis. Stratified random sampling: A probability sampling procedure that is a variation of the simple random sample. The population is divided into two or more strata or groups with different categories of a characteristic. A simple random sample is then taken from each group. Subject sensitization: Subjects become knowledgeable about or sensitized to the procedures used during a research study. Survey research: The collection of data directly from the study subjects, usually by questionnaire or interview. Systematic random sampling: A probability sampling procedure in which subjects are randomly selected from the population at fixed intervals that are predetermined by the researcher. T score: See standard score. t test: A parametric statistical measure to determine the differences between the means of two groups. Symbolized by t. Target population: See population. Test-retest reliability: Approach to estimating reliability that indicates variation in scores from one administration to the next, resulting from measurement errors. The same instrument is administered to the same individuals at different times and the two sets of scores are then correlated. Theoretical definition: Definition of a variable using the specific language of the theory or conceptual model that serves as the framework for a research study. Theoretical framework: Discussion of one theory or inter-related theories being tested in order to support the rationale (reason) for conducting the study. Theoretical sampling: A nonprobability sampling procedure most often associated with qualitative research, primarily the grounded theory method. Theory: A set of logically inter-related statements that is “a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena” (Chinn & Kramer, 1995, p. 72). Theory-generating research: A type of theory-linked research that is designed to develop theory. Theory-linked research “Research designed with reference or linkage to theory” (Chinn & Kramer, 1995, p. 141).

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Essentials of Nursing Research Theory-testing research: A type of theory-linked research that is designed to test how accurately a theory depicts phenomena and their relationships. Time sampling: A nonprobability sampling procedure used by researchers who are concerned with collecting data on activities that take place at specific times or the day or night. Transferability: In qualitative research, asks the questions, “Are the results applicable outside the research situation; would the findings have meaning to others in a similar situation or situations?” Triangulation: (1) The use of both quantitative and qualitative methods in the same research study. (2) In quantitative studies, the use of three or more techniques to collect data. Trustworthiness: See confirmability. Type I error: The rejection of the null hypothesis when it should have been accepted; also called alpha error. Type II error: The acceptance of the null hypothesis when it should have been rejected; also called beta error. U: See Mann-Whitney U. Unobtrusive measure: The researcher decides what needs to be measured and then determines how to measure it without direct intervention. Usability: The practical aspects of using a measuring instrument. Utilization: See research utilisation. Validity: (1) In quantitative research, the ability of a data-gathering instrument to measure what it purports to measure. (2) In qualitative research, “the extent to which research findings represent reality” (Morse & Field, 1995, p. 244). Variable: An attribute or characteristic that can have more than one value, such as height, weight, and blood pressure. Visual analog scale (VAS): A self-report paper-and-pencil scale that consists of a straight line that has the extreme limits of the variable being measured at each end of the line. The straight line may be either vertical or horizontal. The scale is designed to have the respondent indicate a point on the line that indicates where the intensity of the specific attribute being measured is located. Voluntary sampling: A type of nonprobability sampling procedure in which volunteers either offer or are actively recruited to participate in a study. World Wide Web: See Internet; also called www. 2

χ : See chi-squared. 2

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χ r: See Friedman two-way analysis or variance by ranks. Z score: See standard score.

Appendix

Appendix

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

The Evolution of Research in Nursing in India The history of nursing comprises many changes and develop-ments. Reviewing the history of research in nursing enables one to better understand the current status and project the future of nursing research. Historical events also provide a basis for the methods of scientific inquiry that are used in developing the empirical or research knowledge base for nursing. Majority of people, think that research is relatively new to nursing, but “Florence Nightingale” initiated nursing research more than 140 years ago (F. N. 1859). Nightingale’s notes on nursing (1859) describe her initial research activities, which focussed on the importance of a healthy environment in promoting the patient’s physical and mental well-being. She identified the need to gather data on environment, such as ventilation, cleanliness, temperature, purity of water and diet, to determine the influence on the patient’s health (Herbert 1981). Nightingale is most noted for her data collection and statistical analyses during the Crimean war. She gathered data on soldier morbidity and mortality, and the factors influencing these. Her statistical data were clearly presented in tables and pie diagrams, a sophisticated type of data presentation for this period (Palmer 1977). F Nightingale research enabled her to instigate attitudinal, organisational and social change. She changed the attitude of the military and society towards the care of the sick. The military began to view the sick as having the right to adequate food, suitable quarters and appropriate medical treatment. The interventions drastically reduced mortality from 43% in the Crimean war (Cook 1913). Florence Nightingale improved the organisation of army administration, hospital management and hospital construction. Because of the Nightingale’s influence, society began to accept responsibility for testing public water, improving sanitation, ‘preventing starvation and decreasing’ morbidity and mortality (Palmer 1977). Research evolved slowly in nursing from the investigations of Nightingale in the 19th century to the studies of nursing education in the 1930s and 1940s and the studies of nurses and nursing role in the 1950s and 1960s. However, in the 1970s and 1980s numerous studies were conducted that focussed on clinical practice. The conduct of clinical research continued to be a major focus of the 1908, with the intent of developing a research based practice.

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Research in India has its roots with philosophy of Florence Nightingale that a profession is committed to the task of enlarging body of knowledge through systematic approach to solve problems in nursing. The statistics on the insanitary conditions of the army in India prepared by F Nightingale may be called a starting point of research in India. Afterwards so many developments have taken place in India, through the emergence of associations, educational institutions and efforts of prominent educators and administrators though directly or indirectly adopting the scientific approach as shown below: 1905 : Association of Nursing Superintendents was constituted/ formed. 1908 : Trained Nurses Association of India was established/formed. 1909 : Bombay Presidency Nursing Association was formed. Missionary Nurses North India Board, set up under Medical Missionary Association of India. 1911 : The South Indian Board was established INAI affiliated to International Council of Nurses. 1912 : The First Nurses, Registration Act was enacted in Madras Presidency. 1930 : The Christian Nurses Anxilliary formed by the missionary nurses. 1934 : The Bengal Nurses Act was enacted for the nurses, midwives and H.V. of undivided Bengal. 1936 : The Mid India Board of Education affiliated to Christian Nurses league, Christian Nurses Anxilliary Association was affiliated to TNAI. 1941 : Standardised pay scales and terms of services were established in Madras. State nursing superintendent, appointed at state level (Madras). 1942 : The Anxiliary Nursing Service (ANS) was established. One nursing superintendent was appointed as nursing advisor at DGHS, Government of India, to organise nursing services. 1943 : Establishment of School of Nursing Administration for Military Nursing Services Health Survey and Development Committees (Bhore) constituted by Government of India. Study groups worked on proposal for university education in nursing in India. CMC Vellore and Madras General Hospital started courses to train nursing tutors. Commissioned rank was given to the Indian Military Nursing sisters. 1946 : Bhore Committee submitted report, recommendations made on improvement of various aspects of nursing profession: Nursingeducation, working conditions, nursing services in both hospital and community and deputing nurses for higher education to

Appendix

1947

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1948 1950

: :

1951

:

1952

:

1953

:

1954

:

1955

:

1959

:

1961

:

abroad, etc. Establishment of the College of Nursing at Delhi (now Rajkumari Amrit Kaur College of Nursing) under the Union Ministry of Health to start university nursing education programme for the first time in India leading to Bachelor’s degree in nursing, i.e. BSc (Hons.) Nursing. Indian Nursing Council Act was passed (31.12.1947) on the basis of recommendations of Bhore Committee. Degree programme for nursing started in Vellore. The first meeting of Indian Nursing Council (INC) was held. The INC took decision to establish ANM programme to meet the requirement of workers in nursing. Establishment of urbanfield teaching centre is started at College of Nursing, Delhi in collaboration with existing MCH centres of Municipal Corporation, Delhi for teaching of urban community health nursing. Establishment of residential field teaching centre for teaching community health nursing in the rural area under College of Nursing, Delhi in collaboration with primary health centre, Najafgarh. Ms Edith Buchanan, vice principal, College of Nursing (RAK), Delhi was sent to Columbia University to earn her Doctorate in Education (D. Ed.) through WHO fellowship. Government of India constituted committee to review conditions of services, emoluments; etc. of nursing profession (Shetty committee). Shetty Committee Report was published, recommended nursing staff norms of hospital community and other improvements in nursing. Establishment of child guidance clinic at College of Nursing (RAKCON) for providing services and strengthening community health nursing and paediatric nursing. Ms Margaretta Craig, principal, College of Nursing, Delhi attended ICN meeting in France, to present a paper on the need for nursing research in India. Dr Edith M. Buchanan, succeeded in establishing the long cherished “Master of Nursing” degree programme at (RAK) College of Nursing, New Delhi under University of Delhi (October 1959). Healthy Survey and Planning Committee (Dr LN Mudaliar) was constituted by Government of India to review the progress made in health since, Bhore committee recommendation. Mudaliar Committee report published, made some recommendations to improve nursing profession.

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Essentials of Nursing Research 1963

372

: A WHO assisted technical project was undertaken at the INC to revise the GNM course. Dr. Buchanan, succeeded in sending Mrs Sulochana Krishnan, one of the first graduates of this newly established, M.N. degree programme, to earn the D. Ed. degree from Columbia University. 1964 : Dr. Marie Furguson, a public health nurse came to the College of Nursing, Delhi was able to create greater appreciation and understanding of the need and value of research in planning nursing administration and education with senior leaders of the country conducted “Activity studies to define the nursing and non-nursing functions of nursing personnel. 1965 : A WHO publication on ‘Guide for School of Nursing’ in India was published. 1966 : TNAI established research section under the Chairmanship of Ms Margarata Craig. TNAI conducted ‘Time study’ with the co-operation of Ms Anna Gupta, principal, RAKCON, under the supervision of Dr Sulochana Krishnan. 1969-71: INAI and VHAI, CHAP conducted study on survey on the socioeconomic status of nurses in India. 1973 : Kartar Singh Committee report on multipurpose workers and Health and family planning department published and recommended ANM and LHVs were redesignated and health workers (F) and health assistant (F) to cover the required population at rural area for providing proper health services. 1975 : Shrivastav Committee report on 3 tier-plan of health care delivery system to rural area was recommended. 1976 : Dr Marie Farell and Dr Aparna Bhaduri of Rajkumari Amrit Kaur College of Nursing, New Delhi, conducted seminars on nursing research for educationists at Delhi, Mussoorie (Uttarakhand) and Yarcaid (IN) to strength the nursing research in India. 1978 : Government Nurses Association of Karnataka established. 1981 : Dr Farrel and Dr Bhaduri’s book ‘Health Research’–A Community based Approach’ published by World Health Organization. 1986 : The Nursing Research Society of India (NRSI) was established to promote research within and around nursing environment. Dr (Mrs) Inderjit Walia was founder president. Mrs Uma Hunda was its secretary. M Phil in nursing programme started at RAKCON, under Delhi University. 1987 : Reports of the expert committee on health and manpower planning, production and management (Bajaj Committee)

Appendix published. This committee also dealt with nursing service conditions norms and nurses emoluments, etc. 1988 : RAKCON, New Delhi was designated as World Health Collaboration Centre for nursing Developments reports of the high power committee on nursing and nursing profession published. Dr Ruth Hurner book “Nursing Education in India” published on the basis of survey. 1991 : Author registered PhD in nursing at Bangalore University. 1992 : PhD in nursing programme started at RAKCON, under Delhi University. Mrs Asha Sharma got registered for the Doctoral course. 1994 : Author awarded Doctoral degree in nursing by the Bangalore University, under the able guidance of Dr (Mrs) MK Vasundhra, professor and head of Department of Preventive and Social medicine, Bangalore Medical College, Bangalore. Indira Gandhi National Open University, launched post basic 3 years BSc Nursing degree programme on all India level. As I would like to quote some of our senior leaders and educationists, who were Indians and earned their doctoral degrees, are as follows: In the chronological form 1. Dr Sulochana Krishnan from Columbia University. 2. Dr Madhavi Sharma from Boston University 3. Dr Annamma Chandy, from Columbia University 4. Dr Aparna Bhaduri, from Columbia University 5. Dr Margret Dean, from Columbia University 6. Dr Aliyamma Kurian, from Columbia University 7. Late Dr Kasturi Sunder Rao, from Columbia University 8. Dr Homai Dastoor, from Gujarat University 9. Dr Inderjit Walia from PGI, Chandigarh 10. Dr M. Sulakshini Immaneul, from Columbia University 11. Dr Vimala Agarwal from Rajasthan University 12. Dr Naina Potdar from SNDT Women University 13. Dr Prakasamma from Jawaharlal Nehru University, New Delhi 14. Dr B.T. Basavanthappa from Bangalore University Now, so many nurses who acquired MSc nursing degree have been registered in their respective university to earn doctoral degree in nursing in various part of India. Recently national consortium of PhD has came into exisence in collaboration with World Health Organisation, Indian Nursing Council and Rajiv Gandhi University of Health Sciences, Karnataka. India to produce more number of Doctoral degree nurses to take nursing research related to their respective areas in nursing.

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Essentials of Nursing Research Actually the modern trend of nursing research has been started in western world. Here are the chronological development of nursing and its research as follows:

Nineteenth Century after 1850 1852 1856

1859

1859 1860 1861 1872

1893 1899

Nightingale wrote ‘Cassandra.’ Nightingale studied and calculated mortality rates of British in Crimean War and on basis of data developed plans to decrease military overcrowding. Nightingale’s Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, and Notes on Hospitals published. Nightingale’s Notes on Nursing published. Nightingale founded St. Thomas’s Hospital School of Nursing in England. Nightingale developed cost accounting system for army medical services. First nursing schools in the US began New England Hospital for Women and Children, Boston; Women’s Hospital, Philadelphia. Lillian Wald and Mary Brewster established Henry Street Visiting Nurse Service. International Council of Nurses organised.

Twentieth Century before 1950 1902 1900 1909 1909 1912 1914 1923 1923 1924 1926

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Lavina Dock reported school health experiment begun by Lillian Wald for free child health care. American Journal of Nursing publication began. Nursing programs began at Columbia University Teacher’s College and University of Minnesota. “Visiting Nursing in the United States” conducted by Waters. American Nurses Association established. Metropolitan Life Insurance Company contracted nurses to collect data on health problems and tuberculosis. Goldmark Report published. Yale and Case Western Reserve universities nursing programs began. First nursing doctoral program began at Teacher’s College, Columbia University. From 1926 to 1934 Committee on Grading of Nursing Schools convened.

Appendix 1927 1934 1934 1936 1948 1948

Edith S. Bryan became the first nurse to receive a PhD in psychology and counselling from the Johns Hopkins University. Nursing doctoral program established at New York University. Nightingale International Foundation established. Sigma Theta Tau National Hopor Society for Nursing began nursing research funding. Nurses for the Future–The Brown Reports was published. United states public health service division of nursing conducted nursing surveys and published manuals for the conduct of nursing research.

Twentieth Century after 1950 1950 1952 1952 1953 1953 1955 1956 1956 1957 1957

1958 1959 1962 1962 1962 1963

American Nurses Association established a master plan for research 1951-1956. National League for Nursing was established. Nursing Research publication began. Nursing Outlook publication began. Institute of Research and Service in Nursing Education was established at Teacher’s College, Columbia University. American Nurses Foundation was formed. United States public health service began awarding grants for nursing research. Predoctoral fellowships for nursing research were first awarded. Department of Nursing Research was established at Walter Reed Army Hospital. Western Council on Higher Education in Nursing (WCHEN) sponsored Western Interstate for Higher Education (WICHE) to augment graduate nursing education especially in nursing research. Abdellah League for Nursing (ALN) Research and Studies Service was established. First faculty research grants awarded to University of Washington and University of California at Los Angeles. American Nurses Association Blueprint for nursing research was issued. Nurse Scientist Graduate Training Grants Programmes was initiated. Nursing Forum publication began. International Journal of Nursing Studies publication began Surgeon General’s Consultant Group on Nursing report was issued.

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Essentials of Nursing Research 1963 1965 1969 1970 1971 1974 1974

1974 1976 1976 1978 1978 1979 1979 1980 1983 1986 1987 1988 1988

1989 1991

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1991

Lydia Hall published study of chronically ill at Loeb Centre. American Nurses Association began sponsoring conferences for nursing research. Wayne State University College of Nursing established the first nursing research centre. Abstract for Action–Lysaugh: Report was published. American Nurses Association Council of nurse researchers was organised. Western Council on higher education in nursing set five year goal to triple nursing research. American Nurses Association Commission on nursing research proposed involvement of various levels of students in research and a clinical thrust for research. American Nurses Association testified at President Gerald Ford’s Panel on biomedical research. Research in Nursing Toward a Science of Health Care Published by ANA report of nursing research trends. National League for Nursing set criteria for undergraduate nursing research course in BSN programmes. Research in Nursing Health publication began. Advances in Nursing Science publication began. Western Journal of Nursing Research publication began. Haller, Reynolds and Horsley published research utilisation criteria. Commission on nursing research of the American nurses association set research priorities for 1980s. Institute of Medicine completed report of Nursing and Nursing Education Public and Private Action. National Centre for nursing research established at the National Institute of Health. Scholarly Inquiry for Nursing Practice and Applied Nursing Research publication began. Nursing Science Quarterly and Nursing Scan in Research publication began. Conference on research priorities in nursing science (CORP No. 1) to set research priorities known as national nursing research agenda. National Centre for Health Sciences Research became Agency for Health Care Policy and Research (AHCPR). National Pressure Ulcer Advisory Panel gives its first award to Nancy Bergstrom. Qualitative Health Research publication began.

Appendix 1992 1992 1992

1992 1993

1993

Kathleen McCormick calls for outcome research efforts. Conference on Research Priorities in Nursing Science (CORP No. 2) met to set updated research priorities. Clinical Practice Guidelines Urinary Incontinence in Adults Pain Management and Pressure Ulcer in Adults were published by AHCPR. Healthy People 2000 was published by the Public Health Service. Report was released of a proposed multiuser funding mechanism by National Centre for Nursing Research to increase the integration of biological and nursing sciences. National Center for Nursing Research becomes National Institute of Nursing Research (NINR).

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Index

Index

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

A Accidental sampling 353 Action research 36, 41, 353 Administration of questionnaire 280 Alpha error 353 Alternate forms reliability 353 Alternative modes of sending questionnaires 232 Analysing and interpreting data 67 Analysing data 44 Analysis of covariance 204, 353 Analysis understanding 77 Anonymity 353 Applied research 36, 38, 353 Assessment phase 61 Assumption 353 Attrition 353 Audit trail 353 Auditability 353

B Basic research 36, 353 Beta error 353 Biochemical measurements 258 Biological measurement 256 Biophysical measurement 257 Blind study 354 Broad-range theories 354

C Case study 214, 354 advantages of 215 limitations of 215 Categorising observations 60 Category system 270 Census survey 140 Chi-squared 354

Cinahl 354 Cluster random sampling 354 Cohort 354 Collecting data 66 Communicating nursing research 318 Communicating findings 67 Communication behaviour 266 nonverbal 266 verbal 266 Compact disk-read-only memory 354 Complex hypothesis 354 Concealment with intervention 265 Concepts of research 1 Conceptual framework 354 model 183 Concurrent validity 354 Conducting the pilot study 65 Confidentiality 176, 354 Confirmability 354 Confounding variable 354 Constant comparative method 354 Construct validity 355 Constructing a conceptual 97 Construction of theoretical framework 85 Content analysis 60, 238, 355 validity 355 Continuous data 355 Control group 55, 355 Convenience sampling 355 Correct forms of references 190 Correlation 355 coefficient 355 designs 56 research design 355

379

Essentials of Nursing Research Counterbalanced design 54 Credibility 355 Criteria of problem selection 90 Criterion variable 355 Criterion-related validity 355 Critical reading skill and its process 76 Critical thinking skill 75 Critique 352 Critiquing research report 349 Cross-sectional research design 355

D

380

Data analysis and interpretation 296 classification 301 coding 305 collection 194 collection case study method 245 Delphi technique 241 ethologic technique 243 interviewing as a method 220 mail survey as a method 230 measurement as a technique 251 projective techniques 234 secondary 243 sources of field 217 historical 217 primary 216 secondary 216 self-report scales 218 unobtrusive measures 217 types of tools 250 editing 298 accuracy 300 completeness 299 uniformity 300 identifying 298 need 195 pertaining to human beings 194 territorial areas 194 preparation step 298

sources 196 evaluation 199 methods of collecting primary 197 primary 196 secondary 196 transcriptions 304 types 194 Debrief 355 Deductive reasoning 356 Defining objectives of study 97 Defining the concepts and variables 62 Definitions of theory 81 Delimiting the scope of the study 98 Delphi technique of data collection 241 Demerits of interviewing 221 Demographic variable 57, 356 Dependent variable 356 Describing research design 64 Descriptive research 36, 39, 57, 356 statistics 356 Diagnosis phase 62 Diagnostic research 36, 40 Diffusion 356 Directional hypothesis 356 Discrete data 356 Diversity sampling 170, 356 Double-blind study 356

E Educational level of respondents 199 Emic 356 Empirical data 5 evidence 356 generalisation 356 interest 87 Empiricism 356 Equivalent forms reliability 356 Ethical clearance 185 implications for nursing research 175

Index issues in nursing research 171 Ethnographic 43 research 357 Ethnography 46 Ethnomethodology 357 Ethnonursing 357 Ethnoscience 357 Ethology 357 Etic 357 Evaluating a research problem 103 Evaluation phase 67 analysing and interpreting 67 communicating the findings 67 Evaluative research 36, 40 Event sampling 170, 357 Evidence-based practice 357 Evolution of research in nursing in India 369 Ex-post facto research design 357 Experimental design types 127 effect 357 field 206 group 357 laboratory 205 research 49 research design 48, 357 validity of 207 Expert sampling 170, 357 Exploratory research 36, 38 study 357 External criticism 357 factors 93 validity 357 Extraneous variable 358

F Face validity 358 Factorial designs 50 Fatigue 358 Field experiment 206

Fittingness 358 Focus group research design 59, 358 Formulating the research proposal 62 Formulation of hypotheses 98 selected problem 96 process 97 Friedman two-way analysis of variance by ranks 358

G Gathering the data 44 Grand theories 358 Grounded theory research 358 Guidelines for advantages 108 characteristics of a good 108 classification 112 developing the research 114 directional 112 preparing thesis 186 writing references 187

H Hawthorne effect 358 Heterogeneity sampling 170, 358 Historical design 132 factors 358 research 47 Human subjects review board 359 Hypotheses 105, 112, 183, 359 advantages 108 characteristics 108 classification 112 developing the research 114 directional 112 meaning 106 nondirectional 113 purposes 107 role 107 sound 108 sources 110

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I

J

Identifying data structure 298 phenomenon 46 Implementation phase 66 Independent variable 101, 359 Inductive reasoning 359 Inferential statistics 359 Informed consent 175, 359 Innovation 359 Institutional review board 359 Intercellular molecules 256 Interest of professional organisation 88 Interested in untested theory 88 Internal criteria 93 criticism 359 validity 359 Internet 359 Interpretation of data 314 Interrater reliability 359 Interval data 359 Interval measurements 254 Intervening variable 359 Interviewing characteristics 221 demerits 221 merits 220 requirements of successful 222 Interviews types of 223 clinical 226 depth 226 focused 226 personal 223 structured or directive 224 unstructured or non-directive 224 Investigator’s role 120 Irb 359 Isolated research 359

Judgement sampling 359

K Key informants 359 Kinesics 360 Kruskal-wallis one-way analysis 360

L Laboratory experiment 205 Levels of measurement 253 Library methods 215 Likert scale 218, 360 Limitation 360 Link-tracing sampling 360 Logs and field notes 268 Longitudinal research design 360

M Manipulated variable 360 Manipulation 123 Matching samples design 51 Material and methods 187 Measurement process 252 scale and indices 255 Measures of central tendency 360 Measuring biological and physiologic responses 257 Median 360 Merits of interviewing 220 Meta-analysis 59, 360 Method of knowing facts 9 authority 10 intuition 10 tenacity 9 data collection 194 Microtheories 360 Middle-range theories 360 Modal instance sampling 169, 360

Index Mode 360 Mortality threat 361 Multiple analysis of variance 361 Multistage sampling 361 Multi-treatment interference 209

N Narrow-range theories 361 Naturalistic paradigm 361 Need for panel study 228 research in nursing 30 Need of data 195 Network sampling 361 Nominal data 361 measurement 253 Nominated sampling 361 Non-directional hypothesis 361 Non-experimental 36 Nonexperimental quantitative research designs 56 Non-parametric statistics 361 Non-probability sampling 361 Non-probability sampling methods 164 Nonrandomised control group design 54 Normal curve 361 Novelty of the problem 93 Novelty or originality 95 Null hypothesis 361 Nursing research 361

O Objective of the study 182 Observational characteristics 201 controlled 202 direct 201 indirect 202 methods of advantages 271 disadvantages 271

non-participant 201 participant 201 planning 202 types 201 uncontrolled 202 Observers and their role 264 Odd/even reliability 361 Operational definition 361 concepts 98 Opinionnaire 362 Order 362 Ordinal data 362 measurement 254 Originating question 96 Overview of research process 61

P Panel method of data collection 227 types of 228 advantages 229 limitations 229 Paradigm 362 Parametric statistics 362 Participant observation 268, 362 Pearson 362 Phenomena 362 amenable to observation 266 Phenomenological 36, 43 research method 45 Phenomenology 362 Physiological measurement 256 Pilot study 290, 362 purpose 291 Plan for data analysis and interpretation 309 Planning 177 and conducting experiments 203 Planning for communicating the findings of research 66 protection of subject’s rights 171

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Essentials of Nursing Research Planning observation 202 phase 64 Political concerns 88 Popular conceptions 87 Population 362 Positivist-empiricist paradigm 362 Power analysis 362 Practical needs 87 Predictive validity 363 Pretest 363 procedure 295 Previous research 87 Principle of beneficence 363 justice 363 respect for human dignity 363 Priorities 88 Probability sampling 363 Problem solving process 363 Problem statement 101 Projective techniques types 235 test 363 Proportional sampling 363 Prospective designs 58 research design 363 Protection subjects 176 Protocol 178, 363 Proxemics 363 Psychological measurement 259 Purposive or judgement sampling 168 Purposive sampling 364

Q

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Qualitative data 364 measurement 253 research 36, 42, 364 methods 44 Quantitative data 364 designs 70 measurement 253

research 36, 42, 48, 364 Quasi experimental 36 research design 53, 364 Questionable practices involving research 284 Questionnaire 364 Quota sampling 165, 364

R Random route sampling 364 sampling 364 Randomisation 125, 364 Range 364 Rating scale 218, 364 Ratio data 365 level measurements 254 Rationale of question 96 Recording units 240 Refereed journal 365 Regression toward mean 365 Reliability 289, 365 Replication 365 Report typing 345 verbal 318 written 319 Research ability of problem 93 based clinical protocol 365 based document 365 carefully designed 17 carefully recorded and reported 18 critique 365 design 118, 365 advantages of survey 137 experimental 122 major steps in experimental 126 purposes 118 selecting 120 availability of ethical consideration 121

Index feasibility 121 level of knowledge 120 nature of phenomena 120 nature of purpose 120 precision 121 subject 121 validity of data 121 directed towards solution of a problem 16 focus 101 hypothesis 365 in nursing discovering new measures 32 filling gaps in knowledge 31 fostering a commitment 31 helping to improve 33 identifying the role of nurse 32 meaning 27 moulding the attitudes 30 providing basis for profession 31, 32 purposes 29 refining the existing theories 33 significance 22 sources of knowledge 28 personnel 93 planning or proposal (protocol) 177 problems identification 86 process 365 proposal 365 report evaluation checklist 350 requiring expertise 17 setting 176 sometime requiring courage 18 striving to be objective and logical 17 utilisation 365 Researcher’s competence 93, 94 experience 122 interest 93 own resource 93 Respondent’s motivation 223

Retrospective designs 58 research design 365 studies 58 Review of literature 68 characteristics of relevant 73 communicating 79 definition 68 examples of nursing journals 74 objectives 69 purposes 68 selected sources 73 skills needed 75 sources 71 steps in 78 uses 70 nonresearch 71 research 70 Review of related literature 181 Right to self-determination 173 Risk-benefit ratio 366 Role of the investigator 119

S Sample 366 survey 213 advantages of 214 limitations of 214 Sampling 139, 366 accidental 165 advantages and disadvantages 144 area 159 cluster 156 confidence level and significance level 144 convenient 164 design 142 disadvantages 145 disproportionate stratified random 153 distribution 144 diversity 170 error 143 event 170

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expert 170 frame 142, 366 methods 147 modal instance 169 multistage 160 population 141 precision 143 probability 148 process 146 proportional 151 proportionate stratified 152 purposive or judgement 168 quota 165 random route 164 replicated or interpenetrating 158, 162 simple random 149 snowball 167 statistic(s) and parameter(s) 143 stratified random 151 systematic or quasi random 151 theoretical 169 time 170 voluntary 169 probability proportionate size 161 Scales classification 255 levels of measurement 255 number of dimensions 255 scale functions 255 scaling techniques 255 subject matter 255 Scales types of 259 cumulative 260 magnitude estimation 261 semantic differential 260 summated rating 259 visual analog 261 Scientific approach 5 assumptions 7 characteristics 6 control problems 9 empiricism 6 generalisation 6 human complexity 9

limitations 8 measurement problems 9 moral or ethical problems 9 order and control 6 purposes 7 theory 6 Scientific merit 366 method 366 research 14 characteristics of research 16 purposes of research 15 Scope of the study 182 Search for knowledge 1 Selection of a problem and criteria 89 methods of data collection 198 the discipline 86 Self-report 366 Semantic differential scale 219, 366 Sequential sampling 157 Serendipitous findings 366 Setting investigative questions 98 Simple hypothesis 366 random sampling 366 Simulation as a method of data collection 209 Simulation types 211 computer simulation 211 man simulation 211 man-computer 211 Simulation vs experimentation 210 Single-blind study 366 Snowball sampling 167, 367 Sociometric technique 367 Sociometry test 236 used as data collection 236 Solomon four-group design 50 Solvability 95 Spearman’s rho (rs) 366 Split-half reliability 367

Index Standard deviation 367 score 367 Statement of the problem and significance 99, 180 Stating objectives or hypothesis 62 Statistical hypothesis 367 Stratified random sampling 367 Structured interviews 225 observation 268 sources of knowledge 4 deductive 4 inductive 4 scientific approach 5 Style of writing 333 Subcellular organells 256 Subject sensitisation 367 Survey research 57, 134, 367 Synthesis understanding 77 Systematic random sampling 155, 367

T T score 367 T test 367 Target population 367 Techniques of data collection 250 Testing of measurement tools 286 Test-retest reliability 367 Theoretical definition 367 framework 367 framework 84 model 97 sampling 169, 368 Theory and theoretical framework 81 Theory construction factor-isolating 83 factor-relating 84 situation-producing 84 situation-relating 84

Theory-generating research 368 Theory-testing research 368 Time perspective designs 57 sampling 170, 368 Transferability 368 Triangulation 368 True experimental research 50 Trustworthiness 368 Type I error 368 Types of data 194

U Units of enquiry 198 observation 267 molar approach 267 observational methods 268 Unobtrusive measure 368 Unstructured interviews 225 observation 268 sources of knowledge 3 authority 3 experience 3 intuition 4 tradition 3 trial and error 4 Usability 368 Usefulness and social relevance 93 Utilisation 368

V Validity 287, 368 content 287 convergent 288 criterion 288 divergent 288 predictive 288 Vancouver style of writing references 189

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Essentials of Nursing Research Variable 368 Verbal communication behaviour 266 reports 318 techniques 236 Visual analog scale 219, 368 projective techniques 236 Voluntary sampling 169, 368

W World wide web 368 Writing good questions 279 Writing research report guidelines 320 Written reports 319

Z Z score 368

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