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Understanding Nursing Research
Building an Evidence-Based Practice
SIXTH EDITION
Susan K. Grove, PhD, RN, ANP-BC, GNP-BC
Professor Emerita, College of Nursing, The University of Texas at Arlington, Arlington, Texas
Adult Nurse Practitioner, Family Practice, Grand Prairie, Texas
Jennifer R. Gray, PhD, RN, FAAN
George W. and Hazel M. Jay Professor, College of Nursing, Associate Dean, College of Nursing,
The University of Texas at Arlington, Arlington, Texas
Nancy Burns, PhD, RN, FCN, FAAN
Professor Emerita, College of Nursing, The University of Texas at Arlington, Arlington, Texas
Faith Community Nurse, St. Matthew Cumberland Presbyterian Church, Burleson, Texas
Table of Contents
Cover image
Title page
Inside Front Cover
Copyright
Contributor and Reviewers
Dedication
Preface
Acknowledgments
Chapter 1: Introduction to Nursing Research and Evidence-Based Practice
What is Nursing Research?
What is Evidence-Based Practice?
Purposes of Research for Implementing an Evidence-Based Nursing Practice
Historical Development of Research in Nursing
Acquiring Knowledge in Nursing
Acquiring Knowledge Through Nursing Research
Understanding Best Research Evidence for Practice
What Is Your Role in Nursing Research?
Key Concepts
Chapter 2: Introduction to Quantitative Research
What is Quantitative Research?
Problem-Solving and Nursing Processes: Basis for Understanding the Quantitative Research Process
Identifying the Steps of the Quantitative Research Process
Reading Research Reports
Practice Reading Quasi-Experimental and Experimental Studies
Key Concepts
Chapter 3: Introduction to Qualitative Research
Values of Qualitative Researchers
Rigor in Qualitative Research
Qualitative Research Approaches
Qualitative Research Methodologies
Data Collection Methods
Data Management
Data Analysis
Key Concepts
Chapter 4: Examining Ethics in Nursing Research
Historical Events Influencing the Development of Ethical Codes and Regulations
Protecting Human Rights
Understanding Informed Consent
Understanding Institutional Review
Examining the Benefit-Risk Ratio of a Study
Understanding Research Misconduct
Examining the Use of Animals in Research
Key Concepts
Chapter 5: Research Problems, Purposes, and Hypotheses
What Are Research Problems and Purposes?
Identifying the Problem and Purpose in Quantitative, Qualitative, and Outcomes Studies
Determining the Significance of a Study Problem and Purpose
Examining the Feasibility of a Problem and Purpose
Examining Research Objectives, Questions, and Hypotheses in Research Reports
Understanding Study Variables and Research Concepts
Key Concepts
Chapter 6: Understanding and Critically Appraising the Literature Review
Purpose of the Literature Review
Sources Included in a Literature Review
Critically Appraising Literature Reviews
Reviewing the Literature
Key Concepts
Chapter 7: Understanding Theory and Research Frameworks
What is a Theory?
Understanding the Elements of Theory
Levels of Theoretical Thinking
Examples of Critical Appraisal
Key Concepts
Chapter 8: Clarifying Quantitative Research Designs
Identifying Designs Used in Nursing Studies
Descriptive Designs
Correlational Designs
Understanding Concepts Important to Causality in Designs
Examining the Validity of Studies
Elements of Designs Examining Causality
Quasi-Experimental Designs
Experimental Designs
Randomized Controlled Trials
Introduction to Mixed-Methods Approaches
Key Concepts
Chapter 9: Examining Populations and Samples in Research
Understanding Sampling Concepts
Representativeness of a Sample in Quantitative and Outcomes Research
Probability Sampling Methods
Nonprobability Sampling Methods Commonly Used in Quantitative Research
Sample Size in Quantitative Studies
Sampling in Qualitative Research
Sample Size in Qualitative Studies
Research Settings
Key Concepts
Chapter 10: Clarifying Measurement and Data Collection in Quantitative Research
Concepts of Measurement Theory
Accuracy, Precision, and Error of Physiological Measures
Use of Sensitivity, Specificity, and Likelihood Ratios to Determine the Quality of Diagnostic AND Screening Tests
Measurement Strategies in Nursing
Data Collection Process
Key Concepts
Chapter 11: Understanding Statistics in Research
Understanding the Elements of the Statistical Analysis Process
Understanding Theories and Concepts of the Statistical Analysis Process
Using Statistics to Describe
Determining the Appropriateness of Inferential Statistics in Studies
Using Statistics to Examine Relationships
Using Statistics to Predict Outcomes
Using Statistics to Examine Differences
Interpreting Research Outcomes
Key Concepts
Chapter 12: Critical Appraisal of Quantitative and Qualitative Research for Nursing
Practice
When are Critical Appraisals of Studies Implemented in Nursing?
What are the Key Principles for Conducting Intellectual Critical Appraisals of Quantitative and Qualitative Studies?
Understanding the Quantitative Research Critical Appraisal Process
Example of a Critical Appraisal of a Quantitative Study
Understanding the Qualitative Research Critical Appraisal Process
Example of a Critical Appraisal of a Qualitative Study
Key Concepts
Chapter 13: Building an Evidence-Based Nursing Practice
Benefits and Barriers Related to Evidence-Based Nursing Practice
Searching for Evidence-Based Sources
Critically Appraising Research Syntheses
Developing Clinical Questions to Identify Existing Research-Based Evidence for Use in Practice
Models to Promote Evidence-Based Practice in Nursing
Implementing Evidence-Based Guidelines in Practice
Introduction to Evidence-Based Practice Centers
Introduction to Translational Research
Key Concepts
Chapter 14: Outcomes Research
Theoretical Basis of Outcomes Research
Nursing-Sensitive Outcomes
Origins of Outcomes and Performance Monitoring
Federal Government Involvement in Outcomes Research
Advanced Practice Nursing Outcomes Research
Outcomes Research and Nursing Practice
Methodologies for Outcomes Studies
Statistical Methods for Outcomes Studies
Critical Appraisal of Outcomes Studies
Key Concepts
Glossary
Index
Inside Back Cover
Inside Front Cover
Copyright
3251 Riverport Lane
St. Louis, Missouri 63043
UNDERSTANDING NURSING RESEARCH: BUILDING AN EVIDENCE-BASED
PRACTICE, EDITION SIX
ISBN: 978-1-4557-7060-1
Copyright © 2015, 2011, 2007, 2003, 1999, 1995 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying, recording, or
any information storage and retrieval system, without permission in writing from the
publisher. Details on how to seek permission, further information about the Publisher ’s
permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright
by the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional
responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a
matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.
International Standard Book Number: 978-1-4557-7060-1
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributor and Reviewers
Contributor
Diane Doran, RN, PhD, FCAHS, Professor Emerita, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto,
Toronto, Ontario Revised Chapter 14
Reviewers
Lisa D. Brodersen, EdD, MA, RN , Professor, Coordinator of Institutional Research and Effectiveness, Allen College,
Waterloo, Iowa
Sara L. Clutter, PhD, RN , Associate Professor of Nursing, Waynesburg University, Waynesburg, Pennsylvania
Jacalyn P. Dougherty, PhD, RN , Nursing Research Consultant, JP Dougherty LLC, Aurora, Colorado
Joanne T. Ehrmin, RN, COA-CNS, PhD, MSN, BSN , Professor, University of Toledo, College of Nursing, Toledo, Ohio
Betsy Frank, PhD, RN, ANEF , Professor Emerita, Indiana State University College of Nursing, Health, and Human
Services, Terre Haute, Indiana
Tamara Kear, PhD, RN, CNS, CNN , Assistant Professor of Nursing, Villanova University, Villanova, Pennsylvania
Sharon Kitchie, PhD, RN , Adjunct Instructor, Keuka College, Keuka Park, New York
Madelaine Law rence, PhD, RN , Associate Professor, University of North Carolina at Wilmington, Wilmington, North
Carolina
Robin Moyers, PhD, RN-BC, Nurse Educator, Carl Vinson VA Medical Center, Dublin, Georgia
Sue E. Odom, DSN, RN , Professor of Nursing, Clayton State University, Morrow, Georgia
Teresa M. O’Neill, PhD, APRN, RNC, Professor, Our Lady of Holy Cross College, New Orleans, Louisiana
Sandra L. Siedlecki, PhD, RN, CNS, Senior Nurse Scientist, Cleveland Clinic, Cleveland, Ohio
Sharon Souter, PhD, RN, CNE, Dean and Professor, University of Mary Hardin Baylor, Belton, Texas
Molly J. Walker, PhD, RN, CNS, CNE, Professor, Angelo State University, San Angelo, Texas
Cynthia Ward, DNP, RN-BC, CMSRN, ACNS-BC, Surgical Clinical Nurse Specialist, Carilion Roanoke Memorial
Hospital, Roanoke, Virginia
Angela Wood, PhD, RN, Certified High-Risk Prenatal Nurse, Associate Professor and Chair, Department of Nursing,
Carson-Newman University, Jefferson City, Tennessee
Fatma A. Youssef, RN, DNSc, MPH , Professor Emerita, Marymount University, School of Health Professions,
Arlington, Virginia
Dedication
To all nurses who change the lives of patients through applying the best research
evidence.
—Susan, Jennifer, and Nancy
To my husband Jay Suggs who has provided me endless love and support during
my development of research textbooks over the last 30 years.
—Susan
To my husband Randy Gray who is my love and my cheerleader.
—Jennifer
To my husband Jerry who has supported all of my academic endeavors through 58
years of marriage.
—Nancy
Preface
Research is a major force in nursing, and the evidence generated from research is
constantly changing practice, education, and health policy. Our aim in developing this
essentials research text, Understanding Nursing Research: Building an Evidence-Based
Practice, is to create an excitement about research in undergraduate students. The text
emphasizes the importance of baccalaureate-educated nurses being able to read,
critically appraise, and synthesize research so this evidence can be used to make changes
in practice. A major goal of professional nursing and health care is the delivery of
evidence-based care. By making nursing research an integral part of baccalaureate
education, we hope to facilitate the movement of research into the mainstream of
nursing. We also hope this text increases student awareness of the knowledge that has
been generated through nursing research and that this knowledge is relevant to their
practice. Only through research can nursing truly be recognized as a profession with
documented effective outcomes for the patient, family, nurse provider, and healthcare
system. Because of this expanded focus on evidence-based practice (EBP), we have
subtitled this edition Building an Evidence-Based Practice.
Developing a sixth edition of Understanding Nursing Research has provided us with an
opportunity to clarify and refine the essential content for an undergraduate research text.
The text is designed to assist undergraduate students in overcoming the barriers they
frequently encounter in understanding the language used in nursing research. The
revisions in this edition are based on our own experiences with the text and input from
dedicated reviewers, inquisitive students, and supportive faculty from across the country
who provided us with many helpful suggestions.
Chapter 1, Introduction to Nursing Research and Evidence-Based Practice, introduces
the reader to nursing research, the history of research, and the significance of research
evidence for nursing practice. This chapter has been revised to include the most relevant
types of research synthesis being conducted in nursing—systematic review, metaanalysis, meta-synthesis, and mixed-methods systematic review. The discussion of
research methodologies and their importance in generating an evidence-based practice
for nursing has been updated and expanded to include the exploratory-descriptive
qualitative research method. A discussion of the Quality and Safety Education for
Nursing (QSEN) competencies and their link to research has been included in this
edition. Selected QSEN competencies are linked to the findings from studies presented
as examples throughout the text to increase students’ understanding of the importance in
delivering quality, safe health care to patients and families.
Chapter 2, Introduction to Quantitative Research, presents the steps of the quantitative
research process in a concise, clear manner and introduces students to the focus and
findings of quantitative studies. Extensive, recent examples of descriptive, correlational,
quasi-experimental, and experimental studies are provided, which reflect the quality of
current nursing research.
Chapter 3, Introduction to Qualitative Research, describes five approaches to
qualitative research and the philosophies upon which they are based. These approaches
include phenomenology, grounded theory, ethnography, exploratory-descriptive
qualitative, and historical research. Data collection and analysis methods specific to
qualitative research are discussed. Guidelines for reading and critically appraising
qualitative studies are explained using examples of published studies.
Chapter 4, Examining Ethics in Nursing Research, provides an extensive discussion of
the use of ethics in research and the regulations that govern the research process.
Detailed content and current websites are provided to promote students’ understanding
of the Health Insurance Portability and Accountability Act (HIPAA), the U.S.
Department of Health and Human Services Protection of Human Subjects, and the
Federal Drug Administration regulations. Guidelines are provided to assist students in
critically appraising the ethical discussions in published studies and to participate in the
ethical review of research in clinical agencies.
Chapter 5, Research Problems, Purposes, and Hypotheses, clarifies the difference
between a problem and a purpose. Example problem and purpose statements are
included from current qualitative, quantitative, and outcome studies. Detailed guidelines
are provided with examples to direct students in critically appraising the problems,
purposes, hypotheses, and variables in studies.
Chapter 6, Understanding and Critically Appraising the Literature Review, begins with
a description of the content and quality of different types of publications that might be
included in a review. Guidelines for critically appraising published literature reviews are
explored with a focus on the differences in the purpose and timing of the literature
review in quantitative and qualitative studies. The steps for finding appropriate sources,
reading publications, and synthesizing information into a logical, cohesive review are
presented.
Chapter 7, Understanding Theory and Research Frameworks, briefly describes grand,
middle range, physiological, and scientific theories as the bases for study frameworks.
The purpose of a research framework is discussed with the acknowledgement that the
framework may be implicit. Guidelines for critically appraising the study framework are
presented as well. The guidelines are applied to studies with frameworks derived from
research findings and from different types of theories.
Chapter 8, Clarifying Quantitative Research Designs, addresses descriptive,
correlational, quasi-experimental, and experimental designs and criteria for critically
appraising these designs in studies. The major strengths and threats to design validity
are summarized in a table and discussed related to current studies. This chapter has
been expanded to include an introduction to randomized controlled trials (RCT) and
mixed-methods approaches being conducted by nurses.
Chapter 9, Examining Populations and Samples in Research, provides a detailed
discussion of the concepts of sampling in research. Different types of sampling methods
for both qualitative and quantitative research are described. Guidelines are included for
critically appraising the sampling criteria, sampling method, and sample size of
quantitative and qualitative studies.
Chapter 10, Clarifying Measurement and Data Collection in Quantitative Research, has
been updated to reflect current knowledge about measurement methods used in nursing
research. Content has been expanded and uniquely organized to assist students in
critically appraising the reliability and validity of scales; precision and accuracy of
physiologic measures; and the sensitivity, specificity, and likelihood ratios of diagnostic
and screening tests.
Chapter 11, Understanding Statistics in Research, focuses on the theories and concepts
of the statistical analysis process and the statistics used to describe variables, examine
relationships, predict outcomes, and examine group differences in studies. Guidelines
are provided for critically appraising the results and discussion sections of nursing
studies. The results from selected studies are critically appraised and presented as
examples throughout this chapter.
Chapter 12, Critical Appraisal of Quantitative and Qualitative Research for Nursing
Practice, summarizes and builds on the critical appraisal content provided in previous
chapters and offers direction for conducting critical appraisals of quantitative and
qualitative studies. The guidelines for critically appraising qualitative studies have been
significantly revised and simplified. This chapter also includes a current qualitative and
quantitative study, and these two studies are critically appraised using the guidelines
provided in this chapter.
Chapter 13, Building an Evidence-Based Nursing Practice, has been significantly
updated to reflect the current trends in health care to provide evidence-based nursing
practice. Detailed guidelines are provided for critically appraising the four common
types of research synthesis conducted in nursing (systematic review, meta-analysis, metasynthesis, and mixed-method systematic review). These guidelines were used to critically
appraise current research syntheses to assist stude …
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