Nursing Research In Canada: Methods, Critical Appraisal, And Utilization, 3rd Canadian Edition Lecture Notes

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The Role of Research in Nursing
CHAPTER OVERVIEW
Chapter 1 examines the role of research in a practice discipline; the historical foundations of nursing
research; the relationships among research, education, and practice; the roles of professional nurses
in the research process according to their level of educational preparation; and future trends and
priorities for nursing research. It introduces students to their role as research consumers and high-
lights how consumers of research contribute to the development of evidence-informed nursing
practice.
The authors emphasize that baccalaureate graduates must be able to read research critically and
determine when a body of research is ready for use in practice. Nurses prepared at the master’s or
doctoral level conduct research and use its findings.
In general, this chapter raises students’ awareness of their role as consumers of nursing research.
It also fosters an appreciation of the historical evolution of nursing research, that is, where nursing
has been and where it is projected to be in terms of research.
LEARNING OUTCOMES
After reading this chapter, you will be able to do the following:
• State the significance of research to the practice of nursing.
• Identify the role of the consumer of nursing research.
• Discuss the differences in trends within nursing research in Canada.
• Describe how research, education, and practice are related to one another.
• Evaluate the nurse’s role in the research process as it relates to the nurse’s level of education.
• Identify future trends in nursing research.
• Formulate the priorities for nursing research in the twenty-first century.
INSTRUCTOR'S MANUAL: C H A P T E R 1

2 CHAPTER 1 The Role of Research in Nursing
TEACHING STRATEGIES
As a teacher of nursing students, you can facilitate
your students’ awareness of, interest in, and ap-
preciation of research. The teaching strategies
identified in this section are intended to assist you
in helping students become aware of nursing re-
search and its relationship to clinical practice.
1. Critical Thinking Challenges
The following lists of questions are intended to
facilitate review of chapter content and to foster
the critical thinking skills needed to fulfill the role
of research consumer:
RECALL AND UNDERSTANDING
• What is nursing research?
• What is the meaning of the term consumer?
• What is the research role of the registered
nurse? How does this role compare with
that of a nurse who has a master’s degree?
A doctorate?
• How would you define evidence-informed
practice?
ANALYSIS AND SYNTHESIS
• How does nursing research differ from the
research of other disciplines?
• What does it mean to be a consumer of nursing
research?
• How does nursing research contribute to the
development of clinical skills, to the overall
practice of nursing, and to professionalism?
2. Allaying Students’ Anxiety
As stated in the Introduction to the Instructor’s
Manual, students often approach a course in re-
search with preconceived notions about the na-
ture and difficulty of the subject. Therefore, you
should establish a nonthreatening environment. It
may help to begin by encouraging students to ex-
press their concerns and anxieties about the sub-
ject matter. Sharing the responses of students in
your other classes can initiate such a discussion.
This strategy helps students realize that they are
not alone in their feelings and that you as the
teacher are aware of their needs and are concerned
about them. This type of open discussion also can
give you an idea of students’ learning needs and
major areas of potential difficulty. Through this
discussion, misconceptions can be addressed and
clarifi ed right away.
3. Making Research Relevant to Practice
If research concepts have not been incorporated
in previous courses, or even if they have, students
may not be aware of the relationship between
research and practice. A variety of teaching strat-
egies can be used to facilitate this awareness.
Students have found the use of numerous clin-
ical examples during discussions of the role of
research in nursing to be particularly enriching.
For example, you might ask your students
about the techniques they use to give intramuscu-
lar injections. After several students describe their
technique(s), you can ask them to discuss where
they obtained their knowledge and whether they
believe these techniques are valid. You might then
explain that, although research supporting the
theoretical principles related to the administration
of intramuscular injections has existed for 20 years,
findings have not been universally applied in nurs-
ing practice. More specifically, the effect of pos-
itioning (internal rotation of the femur for giving
injections in the dorsogluteal site) was first stud-
ied by nursing in 1979 by Kruszewski, Lang, and
Johnson. Their study, titled “Effect of positioning
on discomfort from intramuscular injections in
the dorsogluteal site,” supported the hypothesis
that “Patients who are placed in prone positions
with femurs internally rotated while receiving an
intramuscular injection in the dorsogluteal site will
report less intense discomfort than patients placed
in prone positions with femurs externally rotated”
(Kruszewski, Lang, & Johnson, pp. 103–105).

CHAPTER 1 The Role of Research in Nursing 3
In 1982, Rettig and Southby supported the
effect of proper positioning in reducing discom-
fort from dorsogluteal injections. In more recent
research, Cocoman and Murray (2008) completed
a comprehensive review of the practice for intra-
muscular injections and discuss the often contra-
dictory available evidence.
4. Involving Guest Speakers
You may want to invite a guest speaker who has
a background in historical research or an in-depth
knowledge of nursing history to address the his-
torical evolution of nursing research. Such a per-
son can make the subject matter come alive by,
for example, interspersing little-known anecdotes
about prominent nurses involved in the develop-
ment of nursing research.
5. Providing Experiential Learning
Activities
a. The Evolution of Nursing Research:
A Game
The purpose of this learning activity is to inject
some spice into what students generally perceive
as a dry subject: the evolution of nursing research.
Student objectives for the learning
activity:
• Relate an historical event to its time and place
or person.
• Recall milestones in the evolution of nursing
research.
Directions for implementation. This activity is a
modified version of Jeopardy, a popular TV game
show. Be sure to explain clearly how the game
will be played before starting. Depending on the
number of students in your class, you may have all
students participate at once in teams or have some
students act as the “audience” while others take the
role of contestants. Form a panel of three students
or three teams of students (a team may consist of
two to four players). You will need index cards, four
bells or buzzers, and a score sheet with marker or
board with chalk. Create three sets of index cards:
set 1 will contain the years that various historical
events took place; set 2 will contain the events
themselves; and set 3 will contain the places, per-
sons, or outcomes related to those events. Each set
of cards should be a different colour. Key the cards
in each set to their related cards in the other two
sets by marking them with the same numbers. As
an example, in 1932 (date on card #23 in set 1) the
Weir report was published (event on card #23 in set
2) and recommended changes in nursing education
(outcome on card #23 in set 3). The instructor acts
as game show host. Contestants take turns picking
one of the three categories. The instructor holds up
and reads a card from that pile. Contestants then
have to provide an answer in the form of a ques-
tion from the other two sets. For example, if the
contestant picked the card from set 1 with the date
“1932,” he or she could correctly respond in ques-
tion form with the following: “In what year was the
Weir report published?” If the contestant picked the
card from set 3 with the outcome “Recommended
changes in nursing education,” the response might
be: “What was the recommendation from the Weir
report?
The game begins with the instructor picking a
card and reading it. The contestant or team who
presses the buzzer (or rings the bell) first is given
the fi rst chance to respond. If that contestant or
team provides the correct answer, another card is
chosen and play continues. If, on the other hand,
the contestant or team who buzzes in first gives an
incorrect answer, the other contestants or teams
are given a chance to answer correctly. Once the
question is answered correctly, the game con-
tinues as before. The instructor or another student
may keep score on a flip chart or board. Score 1
point for each correct answer. The instructor and
students should decide together on a prize before
beginning the game.

Theoretical Framework
CHAPTER OVERVIEW
Chapter 2 introduces students to the nature of knowledge, both from nursing and other disciplines,
discussed within the context of worldview. Philosophies of research and science are shown to
form the basis for beliefs and assumptions that guide the selected approach to studying research
problems. The link to research is demonstrated through a critical thinking decision path.
Next, students are introduced to frameworks for research, providing at the outset an example
of a clinical situation that clearly shows the relationship between practice and research. This is fol-
lowed by a section that illustrates how theory links research and practice. Inductive and deductive
approaches to science are described, using the earlier clinical example. Models are described as
a way to connect concepts and develop hypotheses. Reference is made to the idea of a “ladder
of abstraction” that can be used to gain a research perspective and relate concepts, theories, and
frameworks.
Theory is defined, and the purpose of a theoretical rationale is conveyed as a context in which
to examine problems. More specifically addressed are types of theories—grand, midrange, and
microrange—to introduce readers to theory as a framework to answer nursing questions. A focus
on nursing knowledge and nursing theory development can provide students with the frame of
reference that is so necessary to help nursing continue to define what it is, how it is unique, and
how it differs from other disciplines.
Conceptual and theoretical frameworks are differentiated, and conceptual and operational def-
initions are illustrated for six different concepts. Criteria for critiquing a theoretical framework are
identified to assist students in the development of their roles as research consumers.
INSTRUCTOR'S MANUAL: C H A P T E R 2

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6 CHAPTER 2 Theoretical Framework
LEARNING OUTCOMES
After reading this chapter, the student should be able to do the following:
• Define key concepts in the philosophy of science.
• Identify and differentiate between theoretical/empirical, aesthetic, personal, sociopolitical, and
ethical ways of knowing.
• Identify assumptions underlying the post-positivist, critical, and interpretive/constructivist views of
research.
• Compare inductive and deductive reasoning.
• Differentiate between conceptual and theoretical frameworks.
• Describe how a framework guides research.
• Differentiate between conceptual and operational definitions.
• Describe the relationships among theory, research, and practice.
• Discuss levels of abstraction related to frameworks guiding research.
• Describe the points of critical appraisal used to evaluate the appropriateness, cohesiveness, and
consistency of a framework guiding research.

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CHAPTER 2 Theoretical Framework 7
TEACHING STRATEGIES
The research consumer role should be expanded
in discussions about the development of nurs-
ing knowledge. At this point, students can begin
to engage actively in the consumer role to “test
the waters” in relation to the critical appraisal of
knowledge derived from various sources.
1. Critical Thinking Challenges
a. Stimulating Critical Thinking
The following questions may serve to stimulate
critical thinking about material related to various
sources of knowledge:
RECALL AND UNDERSTANDING
What are the two main paradigms of research?
• What are the major sources of human
knowledge?
• How do qualitative and quantitative approaches
to research differ?
• How are practice and research linked?
• What is the difference between induction and
deduction?
• How would you define model?
• How would you define theory?
ANALYSIS AND SYNTHESIS
• What are your beliefs about nursing? About
health? About human behaviour? Give ex-
amples of how you think these beliefs influ-
ence your clinical practice.
• What scientific paradigm do you feel most
comfortable with? Why do you feel that way?
• Consider a nursing intervention you have used.
On what assumptions is it based?
• What are your beliefs about nursing? About
health? About human behaviour? Give ex-
amples of how you think these beliefs might
influence your approach to research.
• How does theory influence the selection of
study design?
b. Use of Discussion Questions
The use of discussion questions can foster critical
thinking in relation to the parameters of a well-
supported, logical, and clearly articulated theor-
etical framework. It also can serve as a means by
which to meet the learning outcomes identified
for Chapter 2. The following questions can be
used to guide the discussion:

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8 CHAPTER 2 Theoretical Framework
projector, or easel. Common responses focus
on ingredients, media promotion, bottle colour,
smell, cost, and goal for use (e.g., dandruff re-
moval, conditioning). The use of personal know-
ledge derived from various sources to make deci-
sions is related to problem solving typically used
in research.
b. Comparing and Contrasting Processes Used
to Generate Knowledge
Although students can identify how they make
decisions in personal and clinical situations, they
are less familiar with the scientific or research
approach to generating knowledge. Comparing
and contrasting the research process with the
problem-solving process, which is familiar to
students, is a strategy we have used to facilitate
learning this content. An overhead or handout
can be used to show the steps typical of these
processes.
(1) First, the problem-solving process is presented
to students with specific emphasis on its
relation to the nursing process, as follows:
PROBLEM-SOLVING PROCESS
• An obstacle to goal achievement is perceived.
• The underlying difficulty is identified and stated.
• Additional data are collected to validate the
difficulty.
• Possible solutions are suggested and evaluated.
• The most plausible solutions are attempted.
• The solution is evaluated in relation to elim-
ination of the original obstacle.
NURSING PROCESS
• An assessment of data is made.
• A patient health problem is identified, and a
nursing diagnosis is formulated.
• Additional data are collected to validate the
diagnosis.
• Possible interventions are suggested and
evaluated.
• The most plausible interventions are imple-
mented.
•

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CHAPTER 2 Theoretical Framework 9
Student objectives for the learning
activity:
• Based on the findings of this clinical exercise,
identify the bibliographical sources used in the
development of a selected nursing technique/
protocol.
• Determine whether or not the nursing tech-
nique/protocol was based on research.
• Suggest potential problems that may arise
from using non–research-based nursing tech-
niques/protocols.
Directions for implementation. Assign this exer-
cise at the beginning of the course. Have students
select a nursing protocol/technique (such as urinary
catheterization or intravenous maintenance) from
a clinical agency’s policy and procedure manual.
(Explain that they may obtain a copy of the select-
ed protocol from the agency’s nursing or nursing
education office.) Ask them to determine by whom
the protocol (procedure) was written. This infor-
mation may be obtained from an in-service edu-
cator or nursing administrator. Direct students to
request an interview with one or more individuals
who are involved in developing practice protocols
for the agency. The purpose of the interview is to
determine the basis for the existing protocol. Sug-
gested interview questions include the following:
• Can you explain how protocols are written in
your agency?
• On what information was this specific protocol
based?
• Are there any references that will give me a
better understanding of the rationale for the
practices included in the protocol?
After the interview, students should submit a brief
paper that describes the experience and states a
conclusion about whether or not the protocol is
research-based.
On completion of the clinical exercise, stu-
dents may also be asked to present their findings
in class.
During the discussion period it is important to
consider the following questions:
• Was any reference to research made, either by
the interviewee or in the protocol itself?
• If no reference is made or if the reference is a
non-research source, how does one know that
the selected technique/protocol is valid?
• What then is the basis of the selected practice?
• What is the value of research support of the se-
lected technique/protocol or for any technique/
protocol?
4. Using Diagrams to Show
Relationships
Students respond to visual representations be-
cause diagrams often clarify a potentially confus-
ing topic. When using examples in discussions
about concepts, theory, research, and hypothesis
development, you should map out specific rela-
tionships. Diagrams that clearly identify the vari-

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10 CHAPTER 2 Theoretical Framework
Student objectives for the learning
activity:
• Construct a conceptual definition.
• Construct an operational definition.
• Evaluate an operational definition in terms of
clarity and inclusion of an index of measurement.
Directions for implementation. Identify or ask stu-
dents to name concepts. Select four to six of these
concepts for students to define, both conceptually
and operationally, using a library and other resour-
ces. Students can start with a dictionary definition
and then read the work of a theorist who has exam-
ined the concept. To make this activity manageable
for students, you can have each choose one of the
identified concepts to define. Another option is to
have only some students (equal to the number of
concepts to be defined) involved in this particular
learning activity, while others can be engaged in
different learning activities at other times in the re-
search course. This activity also can be a written
assignment completed out of class and then shared
at a subsequent class session. You can also include
the construction of an operational definition as an
item on an examination.
Guidelines for discussion. After students share
their defi nitions with the class, you can focus on
the evaluation of each definition. Of course, stu-
dents should be actively involved in the evalua-
tion discussion. You can prompt students by
asking them whether each definition is clear and
unambiguous and to identify the specific index of
measurement that operationalizes the definition.
FIGURE 2-5 Model of conceptual foundation. From Stewart, M., Reutter, L., Letoumeau, N., & Makwarimba, E. (2009).
A support intervention to promote health and coping among homeless youths. Canadian Journal of N ursing Research,
41(2), 54–77.

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INSTRUCTOR'S MANUAL: C H A P T E R 3
Critical Reading Strategies:
Overview of the Research Process
CHAPTER OVERVIEW
Chapter 3 begins by emphasizing the need to use critical thinking and critical reading skills when
reading a research article. Both concepts are defined and discussed as a means to help students
more effectively read and understand research articles. The authors separate the process of critical
reading into four levels, or stages, of understanding: preliminary, comprehensive, analysis, and
synthesis. Strategies to facilitate each stage of understanding are presented.
A section of Chapter 3 addresses and validates the difficulties perceived by a novice reader of
research. A major portion of this chapter is devoted to describing the format and style of research
reports. The authors walk the reader through each step of the research process, indicating how
and where to find related content in published research and in this textbook. Examples from
published studies are presented to bring abstract discussion to a concrete level.
LEARNING OUTCOMES
After reading this chapter, the student should be able to do the following:
• Identify the steps that researchers use to conduct quantitative and qualitative research.
• Identify the importance of critical thinking and critical reading for the reading of research articles.
• Identify the steps associated with critical reading.
• Use the steps of critical reading to review research articles.
• Use identified strategies to critically read research articles.
• Use identified critical thinking and critical reading strategies to synthesize critiqued articles.
• Identify the format and style of research articles.

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