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Resource Manual for Nursing Research:

Generating and Assessing Evidence for

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&. Wolters Kluwer

Resource Manual for

Nursing Research GENERATING AND ASSESSING EVIDENCE FOR NURSING PRACTICE

ELEVENTH EDITION

Denise F. Polit, PhD, FAAN President

Humanalysis, Inc.

Saratoga Springs, New York, and

Adjunct Professor

Griffith University School of Nursing

Brisbane, Australia

(www.denisepolit.com)

Cheryl Tatano Beck, DNSc, CNM, FAAN Distinguished Professor

School of Nursing

University of Connecticut

Storrs, Connecticut

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Preface

This Resource Manual for the 11th edition of Nursing Research: Generating and Assessing Evidence for Nursing Practice complements and strengthens the textbook in

important ways. The manual provides opportunities to reinforce the acquisition of basic research skills through systematic learning exercises. We have emphasized exercises that involve careful reading and critical appraisal of actual studies. Critical appraisal skills are increasingly important in an environment that promotes evidence-based nursing practice. Moreover, the ability to think critically about research decisions is fundamental to being able to design and plan one’s own study.

Full research reports and two grant applications are included in 16 appendices to this Resource Manual. These reports, which represent a rich array of research endeavors, form the basis for exercises in each chapter. There are reports of quantitative, qualita- tive, and mixed methods studies. The reports include an evidence-based practice project report, an instrument development paper, a quality improvement project paper, a meta- analysis, and a metasynthesis. We are particularly excited about being able to include a full grant application that was funded by the National Institute of Nursing Research

(NINR), together with the Study Section’s summary sheet. We firmly believe that noth-

ing is more illuminating than a good model when it comes to research communication. In this edition, we have also included segments from a more recent grant application funded by NINR, including reviewers’ comments.

An important feature of this Resource Manual is the online Toolkit, which offers important resources to beginning and advanced researchers. Our mission was to include easily adaptable tools for a broad range of research situations. In this edition, we have added many more resources for qualitative researchers and tools that can be used in quality improvement projects. In our own careers as researchers, we have found that adapting existing forms, figures, manuals, or protocols is far more efficient and productive than “starting from scratch.” By making these tools available as Word files, we have made it

possible for you to adapt tools to meet your specific needs, without the tedium of having to

retype basic information. We wish we had had this Toolkit in our early years as research- ers! We think seasoned researchers are likely to find parts of the Toolkit useful as well.

The Resource Manual consists of 33 chapters—one chapter corresponding to every chapter in the textbook. Each chapter has relevant resources and exercises. Answers to exercises for which there are objective answers are included at the back of the book in

Appendix P. Each of the 33 chapters consists of four components:

e A Crossword Puzzle. Terms and concepts presented in the textbook are reinforced in

an entertaining and challenging fashion through crossword puzzles.

© Study Questions. Each chapter contains several short individual exercises relevant to

the materials in the textbook.

iv Preface

¢ Application Exercises. These exercises are designed to help you read, comprehend,

and critically appraise nursing studies. These exercises focus on studies in the appen- dices and ask questions that are relevant to the content covered in the textbook. For most chapters, there are two sets of questions—QOuestions of Fact and Questions for Discussion. The Questions of Fact will help you to read the report and find specific types of information related to the content covered in the textbook. For these ques-

tions, there are usually “right” and “wrong” answers. For example, for the chapter on sampling, a question might ask: How many people participated in this study? The Questions for Discussion, by contrast, require an assessment of the merits of various features of the study. For example, a question might ask: Was there a sufficient num- ber of participants in this study? The second set of questions can serve as the basis for classroom discussions.

¢ Toolkit @. This resource, found online on http://thepoint.lww.com/Polit1 1eRM,

includes tools and resources that can save you time—and that will hopefully result in higher-quality tools than might otherwise have been the case. Each chapter has tools appropriate for the content covered in the textbook.

We hope that you will find these resources rewarding, enjoyable, and useful in your effort to develop and hone skills needed in critically appraising and conducting research.

Contents

PART 1

Foundations of Nursing Research and Evidence-Based Practice 1

1. Introduction to Nursing Research in an Evidence-Based Practice Environment 2

2 Evidence-Based Nursing: Translating Research Evidence Into Practice 8

3 Key Concepts and Steps in Qualitative and Quantitative Research 13

PART 2

Conceptualizing and Planning a Study

to Generate Evidence for Nursing 23

4 Research Problems, Research Questions, and Hypotheses 24

5 Literature Reviews: Finding and Critically Appraising Evidence 31

6 Theoretical Frameworks 38

7 Ethics in Nursing Research 44

8 Planning a Nursing Study 51

PART 3

Designing and Conducting Quantitative Studies to Generate Evidence for Nursing 57

9 Quantitative Research Design 58

10 Rigor and Validity in Quantitative Research 64

11. Specific Types of Quantitative Research 70

12 Quality Improvement and Improvement Science 75

13 Sampling in Quantitative Research 80

14 Data Collection in Quantitative Research 85

15 Measurement and Data Quality 92

16 Developing and Testing Self-Report Scales 98

17 Descriptive Statistics 104

18 Inferential Statistics 110

vi Contents

19 Multivariate Statistics – 118

20 Processes of Quantitative Data Analysis 124

21 Clinical Significance and Interpretation of Quantitative Results 129

PART 4

Designing and Conducting Qualitative

Studies to Generate Evidence for Nursing 135

22 Qualitative Research Design and Approaches 136

23 Sampling in Qualitative Research 142

24 Data Collection in Qualitative Research 147

25 Qualitative Data Analysis 153

26 Trustworthiness and Rigor in Qualitative Research 163

PART 5

Designing and Conducting Mixed Methods

Studies to Generate Evidence for Nursing 169

27 Basics of Mixed Methods Research 170

28 Developing Complex Nursing Interventions Using Mixed Methods Research Wa

29 Feasibility and Pilot Studies of Interventions Using Mixed Methods 183

PART 6

Building an Evidence Base for Nursing Practice 189

30 Systematic Reviews of Research Evidence 190

31 Applicability, Generalizability, and Relevance: Toward Practice-Based

Evidence ie

32 Disseminating Evidence: Reporting Research Findings 202

33. Writing Proposals to Generate Evidence 207

Appendix A: Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women 213

Appendix B: Infant Feeding Beliefs and Day-to-Day Feeding Practices

of NICU Nurses 232

Appendix C: A Nurse-Facilitated Depression Screening Program in an Army Primary Care Clinic 245

Appendix D: Translation and Validation of the Dietary Approaches to Stop Hypertension for Koreans Intervention 258

Appendix E: Sharing a Traumatic Event 273

Contents

Appendix F: Fatigue in the Presence of Coronary Heart Disease

Appendix G: Care Transition Experience of Spousal Caregivers

Appendix H: A Randomized Controlled Trial of an Individualized

Preoperative Education Intervention for Symptom Management

After Total Knee Arthroplasty

*Critical Appraisal of the Study

Appendix I: Differences in Perceptions of the Diagnosis and

Treatment of Obstructive Sleep Apnea and Continuous Positive

Airway Pressure Therapy Among Adherers and Nonadherers

*Critical Appraisal of the Study

Appendix J: The Cancer Worry Scale Revised for Breast Cancer

Genetic Counseling

Appendix K: Medication Adherence Interventions, Patients With Cad

Appendix L: A Metaethnography of Traumatic Childbirth and Its Aftermath

Appendix M: Increasing Colorectal Cancer Screening Using

A Qi Approach

Appendix N: Health Care Practitioner Pain Communication:

R21 Grant Application

Appendix O: Multi-Omics Analysis: R01 Grant Application

Appendix P: Answers to Selected Resource Manual Exercises

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Foundations of

Nursing Research

and Evidence-Based

Practice

CHAPTER 1

Introduction to Nursing Research

in an Evidence-Based Practice

Environment

= A. Crossword Puzzle

Complete the crossword puzzle below, which uses terms and concepts presented in

Chapter 1. (Puzzles may be removed for easier viewing.)

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aE ae

BEER “pealaleds Ee

R rey : _

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nN N |

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a

2 Copyright © 2021 Wolters Kluwer. Polit & Beck: Resource Manual for Nursing Research: Generating and Assessing Evidence for Nursing Practice (11th ed.)

CHAPTER 1 = Introduction to Nursing Research in an Evidence-Based Practice 3

Note that there is a crossword puzzle in all chapters of this Resource Manual. We hope they will be a “fun” way for you to review key terms used in each chapter. However, we are not professional puzzle designers, and so there are some oddities about the puzzles. These oddities are not intended to be trick questions, but rather represent liberties we took in trying to get as many terms as possible into the puzzle. So, for example, there are a lot of acronyms (e.g., evidence-based practice = EBP) and abbreviations (e.g., evidence = evid) and even a few words that are written back- wards (e.g., evidence = ecnedive). Two-word answers sometimes appear with a space

(e.g., evidence-based), and sometimes they are just run together (e.g., evidencebased). The crossword puzzle answers are at the back of this Resource Manual, in case our intent is too obscure!

ACROSS

1. Nurses are increasingly encouraged to develop a practice that is (hyphenated).

3. The clinical learning strategy developed at the McMaster School of Medicine (acronym).

4. A world view, a way of looking at natural phenomena. 7, _____ ematic reviews are said to be the cornerstone of EBP because they integrate

research evidence on a research question. 10. The world view that assumes that there is an orderly reality that can be studied

objectively. 12. Studies designed to illuminate the underlying causes of phenomena are called

auise- phe aie cric inquiries.

13. Successively trying alternative solutions is known as and error. 14. Research designed to solve a practical problem is__ _ _ ied research. 15. Nurses who use evidence-based practice in making clinical decisions tend not to be

content with the status __. 17. Research designed to provide evidence to guide nursing practice is referred to as _ _

____al nursing research.

TS Oneontne mo ations of health care studies, regardless of paradigm, is that they often tend to be fallible.

19. The U.S. agency, which came into being in 1993, that promotes and sponsors nursing

research (acronym).

21. A source of “evidence” reflecting ingrained customs. 23. Studies that are designed to provide evidence about the effectiveness of health care

interventions fall within the EBP purpose category called ‘ 27. The Institute for Medicine’s (2010) report on The Future of Nursing recommended

qoreater ceeree Ol a ciplinary collaboration.

28. methods research involves the collection and analysis of both qualita-

tive and quantitative data.

Copyright © 2021 Wolters Kluwer. Polit & Beck: Resource Manual for Nursing Research:

Generating and Assessing Evidence for Nursing Practice (11th ed.)

4 PART 1 = Foundations of Nursing Research and Evidence-Based Practice

DOWN

25;

26r

. One system of classifying research purposes concerns the description/

. Evidence that is rooted in objective reality and gathered through the senses.

. The positivist assumption that phenomena are not random, but rather have antecedent

causes. The repeating of a study to see if findings can be upheld in a new setting with a

different group of people. . A purpose of doing research, involving a depiction of phenomena (e.g., their preva-

lence or nature). . An EBP-related purpose of doing research, concerning the rigorous development of

health-related instruments.

continuum.

. The techniques used by researchers to guide or structure a study are called research

_ ods.

. The type of research that collects and analyzes narrative, subjective materials is__ _

_ _ ative research.

. In the constructivist paradigm, researchers tend to use , evolving proce-

dures that are used to address emerging findings. . Constructivist inquiry typically takes place in the , that is, in naturalistic

settings.

. One EBP-related purposes of health care research is to discover me___ _ from

clients’ perspectives and to understand processes in important health care transitions.

. One of the EBP-related purposes concerns the etiology of health risks, geared to the prevention of

A ____ucer of nursing research is a person who conducts a study to develop new evidence.

A(n) __ _ umption is a basic principle that is believed to be true without proof.

= B. Study Questions

ile

Me

2] a.

Why is it important for nurses who will never conduct their own research to under- stand research methods?

What are some potential consequences to the nursing profession if nurses stopped conducting their own research?

What are some of the current changes occurring in the health care delivery system, and how could these changes influence nursing research and the use of research findings?

Copyright © 2021 Wolters Kluwer. Polit & Beck: Resource Manual for Nursing Research:

Generating and Assessing Evidence for Nursing Practice (11th ed.)

CHAPTER 1 a ~~ Introduction to Nursing Research in an Evidence-Based Practice 5

. Below are descriptions of several research problems. Indicate whether you think the problem is best suited to a qualitative or quantitative approach and explain your rationale.

a. What is the decision-making process of patients with prostate cancer who are weighing treatment options?

b. What effect does room temperature have on the colonization rate of bacteria in urinary catheters?

c. What are the perceptions of a healthy family among political refugees who immi- grate to North America?

d. Does therapeutic touch affect the vital signs of hospitalized patients? e. What is the meaning of hope among stage IV cancer patients? f. What are the effects of prenatal instruction on the labor and delivery outcomes of

pregnant women?

8. What are the experiences of the homeless living in cold climates in the winter?

. What are some of the limitations of quantitative research? What are some of the limitations of qualitative research? Which approach seems best suited to address problems in which you might be interested? Why is that?

. Scan through the titles in the table of contents of a recent issue of a nursing research journal (e.g., Nursing Research, Research in Nursing & Health, International Journal of Nursing Studies). Find the title of a study that you think is basic research and another that you think is applied research. Read the abstracts for these studies to see if you can determine whether your original supposition was correct.

. Apply the questions from Box 1.1 of the textbook (available as a Word document in the Toolkit @ on thePoint’ ) to one or more of the following studies. They are

available as open-access journal articles, and links to them are available in the

Toolkit @ :

e Dosani, A.; Hemraj, J.; Premji, S., Currie, G., Reilly, S-; Lodha;“A’, Hall; M.-..

(2017). Breastfeeding the late preterm infant: Experiences of mothers and perceptions of public health nurses. International Breastfeeding Journal,

roe e Holmberg Fagerlund, B., Helseth, S., Andersen, L., Smastuen, M., & Glavin, K.

(2018). Parental concerns of allergy or hypersensitivity and the infant’s diet.

Nursing Open, 6, 136-143. e Ullgren, H., Kirkpatrick, L., Kilpelainen, S., & Sharp, L. (2017). Working in

silos? Health & neck cancer patients during and after treatment with or with-

out early palliative care referral. European Journal of Oncology Nursing, 26,

56-62.

. Consider the nursing research priorities promoted by the National Institute of Nursing

Research, as identified in the textbook. Which priority resonates with you? Why?

Copyright © 2021 Wolters Kluwer. Polit & Beck: Resource Manual for Nursing Research:

Generating and Assessing Evidence for Nursing Practice (11th ed.)

6 PART 1 = Foundations of Nursing Research and Evidence-Based Practice

a C. Application Exercises

EXERCISE 1: STUDY IN APPENDIX A

Read the abstract and introduction to the report by Nyamathi and colleagues — . (“Achieving drug and alcohol abstinence”) in Appendix A. Then answer the following

questions:

Questions of Fact

a. Does this report describe an example of “disciplined research”?

b. Is this a qualitative or quantitative study? c. What is the underlying paradigm of the study? d. Does the study involve the collection of empirical evidence? e. Is this study applied or basic research? f. Could this study be described as cause probing? g. Is the purpose of this study identification, description, exploration, prediction/control,

and (or) explanation?

h. What is the EBP-focused purpose of this study (e.g., Therapy/intervention, Diagnosis, Prognosis, Etiology/harm, or Meaning/process)?

Questions for Discussion

a. How relevant is this study to the actual practice of nursing? b. Could this study have been conducted as either a quantitative or qualitative study?

Why or why not?

EXERCISE 2: STUDY IN APPENDIX B

Read the abstract and introduction to the report by Cricco-Lizza (“Infant feeding beliefs”) in Appendix B. Then answer the following questions:

Questions of Fact

a. Does this report describe an example of “disciplined research” ? b. Is this a qualitative or quantitative study?

c. What is the underlying paradigm of the study? d. Does the study involve the collection of empirical evidence? e. Is this study applied or basic research?

f. Is the specific purpose of this study identification, description, exploration, explana- tion, and/or prediction and control?

g. Could the study be described as cause probing?

h. What is the EBP-focused purpose of this study (e.g., Therapy/intervention, Diagnosis, Prognosis, Etiology/harm, or Meaning/process) ?

Copyright © 2021 Wolters Kluwer. Polit & Beck: Resource Manual for Nursing Research:

Generating and Assessing Evidence for Nursing Practice (11th ed.)

CHAPTER 1 = Introduction to Nursing Research in an Evidence-Based Practice if

Questions for Discussion

a. How relevant is this study to the actual practice of nursing? b. Could this study have been conducted as either a quantitative or qualitative study?

Why or why not?

c. Which of the two studies cited in these exercises (the one in Appendix A or Appendix B) is of greater interest and/or relevance to you personally? Why?

= D. The Toolkit $4)

For Chapter 1, the Toolkit GY on thePoint’ contains a Word file with the following:

¢ Questions for a Preliminary Review of a Research Report (Box 1.1 of the textbook) e Links to useful websites for Chapter 1 e Links to relevant open-access journal articles for Chapter 1

Copyright © 2021 Wolters Kluwer. Polit & Beck: Resource Manual for Nursing Research:

Generating and Assessing Evidence for Nursing Practice (11th ed.)

CHAPTER 2

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