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Finding and Appraising the Literature CHAPTER OVERVIEW Chapter 5 introduces the student to the process of conducting a search and review of the literature for a research study. The overall purposes of a literature review are described for quantitative and qualitative research designs. Discussed in detail is the use of the literature review from the perspective of the investigator and the consumer, as well as the relationship of the literature review to the 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 scholarly research publications are also discussed, with emphasis on computer-generated strategies. Numerous examples of primary and secondary journal articles, books, book chapters, and documents 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 are the ways to begin and complete a literature search. Recognizing the role of the nurse in research, the section on critiquing emphasizes the consumer perspective and quantitative research, although reference is made to qualitative studies and the different nature of the literature review for this kind of design. LEARNING OUTCOMES After 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 the research 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 print database 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 of a literature review. Apply critiquing criteria to the evaluation of literature reviews in selected research studies
CHAPTER 5 Finding and Appraising the Literature 27
• TEACHING STRATEGIES Although students are not expected to develop an extensive literature review during their research course, they will need to be prepared to think critically and make judgements as to the merit of the literature reviews they read in the professional literature. Therefore the nature and process of the literature review form the basis for the following teaching strategies. 1. Critical Challenges For purposes of general discussion and critical thinking, the following questions can be used: RECALL AND UNDERSTANDING What are the purposes of a literature review for research investigator and research consumer activities? What are conceptual and data-based literature? What are the differences between primary and secondary sources of information? What are the characteristics of a written, relevant literature review? What is the role of electronic databases in a literature review? ANALYSIS AND SYNTHESIS How does the literature review enable the r esearcher to estimate the potential for success of a study? How do you know that suffi cient literature has been reviewed? How is a literature review used in quantitative versus qualitative research studies? How can you be sure that a literature review has been approached critically? You can engage students in a variety of discussions based on the literature review of an assigned article. These may include the following basic questions: What is known about this problem? Does the literature review uncover knowledge? Does the literature review support the hypotheses or research question(s)? Does the literature review uncover research fi ndings that support evidence-informed practice? What is the overall value of the literature review in developing the knowledge base necessary to carry out the research? Your goal here is to help students understand the status of research in the identifi ed problem area. Introducing Students to the Library In an effort to bring meaning to the experience of conducting a literature review, a trip to the library is recommended. The reference librarian can be tremendously helpful in providing explanations about nursing and non-nursing indexes, what they consist of, where to fi nd them, and how to use them. This person can fi eld questions pertaining to primary and secondary sources of information. It may be advantageous to speak with the librarian in advance of the library class to discuss the substance of the orientation and the students’ background in research. To be included is information about how to conduct a computer search, where measurement tools can be found, and how to use a thesaurus for indexes. It also is helpful if the librarian can demonstrate a search using one or more electronic databases, using actual variables pertinent to a clinical problem that you identify. The library introduction should take 1-1/2 to 2 hours, or approximately one class session. After the formal introduction by the librarian, students should be encouraged to examine one or more of the indexes relevant to nursing research. If possible, book a computer lab to allow the students to access the electronic databases and practice searching after the presentation. Providing Experiential Learning Activities a. Identifying Strong and Weak Areas of a Literature Review The purpose of this learning activity is to help students identify strong and weak areas of a selected literature review. It gives students an opportunity to critically appraise the content and style of at least one published research report. Student objectives for the learning activity: Identify all relevant variables discussed in the selected literature review. Determine whether the essential variables are discussed in the review. Determine the ratio of primary sources to secondary sources cited. Evaluate the review for completeness and evidence of bias. Directions for implementation. Students should review Chapter 5 in the textbook. In addition, assign a study for in-depth discussion and analysis by students. Use one of the studies from the appendix of the textbook. Based on the assigned study reading, ask students to do the following: For quantitative articles, identify all the relevant variables in the research question and determine whether each was addressed in the literature review. For qualitative articles, does the literature review describe what is known about the phenomenon under study? Determine what proportion of the bibliographic citations in the literature review were primary sources. Critically evaluate the literature review for evidence of completeness and bias. Evaluate whether the literature review refl ects analysis and synthesis of material. Guidelines for discussion. Engage students in a discussion of the literature review presented in the assigned paper. Students should use as a basis for evaluating the adequacy of the review or the critique criteria presented in Chapter 5 of the textbook. b. Primary and Secondary Sources of Information This learning activity gives students an opportunity to develop skill in differentiating primary from secondary sources of information. Although a sample reference list is provided in this exercise, any list can be substituted. Student objectives for the learning activity: Identify primary and secondary sources from a reference list derived from a research report. Evaluate the adequacy of primary sources from a reference list derived from a research report. Directions for implementation. Hand out the one-page activity (Figure 5-1 Primary and Secondary Sources of Information) found at the end of this chapter, for completion in class. After everyone has completed the activity, discuss the students’ choices for each source and whether the number of primary sources used is adequate. Ask students to provide their rationale for each response made. c. Doing a Bibliographic Computer Search The purpose of this activity is to give students an opportunity to conduct a computer search of the literature. Student objectives for the learning activity: Conduct a computer search. Compare two computer search methods and a print resource.
CHAPTER 5 Finding and Appraising the Literature 29
Directions for implementation. Help students choose two variables of interest or assign group projects to develop research-based clinical protocols. The variables (or protocol topics) may be ones you have previously discussed in class or ones that students have as an assignment for another course. After the variables (or protocol topics) have been selected, students should do the following: Spend 2 hours in the library doing a search of the literature. If you used strategy 2 above, “Introducing S tudents to the Library,” students should be familiar with the librarians who can assist them. If you have not used that strategy, inform students of the appropriate reference librarian to contact. The search should be limited to the past 3 years, because computer time can be expensive and a 3-year period is adequate to make the point. Ask students to note how long it takes the computer to process the search, including printing out the references. Guidelines for discussion. The following questions are suggested to stimulate discussion after students have conducted their own computer search: How did you find key terms to begin the search? What tactics were effective? How did you maximize results? Limit results? How do you determine whether the results were useful? How do you access the full text? Are accessing and reading full abstracts useful?
FIGURE 5-1. Primary and Secondary Sources of Information. (Partial reference list from: Mahon, N.E., Yarcheski, A, & Yarcheski, T.J. (2000). Positive and negative outcomes of anger in early adolescents. Research in Nursing & Health, 23, 177–24.)
Legal and Ethical Issues CHAPTER OVERVIEW Chapter 6 focuses on ethical guidelines for the inclusion of human subjects in research. The first section of the chapter details the historical background for guideline development, presents the articles of the Nuremberg code, and highlights unethical research studies that led to the development of federal regulations for the protection of human subjects. In addition, basic ethical principles of respect for persons, beneficence, and justice are defined. The author predicts that current and future ethical dilemmas in research will relate to the use of biotechnology and animals. The second section of this chapter focuses on the evolution of ethics in nursing research, detailing the Canadian Nurses Association’s Ethical Research Guidelines for Registered Nurses (Canadian Nurses Association, 2002) and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. The authors present examples of how to implement each guideline in nursing practice. The protection of human rights is emphasized, particularly in relation to the tenets of informed consent and the role of research ethics boards (REBs). The chapter also deals with populations of potential research subjects that require special legal and ethical considerations, for example, children and the vulnerable elderly. The difference between consent and assent is discussed. A section on scientific fraud and misconduct defines these terms and provides a discussion of them in relation to unauthorized research, product testing, and the legal/ethical aspects of animal experimentation. The final section of Chapter 6 provides critiquing criteria to use in evaluating the legal and ethical aspects of a research study. In general, this chapter can alert nursing students to the various legal and ethical issues inherent in participating in the research process. Such awareness can strengthen the students’ ability to evaluate whether a researcher has sufficiently addressed the protection of human or animal rights. Copyright © 2013 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 31 CHAPTER 6 Legal and Ethical Issues LEARNING OUTCOMES After reading this chapter, the student should be able to do the following: Describe the historical background that led to the development of ethical guidelines for the use of human participants in research. Identify the essential elements of an informed consent form. Evaluate the adequacy of an informed consent form. Describe the REB’s role in the research review process. Identify populations of participants who require special legal and ethical research considerations. Appreciate the nurse researcher’s obligations to conduct and report research in an ethical manner. Describe the nurse’s role as client advocate in research situations. Discuss the nurse’s role in ensuring that Health Canada guidelines for testing of medical devices are followed. Discuss animal rights in research situations. Critique the ethical aspects of a research study. Copyright © 2013 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved.
TEACHING STRATEGIES When research is taught to nursing students, legal and ethical issues related to research should be considered. This content should be presented as integral to the research process and not s imply “additional information of interest.” The suggested teaching strategies are designed to e mphasize this approach. 1. Critical Thinking Challenges The following questions are suggested to review chapter content and to provide a mechanism of critical thought about the material presented: RECALL AND UNDERSTANDING What are the basic ethical principles relevant to the conduct of research involving human subjects? How would you defi ne these basic ethical principles? Identify the CNA’s human rights guidelines. How would you implement each guideline in your practice? What is informed consent? What role does an REB play in the review of research? What is the difference between consent and assent? Identify and defi ne three classes related to product testing. ANALYSIS AND SYNTHESIS What questions would you ask a researcher to determine whether his or her study adhered to the ethical principles of respect for persons, benefi cence, and justice (refer to Boxes 6-1 and 6-2 on p. 114 of the text)? Suppose you were caring for an elderly patient who was not competent to give informed consent. Under what circumstances would you consider it appropriate for your patient to participate in a study? CHAPTER 6 Legal and Ethical Issues 33 Involving Guest Speakers One way to introduce students to the evolution of ethical guidelines for the use of human subjects in research is by inviting a guest speaker who is involved with or directs the research review process in a clinical agency. For example, the director of research and grants or the chairperson of an institutional review board from a nearby medical centre (or, if appropriate, from your own educational institution) would be good choices. Not only are such people familiar with the development of federal guidelines for the protection of human subjects, but they are also usually able to offer a wide variety of clinical examples related to this topic. Because the greater majority of research conducted at medical centres is carried out by physicians and is therefore medically oriented, it may be wise to assess the potential speaker’s familiarity with nursing and nursing research before you decide to invite him or her. Alternatively, you might consider supplementing the speaker’s commentary with several examples related to nursing research as part of the same class. Using Case Studies Most students are unaware of their role as a patient advocate in research situations. This role involves not only knowledge of the guidelines for carrying out the necessary behaviour but also belief in the ethical principles underlying these behaviours and the ability to take the assertive action that is sometimes required. Thus you need to deal with the affective as well as the cognitive learning domain in relation to this content.
Copyright © 2013 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved.
Presenting case studies for discussion can facilitate students’ expression of feelings and beliefs and provide an opportunity to learn about the role of patient advocate in research situations. An example of a case study follows. After presenting the case study, ask students what they would do in that particular situation. Encourage them to CHAPTER 6 Legal and Ethical Issues explore alternatives with one another and attempt to reach a consensus on the appropriate course of action. Try not to impose your beliefs or values on the class during discussion. This could result in the students’ attempt to focus on providing you with the “right answer” rather than thinking through the situation from their own perspectives. CASE STUDY Mr. G., a patient with advanced carcinoma of the lung, has been randomly assigned to an experimental group that receives a new chemotherapeutic protocol. The study also involves a control group that consists of patients who have the same medical diagnosis and do not receive any chemotherapy but do receive supportive care. The study has been approved by the REB in your institution. As you are taking care of Mr. G. one day, he tells you that he is sick and tired of feeling nauseated and vomiting after each treatment and that he would rather go home and live out his remaining days in peace with his family. You ask Mr. G. whether he has discussed his feelings with his physician. He responds that he has, but that his physician explained how important the study is and said that he hoped Mr. G. would remain part of it. After you explore with Mr. G. the pros and cons of remaining in the study, he decides that he wants to withdraw and go home. He is, however, concerned that his physician will be “mad” at him. 4. Providing Experiential Learning Activities Critiquing Ethics in a Research Report The purpose of this exercise is to assist students in identifying the ethics issues associated with a qualitative research project and evaluate the ethical aspects of a research report. Student objectives for the learning activity: Identify ethical issues arising from a research report. Critically appraise the article for potential violations. Directions for implementation. The following resources are needed for this activity: Box 6-2 Article: De Witt, L., Ploeg, J., & Black, M. (2010). Living alone with dementia: An interpretive phenomenological study with older women. Journal of Advanced Nursing, 66(8), 1698–1707. Table 6-2 (pp. 117–119) Box 6-3 (p. 122) Critiquing Criteria (p. 137) Review with students the information provided in Boxes 6-2 and 6-3, and Table 6-2. Next, provide a copy of the article to groups of four to six students and ask them to review all information related to the sample, data collection, ethics, and data analysis. The goal is for students to develop a comprehensive understanding of these components of the article and to be able to evaluate the components using the Critiquing Criteria on page 137. To ensure a comprehensive understanding, review what they understand about the article prior to moving on to the evaluation phase of the activity. Provide copies of the Critical Appraisal Activity found on the Evolve site for Chapter 6, and ask students to work together to critically appraise the de Witt article. As a class, review the correct answers and provide students with ample opportunity to ask clarifying questions.
Copyright © 2013 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved.
Introduction to Qualitative Research CHAPTER OVERVIEW Chapter 7 introduces students to qualitative research as a term and a method, as well as the importance of choosing the appropriate method to investigate a phenomenon. Several research traditions commonly used in qualitative nursing research are described, including the following: (1) grounded theory, (2) case study, (3) historical research, (4) ethnographic, (5) phenomenological research, (6) narrative analysis, and (7) participatory action research. Several issues in qualitative research are highlighted: (1) unique concerns regarding ethics including the need to acquire informed consent in naturalistic settings, the emergent nature of the research design, and the nature of researcher–participant interaction, and (2) the researcher’s role as instrument and the usefulness and use of triangulation and mixed methods approaches. LEARNING OUTCOMES After reading this chapter, the student should be able to do the following: Identify assumptions underlying the qualitative methods of grounded theory; case study; historical, ethnographic, and participatory action research; and phenomenological approaches to research. Identify the links between qualitative research and evidence-informed practice. Discuss significant issues that arise in conducting qualitative research in relation to topics such as ethics, criteria for judging scientific rigour, combination of research methods, and use of computers to assist data management.
CHAPTER 7 Introduction to Qualitative Research TEACHING STRATEGIES 1. Critical Thinking Challenges The following questions may serve to stimulate critical thinking about qualitative research: RECALL AND UNDERSTANDING What is the goal of qualitative methods? What are the characteristics of a case study? What is the primary aim of ethnographic research? What kind of questions does phenomenological research seek to answer? What are four different issues in qualitative research? ANALYSIS AND SYNTHESIS How do the underlying beliefs of the different qualitative approaches fi t with your philosophy of nursing? How would you decide whether to use a quantitative or a qualitative approach to a research problem? Explain the differences between research that uses a perceived paradigm and research that uses a received paradigm as the basis of two research studies. What is the value of qualitative research for nursing practice? 2. Understanding the Relationship Between Concepts and Research Approaches This exercise is designed to help students think about how different qualitative approaches can be used to understand a single concept. Using one or more concepts, individuals or groups of students describe how a study could be conducted. For example, if the purpose of a study is to understand the experience of postpartum depression, students could be asked to describe how a study of this phenomenon could be conducted using the following qualitative methods: Phenomenological Grounded theory Ethnography Case method Involving Qualitative Researchers Unless you have conducted qualitative research studies yourself, it may be diffi cult for you to give students examples of, or convey enthusiasm for, these research approaches. Therefore you may fi nd it helpful to invite a nurse researcher who has used one or more qualitative methods to study a nursing problem to participate in your class. This researcher can either conduct the entire class on qualitative research methodology, using rich examples from his or her work, or present a detailed discussion of the research. The focus of the class should be on how the various qualitative approaches were guided by the initial questions of the researcher and the research problem. Providing an Experiential Learning Activity a. Critiquing the Foundation of Qualitative Research In this activity, students are assigned one or more published research articles for which they will respond to the three critique criteria found in Chapter 7. Choose articles from the appendix or from the following list: Forbes, S., Bern-Klug, M., & Gessert, C. (2000). End-of-life decision making for nursing home residents with dementia. Journal of Nursing Scholarship, 32, 251–258. Fournier, B., Mill, J., Kipp, W., & Walusimbi, M. (2006). Discovering voice: A participatory action research study with nurses in Uganda. International Journal of Qualitative Methods, 6(2). Retrieved from http://www.ualberta.ca/ iigm/
CHAPTER 7 Introduction to Qualitative Research 37
O’Donnell, M. E. (2000). The long gray tunnel: The day-to-day experience of spouse caregivers of people with Alzheimer’s disease. Scholarly Inquiry for Nursing Practice, 14, 47–71. Sword, W. (2003). Prenatal care use among women of low income: A matter of “Taking care of self.” Qualitative Health Research, 13(3), 319–332. Varcoe, C. (2001). Abuse obscured: An ethnographic account of emergency nursing in relation to violence against women. Canadian Journal of Nursing Research, 32(4), 95–115. The three criteria are as follows: Is the philosophical basis of the research method consistent with the study’s purpose? Are the researchers’ values apparent? Do they infl uence the research or the results of the study? Is the phenomenon focused on human experience within a natural setting?
Qualitative Approaches to Research CHAPTER OVERVIEW Chapter 8 expands upon the introduction of Chapter 7, describing in more detail the qualitative approach to research to guide clinical practice, instrument development, and theory building. Several qualitative research methods are discussed at length: phenomenology, grounded theory, ethnographic, historical, participatory action research, and case study, including a focus on five basic elements: (1) identifying the phenomenon, (2) structuring the study, (3) gathering the data, (4) analyzing the data, and (5) describing the findings. Examples are given of nurse theorists who have created research methods specific to their theories. Finally, the authors provide excellent critical thinking challenges and a comprehensive set of general critiquing criteria that the consumer of qualitative research may use as a guide. These criteria are general for qualitative research methods rather than specific to particular methods, approaches, or models within the qualitative tradition. The criteria use the five basic elements described above and other factors mentioned throughout Chapter 8. LEARNING OUTCOMES After reading this chapter, the student should be able to do the following: Identify connections between and among the researcher’s worldview, research question, and r esearch method. Recognize the uses of qualitative research for nursing. Identify the processes of phenomenological, grounded theory, ethnographic, and case study methods. Recognize appropriate use of historical methods. Recognize appropriate use of participatory research methods. Apply the critiquing criteria to evaluate a report of qualitative research.
• 40 CHAPTER 8 Qualitative Approaches to Research TEACHING STRATEGIES Because students may fi nd it diffi cult to grasp the qualitative approach to nursing research, the learning activities in this chapter provide them with experiential opportunities. Through active participation in the process of qualitative data collection, students can gain an appreciation of this important approach to understanding nursing phenomena. 1. Critical Thinking Challenges The following questions are intended to facilitate review of chapter content and help students think critically about qualitative research: RECALL AND UNDERSTANDING What are the primary differences between the different qualitative approaches to research? What determines which approach should be used in a study? Which qualitative method focuses on: the lived experience of people? the development of theory? specifi c cases? cultural patterns? ANALYSIS AND SYNTHESIS How do the underlying beliefs of each approach fi t with your philosophy of nursing? How would you protect privacy of study participants being interviewed in person? Via the Internet? How would you apply the process of bracketing when approaching a patient for the fi rst time in a nursing care situation? Listening to Audiotapes of Participant Interviews Because qualitative research is intended to provide a rich description of participants’ experiences with a particular phenomenon, we have found it helpful to provide students with an opportunity to listen to recordings of actual interviews we have conducted. This strategy, validated by students, transforms the qualitative data-collection process from an abstract concept to an interesting reality and provides insight into how an actual interview is conducted. Because interviews are often quite long, select an appropriate section (no longer than 10 minutes) and play it for the class as an introduction to Chapter 8 content or when discussing data- collection procedures. Providing Experiential Learning Activities a. Experiencing the Phenomenological Approach The purpose of this learning activity is to facilitate students’ understanding of the subjective nature of the phenomenological approach and the way in which experiential themes are identifi ed. The initial interview of the research participant should be held before class time; then devote the actual class to data analysis and discussion. Student objectives for the learning activity: Conduct an interview with a research participant. Using the interview data, identify common themes in participants’ experience. Directions for implementation. Groups of three students are each assigned a research question (either the same one or a different one for each group) that lends itself to the phenomenological approach. (Note: At least one student in each group needs to have experienced the phenomenon in question. Determine this before forming your groups and assigning the questions.) Here are some examples: What is the experience of surgery like? What is it like to give birth to a baby?
CHAPTER 8 Qualitative Approaches to Research 41
What is the experience of being immobile? Once the questions are assigned, one student in the group who has had the experience in question agrees to be interviewed. A second student conducts the interview, and the third member acts as the observer and recorder of the interaction. To provide some structure to this learning activity, develop an interview guide in advance that contains open-ended questions about the experience to be studied. Using the fi rst example above, an interview guide might include the following: Tell me about your experiences. What was it like when you were told you needed surgery? How did you feel when you entered the hospital? The operating room? What was it like when you woke up in the recovery room? How did you feel during the postoperative period? What was the most important thing you learned from this experience? Students should be directed to tape-record (with permission from the participant) and then transcribe the interview, or simply to record the interaction using verbatim notes. The interview should be limited to 20 to 30 minutes so that the transcription of data is manageable. After data collection is complete, ask students to bring their transcribed interviews to class. Have the interviewer and observer/recorder work in teams to cluster their data. The student who was interviewed should observe this process. After data have been clustered, come back together as a class to share the fi ndings of all groups. Write these on the board. From the clusters, work with students to identify experiential themes emerging from the data. b. Critiquing Qualitative Studies This learning activity is designed to help students apply the Critiquing Criteria listed in the textbook (p. 191). Student objectives for the learning activity: State the research question of a selected study. Identify the research design of the study. Describe the strengths and weaknesses of the research design. Evaluate the study’s fi ndings and conclusions in relation to the research questions. Directions for implementation. To implement this exercise, select a qualitative research report from the appendix or from the following list: Carroll, S. (2004). Nonvocal ventilated patients’ perceptions of being understood. Western Journal of Nursing Research, 24, 454–471. (Ethnographic) Chircop, A., & Keddy, B. (2003). Women living with environmental illness. Health Care for Women International, 24, 371–383. (Case Study) Hupcey, J. E. (2000). Feeling safe: The psychosocial needs of ICU patients. Journal of Nursing Scholarship, 32, 361–367. (Grounded theory) Strandberg, G., Norberg, A., & Jansson, L. (2000). An exemplar of a positive perspective of being dependent on care. Scholarly Inquiry in Nursing Practice, 14, 327–346. (Phenomenology) Have students read the selected study before class and use the criteria found in Chapter 8 of the textbook to critique the study. Students should make notes in response to each criterion as a basis for discussion in class. As an alternative plan, the class can be divided into three or four groups, with each group selecting a study that has a different methodological approach for critique and then presenting to the entire class. In addition, the Critical Appraisal Activity found on the Evolve site for Chapter 8 can be assigned for further study. Instructor Manual for Nursing Research in Canada: Methods, Critical Appraisal, and Utilization Geri LoBiondo-Wood, Judith Haber, Cherylyn Cameron, Mina Singh 9781926648545, 9781771720984, 9780323447652, 9780323057431
