The Research Process in Nursing

Kate Gerrish, Anne Lacey, Kate Gerrish, Anne Lacey

• Publisher: Wiley-Blackwell
• Year: 2013
• Print ISBN: 9781405190480
• eBook ISBN: 9781118682098
• Edition: 6
• Topic: Medicine
• Subtopic: Nursing

'The perfect text for any health care professional who wishes to gain a sound understanding of research…This text succeeds where others fail in terms of the thoroughness of the research process and the accessible style in which the material is presented. In an age when nursing and health care research is going from strength to strength this book offers those in the world of academia and practice an excellent and essential 'bible' that is a must on any bookshelf'
Dr Aisha Holloway, Lecturer Adult Health, Division of Nursing, The University of Nottingham

'a book that helps you each step of the way. A very understandable and enjoyable publication'
Accident and Emergency Nursing Journal

'key reference resource that students of research can use at various levels of study. It is comprehensive, user friendly and very easy to read and make sense of'
Gillian E Lang, Amazon reviewer

The sixth edition of this book reflects significant developments in nursing research in recent years, ensuring the reader is provided with the very latest information on research processes and methods. It continues to explore how to undertake research as well as evaluating and using research findings in clinical practice, in a way that is suitable for both novice researchers and those with more experience.

Divided into six sections, the chapters are ordered in a logical fashion that also allows the reader to dip in and out. The first two sections of the book provide a comprehensive background to research in nursing. The third section presents a variety of qualitative and quantitative approaches,  both new and well-established. The final three sections then look at collecting and making sense of the resulting data and putting the research findings into clinical practice.

• Summarises key points at the start of each chapter to guide you through
• Includes contributions from a wide range of experts in the field
• Accessible but doesn't shrink away from complex debates and technical issues

New to this edition:

• Accompanying website (www.wiley.com/go/gerrish)
• Ten completely new chapters including Narrative Research, Mixed Methods and Using Research in Clinical Practice
• 'Research Example' boxes from a wide variety of research types

SECTION 1

Setting the Scene

Nursing research does not exist in a vacuum, but is an applied discipline set in the context of a dynamic academic community and relating to a complex healthcare system. This section explores this context and introduces the reader to the nature of nursing research.

Chapter 1 presents the fundamental concepts of the discipline, reviews the current context of nursing research, and emphasises the essential connection between nursing research and the practice of the profession. Even those who do not see themselves as active researchers should be users of the knowledge generated by research, and so need to understand much of what follows in the sections of this book. Chapter 2 then takes the reader through the essential steps in the research process, each of which will be dealt with in much more depth in later sections, but with the aim of giving an overview of the entire undertaking that is research. Recent examples from the literature are used to illustrate the varied nature of nursing research.

Research in nursing, as in healthcare generally, is complicated by the fact that it is involved with vulnerable human beings, and ethical principles need to be observed from the outset of any research project. Chapter 3, therefore, tackles this moral obligation on the researcher, drawing out the practical implications for the researcher and setting the context for the more specific ethical regulations dealt with in Section 2 of the book.

The final two chapters in this section deal with the need for nursing research to be inclusive in scope. User involvement in research has been advocated from within and outside the profession for more than a decade now, and Chapter 4 argues for the full inclusion in the research process of those to whom the outcomes might apply. New to this edition of the book is Chapter 5 on research in a multi-ethnic society. Although there are many minority groups that deserve special consideration when designing nursing research, ethnicity perhaps merits particular consideration as a major factor impacting on healthcare in UK society.

CHAPTER 1

Research and Development in Nursing

Kate Gerrish and Anne Lacey

Key points

• Research is concerned with generating new knowledge through a process of systematic scientific enquiry, the research process.
• Research in nursing can provide new insights into nursing practice, develop and improve methods of caring, and test the effectiveness of care.
• Whereas comparatively few nurses may undertake research, all nurses should develop research awareness and use research findings in their practice.
• Evidence-based practice involves the integration of the best available research evidence with expert clinical opinion while taking account of the preferences of patients.

INTRODUCTION

Significant changes in healthcare have taken place in the 26 years since the first edition of this book was published and these changes are set to continue. Technological developments have led to improved health outcomes and at the same time have raised public expectations of healthcare services. Increased life expectancy and lower birth rates mean that the United Kingdom (UK) population is ageing. An older population is more likely to experience complex health needs, especially in regard to chronic disease, and this places additional demands on an already pressurised health service. At the same time, the escalating cost of healthcare is leading to a shift from expensive resource-intensive hospital care to more services being provided in the primary and community care sectors. In response to these changes, government health policy is increasingly focused on improving the clinical and cost-effectiveness of healthcare, while at the same time reducing the burden of ill health through active public health and health promotion strategies. For example, the recent review of the NHS in England undertaken by Lord Darzi has identified a number of priorities that need to be progressed in order to provide high quality care for patients and the wider public (DoH 2008). The review stresses the importance of improving health outcomes by preventing illness, as well as enhancing the quality of care provided to people with particular needs, for example patients with common long-term conditions such as diabetes, or those in need of palliative and end-of-life care.

To achieve the outcomes for enhancing quality set out in the review, there is a need to change the way healthcare professionals work and the way health services fit together, and to ensure that patients have access to the best available treatments. However, achieving quality in healthcare is a moving target. What was considered high quality care in 1948 when the NHS was first founded is no longer considered to be the case 60 years on. Knowledge about effective healthcare interventions has increased enormously, and this is certainly the case with nursing interventions. In the past, custom and practice, often based on the ward sister’s or doctor’s likes and dislikes, dictated what nurses did to patients, but nursing research has provided a new evidence base to inform the care that nurses provide. One clear example is in the field of pressure area care. It is not that long ago that nurses applied various techniques in an attempt to reduce the risk of a patient developing a pressure sore, these included egg white and oxygen, methylated spirits and vigorously rubbing the area at risk. Yet research by Doreen Norton more than 30 years ago clearly identified that moving patients regularly, keeping their skin clean and dry, and using the right equipment was the most effective way to reduce the risk (Norton et al. 1975).

It is essential that nurses respond proactively to the developments outlined above in order to provide high quality care in response to the needs of the individuals and communities with whom they work. To do this, they need up-to-date knowledge to inform their practice. Such knowledge is generated through research. This chapter introduces the concept of nursing research and considers how research contributes to the development of nursing knowledge. In recognising that nursing is a practice-based profession the relevance of research to nursing policy and practice is examined within the context of evidence-based practice and the responsibilities of nurses is explored in respect of research awareness, research utilisation and research activity.

NURSING RESEARCH AND DEVELOPMENT

The definition of research provided by Hockey (1984) in the first edition of this book is still pertinent today:

‘Research is an attempt to increase the sum of what is known, usually referred to as a “body of knowledge” by the discovery of new facts or relationships through a process of systematic scientific enquiry, the research process’ (Hockey 1984: 4)

Other definitions of research emphasise the importance of the knowledge generated through research being applicable beyond the research setting in which it was undertaken, i.e. that it is generalisable to other similar populations or settings. The Department of Health, for example, defines research as:

‘the attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods’ (DoH 2005: 3, section 1.10)

Research is designed to investigate explicit questions. In the case of nursing research these questions relate to those aspects of professional activity that are predominantly and appropriately the concern and responsibility of nurses (Hockey 1996). The International Council of Nursing’s (ICN) definition of nursing research captures the broad areas of interest that are relevant to nurse researchers.

‘Nursing research is a systematic enquiry that seeks to add new nursing knowledge to benefit patients, families and communities. It encompasses all aspects of health that are of interest to nursing, including promotion of health, prevention of illness, care of people of all ages during illness and recovery or towards a peaceful and dignified death’ (ICN 2009)

The ICN has identified nursing research priorities in two broad areas, namely health and illness, and the delivery of care services. These priority areas are outlined in Box 1.1. In addition, research in the field of nursing education is important, for unless nurses are prepared appropriately for their role, they will not be able to respond to the needs of patients, families and communities. Priorities for research in nursing education are broad ranging as illustrated in Box 1.2. Most nursing research investigates contemporary issues; however, some studies may take an historical perspective in order to examine the development of nursing by studying documentary sources and other artefacts (see Chapter 26).

The questions that nursing research may address vary in terms of their focus. More than 20 years ago, Crow (1982) identified four approaches that research could take; these remain pertinent today:

Box 1.1 Priorities for nursing research identified by the International Council of Nurses

Health and illness

Nursing research priorities in health and illness focus on:

• health promotion
• prevention of illness
• control of symptoms
• living with chronic conditions and enhancing quality of life
• caring for clients experiencing changes in their health and illness
• assessing and monitoring client problems
• providing and testing nursing care interventions
• measuring the outcomes of care.

Delivery of care services

Nursing research priorities in delivery of care services focus on:

• quality and cost-effectiveness of care
• impact of nursing interventions on client outcomes
• evidence-based nursing practice
• community and primary healthcare
• nursing workforce to include quality of nurses’ work life, retention, satisfaction with work
• impact of healthcare reform on health policy, programme planning and evaluation
• impact on equity and access to nursing care and its effects on nursing
• financing of healthcare.

Source: ICN (2009)

Box 1.2 Priorities for research in nursing education

• Curriculum design and evaluation, including community-driven models for curriculum development
• New pedagogies
• Innovation in teaching and learning
• Use of instructional technology, including new approaches to simulated learning
• Student/teacher learning partnerships
• Clinical teaching models
• Assessment of student learning in classroom and practice settings
• New models for teacher preparation and faculty development
• Quality improvement processes
• Educational systems and infrastructures

Adapted from National League for Nursing (2008)

• research that will provide new insights into nursing practice
• research that will deepen an understanding of the concepts central to nursing care
• research that is concerned with the development of new and improved methods of caring
• research that is designed to test th...

Table of contents

• Cover page
• Contents
• Title page
• Copyright page
• Contributors
• Introduction
• Section 1: Setting the Scene
• Section 2: Preparing the Ground
• Section 3: Choosing the Right Approach
• Section 4: Collecting Data
• Section 5: Making Sense of the Data
• Section 6: Putting Research into Practice
• Glossary
• Index