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Unit 4: Finding Problems and Writing Questions Unit 4: Finding Problems and Writing Questions Introduction to the

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Topic: This unit focuses on the process of identifying research problems and creating researchable questions. Critically analyzing a research question is key to determining if it is appropriate evidence for nursing practice. Traditional Evolution of the Research Question Figure 4.1 Nursing Research Concepts • Abstract ideas that must be narrowed to researchable questions for study • Common categories for nursing research: – Patient-sensitive concepts – Staff-member-sensitive concepts – Organizationally sensitive concepts Sources of Research Problems • Clinical practice observations • Educational experiences • Consumer/customer feedback and personal experience • Theoretical models and frameworks Sources of Research Questions • • • • Professional literature Performance improvement studies Research reports and priorities Social issues The Research Question • Specifically identifies the key elements to be studied • Guides the design and methodology • Carefully constructed and refined Classifications of Questions • Descriptive – Studies a subject of interest in a defined population or setting • Analytic – Studies that compare interventions and outcomes Classifications of Questions • Prospective – Studies that are planned and carried out in the future under control of the researcher • Retrospective – Studies that use existing secondary data to answer a research question The PICO Approach • Population: Who is the patient, or what is the population of interest? • Intervention: What is the planned nursing intervention? • Comparison: What is the comparison intervention? • Outcome: What is the outcome of interest? Problem Statements • Statements of the gap between what is known and unknown • Articulate the area of concern and provide support for the extent of the problem • Focus the research process on a known nursing practice problem Purpose Statements • Objective statement indicating the general goal of the study • Describe the direction of the inquiry • Contain the key variables to be studied, their possible relationships, and the nature of the population of interest A Qualitative Example Problem statement “I have been surprised to find that while the neonatal literature presents a description of what happens when parents in the neonatal unit are excluded from their babies’ pain management, it does not provide a picture of what happens when they are involved.” Purpose statement “To fill this gap, I began a study to answer the following research question: ‘How do parents interact with babies and nurses around the provision of comfort care in a neonatal intensive care unit where information and training in comfort care have been provided?” A Quantitative Example Problem statement “To date, we have been unable to find any research that compares the relative contribution of (i) essential clinical indicators of diabetes regulation, (ii) coping styles, and (iii) perceived social support to the variation in diabetes-related distress among adults with type 2 diabetes.” Purpose statement “The main aim of this study was to investigate the extent to which (i) clinical indicators such as Hgb A1c, diabetes treatment, diabetes-related complications, disease duration and BMI, (ii) coping styles, and (iii) perceived support from healthcare professionals and family are related to diabetes-related distress.” Research Questions • • • • • Specify the population of interest Identify the variables to be measured Describe the comparison group Relate the outcome of interest Sometimes include the measurement Research Requires All Three… • Problem Statements – Identify a gap in knowledge that requires disciplined study • Purpose Statements – Declarations of intent of the study • Research Questions – Identify the specifics of who, what, when, and how in a study The Critical Reader • Development gets more specific • The purpose, problem, and question are explicit and easy to find • These statements are unbiased • The design is described • The population, variables, and setting are described • The purpose and design are congruent FINER Criteria • Used for evaluating the desirability of a research question – Feasible – Interesting – Novel – Ethical – Relevant Feasibility of the Study • Appraised prior to developing the study design • Evaluate: – Requires resources – Ethical considerations – Specific variables to be studied – Availability of the population – Potential access to the setting An Example… Does the use of teach-back as a method of validating discharge understanding decrease diagnosis-related readmissions in patients with heart failure, as compared with patients who receive standard discharge instructions? An Example… What is the population? Patients with heart failure What is the intervention? Teach-back method of validating discharge instructions What is the comparison group? Those receiving standard discharge instructions What is the outcome of interest? Diagnosis related readmissions Conclusions • A research problem starts the research process • The purpose statement clearly identifies what the study will accomplish • The research question makes the elements of the study explicit • All three are needed to translate research into practice Unit 5: The Successful Literature Review Unit 5: The Successful Literature Review Introduction to the Topic: This unit focuses on the literature review as a basis for both research and practice. Evaluating the elements of a strong literature review is an important part of translating research into practice. The Literature Review A critical component of the research process that provides an in-depth analysis of recently published research findings relevant to the study being considered. The review informs the research question and guides development of the research plan. Rationale for the Literature Review • Adds credence to the importance of the topic • Provides studies that can be replicated – This is a source of time savings for researchers! • Locates instruments that have already been tested – Existing instruments save time (and often money) – No need to develop and test an instrument, which often takes months or years Rationale for the Literature Review • Reveals potential theoretical frameworks • Establishes the basis for the subject under study – Provides a reason to believe a particular intervention might work – Determines if established relationships exist • Enhances the body of knowledge regarding a specific issue Too Much or Too Little? • A paucity of literature may indicate a significant gap in clinical knowledge • A large amount of literature may point to a clinical guideline rather than a research study • Scope of the review is dependent on the use of the literature review Types of Literature Used in the Review • Primary sources – Information is summarized directly from the original, published articles • Secondary sources – Results are reported in an article or publication that summarizes the findings – Includes syntheses of results as well as systematic reviews Types of Literature Used in the Review • Theoretical literature – Poses relationships – Creates rational argument – Forms the foundation for the major study elements Types of Literature Used in the Review • Empirical literature – Reports tests of relationships and actual outcomes – Tests arguments for effectiveness – Research studies focused on the question posed – Need to report literature that supports as well as literature that does not Types of Literature Used in the Review • Seminal works – Works that are groundbreaking or historically important – Research that has stood the test of time – Works that are commonly quoted as foundational The Evidence Pyramid • • • • • • Systems – smallest quantity Summaries Synopses of syntheses Syntheses Synopses of studies Studies – largest quantity Steps of the Search Strategy • Identify the research problem and question • Select the resources to search – Databases – Dissertation abstracts – “Gray literature” – Websites ending in .edu, .gov, or .org – Books Steps of the Search Strategy • Identify inclusion and exclusion criteria – Study designs – Publication year – Population of interest – Interventions – Outcomes of significance Steps of the Search Strategy • Build the search strategy – Identify major search concepts – Determine search terms for concepts • Screen the initial list and organize • Retrieve full text • Summarize relevant articles Steps of the Search Strategy • Critically appraise the study quality – Relevance – Study design appropriate for question – Potential sources of bias – Conclusion supported by data – Study contribution to care • Synthesize key findings The Literature Search for Research • Provides background and context – Previous studies and findings • Incorporates a theoretical framework – Provides support for the rational argument • Specific to a single research question – The literature is focused down to a single topic and reported exhaustively What Literature to Review • Scholarly works from peer-reviewed sources – Articles and publications – “Gray literature” – Dissertations and original academic studies – Proceedings from conferences • Critical appraisal of single-focused research reports – Take care with articles reported on websites – Trustworthy: .edu; .gov; .org The Literature Search for Practice • • • • • Focused on a clinical question limited in time frame Focuses on application of research to practice Specific to a clinical question From works in peer-reviewed journals Critical appraisal of single studies and aggregate research reports Appropriate Resources for the Literature Search Includes: • Electronic databases • Books • Dissertations • Websites • Journals Critically Appraise the Literature Review • Relies primarily on studies within 5 years • Peer reviewed – How will you know? • Relationship to the research problem is clear • Review can be linked directly and indirectly to the research question • Theoretical framework identified Critically Appraise the Literature Review • • • • Authors use primary sources Studies are critically examined Results are reported without bias Review includes studies with and without significant findings • Review is organized and logically unfolds Information Literacy for Nurses • • • • • • Identify question or problem clearly Use databases, websites, and other reliable sources Create effective search strategies Think critically to analyze and solve problems Computer literacy Integrate literature into practice Build Literature Review Skills • • • • • • Involve a health sciences librarian early in the process Go from general to specific in the search Select references that are the most relevant Resist the urge to look only at full text Use a broad range of sources Rely on primary sources Conclusions • The literature review can support research or practice • Health information is massive–information literacy is a must • Work closely with a health sciences librarian • Plan search strategies and critically appraise evidence using standards
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