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

Preview (31 of 110 Pages)

100%

Purchase to unlock

Loading page image...

The Role of Research in NursingCHAPTER OVERVIEWChapter 1 examines the role of research in a practice discipline; the historical foundations of nursingresearch; the relationships among research, education, and practice; the roles of professional nursesin the research process according to their level of educational preparation; and future trends andpriorities 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 nursingpractice.The authors emphasize that baccalaureate graduates must be able to read research critically anddetermine when a body of research is ready for use in practice. Nurses prepared at the master’s ordoctoral 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 nursinghas been and where it is projected to be in terms of research.LEARNING OUTCOMESAfter 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 R1

Loading page image...

2CHAPTER 1The Role of Research in NursingTEACHING STRATEGIESAs a teacher of nursing students, you can facilitateyour students’ awareness of, interest in, and ap-preciation of research. The teaching strategiesidentified in this section are intended to assist youin helping students become aware of nursing re-search and its relationship to clinical practice.1. Critical Thinking ChallengesThe following lists of questions are intended tofacilitate review of chapter content and to fosterthe critical thinking skills needed to fulfill the roleof research consumer:RECALL AND UNDERSTANDING•What is nursing research?•What is the meaning of the termconsumer?•What is the research role of the registerednurse?Howdoesthisrolecomparewiththat of a nurse who has a master’s degree?A doctorate?•Howwouldyoudefineevidence-informedpractice?ANALYSIS AND SYNTHESIS•How does nursing research differ from theresearch of other disciplines?•What does it mean to be aconsumer of nursingresearch?•How does nursing research contribute to thedevelopment of clinical skills, to the overallpractice of nursing, and to professionalism?2. Allaying Students’ AnxietyAs stated in the Introduction to theInstructor’sManual, students often approach a course in re-search with preconceived notions about the na-ture and difficulty of the subject. Therefore, youshould establish a nonthreatening environment. Itmay help to begin by encouraging students to ex-press their concerns and anxieties about the sub-ject matter. Sharing the responses of students inyour other classes can initiate such a discussion.This strategy helps students realize that they arenot alone in their feelings and that you as theteacher are aware of their needs and are concernedabout them. This type of open discussion also cangive you an idea of students’ learning needs andmajor areas of potential difficulty. Through thisdiscussion, misconceptions can be addressed andclarifi ed right away.3. Making Research Relevant to PracticeIf research concepts have not been incorporatedin previous courses, or even if they have, studentsmay not be aware of the relationship betweenresearch 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 ofresearch in nursing to be particularly enriching.For example, you might ask your studentsabout the techniques they use to give intramuscu-lar injections. After several students describe theirtechnique(s), you can ask them to discuss wherethey obtained their knowledge and whether theybelieve these techniques are valid. You might thenexplainthat,althoughresearchsupportingthetheoretical principles related to the administrationof 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 givinginjections in the dorsogluteal site) was first stud-ied by nursing in 1979 by Kruszewski, Lang, andJohnson. Their study, titled “Effect of positioningon discomfort from intramuscular injections inthe dorsogluteal site,” supported the hypothesisthat “Patients who are placed in prone positionswith femurs internally rotated while receiving anintramuscular injection in the dorsogluteal site willreport less intense discomfort than patients placedin prone positions with femurs externally rotated”(Kruszewski, Lang, & Johnson, pp. 103–105).

Loading page image...

CHAPTER 1The Role of Research in Nursing3In 1982, Rettig and Southby supported theeffect of proper positioning in reducing discom-fort from dorsogluteal injections. In more recentresearch, Cocoman and Murray (2008) completeda comprehensive review of the practice for intra-muscular injections and discuss the often contra-dictory available evidence.4. Involving Guest SpeakersYou may want to invite a guest speaker who hasa background in historical research or an in-depthknowledge 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 anecdotesabout prominent nurses involved in the develop-ment of nursing research.5. Providing Experiential LearningActivitiesa. The Evolution of Nursing Research:A GameThe purpose of this learning activity is to injectsome spice into what students generally perceiveas a dry subject: the evolution of nursing research.Student objectives for the learningactivity:•Relate an historical event to its time and placeor person.•Recall milestones in the evolution of nursingresearch.Directions for implementation. This activity is amodified version ofJeopardy, a popular TV gameshow. Be sure to explain clearly how the gamewill be played before starting. Depending on thenumber of students in your class, you may have allstudents participate at once in teams or have somestudents act as the “audience” while others take therole of contestants. Form a panel of three studentsor three teams of students (a team may consist oftwo to four players). You will need index cards, fourbells or buzzers, and a score sheet with marker orboard with chalk. Create three sets of index cards:set 1 will contain the years that various historicalevents took place; set 2 will contain the eventsthemselves; and set 3 will contain the places, per-sons, or outcomes related to those events. Each setof cards should be a different colour. Key the cardsin each set to their related cards in the other twosets by marking them with the same numbers. Asan example, in 1932 (date on card #23 in set 1) theWeir report was published (event on card #23 in set2) and recommended changes in nursing education(outcome on card #23 in set 3). The instructor actsas game show host. Contestants take turns pickingone of the three categories. The instructor holds upand reads a card from that pile. Contestants thenhave to provide an answer in the form of a ques-tion from the other two sets. For example, if thecontestant 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 theWeir report published?” If the contestant picked thecard from set 3 with the outcome “Recommendedchanges in nursing education,” the response mightbe: “What was the recommendation from the Weirreport?The game begins with the instructor picking acard and reading it. The contestant or team whopresses the buzzer (or rings the bell) first is giventhe fi rst chance to respond. If that contestant orteam provides the correct answer, another card ischosen and play continues. If, on the other hand,the contestant or team who buzzes in first gives anincorrectanswer, the other contestants or teamsare given a chance to answer correctly. Once thequestion is answered correctly, the game con-tinues as before. The instructor or another studentmay keep score on a flip chart or board. Score 1point for each correct answer. The instructor andstudents should decide together on a prize beforebeginning the game.

Loading page image...

4CHAPTER 1The Role of Research in NursingBOX1-1

Loading page image...

Theoretical FrameworkCHAPTER OVERVIEWChapter 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 toform the basis for beliefs and assumptions that guide the selected approach to studying researchproblems. 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 exampleof 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 deductiveapproaches to science are described, using the earlier clinical example. Models are described asa way to connect concepts and develop hypotheses. Reference is made to the idea of a “ladderof abstraction” that can be used to gain a research perspective and relate concepts, theories, andframeworks.Theory is defined, and the purpose of a theoretical rationale is conveyed as a context in whichto examine problems. More specifically addressed are types of theories—grand, midrange, andmicrorange—to introduce readers to theory as a framework to answer nursing questions. A focuson nursing knowledge and nursing theory development can provide students with the frame ofreference that is so necessary to help nursing continue to define what it is, how it is unique, andhow 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 areidentified to assist students in the development of their roles as research consumers.INSTRUCTOR'S MANUAL:C H A P T E R2

Loading page image...

6CHAPTER 2Theoretical FrameworkLEARNING OUTCOMESAfter 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, andethical ways of knowing.•Identify assumptions underlying the post-positivist, critical, and interpretive/constructivist views ofresearch.•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, andconsistency of a framework guiding research.

Loading page image...

CHAPTER 2Theoretical Framework7TEACHING STRATEGIESThe research consumer role should be expandedin discussions about the development of nurs-ing knowledge. At this point, students can beginto engage actively in the consumer role to “testthe waters” in relation to the critical appraisal ofknowledge derived from various sources.1. Critical Thinking Challengesa. Stimulating Critical ThinkingThe following questions may serve to stimulatecritical thinking about material related to varioussources of knowledge:RECALL AND UNDERSTANDINGWhat are the two main paradigms of research?•Whatarethemajorsourcesofhumanknowledge?•How do qualitative and quantitative approachesto research differ?•How are practice and research linked?•What is the difference between induction anddeduction?•How would you definemodel?•How would you definetheory?ANALYSIS AND SYNTHESIS•What are your beliefs about nursing? Abouthealth? About human behaviour? Give ex-amples of how you think these beliefs influ-ence your clinical practice.•What scientific paradigm do you feel mostcomfortable 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? Abouthealth? About human behaviour? Give ex-amples of how you think these beliefs mightinfluence your approach to research.•How does theory influence the selection ofstudy design?b. Use of Discussion QuestionsThe use of discussion questions can foster criticalthinking in relation to the parameters of a well-supported, logical, and clearly articulated theor-etical framework. It also can serve as a means bywhich to meet the learning outcomes identifiedfor Chapter 2. The following questions can beused to guide the discussion:RECALL AND UNDERSTANDING•What is the most prominent type of researchconducted until recently in nursing research?•Howwouldyoudifferentiateaconceptualfrom an operational definition?•What is an assumption?•What is the purpose of a theoretical frame-work?•What is the ladder of abstraction?•What are the central phenomena of concern tonursing?ANALYSIS AND SYNTHESIS•What nursing theories or models have youheard or learned about?•How useful are they for practice?•How would you evaluate the appropriatenessof a particular operational definition?•How are hypotheses related to models andtheories?2. Using the Learner’s PreviousExperiencea. Everyday Experiences as a ConsumerA “warm-up” exercise used with beginning re-search students involves an everyday experience,for example, how one determines which sham-poo to purchase. The purpose of this exerciseis to show that different sources of informationsupport how decisions are made. Students areasked what factors go into making this decision,and a list is written on a chalkboard, overhead

Loading page image...

8CHAPTER 2Theoretical Frameworkprojector, or easel. Common responses focuson 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 usedin research.b. Comparing and Contrasting Processes Usedto Generate KnowledgeAlthough students can identify how they makedecisions in personal and clinical situations, theyare less familiar with the scientific or researchapproach to generating knowledge. Comparingand contrasting the research process with theproblem-solving process, which is familiar tostudents, is a strategy we have used to facilitatelearning this content. An overhead or handoutcan be used to show the steps typical of theseprocesses.(1)First, the problem-solving process is presentedtostudentswithspecificemphasisonitsrelation 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 thedifficulty.•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 anursing diagnosis is formulated.•Additional data are collected to validate thediagnosis.•Possibleinterventionsaresuggestedandevaluated.•The most plausible interventions are imple-mented.•The patient’s response is evaluated in relationto his or her goals.(2)Next,thefollowingcharacteristicsofthescientific method and the problem-solvingprocess are compared and contrasted:SCIENTIFIC METHOD•Control of extraneous influencing factors•Problem solving•Evidence based on “objective” reality•Purpose—to make a contribution to generalknowledgePROBLEM SOLVING•No control of extraneous influencing factors•Does not necessarily involve research•May include subjective bias in investigation ofproblem•Concerned with a situation-specific solution(3)Finally, a clinical situation is used to emphasizethe difference between problem solving andusing research to generate knowledge. Forexample, a nurse may notice that Mrs. X has apressure ulcer. Her statement of the situation-specific problem might be as follows: “How canfurther development of the ulcer be prevented,and how can the ulcer be healed?” If the nurseobserves the development of pressure ulcers inmany patients over time, he or she may ask theresearch question, “What is the most effectivemethod for preventing pressure ulcers?”3. Providing Experiential LearningActivitiesa. Identifying the Basis of Nursing Techniques/ProtocolsThis learning activity provides students with anopportunity to question the theoretical basis ofstandard nursing interventions.

Loading page image...

CHAPTER 2Theoretical Framework9Student objectives for the learningactivity:•Based on the findings of this clinical exercise,identify the bibliographical sources used in thedevelopment of a selected nursing technique/protocol.•Determine whether or not the nursing tech-nique/protocol was based on research.•Suggestpotentialproblemsthatmayarisefrom using non–research-based nursing tech-niques/protocols.Directions for implementation. Assign this exer-cise at the beginning of the course. Have studentsselect a nursing protocol/technique (such as urinarycatheterization or intravenous maintenance) froma 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 nursingeducation office.) Ask them to determine by whomthe protocol (procedure) was written. This infor-mation may be obtained from an in-service edu-cator or nursing administrator. Direct students torequest an interview with one or more individualswho are involved in developing practice protocolsfor the agency. The purpose of the interview is todetermine the basis for the existing protocol. Sug-gested interview questions include the following:•Can you explain how protocols are written inyour agency?•On what information was this specific protocolbased?•Are there any references that will give me abetter understanding of the rationale for thepractices included in the protocol?After the interview, students should submit a briefpaper that describes the experience and states aconclusion about whether or not the protocol isresearch-based.On completion of the clinical exercise, stu-dents may also be asked to present their findingsin class.During the discussion period it is important toconsider the following questions:•Was any reference to research made, either bythe interviewee or in the protocol itself?•If no reference is made or if the reference is anon-research source, how does one know thatthe 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 ShowRelationshipsStudents respond to visual representations be-cause diagrams often clarify a potentially confus-ing topic. When using examples in discussionsabout concepts, theory, research, and hypothesisdevelopment, you should map out specific rela-tionships. Diagrams that clearly identify the vari-ables being studied and the relationships betweenthem will enhance students’ understanding of theprocess used to summarize literature and arriveat hypotheses. In Figure 2-5 below, the link be-tween the independent variables (stress, socialsupport, coping) and dependent variable (healthoutcomes) is illustrated. The figure outlines theprocess through which a supportive interven-tion influences the health outcomes of homelessyouth. Locate the article and work with the stu-dents to understand how the framework informedthe hypothesized relationships.5. Providing Experiential LearningActivitiesFORMULATING DEFINITIONSThis learning activity is designed to give stu-dentsexperienceindevelopingoperationaldefinitions in an effort to increase their abilityto critique the definitions they read in researchreports.

Loading page image...

10CHAPTER 2Theoretical FrameworkStudent objectives for the learningactivity:•Construct a conceptual definition.•Construct an operational definition.•Evaluate an operational definition in terms ofclarity and inclusion of an index of measurement.Directions for implementation. Identify or ask stu-dents to name concepts. Select four to six of theseconcepts for students to define, both conceptuallyand operationally, using a library and other resour-ces. Students can start with a dictionary definitionand then read the work of a theorist who has exam-ined the concept. To make this activity manageablefor students, you can have each choose one of theidentified concepts to define. Another option is tohave only some students (equal to the number ofconcepts to be defined) involved in this particularlearning activity, while others can be engaged indifferent learning activities at other times in the re-search course. This activity also can be a writtenassignment completed out of class and then sharedat a subsequent class session. You can also includethe construction of an operational definition as anitem on an examination.Guidelines for discussion. After students sharetheir defi nitions with the class, you can focus onthe evaluation of each definition. Of course, stu-dents should be actively involved in the evalua-tion discussion. You can prompt students byasking them whether each definition is clear andunambiguous and to identify the specific index ofmeasurement that operationalizes the definition.FIGURE 2-5Model 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.

Loading page image...

INSTRUCTOR'S MANUAL:C H A P T E R3Critical Reading Strategies:Overview of the Research ProcessCHAPTER OVERVIEWChapter 3 begins by emphasizing the need to use critical thinking and critical reading skills whenreading a research article. Both concepts are defined and discussed as a means to help studentsmore effectively read and understand research articles. The authors separate the process of criticalreading into four levels, or stages, of understanding: preliminary, comprehensive, analysis, andsynthesis. Strategies to facilitate each stage of understanding are presented.A section of Chapter 3 addresses and validates the difficulties perceived by a novice reader ofresearch. A major portion of this chapter is devoted to describing the format and style of researchreports. The authors walk the reader through each step of the research process, indicating howand where to find related content in published research and in this textbook. Examples frompublished studies are presented to bring abstract discussion to a concrete level.LEARNING OUTCOMESAfter 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.

Loading page image...

12CHAPTER 3Critical Reading Strategies: Overview of the Research ProcessTEACHING STRATEGIESBecause practice is required to develop skill inthe use of critical thinking and critical reading, itis essential to engage the learner in dialogue andexperiential learning activities. Clarification ofthese concepts through discussion should there-fore be followed by in-class practice, so that youcan facilitate students’ use of these essential skills.1. Critical Thinking ChallengesThe following discussion questions provide aguide for reviewing the content of Chapter 3 andhelping students to think about their past use ofcritical thinking and reading skills:RECALL AND UNDERSTANDING•What is critical thinking?•What is critical reading?•How would you define the stages of criticalreading?•What strategies facilitate comprehensive under-standing of a research report?•What questions are helpful to ask when ana-lyzing a research report?•What are the main sections of a research report?How do you know them when you see them?ANALYSIS AND SYNTHESIS•How have you used critical thinking skills inthe past?•What general assumptions have you madeabout the literature you have read for othercourses?•Compare and contrast critical reading withreading for pleasure.•How does a dialogue with the text enhanceyour ability to understand its meaning?2. Questioning by the Socratic MethodSocratic questioning involves challenging stu-dents to find their own answers to a dilemma andhelping them accept that not all questions have“right” answers. It goes beyond recall of facts ordescriptions of concepts by encouraging studentsto think critically about their own ideas as theyare challenged by opposite points of view. This isa classic technique and was first applied to teach-ing nursing research by Sakalys (1985). She sug-gested that the questions asked in the ReflectiveJudgment Interview (RJI), developed by Kingand Kitchener, are consistent with questioningby the Socratic method. The RJI poses dilemmaswith two conflicting statements, followed by stan-dard questions that are intended to elicit students’opinions about the issue and their rationale for thestand they take.The dilemmas contained in the RJI are not clin-ically oriented, but you can develop ones that arerelevant to the research consumer role. A dilemmashould be read aloud to the class while students readalong from a copy. The questions are then posed,and students are encouraged to share their beliefs,opinions, and hypotheses relevant to the issue.3. Providing Experiential LearningActivitiesa.Developing Critical Reading SkillsThe purpose of this in-class group exercise is toactively engage students in critical dialogue aboutwritten material. Based on the Intra-Act procedurefor critical reading (Hoffman, 1979), this learn-ing activity fosters “… problem-solving, criticalanalysis, and metacognitive awareness while at-tending to course content” (Van Dyk & Jensen,1990).Student objectives for the learningactivity:•Identify the main ideas of a text selection.•Engage in the process of valuing by formingopinions about the selection.•Differentiate quickly formed opinions fromthose arrived at by critical analysis of the textand dialogue with peers.

Loading page image...

CHAPTER 3Critical Reading Strategies: Overview of the Research Process13Directions for implementation. Choose a rela-tively simple research report for in-class reading.The report should be no more than four to fivepages and should be simple versus complex in itspresentation. Form small groups (four to six stu-dents) and appoint a student from each group tobe the leader. In choosing a group leader, keepin mind that he or she should possess the abilityto initiate and sustain discussion. Provide a copyof the report to each study. Provide a handout forstudents that includes a description of the CriticalReading Process (see Table 3-1 in the core text),the appropriate critical appraisal table (18-1 or19-1 in the core text), and the Intra-Act sheet (seesample below). Explain the purpose and methodsof the exercise before proceeding with the follow-ing phases.Comprehending Research ArticlesBegin this activity by instructing students to usethehighlights of critical reading process strat-egiesto read the article. The focus will be onpreliminary and comprehensive understanding,as this phase of the activity is intended to helpstudents build a frame of reference for the text.The group leader’s responsibility is to summar-ize the text, encourage group members to contrib-ute additional information about what was read,or ask questions to clarify the main ideas of theselection.This phase should be limited to 15 to 20 min-utes for reading and 10 minutes for discussion.Step 1: Strategies for preliminary understanding•Review critiquing guidelines from your textand keep these in mind as you read.•Review the title, headings, and subheadings,cap tions under pictures, charts, graphs, ormaps.•Turn each heading into a question that youattempt to answer.•Read the introduction and discussion sec-tion of the article.•Highlight or underline on the photocopyany new terms, unfamiliar terms, and sig-nifi cant sentences.•Look up the definitions of new terms, andwrite them on the photocopy.•Highlight or underline identified steps ofthe research process.Step 2: Strategies for comprehensive understanding•Identify the main idea or theme of the arti-cle; state it in your own words in one or twosentences.•Before critiquing the article, make sureyou understand the main points of each re-ported step of the research process that youidentified.Step 3: Group ThinkThe leader should next shift the discussion from theideas contained in the text selection to the group’spersonal reactions and values related to the contentof the reading material. (This shift often occurs nat-urally.) All members should be encouraged to sharetheir personal impressions and opinions.This phase should be limited to 10 minutes.Step 4: Valuation phaseEach class member is then asked to remove anIntra-Act sheet that contains four value statementsthat you previously wrote about the research article(seesamplebelow).Thesestatementsshouldreflect opinions about the article and/or be a vehiclefor providing new insights about its meaning of thefindings from the article. Instruct students to markeitherA(agree) orD(disagree) for each statementunder their own name. This phase is intended tohelp students derive and integrate the personalmeaning that the text has for them.When critiquing the theoretical framework for aquantitative article, one example may include:Theframework of this article is not consistent with anursing perspectiveorIt is difficult to link the frame-work to the hypothesis outlined by the author(s).

Loading page image...

14CHAPTER 3Critical Reading Strategies: Overview of the Research ProcessStudents should next engage in discussionabout the statements on the game sheet (approxi-mately 10 minutes). Based on the discussion,students should then be asked to predict how eachof the other group members responded to thevalue statements by placing anAorDunder eachperson’s name for each statement.Step 5: Reflective phaseBegin this phase by having students score thegame sheets. Group members should then taketurns sharing how each responded and how eachpredicted the others would respond. As the dis-cussion takes place, students should check wheth-er their predictions agreed with other members’actual responses.During this phase, your role is that of a facilita-tor, rephrasing students’ comments for validation,summarizing how students responded, but notmaking value judgments about students’ opinionsor comments. This is a time to allow studentsto reflect on what they have learned in terms ofcontent and process.Step 6: Debriefing phaseAfterward, debrief the class by posing the follow-ing questions:•What did you learn from participation in Intra-Act?•Why must all group members participate?•How might discussion improve the next timewe use this method?These questions attempt to sensitize students tothe purpose of the exercise (critical reading) andto the role that collegial dialogue plays in help-ing an individual to clarify his or her own ideas.Intra-Act Activity SheetName:Date:Total Score:Percentage of Correct Predictions:Directions:Write the names of all members of the group, including yourself, in the boxes at the top of the columns(one name per column). Then read the statements. Indicate whether you agree or disagree with thestatement by circling either(A)for agree or(D)for disagree. Then predict the responses of the othermembers of your group by doing the same thing. Once all members of your group are finished, score thesheets and discuss why you agreed or disagreed with the statements.NameStatementADADADADADADADADADADADADADADADADADADADADADADADADADADADADADADADADADADADAD

Loading page image...

CHAPTER 3Critical Reading Strategies: Overview of the Research Process15

Loading page image...

INSTRUCTOR'S MANUAL:C H A P T E R4Developing Research Questionsand HypothesesCHAPTER OVERVIEWChapter 4 first addresses the development of a research question and hypotheses, includingnumerous examples of how practical experience leads to the identification of a clinical question,and the scientific literature enables refinement of that question. Also provided are examples ofproblem statements taken from the research literature. It is important for students to understandthat the research question or research problem will drive the design of the research, and thedevelopment of a hypothesis heralds quantitative research design.Second, this chapter provides an extensive examination of the nature, depth, and scope ofresearch questions and hypotheses. Characteristics of a hypothesis statement are discussed indetail and include a relationship statement, the nature of the relationship, testability, and theorybase. Examples are provided of hypotheses that meet and fail to meet these characteristics. Inaddition, research questions are discussed in terms of the kinds of studies and conditions in whichthey commonly are posed.Perhaps the most salient aspect of this chapter is the critiquing process involved in evaluatingthe soundness of a stated research question and the strengths and weaknesses of a hypothesisstatement. Three key elements are highlighted for evaluating a research question for quantitativeresearch:1.Does the research question express a relationship between two or more variables, or at least betweenan independent and a dependent variable?2.Does the research question specify the nature of the population being studied?3.Does the research question imply the possibility of empiric testing?

Loading page image...

18CHAPTER 4Developing Research Questions and HypothesesStudents are shown, through discussion and example, how to examine a hypothesis to determine(1) its ability to answer the research problem directly; (2) its clarity, succinctness, and objectivity; (3)whether it expresses the relationship between key variables, and (4) whether it is understandableto the reader.LEARNING OUTCOMESAfter reading this chapter, the student should be able to do the following:•Describe how the research question and hypothesis relate to the other components of the researchprocess.•Describe the process of identifying and refining a research question.•Identify the criteria for determining the significance of a research question.•Discuss the purpose of developing a research question.•Discuss the appropriate use of the purpose, aim, or objective of a research study.•Discuss how the purpose, research question, and hypothesis suggest the level of evidence to beobtained from the findings of a research study.•Identify the characteristics of research questions and hypotheses.•Describe the advantages and disadvantages of directional and nondirectional hypotheses.•Compare the use of statistical hypotheses versus research hypotheses.•Discuss the appropriate use of research questions versus hypotheses in a research study.•Discuss the differences between a research question and a clinical question in relation to evidence-informed practice.•Identify the criteria used for critiquing a research question and a hypothesis.•Apply the critiquing criteria to the evaluation of a research question and a hypothesis in a researchreport.

Loading page image...

CHAPTER 4Developing Research Questions and Hypotheses19TEACHING STRATEGIESStrategies for facilitating learning of the researchquestion and hypothesis are described separately.The first group of teaching strategies focuseson the research question, and the second groupfocuses on the hypothesis.A. The Research QuestionIn relation to developing and evaluating researchquestions, teaching strategies should routinelyinclude examples that students can relate to theirclinical experience. Such an approach can facili-tate meaningful discussions about the relationshipbetween the study of research questions and nurs-ing practice. The following teaching strategiesare designed to incorporate this approach and en-hance the nursing student’s acuity in recognizingand judging the merits of research questions.1. Critical Thinking ChallengesTo stimulate critical thinking about researchableresearch questions and the question itself, the fol-lowing questions are proposed:RECALL AND UNDERSTANDING•How is a research question identified?•Define the termsindependent variableanddependent variable.•How is the research question refined?•What are research and statistical hypotheses?•What are the components of a research question?ANALYSIS AND SYNTHESIS•How might you go about developing a researchquestion to address anorexia in adolescents?•What is the relationship between the literaturereview and the research question?•Why is potential significance to nursing animportant attribute of a research question?2. Identifying Relational StatementsOne of the criteria for evaluating a research ques-tion is the expression of a relationship betweenkey variables. It has been our experience that stu-dents have difficulty identifying the terms that ex-press a relationship between variables. In the past,students have confused the predictive terminol-ogy used in hypotheses with the relationship cri-teria for research questions and have, therefore,critiqued the latter statements inappropriately. Apossible way of clarifying the identification of arelational statement in the research question is toshare with students examples of different termin-ology used by researchers to convey relationshipsbetween variables under study. Several of theseexamples follow. (The relational terms are itali-cized.)•What is therelationship betweenpreopera-tive anxietyandpostoperative pain in patientsundergoing elective cholecystectomy?•What is theeffect ofa prenatal nutrition pro-gramonthe rate of premature delivery in pri-miparous Aboriginal women?•What is thedifference inthe incidence of falls inelderly patientsin relation tothe use of side rails?3. Using Examples to Point out DifferentForms of the Research QuestionBecause research questions are stated in both in-terrogative and declarative forms, it is importantthat this be clearly conveyed to students to avoidunnecessary confusion or misinterpretation whenthey are evaluating research reports. It is helpfulto present students with a number of examplesof how an interrogative form (a question) can bephrased in declarative form (a statement) with-out changing the content of the inquiry and viceversa. Two such examples follow:INTERROGATIVE FORM•Is there a relationship between the physicalsymptoms of pregnancy and maternal–fetalattachment in primigravidae?•What is the difference in the incidence ofcontractures in comatose patients in relation tofrequency of positioning?

Loading page image...

20CHAPTER 4Developing Research Questions and HypothesesDECLARATIVE FORM•The purpose of this study is to investigate therelationship between the physical symptomsof pregnancy and maternal–fetal attachment inprimigravidae.•This study investigates the difference in the in-cidence of contractures in comatose patients inrelation to frequency of repositioning.4. Providing Experiential LearningActivitiesa. Critiquing Research Questions or StatementsThe purpose of this exercise is to provide studentswith an opportunity to critique the research ques-tions/statements of research studies using thecriteria presented in Chapter 4.Student objectives for the learning activity:•Identify the research question of a clinicalnursing study.•Evaluate the strengths and weaknesses of thestatement.Directions for implementation. Have studentsread Chapter 4 with emphasis on “CritiquingCriteria.”Selecttwoclinicalresearchstud-ies (from the appendix in the text or one of thestudies listed below) and ask students to read theintroduction and literature review of the selectedstudies before class. Suggested studies follow:Study 1:Christman, S. K., et al. (2000).Continuoushandrailsupport,oxygenuptake, and heart rate in women during sub-maximal step treadmill exercise.Researchin Nursing and Health, 23(1), 35–42.Study 2:Wilson, D. (2002). The durationand degree of end-of-life dependency ofhome care clients and hospital inpatients.Advanced Nursing Research, 15, 81ncedStudy3:Watt-Watson,J.,Garfinkel,P.,Gallop, R., Stevens, B., & Streiner, D. (2000).The impact of nurses’ empathic responses onpatients’ pain management in acute care.Nursing Research, 49(4), 191–200.In seminar, students present their evaluations of theresearch question of each study. Encourage studentsto discuss their evaluations with each other and toreach a consensus on whether the problem statementmeets each of the criteria listed in Chapter 4 of thetextbook. Allow 30 to 45 minutes for this exercise.b. Analyzing Research QuestionsThe purpose of this exercise is to provide studentswith an opportunity to analyze the researcher’sdevelopment of a research question (see Chapter 4in the textbook).Student objectives for the learningactivity:•Analyze the relationship between the researchquestion and the literature review.•Evaluate the researcher’s discussion of thequestion’s significance.Directions for implementation. This is a continu-ation of learning activitya, “Critiquing Researchquestions.” Using the same three studies, havestudents first determine the variables presented inthe literature review. Then ask students to identifywhether relationships between these variables arepresented and, if so, with what degree of clarity.Afterward, encourage students to discuss the con-nections between the problem statement and theliterature review. Questions that may be used toinitiate discussion include the following:•Are all the variables contained in the researchquestion presented in the literature review?•Are there any gaps between previous researchcontained in the literature review and the ques-tion under study?Once the relationship between the research ques-tion and the literature review has been analyzed,have students determine whether the researcher

Loading page image...

CHAPTER 4Developing Research Questions and Hypotheses21has discussed the significance of the questiontonursing.Ifadiscussionofthequestion’ssignificance is present, encourage students toevaluate the validity of the researcher’s presen-tation. If not, have students explore their ownthoughts about the question’s significance. Allow30 to 45 minutes for this exercise.c. Developing a Research QuestionThe purpose of this activity is to give students anopportunity to formulate a research question or aclinical nursing study.Student objectives for the learning activity:•Identify a clinical nursing question.•Formulate a research question that is related toa clinical nursing situation.•Evaluate the formulated question according to thecriteria presented in Chapter 4 of the textbook.Directions for implementation. Ascertain the clin-ical interests of your students; then divide theminto small groups (four or five students per group)based on those interest areas. Ask the groups todevelop a research question for a nursing study.Allow about 30 minutes for this portion of the ex-ercise. Have each group then present its researchquestion to the entire class. Instruct students toevaluate each statement presented and to sharetheir comments with their peers. The time neededfor this portion of the exercise will depend on thenumber of groups involved. Allow 5 to 10 minutesfor discussion of each group’s research question.B. The HypothesisAs stated in the textbook, hypotheses are anattempt to answer the posed research questions.They are critical to testing the validity of the as-sumptions of the stated theoretical framework.The teaching strategies that follow are designedto facilitate students’ understanding of movementwithin the research process from assumptions totheoretical framework to hypothesis formulationand to provide an opportunity to write and cri-tique hypothesis statements.1. Critical Thinking ChallengesTo stimulate critical thinking about the hypoth-esis, the following questions are proposed:RECALL AND UNDERSTANDING•What are the characteristics of a hypothesis?•What are the different types of hypotheses?•How are hypotheses derived?•What must occur for a hypothesis to meet thecriterion of testability?•What are hypotheses actually testing?ANALYSIS AND SYNTHESIS•In what situations would research be con-ducted to generate hypotheses?•In what situations would research be con-ducted to test hypotheses?•How do research questions differ from hypoth-eses, and in which instance is each appropriate?•What does it mean to have a hypothesis sup-ported? Rejected?2. Using Examples to Reinforce theConnections between Prior and NewLearningA technique often used in teaching is reinforcementof previous learning. Reinforcement is used tostrengthen a particular behaviour—in this case,knowledge of the research process. It can alsoserve as a precursor to making new connectionstopreviouslearning.Thefollowingteachingstrategy can be used to reinforce learning aboutassumptions, the theoretical framework, and theirconnection, while at the same time reinforcing theconnection between the hypothesis statement andthe steps that precede its formulation. Studentsshould read the following studies before class:Study 1:Bliss, D. Z., et al. (2001). Supple-mentation with dietary fiber improves fecal

Loading page image...

22CHAPTER 4Developing Research Questions and Hypothesesincontinence.NursingResearch,50(4),203–213.Study 2:LeFort, S. M. (2000). A test ofBraden’sself-helpmodelinadultswithchronic pain.Journal of Nursing Scholarship,32(2), 153–160.After briefly reviewing key information aboutwhat an assumption is (Chapter 3), the nature anddevelopment of a theoretical framework (Chapter2), and hypothesis development (Chapter 4), useStudy 1 to reinforce learning about the connec-tions among these three aspects of the scientificapproach.As you will note, the connections are logicaland the students should be able to understandthem readily. Once you determine that they havegrasped the interrelationships of Study 1, moveon to Study 2.Draw Figure 4-2 on the blackboard and askstudents to identify the assumptions, theoreticalrationale, and hypothesis of Study 2. If studentshave a good grasp of what these three aspects areand how they are connected, they should be easilyable to fi ll in the blanks.3. Providing Experiential LearningActivitiesa. Examining Sources Used to SupportHypothesesThis learning activity enables the student toexamine more closely some of the researchcited in a literature review in support of studyhypotheses.Student objectives for the learning activity:•Identify how a specific hypothesis is sup-ported, based on the conceptual (theory-based)literature of a selected research study.•Identify how a specific hypothesis is supported,based on the data-based (previous research inthe area) literature of a selected research study.Directions for implementation. Students can readany of the studies listed in a previous learning ac-tivity, paying particular attention to the literaturereview, hypothesis statement, and findings. Stu-dents should focus on the specific theory refl ectedby the hypothesis statement. They should selectone or two primary and one or two secondaryFIGURE 4-1.Study No. 1(Refer to Bliss, D.Z., et al. (2001). Supplementation with dietary fiber improves fecal incontinence. Nursing Research, 40,203–213.)

Loading page image...

CHAPTER 4Developing Research Questions and Hypotheses23sources listed in the bibliography of the articlethat pertain to one of the study hypotheses. Whilereviewing these sources, students should exam-ine their relevance to the hypothesis statement.They should take a position—pro or con—as towhether the sources support the hypothesis anddefend that position.b. Differentiating Between Dependent andIndependent VariablesMany students fi nd it difficult to differentiatebetween dependent and independent variables.After reviewing Table 4-4 (p. 79) in the textbook,have the students list a variety of variables, (age,weight, gender, GPA, satisfaction, blood pressure,and so forth). Ask them to construct a variety ofhypotheses from the list of variables. Challengethem to have statements in which one variable(e.g., blood pressure) is a dependent variable andthen an independent variable.c. Constructing Hypothesis StatementsThis learning activity is designed to give studentsexperience in writing hypothesis statements sothey will have a better understanding of whatconstitutes an appropriately written hypothesis.Ultimately, the student can use this informationto evaluate hypotheses.Student objectives for the learningactivity:•Construct a hypothesis statement.•Identify the characteristics of hypothesis state-ments that appear in the constructed hypothesis.•Identify the characteristics of hypothesis state-ments that do not appear in the constructedhypothesis.Directions for implementation. Ask students toread just the literature review of either Appendix Aor C. This should be a pre-class assignment. In class,you may want to review briefly the characteristics ofa hypothesis statement to reinforce prior learning.In class, ask the students, without readingfurther in the study, to develop a hypothesis state-ment based on the theoretical rationale they haveread. (You can suggest that they construct an in-ventory of relationships to get them started.)Guidelines for discussion. After the experiential ac-tivity, students can either independently or throughFIGURE 4-2.Study No. 2

Loading page image...

24CHAPTER 4Developing Research Questions and Hypothesesclass discussion identify the characteristics that ap-pear in their hypotheses; they should also identifythose that do not appear. Taking this a step further,to enhance students’ ability to construct hypothesisstatements, you may want to have them reconstructtheir statements to include any omitted character-istics. Then have the students compare their state-ments to the hypothesis stated in the article.d. Critiquing Hypothesis StatementsThe purpose of the following learning activity is toenhance students’ ability to evaluate the structuralaspects of a hypothesis statement, using criteria 1through 11 identified under “The Hypotheses” inthe Critiquing Criteria box (p. 87 in the textbook).Student objectives for the learningactivity:•Use criteria 1 through 11 (see Critiquing Cri-teria box) to critique a hypothesis statement.•Evaluate the structural aspects of a selectedhypothesis statement.Directionsforimplementation.Examplesofhypotheses that can be used for this learningactivity can come from a variety of other studieslisted in either the textbook or theInstructor’sManualthat accompanies it. To reinforce priorlearning, the students should review criteria 1through 11. After the review, present several hy-pothesis statements (a list of four to six shouldsuffice) in class. Students can refer to the text-book for information about the criteria, or theCritiquing Criteria can be duplicated and distrib-uted for use during the actual critique. Groups ofthree or four students should select two or threehypothesis statements and discuss them, usingcritiquing criteria 2 through 8. Small group dis-cussions should last about 10 minutes per hy-pothesis. An example of this activity is providedon the Evolve site (see Critical Appraisal Activ-ity, Chapter 4).Guidelines for discussion. Each group can se-lect one or two of the hypotheses evaluated andshare the evaluation with the rest of class. As theinstructor, you will embellish the students’ cri-tiques, reinforcing their appropriate responses.Your role also may consist of clarifying the estab-lished criteria.

Loading page image...

INSTRUCTOR'S MANUAL:C H A P T E R5Finding and Appraisingthe LiteratureCHAPTER OVERVIEWChapter 5 introduces the student to the process of conducting a search and review of the literaturefor a research study. The overall purposes of a literature review are described for quantitative andqualitative research designs. Discussed in detail is the use of the literature review from the perspec-tive of the investigator and the consumer, as well as the relationship of the literature review tothe following steps of the quantitative research process: (1) theoretical or conceptual framework,(2) research question and hypothesis, (3) design and method, and (4) outcome of the analysis.Both conceptual and data-based literature are discussed. Literature retrieval methods and schol-arly research publications are also discussed, with emphasis on computer-generated strategies.Numerous examples of primary and secondary journal articles, books, book chapters, and docu-ments are provided. Extensive discussion is devoted to various databases and online resources,including selected Web sites and the possible outcomes of using these sites. Also addressed arethe ways to begin and complete a literature search.Recognizing the role of the nurse in research, the section on critiquing emphasizes the consumerperspective and quantitative research, although reference is made to qualitative studies and thedifferent nature of the literature review for this kind of design.

Loading page image...

26CHAPTER 5Finding and Appraising the LiteratureLEARNING OUTCOMESAfter reading this chapter, the student should be able to do the following:•Discuss the relationship of the literature review to nursing theory, research, education, and practice.•Discuss the purposes of the literature review from the perspective of the research investigator and theresearch consumer.•Discuss the use of the literature review for quantitative designs and qualitative methods.•Discuss the purpose of reviewing the literature in the development of evidence-informed practice.•Differentiate between primary and secondary sources.•Compare the advantages and disadvantages of the most commonly used online databases and printdatabase sources for conducting a literature review.•Identify the characteristics of an effective electronic search of the literature.•Critically read, appraise, and synthesize primary and secondary sources used for the development ofa literature review.•Apply critiquing criteria to the evaluation of literature reviews in selected research studies

Loading page image...

CHAPTER 5Finding and Appraising the Literature27TEACHING STRATEGIESAlthough students are not expected to develop anextensive literature review during their researchcourse, they will need to be prepared to think crit-ically and make judgements as to the merit of theliterature reviews they read in the professional lit-erature. Therefore the nature and process of theliterature review form the basis for the followingteaching strategies.1. Critical ChallengesFor purposes of general discussion and criticalthinking, the following questions can be used:RECALL AND UNDERSTANDING•What are the purposes of a literature review forresearch investigator and research consumeractivities?•What are conceptual and data-based literature?•What are the differences between primary andsecondary sources of information?•What are the characteristics of a written, rel-evant literature review?•What is the role of electronic databases in aliterature review?ANALYSIS AND SYNTHESIS•How does the literature review enable theresearcher to estimate the potential for successof a study?•How do you know that sufficient literature hasbeen reviewed?•How is a literature review used in quantitativeversus qualitative research studies?•How can you be sure that a literature reviewhas been approached critically?You can engage students in a variety of discus-sions based on the literature review of an assignedarticle. These may include the following basicquestions:•What is known about this problem?•Does the literature review uncover knowledge?•Does the literature review support the hypoth-eses or research question(s)?•Does the literature review uncover research find-ings that support evidence-informed practice?•What is the overall value of the literaturereview in developing the knowledge base ne-cessary to carry out the research?Your goal here is to help students understandthe status of research in the identified problemarea.2. Introducing Students to the LibraryIn an effort to bring meaning to the experience ofconducting a literature review, a trip to the libraryis recommended. The reference librarian can betremendously helpful in providing explanationsabout nursing and non-nursing indexes, what theyconsist of, where to find them, and how to usethem. This person can field questions pertainingto primary and secondary sources of information.It may be advantageous to speak with the librarianin advance of the library class to discuss the sub-stance of the orientation and the students’ back-ground in research. To be included is informationabout how to conduct a computer search, wheremeasurement tools can be found, and how to usea thesaurus for indexes. It also is helpful if thelibrarian can demonstrate a search using one ormore electronic databases, using actual variablespertinent to a clinical problem that you identify.The library introduction should take 1-1/2 to2 hours, or approximately one class session. Afterthe formal introduction by the librarian, studentsshould be encouraged to examine one or more ofthe indexes relevant to nursing research. If pos-sible, book a computer lab to allow the studentsto access the electronic databases and practicesearching after the presentation.

Loading page image...

28CHAPTER 5Finding and Appraising the Literature3. Providing Experiential LearningActivitiesa. Identifying Strong and Weak Areasof a Literature ReviewThe purpose of this learning activity is to help stu-dents identify strong and weak areas of a selectedliterature review. It gives students an opportunityto critically appraise the content and style of atleast one published research report.Student objectives for the learningactivity:•Identify all relevant variables discussed in theselected literature review.•Determine whether the essential variables arediscussed in the review.•Determine the ratio of primary sources to sec-ondary sources cited.•Evaluate the review for completeness and evi-dence of bias.Directions for implementation. Students shouldreview Chapter 5 in the textbook. In addition, as-sign a study for in-depth discussion and analysisby students. Use one of the studies from the ap-pendix of the textbook.Based on the assigned study reading, ask studentsto do the following:•For quantitative articles, identify all the rel-evant variables in the research question anddetermine whether each was addressed in theliterature review. For qualitative articles, doesthe literature review describe what is knownabout the phenomenon under study?•Determine what proportion of the bibliographiccitations in the literature review were primarysources.•Critically evaluate the literature review for evi-dence of completeness and bias.•Evaluate whether the literature review reflectsanalysis and synthesis of material.Guidelines for discussion. Engage students in adiscussion of the literature review presented inthe assigned paper. Students should use as a basisfor evaluating the adequacy of the review or thecritique criteria presented in Chapter 5 of the text-book.b. Primary and Secondary Sources of InformationThis learning activity gives students an opportun-ity to develop skill in differentiating primary fromsecondary sources of information. Although asample reference list is provided in this exercise,any list can be substituted.Student objectives for the learningactivity:•Identify primary and secondary sources froma reference list derived from a research report.•Evaluate the adequacy of primary sources froma reference list derived from a research report.Directions for implementation. Hand out theone-page activity (Figure 5-1 Primary and Sec-ondary Sources of Information) found at the endof this chapter, for completion in class. Aftereveryone has completed the activity, discuss thestudents’ choices for each source and whetherthe number of primary sources used is adequate.Ask students to provide their rationale for eachresponse made.c. Doing a Bibliographic Computer Search•The purpose of this activity is to give studentsan opportunity to conduct a computer searchof the literature.Student objectives for the learningactivity:•Conduct a computer search.•Compare two computer search methods and aprint resource.

Loading page image...

CHAPTER 5Finding and Appraising the Literature29Directions for implementation. Help studentschoose two variables of interest or assign groupprojects to develop research-based clinical proto-cols. The variables (or protocol topics) may beones you have previously discussed in class orones that students have as an assignment foranother course. After the variables (or protocoltopics) have been selected, students should do thefollowing:•Spend 2 hours in the library doing a search ofthe literature.•If you used strategy 2 above, “IntroducingStudents to the Library,” students should befamiliar with the librarians who can assistthem. If you have not used that strategy, informstudents of the appropriate reference librarianto contact. The search should be limited to thepast 3 years, because computer time can beexpensive and a 3-year period is adequate tomake the point. Ask students to note how longit takes the computer to process the search, in-cluding printing out the references.Guidelines for discussion. The following ques-tions are suggested to stimulate discussion afterstudentshaveconductedtheirowncomputersearch:1.How did you find key terms to begin thesearch?2.What tactics were effective?3.How did you maximize results? Limit results?4.How do you determine whether the resultswere useful?5.How do you access the full text?6.Areaccessingandreadingfullabstractsuseful?

Loading page image...

30CHAPTER 5Finding and Appraising the LiteratureFIGURE 5-1.Primary and Secondary Sources of Information.(Partial reference list from: Mahon, N.E., Yarcheski, A, & Yarcheski, T.J. (2000). Positive and negative outcomesof anger in early adolescents.Research in Nursing & Health, 23, 177–24.)

Preview Mode

This document has 110 pages. Sign in to access the full document!

Report

Study Now!

Document Details

Related Documents

Nursing Research In Canada: Methods, Critical Appraisal, And Utilization, 3rd Canadian Edition Solution Manual

Laboratory 8 Muscle Soreness Lab Manual

Case Diana

Identifying a Local Healthcare Economic Issue

Dashboard Metrics Evaluation 1 Dashboard Metrics E

NRP 563 DQ 2

NRP 563 DQ 7

Clinical Supervision Report Week 2

NU 185 Exam 5 Final

NURS FPX 4010 Assessment 3

Company

Explore

Study Tools