DEEPA

Review:
Problem solving and
scientific method.
Research –definition, characteristics, purposes, types of
research, Basic research terms, Scope of nursing
research, Overview of Research process, Significance
of research in nursing, Historical Evolution of nursing
research.
Future trends in nursing research.
Problems and challenges in nursing research, health
and social research.
Priorities for nursing research.
Evidence based practice.
Ethics in research


 Looking for new knowledge, doing something
new ??
 Looking for facts
 Measuring phenomenon, health states,
including health and disease
 Developing new – materials, products
including drugs, processes, designs….
 New models of delivery of health services

 Organised investigation of a problem
 French word - re- cerche “ to search again”
 A careful investigation or inquiry

 A systematic and objective analysis and
recording of controlled observation that may
lead to the development of generalisation of
principles, theories, resulting in prediction
and possible ultimate control of events
 J. W. BEST

 It is a careful inquiry or examination seeking
facts or principles , a diligent investigation to
ascertain something
 CLIFFORD WOODY

 It is an attempt to gain solutions to problems;
more precisely it is the collection of data in a
rigorously controlled situation for the
purpose of prediction or explanation
 TREECE AND TREECE

• Discovery – finding what existed
• Inventions – new produce development that
did not exist in nature
• Innovation – new ways to solve old problems
• Development – after invention to useful
products and services
• Testing new and old products/drugs and
services
• Evaluation of programs – wider outcomes
and impacts, including unintended outcomes.

Generation of knowledge
Problem solving
Demands accurate observation and description
Originality
Empirical
Logical

Replicable
Theory development and testing
Appropriate methodology
Conducted on representative sample
Good tools
Recorded and reported
Findings are made available to other scholars

 Orderly and systematic process
 Based on current professional issues
 Begin with clearly defined purposes
 Emphasise to develop, refine and expand
professional knowledge
 Directed towards development or testing
theories
 Finding solution of problem
 Dedicated to develop empirical evidence
 Strives to collect first hand information and
data

 Generate findings to refine and improve
professional practices
 Use of appropriate methodology
 Conducted on representative sample
 Conducted through appropriate use of
methods and tools of data collection
 Use of valid and reliable data collection tools
 Carefully recorded and reported
 Adequately and appropriately analysed
research

 Patiently carried out activity
 Researcher’s expertise, interest, motivation
and courage
 Adequately communicated

Observations, Research and Science relationship
• Observations and thinking are basis for scientific development
• Archimedes’s observations on water displaced in the bath tub –
volume, density… principles of floating bodies ‐ 250 BC.
• Renaissance (14‐17th centuries) was spearheaded by systematic
observations of natural processes ‐> new thinking, writing, and
correlating observations and theory
• Galileo's observations on pendulum’s movement ‐
>measurement of time, Telescope ‐> planetary bodies….
• Newton's observation on apple falling ‐> gravitation
• Before that Indian scientists observed, developed theories and
written down… but forgotten…Arya Bhatt, Panini, ……
• Observations, thinking, documentations, experimentation further
development of theory, application to practice….. Basis of science

It is the
systematic
inquiry
designed
to develop
trustworthy
evidence
about issues
of
importance
to the
nursing
profession,
including
nursin
g
practic
e,
educat
ion,
adminis
tration,
and
informa
tics.
POLIT
AND
BECK,
2008

 Build and expand the body of nursing
knowledge
 Validate and refine the existing nursing
practice and
 Make health care efficient and cost effective

 It is a systematic approach to the solution or
alleviation of problems characterised by
sequential execution of the following
observation through action processes

 Inductive
 Deductive
 Analytic
 Synthetic

PLAN
•1. Clarify the problem
•2. Break down the problem
•3. Set a target
•4. Analyze the root cause
DO
•5. Develop counter measures
•6. Implement counter measures
CHECK
•7. Evaluate results and processes
ACT
•8. Standardize successful improvements

Research (Scientific) Problem solving
Selecting the topic Identifying problem
Quantitative or qualitative data,
statistically analysed
No statistical analysis
Control factors other than variables
in study
No controls are imposed
Generalisable Generalisation is not possible
Replication and verification Entails no such requirements
Disseminate the research findings Evaluation, revision and utilisation of the
findings in specific situations, no
dissemination.
Finding process Learning and problem solving process

Specific problem-
recognize, select
& state
Defining
Collecting relevant
information
Formulation of
hypothesis / solutions
Evaluation of
hypothesis
Verifying validity
Choosing alternatives
if unsuccessful or till
successful

1. Basic and applied research
2. To achieve various levels of explanation
3. Research purposes linked to EBP

 Description
 Exploration
 Explanation
 Prediction and control

 Discover knowledge of the discipline
 Answers to question/ solution to a
problem
 Discovering and interpreting new facts
 Establishes generalization and builds
theory

 Formulating new phenomenon
 Development of clinical
interventions
 Identification- novel insight
 Promotes EBN

 Document cost effectiveness
 Develop nursing principles and theories

 Treatment, Therapy or intervention
 Diagnosis and assessment
 Prognosis
 Prevention of harm
 Etiology or causation
 Meaning and processes

 Forms of Research
• Natural Science
• Humanities
• Economic
• Social
• Business

• Relies on the application of the scientific
methods.
• Searches for the “truth”
• The knowledge generated is practically
applicable.
• Can be further classified according to
different disciplines of academic or
applications

• Employs a more relativist epistemology
• It usually tries to understand a condition or
question in the context of the issues and
factors surrounding it, rather than trying to
find out a single “true” answer to it
• It focuses on the “context” – social, political,
economical, ethnic, cultural

 Basic vs. Applied

 Type of applied research
 Cyclical in nature

• A special category of applied or action
research
• Aims at maximizing the profit & minimizing
the cost or expenses
• Applying advanced analytical methods to
help make better decisions.

• Business management
• Engineering
• Economics
• Agriculture
• Financial institutions
• City planning
• Transportation
• Crime investigations
• Health

• How many beds in a hospital/speciality
• How to minimize waiting time in OPD?
• How to reduce interval between two
operations
• How best to deliver some medicine to the
target community
• How to optimize the supply for vaccine in an
immunization program

• Primary – Collecting the data from primary
sources like patients, users, practitioners,
environment etc
• Secondary – Collecting the data from
secondary sources like hospital records,
government records, meteorological records,
Survey reports etc

 Research confined to the laboratories‐ Most
of the biochemical, pharmacological, Genetic
studies – Many are at cellular level.
 Research conducted in the community, field
program operations etc – Most of the public
health researches are in field.
 Clinical Trials – may be a combination of
both.

• Descriptive Research is a fact finding
investigation which is aimed at describing the
characteristics of individual, situation or a group
(or) describing the state of affairs as it exists at
present.
• Analytical Research is primarily concerned with
testing hypothesis and specifying and
interpreting relationships, by analyzing the facts
or information already available.
• Experimental Research is considered by some
people as a distinct group of analytical research

Quantitative Research
• Deals with numbers and try to quantify and
measure a particular phenomena.
• Often uses statistical methods aimed at
establishing significance.
• Aims to find the “true cause”.
• Tries to answer questions “how many” or
“how much”.

• Primarily does not deal with numbers but the
nature of data.
• Follows an “interpretivist” approach instead
of a statistical one.
• Aims to understand a phenomenon in its
proper “context”.
• Tries to answer questions like “what”, “why”
and “how”.

Diagnostic Research – It is also called clinical
research which aims at identifying the causes
of a problem, frequency with which it occurs
and the possible solutions for it.
Exploratory Research – It is the preliminary
study of an unfamiliar problem, about which
the researcher has little or no knowledge. It is
aimed to gain familiarity with the problem, to
generate new ideas or to make a precise
formulation of the problem. Hence it is also
known as formulative research.

Experimental Research – It is designed to
assess the effect of one particular variable on
a phenomenon by keeping the other variables
constant or controlled.
Historical Research – It is the study of past
records and other information sources, with a
view to find the origin and development of a
phenomenon and to discover the trends in
the past, in order to understand the present
and to anticipate the future

• Clinical trials are a set of procedures in
medical research and drug development that
are conducted to allow safety and efficacy
data to be collected for health interventions
(e.g., drugs, diagnostics, devices, therapy
protocols)
• These are usually conducted in 4 phases ‐ I
to IV on human subjects (preceded by animal
experiments and basic research in
laboratories)

We can classify research in many ways but
these are not watertight compartments
• Such classifications are more for broad
conceptualisation
• In practice, many a times there are a lots of
overlapping

 Conceptual and Empirical research

 Any other types of research?
 Applications in Nursing?

 Nursing service
 Nursing education
 Nursing administration
 Nursing informatics

 Influences current and future practices
 Adequately trained nurses can conduct
quality clinical research
 Leads to EBN practice
 Provide description, explanation, prediction
and control of nursing situations in nursing
practice
 Identifies cost effective practices
 Problem solving

 WORLD VIEW/ GENERAL PERSPECTIVE OF THE
COMPLEXITIES OF REAL WORLD
 BASIC PHILOSOPHICAL QUESTIONS
◦ Ontologic –what is the nature of reality?
◦ Epistemologic- what is the relationship with the
inquirer and that being studied?
◦ Axiologic- what is the role of values in inquiry?
◦ Methodologic – how should the inquirer obtain
knowledge?

 Intellectual pluralism

A beautiful thing about
learning is that nobody
can take it away from
you

Future trends
• Heightened focus on EBP
• Development of stronger
evidence base
• Emphasis on SR
• Expanded local research in
health care settings

Improved
patient
outcomes
Patient
preferences and
circumstances
Best
available
clinical
evidence
Awareness of
clinical setting
& resource
constraints
Individual
clinical
expertise
EBP

Future trends

 Strengthening of multidisciplinary
collaboration
 Expanded dissemination of
research findings
 Increasing visibility of nursing
research
 Increased focus on cultural issues
and health disparities

 Inadequate knowledge
 Lack of qualified guide
 Difficulty in controlling external variables
 Lack of time
 Lack of standardized tools
 Reliability of disciplined research
 Studying many variables
 Ethical problems
 Lack of support from administrative set up
 Financial constraints

 Fallibility of disciplined research
 Handling multiple variables
 Difficulty in control of external variables
 Minimal possibility of lab research
 lack of standardized tools
 Measuring qualitative phenomenon through
quantitative means
 Lack of interest among the nurses and other
health personnel
 Ethical constraints

 Health promotion and disease prevention
 Promotion of health of vulnerable and
marginalized communities
 Patient safety and quality of health care
 Development of EBP and translational
research
 Promotion of health of older people
 Patient centered care and care co ordination
 Palliation and end of life care
 Care implications of genetic testing and
therapeutics

 Capacity development of nurse researchers
 Nurses working environment
 STTI 2005

• Evidence is materials and observations collected to
demonstrate “truth” or what works
• What looks apparent and obvious may not be true – sun
moving around the earth !!
• Evidence is systematically collected information
(measurement ) to support or disprove a hypothesis or
theory
• Two types of evidence ‐ direct evidence and circumstantial
evidence
• Observations lead to theory – theory leads to observations or
experimentation to confirm theory
• Experimentation provides strongest
evidence

 Sources
◦ Tradition and authority
◦ Clinical experience, trial and error and intuition
◦ Logical reasoning
◦ Assembled information
◦ Disciplined research

 “Evidence‐based medicine (EBM) or
evidence‐based practice (EBP) aims to apply
the best available evidence gained from the
scientific method to clinical decision making.
 It seeks to assess the strength of the
evidence of risks and benefits of treatments
and diagnostic tests. This helps clinicians
understand whether or not a treatment will
do more good than harm.”

 How evidence grows: No evidence, to some
evidence, substantial evidence, review of
evidence, meta‐analysis, overall
recommendation.
 Authority based policies and programs – vs.
evidence based policies and programs.
 Systematic evaluation of evidence is new
science – but clinical trials are not new – first
trial was done by James Lind 1747 on 12
sailors on board a ship to see effect of limes
and oranges on Scurvy (bleeding gums)

Observations – basis of most clinical science developments –
disease and syndromes defined by observed symptoms and signs –
systematic observations on series of similar cases
• Observations during epidemics ‐ John Snow on Cholera…
Observational studies – without interventions – special studies to
understand natural progress of disease
• Smoking and lung cancer or CVD studies
• Observational studies following natural events or accidents
Study of Interventions / programs – interventions happening –
scientists measure the impact – Effect of program by comparing
with non‐program areas, Before after Studies.
Experimental studies – specific interventions introduced to
measure effectiveness or impact with well planned study design
– effect of new drugs – clinical trials or community trials

• Observations of association – air from swamps‐>
Malaria
• Case series – systematic case observations and
compilation
• Ecological studies – salt intake and hypertension, heat
wave /temperature and mortality…
• Case control studies – contraceptives and heart and
vascular diseases, smoking and cancer
• Cohort studies – smoking and cancer, cholesterols and
heart disease
• Trials – non randomized – new treatments – patient
chooses
• Trials Randomized
• Blinded randomized, multicentre, multi‐country trials

 Phase I
 Conceptual Phase
Formulating and
delimiting the problem
Reviewing the related
literature
Undertaking clinical
fieldwork
Developing conceptual
framework
Formulating
hypotheses

 Phase II
 Design and planning phase
Selecting
a
research
design
Developing
intervention
protocols
Identifying
the
population
Designing the
sampling plan
Specifying
methods to
measure
research
variables
Developing
methods to
safe guard
subjects
Finalizing
the
research
plan

 Phase III
 Empirical phase
Collecting the
data
Preparing the
data for
analysis

 Phase IV
 Analytic phase
Analyzing the
data
Interpreting
the results

 Phase V
 Dissemination phase
Communicating
the findings
Utilizing the
findings in
practice

Planning
Developing data collection
strategies
Gathering and analysing data
Disseminating findings

 Every study involving human subjects raises a
unique set of ethical issues. A practical way
to address these issues is to work from the
regulations of federal agencies that fund
research and guidelines of the Indian
Nursing Council

How long does it take for body parts to
freeze when people are kept naked
outdoors in subfreezing temperatures?
What signs and symptoms are seen
when people are kept in tanks of ice
water for 3 hours? These questions
were asked by so-called researchers in
Germany in the early 1940s.

During 1942 and 1943, prisoners’
wounds were deliberately infected with
bacteria. Infection was aggravated by
the forcing of wood shavings and
ground glass into the wounds.
Contd..

Sulfanilamide was then given to these
prisoners to determine the effectiveness
of this drug. Some subjects died and
others suffered serious injury. Many
nurses participated in these unethical
experiments.
(Bonifazi 2004)

Between June and September 1944,
photographs and body measurements
were taken of 112 Jewish prisoners.
Then they were killed, and their
skeletons were defleshed.
Contd..

One purpose of this study was to
determine if photographs from live
human being could be used to predict
skeletal size. The skeleton collection
was to be displayed at the Reich
University of Strasbourg.
(Nuremberg Military Tribunals, 1949)

 Infecting women prisoners with
syphilis, having them impregnated by
male prisoners, then dissecting the
live babies and mothers.
 Draining the blood from prisoners’
veins and substituting horse blood.
Contd..

 Exploding gas gangrene bombs next
to prisoners tied to stakes.
 Vivisecting prisoners to compile data
on the human endurance of pain.
(Scientific Atrocities, 1996,
Japan)

Of the 600 black male subjects, 399 had
syphilis, and 201 did not have the
disease. Those subjects with active
cases were given no treatment. All
subjects were given free medical
exams, free meals, and burial
expenses.
Contd…

Even after penicillin was accepted as the
treatment of choice for syphilis in 1945,
subjects were still given no treatment. This
unethical study became common
knowledge 40 years after it was begun. On
May 16, 1997, president Bill Clinton made a
public apology on behalf of the nation.
(CDC 2006)

It is common knowledge that smallpox
is no threat to the world. Few people
remember, or even know, that Edward
Jenner deliberately exposed an 8 year
old child to cowpox to try out his new
vaccine for smallpox.
(Hayter, 1979)

In July 1963, doctors at the Jewish
Chronic Disease Hospital in Brooklyn,
New York, injected live cancer cells into
22 elderly patients. The study was
designed to measure patients’ ability to
reject foreign cells. The patients were
told that they were being given skin
tests.
(Katz, 1972)

In 2005, it was revealed that
government-funded researchers tested
experimental AIDS drugs on hundreds
of foster children.
(Solomon, 2005)

Ethics is the science that deals with
rightness and wrongness of actions.
Bioethics is the term applied to these
principles when they refer to concepts
within the scope of medicine, nursing,
and allied health .
(Aiken, 2004)

Moral behavior is defined as conduct that results
from serious critical thinking about how individuals
ought to treat others. Moral behavior reflects the way
a person interprets basic respect for other persons,
such as the respect for autonomy, freedom, justice,
honesty, and confidentiality.
(Pappas, 2003)

Values are ideals or concepts that give
meaning to the individual ’s life.
(Aiken, 2004)

A right is defined as “ a valid, legally
recognized claim or entitlement,
encompassing both freedom from
government interference or
discriminatory treatment and an
entitlement to a benefit of service”.
(Levy and Rubenstein 1996)

 Nuremberg code: 1947
 Helsinki Declaration: 1975
 Belmont Report: 1979
 CIOMS Council for International Organisations
of Medical Sciences : 1982
 ICMR (Indian Council of Medical Research)
Guidelines: 1980, revised 2000
 CTRI – Clinical Trial Registry of India

The development of appropriate
ethical guidelines are complex as it
concerns with human behaviour.
Ethical principles changes with time
and newer knowledge. Because of
public outcry against the atrocities
committed in Germany in 1940s,
the Nuremberg code was developed
in 1947.

The Nuremberg code
 Researcher must inform subjects
about the study
 Research must be for the good of
society
 Research must be based on
animal experiments, if possible
contd…

 Researcher must try to avoid
injury to research subjects
 Researcher must be qualified to
conduct research
 Subjects or the researcher can
stop the study if problems occur.

Based on the preliminary efforts of the Council
for International Organisations of Medical
Sciences (CIOMS) in 1964 at Helsinki, the
World Medical Association formulated general
principles and specific guidelines on use of
human subjects in medical research, known
as the Helsinki Declaration

 National Commission for the Protection of
Human Subjects of Biomedical and Behavioral
Research.
 The Belmont Report summarizes ethical
principles and guidelines for research involving
human subjects.
 Three core principles
◦ respect for persons
◦ Beneficence
◦ justice.
 Three primary areas of application
◦ informed consent
◦ assessment of risks and benefits
◦ selection of subjects.

Respect for person
Beneficence
Justice
Belmont principles

 Requires investigators to treat
subjects as autonomous individuals
and obtain their informed consent
 Research subjects must be regarded
not as passive sources of data, but
as individuals whose welfare and
rights must be respected.

 requires investigators to design
protocols that will provide valid
and generalisable knowledge
 ensure that the benefits of the
research are proportionate to the
risks assumed by the subjects.
 wellbeing of the subjects must be
protected.

 Level 1: No anticipated effects: no positive
or negative effects for the subjects

 Level 2: Temporary discomfort considered
minimal risk studies
 discomfort is simulate to that which the subject would
experience in his/her daily life and cease with
termination of the study

 Level 3: Unusual levels of temporary
discomfort during the study and after the
study has terminated
 Level 4: Risk of permanent damage,
potential for subject to suffer permanent
damage

 Level 5: Certain permanent damage; no
experiment should be conducted where
there is an a priori reason to believe that
death or disabling injury will occur...

requires that the benefits and burden
of research be distributed fairly .
Research participants assume some
risk in order to benefit the society as
a whole.
Therefore no single group, especially
not disadvantaged, vulnerable or
minority groups should be asked to
bear a disproportionate share of risk.

 Beneficence ‐ a practitioner/researcher should act
in the best interest of the patient/participant
 Non‐maleficence ‐ "first, do no harm”
 Autonomy ‐ the participant has the right to refuse
the intervention or opt out from the research
study
 Justice ‐ concerns the distribution of scarce
health resources and the decision of who gets
what treatment
 Dignity ‐ the patient/participant (and the person
treating the patient) have the right to dignity.
 Truthfulness and honesty ‐ the concept of
informed consent has increased in importance
since the historical events of the Nuremberg
trials and Tuskegee Syphilis Study

 Abstract of a SR in the field of Non
communicable disease
 Research priorities by ICN,INC, KUHS
 Mention instances that you have noticed
which violated the principles of ethics.
 Describe the process of INFORMED CONSENT

 Means that participants have adequate
information about the research, comprehend
that information and have the ability to
consent to or decline participation voluntarily.
 Complying with HIPAA rules
 Health Insurance Portability and
Accountability Act

 Participant status
 Study goals
 Type of data
 Procedures
 Nature of commitment
 Sponsorship
 Participant selection

 Potential risks
 Potential benefits
 Alternatives
 Compensation
 Confidentiality pledge
 Voluntary consent
 Right to withdraw and withhold information
 Contact information

 Researchers are identified and credentials
presented
 Compensation if any
 Offer answers
 Means of obtaining study results
 Documentation of informed consent

 Comprehension of the informed consent
 Documentation of informed consent
 Authorization to access private health
information

 Anonymity
 Confidentiality in the absence of anonymity
 Certificates of confidentiality

 Ask questions and air complaints
 After the data collection thanking the
participants
 Referrals to appropriate health, social and
psychological services

 Children
 Mentally and emotionally disabled people
 Severely ill or physically disabled people
 Terminally ill
 Institutionalized people
 Pregnant women

 Institutional review boards
 Requirements

 Whether clinically significant
 Properly designed

 When animals are used

 Or scientific misconduct
 Fabrication, falsification, or plagiarism in
proposing, performing or reviewing or in
reporting research results

Guidelines of DHHS
 Risks to subjects are minimised and
proportionate to the anticipated benefits
and knowledge.
 Data are monitored to ensure safety of
subjects
 Selection of subjects is equitable
 Informed consent is obtained, if appropriate
 Confidentiality is adequately protected

ETHICAL GUIDELINES FOR
BIOMEDICAL RESEARCH ON
HUMAN PARTICIPANTS- ICMR
REPORT

Researchers need to be aware of
the Health Insurance Portability
and Accountability Act (HIPPA,
2003). This act protects an
individual’s health information.
This ensures participant taking
part voluntarily and is aware of
what is about to happen.

Participants must be given all
necessary information that might
affect their willingness to
participate. The investigators
must disclose information that
will be relevant to the subject’s
decision whether or not to
participate.
contd..

Necessary information
 Informed consent
◦ The nature of research project
◦ Procedures of the study
◦ The potential risks & benefits of the
study
 Assurances that participation is
voluntary
 Protection of confidentiality
 Questions about the study

 Plagiarism
 Fabrication & falsification
 Non publication of data
 Faulty data gathering
procedure
 Poor data storage and
retention
 Misleading authorship
 Sneaky publication practices

Guidelines for Nurses
 Advocacy
 Privacy
 Confidentiality
 Debriefing
 Anonymity

 An independent review board comprises
medical/scientific and non‐medical
/nonscientific members
 9‐15 members
 Review every research proposal on human
subjects
IT IS MANDATORY THAT ALL PROPOSALS ON
BIOMEDICAL RESEARCH INVOLVING HUMAN
SUBJECTS SHOULD BE CLEARED BY AN
APPROPRIATELY CONSTITUTED
INSTITUTIONAL ETHICS COMMITTEE

 How essential is the research?
 Informed consent‐ voluntariness
 Non exploitation of vulnerable population
 Privacy and confidentiality ( HIV/AIDS)
 Minimal risks and dangers for subjects
 Reasonable risk ‐ benefit ratio
 Professional competence of
investigator/researcher

 Accountability and transparency
 Institutional arrangements/adequate clinical
monitoring to ensure safety
 Emergency care provision
 Totality of responsibility
 Compliance of GCP (Good Clinical Practice)
 Informed consent document‐ contents

Critiquing the Ethical Aspects
i) Was the study approved by an
Institutional Review Board (IRB)?
ii) Was informed consent obtained
from the subjects?
iii) Is there information about
provisions for anonymity or
confidentiality?
contd…

iv) Were vulnerable subjects used?
v) Does it appear that subjects
might have been coerced into
acting as subjects?
vi) Is it evident that the benefits
of participation in the study
outweighed the risks involved?

vii) Were subjects provided the
opportunity to ask questions
about the study and told how to
contact the researcher if other
questions arose?
viii) Were subjects told how they
could get the results of the
study?

Conducting research ethically
requires protection of human
rights of subjects. Human rights
that require protection in research
include - self determination,
privacy, anonymity &
confidentiality and fair treatment.
Research need to be conducted
with ethical guidelines.

 Evidence Based Nursing and prepare notes..

 Burns and Grove 5 th edition 2005
 Polit and Beck 8th edition 2012
 Wood and Haber 6th edition 2006
 Schmidt and Brown 2009

LITERATURE REVIEW

 Scientific knowledge grows day by day
 Multiplication of research information
 Studies are undertaken with the context of an
existing base of knowledge
 Researcher’s work to be built on the work of others
(Kaplan,1964)

 Consists of all written sources relevant to
the selected topic
 Availability of research information
continues to escalate
 Computerized data bases

Definitions
 An organized written presentation of what has
been published on a topic by the scholars – Burns &
Grove (2005)
 An account of what has been published by
accredited scholars and researchers – Taylor(2011)

 Is not a list of published studies
 Presents identified themes & trends
 Critically analyses the available literature on the
topic
 Evaluates the studies based on the focus of your
study

 Sources that are important in providing in-
depth knowledge needed to make changes in
nursing practice or to study a selected
problem

 Increase in number of nursing journals
 Availability of computerized data bases
 Review process has become more
enlightening & challenging

 Discovers knowledge
 Conveys to the reader what is currently known
regarding the topic of interest
 Determines gaps , consistencies and
inconsistencies
 Discovers unanswered questions
 Describes the strengths & weaknesses of designs,
instruments used in studies

 Determines the need to replicate a study
 For development of new/refined interventions
 Identifies relevant framework designs & methods
 Identifies the source of funding & the experts in
the field
 Assists in interpreting study findings

 Major review is done at the beginning of the
research process & limited review during the
generalization of research report

 Purpose & timing depend on the type of study
 Phenomenological research – Experiences of
individual within their life world.
◦ after the data collection & analysis
 Grounded theory research – social structural
process within a social setting.
◦ minimal relevant review in the beginning of the study
 Ethnographical research – Holistic view of culture.
◦ done early in research process to give background for the
study
 Historical research –description and interpretation
of historical events.
◦ an initial review to select the research problem & to develop
research questions

 Broad – to become knowledgeable about the
research problem
 Narrow – to predominantly relevant sources

 Types of sources & information available
 Approximate depth and breadth of review
 Time frame for conducting review

 Theoretical literature
 Empirical literature

 It consists of concept analysis, models, theories
& conceptual frameworks that support a selected
research problem and purpose
 It reflects the current understanding of the
research problem
 Theoretical literature can be found in the serials,
periodicals & monographs

 Comprises of relevant studies in journals & books
as well as unpublished theses
 Empirical literature reviewed depends on the study
problem & the type of research conducted

 Primary sources
 Secondary sources

 A primary source is written by a person who is
responsible for originating or generating the ideas
published
 Research publications written by the person or
people who conducted the research/ theorists who
developed the theory

 Secondary source –Research reports prepared by
someone other than the original researcher
 Problems
- Interpretation is influenced by the author’s
perception & may be biased
- Possibility of errors
- Fails to provide the details of study

DEPTH AND BREADTH OF REVIEW
 Depth – number & quality of sources referred
on a topic
 Breadth – number of different topics
examined

FACTORS AFFECTING DEPTH & BREADTH
OF REVIEW
 Researcher’s background
- new investigator & experienced investigator
 Complexity of research project
- numerous variables & complex methodologies
 Availability of sources
- articles, journals & books

TIME FRAME FOR LITERATURE REVIEW
• Depends on the type of problem, sources available & goals
of the scholar
• No set length of time for review
• Narrower the focus of study – lesser time is needed
• Set a time frame for literature review

Formulate and
refine 1* & 2*
qns
Devise search
strategy
Search for,
identify &
retrieve potl 1*
source materials

Search for, identify
& retrieve potl 1*
source materials
Screen sources for
relevance and
appropriate ness
Read source
materials
Discard irrelevant or
inappropriate ref
Identify new
references,
leads
Document search
decisions and actions

Abstract,
encode
information
from the
studies
Critique,
evaluate the
studies
Analyse
integrate
information,
search for
themes
Prepare
synthesis
/critical
summary

 Searching the literature
 Reading the literature
 Writing the literature

“A systematic and explicit approach to the
identification, retrieval and bibliographical
management of independent studies for the
purpose of locating information on a topic,
synthesizing conclusions, identifying areas for
future studies and developing guidelines for
clinical practice”
- Auston, Cahn & Selden (1992)

 Develop a search strategy to retrieve as
much relevant literature as possible
 Develop a strategy based on time &
finances available

 Develop a search strategy
 Select data bases to search
 Select key words
 Systematically record references
 Use reference management software
 Locate relevant literature
 Perform complex searches
 Select search fields
 Select electronic journals
 Search the internet
 Finding every relevant sources

Cooper (1998)
 Bibliographic databases
 Ancestory approach – use the citations from
relevant studies & track down earlier research
 Decendancy approach – search forward to find
recent studies
 Grey literature – refers to studies with limited
distribution (conference papers, unpublished
reports, dissertations)

 Written search strategy saves time . It helps to
- avoid going back along paths you have already
searched
- retrace your steps
- search new paths
 Initial search should be wide & later narrow the
focus of search
 Get consultation for literature search approach

 A bibliographical database is a compilation of citations
relevant to a specific discipline or from a variety of disciplines
 Three distinct types
- Indexes & abstracts
- Full text reprint services
- Link citations
 Data bases
- Printed form
- Electronic data base

 CINAHL (Cumulative Index to Nursing and Allied Health
Literature) Pubmed
 MEDLINE (Medical Literature Online)
 ISI (Institute for Scientific Information Web of Knowledge)
 British Nursing Index- Nursing and Allied Health Source
(ProQuest)
 Cochrane Database of Systematic Reviews
 HaPI (Health and Psychological Instruments Database)
 Dissertation Abstracts Online

 Contains citations of nursing literature published after 1955
 Referred as “Red Books” by nursing scholars
 Covers English language, Nursing and Allied Health journals,
books, book chapters, dissertations & selected conference
proceedings
 Electronic version contains database from 1982 to the
present (more than one million records)
 Accessed online http://www.cinahl.com or by CD-ROM

 Developed by US National Library of Medicine (NLM)
– Free access
 Covers about 5000 Medical, Nursing and Health
journals
 15 million records from mid 1960’s
 From 1999, Abstracts of Cochrane collaboration
became available
 Is an online database with free access through
PubMed web
www.ncbi.nlm.gov/entrez/query.fcgi

 Maintains multidisciplinary resources called the
web of knowledge
 Offers integrated searching
 Covers most fields of social & applied sciences
including medicine and nursing

 Cancer Lit
 Cochrane database of systematic review
 Dissertations abstract online
 Psych Info
 Ovid sp
 Science direct

 Key words are the major concepts or variables that
must be included in your search
 To determine the key words, identify concepts,
variables, population, interventions, measurement
methods or relevant outcomes
 Subject headings and phrases can be used
 Think of alternative terms (synonyms)
 Note down the key words in the written search plan

 Truncating words allow to locate more citations
related to the term
 Do not truncate terms to less than four letters –
will give unwanted references
 Pay attention to variant spellings
 Frequently cited author’s name can be used to
perform search
 Use a journal title in case of well known journal in
that particular topic/field

 Name of databases used
 Exclusion & inclusion criteria used
 Date of performing search
 Exact search strategy used
 Key words used
 Combining strategies used
 Number of articles found
 Percentage of relevant articles
 Websites visited & links pursued
 Authors contacted for further information
 Develop a table of record and save it in the computer

 As per the format used in the reference list
 APA (American Psychological Association,2001),
Vancouver
 Cross check the sources cited two or three times to
prevent errors
 Use reference management software

 To track the references you have obtained
 To store information on all search fields
 As you read insert comments
 It also organizes the references into the reference style you
intend to use
 Eg ProCite till May 13 now EndNote

 Mapping is the feature that allows you to
search for topics using your own keywords
rather that the Medical Subject Headings

 Initiate search using key words identified
 Citations are listed with the most recent ones first
 Proceed to next key word
 Plan for complex search

 Combines two or more concepts or synonyms in
one search
 Three most common ways
- Boolean operators
- Locational operators
- positional operators
 Truncation symbols - !, +, $,*,? AND #

 Permit grouping of ideas, selection of places to
search,& to show relationship within a data base
record
 Examine “Help Screen” to see whether the
operators are available and how they are used

 3 words – AND, OR and NOT
 Often capitalized
 Used with the identified concepts
 OR is commonly used

 AND- delimits the search
 OR- expands the search
 NOT- narrows the search
 Truncation symbols
 *- wom*n,
 Wild card symbols- ?, *-behavio?r,
organi*ation
 Alternative spellings

 Identify terms in specific areas
 Article name, journal & author name
 Subject headings, abstracts, cited references,
publication type, instruments used

 To look for requested terms
 Highly dependent on data base search software
 Common ones are – NEAR, WITH & ADJ (adjacent)

Search topic Hits
Pain 3,35,949
Pain AND Child* AND Nur 2054
Limit to English 1834
Limit to entries with abstracts 1430
Limit to nursing journals 794
Limit to 2001-2010 399

 Limits
- vary with the data base
- limit the years of search
- limit within particular years & get
the hits
- depends on the time limit
- full text articles are better
 Helps to avoid irrelevant & non useful material

 Have more current information
 Need to subscribe to online journals
 Can access full text article
 Articles are reviewed & published within 3 months
 List of current electronic nursing journals are
available at
www.4nursingjournals.com

 Unlikely to find relevant studies but may get
information relevant to background & significance
 Advantage – information are current
 Disadvantage – accuracy is questionable & no
screening process
 Important to check the source
 Identify the best search engine

 Coding
 Read, categorise, code key variables, record them
 Literature review protocol
 Literature review matrices
- Methodologic matrix
- Results matrix
- Evaluation matrix

TYPES OF REVIEW MATRIX
 Methodologic Matrix –How have researchers studied this
research question?
 Results Matrix –What have researchers found?
 Evaluation Matrix – How much confidence we have in the
evidence?

METHODOLOGIC MATRIX
 Authors
 Publication year
 Country
 Dependent variables
 Independent variables
 Study designs
 Sample size
 Sampling method
 Data collection method

RESULT MATRIX
 Authors
 Publication year
 Dependent variables
- pain perception
- use of analgesics
- Effect of nursing
intervention
 Others – association & relationships

EVALUATION MATRIX
 Authors
 Publication years
 Major strengths
 Major weaknesses
 Quality score

SUMMARY- SEARCHING THE
REVIEW
 DEF
 PURPOSES
 STRATEGIES
 APPROACHES
 STEPS
 STRATEGY DEVELOPING
 SELECT DATABASE
 SELECT KEYWORDS

CONTD
 RECORD SEARCH- REF
MANAGEMENT SW
 LOCATE RELEVANT LITERATURE
 COMPLEX SEARCHES
 LIMIITING SEARCHES
 SEARCHING E JOURNALS AND
INTERNET
 RECORDING MECHANISMS
◦ PROTOCOL
◦ MATRICES

 Skimming resources
 Comprehending resources
 Analyzing resources
 Synthesizing resources

 Quickly reviewing a source to gain a broad
overview of its content
 Read title, author’s name, abstract or introduction
& the major headings
 Finally review the conclusion or summary
 Helps to make a preliminary judgement about the
value of the source
 Helps to determine whether it is primary or
secondary source

 Requires complete reading of an article
carefully
 Highlight the content you consider
important
 Relevant categories are identified for
sorting & organizing sources
 These categories serve as a guide for
writing the literature review

 Can determine the value of a source for a particular
study
 Analysis takes place in two ways
- Critique individual studies
- Making comparisons among
studies

 Basis for developing review of literature
section
 Involves clarifying the meaning obtained
from the source as a whole
 Can cluster & interrelate ideas from several
sources
 Avoid using direct quote, instead
paraphrase (expressing the ideas clearly in
your own words)
 The meanings obtained from all sources are
then combined or clustered to the proposed
study

 Sorting sources
 Developing the written review
 Checking references

 Is challenging
 Relevant sources
 Organizing the review – meaningful
 Structure in such a way that the presentation is
logical, demonstrates meaningful thematic
integration & leads to a conclusion about the state
of evidence on the topic

Major sections
 Introduction
 Discussion of theoretical literature
 Discussion of empirical literature
 Summary

 Definition of the topic of review
 Context
 Purpose / objectives
 Scope
 Structure

 Include emerging themes, solutions, gaps,
point out recent trends, Divergent perspectives
 Give structure or narrative thread
◦ Chronological; by themes; by sector / domains / sub-
groups; by development of ideas or along a process;
by themes)
 Use sub-headings organized in proper layers
 Signposting
 Adduce evidence - citation
 Quotes
 Paraphrase
 Style – detached narration, a dialogue with the
literature,
 Use tables to compare two or more
perspectives, methods, profile of participants