An overview of research theory and process

Chapter

2

An overview of research theory and process Dean Whitehead

KEY TERMS

LEARNING OUTCOMES

critical social theory epistemology interpretive ontology paradigm tension paradigms positivism qualitative quantitative research design research framework research philosophy research process research theory

After reading this chapter, you should be able to: • identify the theoretical and philosophical positions that underpin different research approaches • explain the existence of a ‘paradigm tension’ in research • note broad commonalities and differences between qualitative and quantitative research approaches • discuss the nature, intention and framework of the research process and research design.

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INTRODUCTION Understanding how research works and what methods and processes it adopts is one of the first steps in becoming a knowledgeable research consumer. Research is a systematic and logical process and exists as a mechanism or tool through which knowledge is generated and tested. Generating and testing new knowledge is a vital component in the nursing and midwifery disciplines as a means to examine and evaluate practice. It is expected that initial research inquiry equips the research individual or group to make those early tentative, and then likely full-scale, attempts at actually conducting and implementing research in a variety of nursing and midwifery environments; for example, clinical, administration, teaching/learning and quality assurance disciplines. Without this initial understanding, the research journey rarely flourishes and, instead, confusion and frustration quickly set in as the research novice struggles to come to terms with the ‘language’ and instruction of research. It is recommended here then that the novice research consumer adopts a step-by-step approach to understanding research and its different approaches. This chapter offers the initial theoretical and philosophical foundations for understanding research, as well as mapping out the frameworks and processes that originate from these positions. The intention is to produce a firm foundation from which beginning consumers of research can proceed in an informed manner.

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Tutorial Trigger How might the absence of knowledge of the underpinning theories and philosophies of research affect nursing and midwifery research?

RESEARCH THEORIES, PHILOSOPHIES AND PARADIGMS Essentially, theory and philosophy mean the same thing. The word theory evolved from ancient Greek philosophy. In research, sometimes the terms are separated out but, more often, they are used interchangeably. Where they are separated out, generally, theory relates to quantitative research (measurable observations) while philosophy relates to qualitative research (ideas) (see later in this section). For the purpose of this chapter, however, reference to one term covers all eventualities. Kitson (2001), in evaluating the state of nursing research in Australia and New Zealand, believes that there is a real need for nurses to understand the

underlying theories that underpin research. The same could easily be argued in the case of midwives. Nurse and midwifery researchers often turn to theory to understand research problems and guide the subsequent investigation and inquiry. Wallin (2009) tells us that research theory is needed to aid understanding of the range of factors at different levels that interact with and determine the extent to which interventions result in change. However, the fact that this is not always the case continues to hinder the national and international progress of research in these disciplines. Hutchinson and Johnston (2004), in their Australasian-based study, found that one of the main reasons why nurses fail to use research evidence in practice is because they do not know or understand the theoretical constructs. A number of other studies present similar findings for both nursing and midwifery (Edwards et al. 2002; Olade 2003; Veeramah 2004; French 2005; Roxburgh 2006; Ofi et al. 2008). Theories are conceptual abstract interpretations of phenomena and their relationships. It is recognised that theory guides practice and that theory, research and practice are very closely linked together (Cody 2003; 21

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Marrs & Lowry 2006; Wu & Volker 2009). According to Graham (2003), research-based theory-building is appealing due to its problemfocused nature and its potential to change and improve practice. However, before the novice researcher ‘rushes off ’ to perform actual research in practice or use existing research evidence to influence and change practice, it is vital that they first understand the theoretical and philosophical foundations of research and their related processes. Part of the problem with this is that exact definitions are difficult to find as not all research theorists agree on exactly how research theories and philosophies present. Added to this, they do change over time too. There are ways around this problem, though. For instance, Fawcett et al. (2001) insist that, as an acknowledgment of different forms of ‘knowing’, any form of evidence has to be both interpreted and critiqued against whether or not theory can be applied to practice situations and, if so, what it looks like. Such viewpoints do allow a degree of flexibility and fluidity but this should not amount to ‘making things up as you go along’. Theories should only ever be adopted properly. To approach research from a theoretically ‘blind’ or ‘forced’ position is both unethical and highly questionable. Forbes (2009), though, has identified that often our research is not conducted in a theoretically complete manner. Studies in midwifery and nursing may not always be guided by a theoretical framework: some studies benefit from a theoretical standpoint and some do not (see Chapter 15). When researchers use a theoretical framework they provide justification for doing so. For example, Ip et al. (2009) evaluated an efficacyenhancing educational intervention based on Bandura’s self-efficacy theory. The researchers used this framework ‘to explore, explain and predict healthy behaviour in a variety of health promoting research’ (p 2125). It is well accepted that research is divided into two broad classifications or paradigms (although multiple paradigms exist within these); that of qualitative and quantitative research. The philosophical basis of a researcher often stems from a specific paradigm. A paradigm is a position or view of understanding the world we live in (world-view or view-of-the-world) which covers philosophical assumptions that are shared by a community of scholars or scientists.

Research paradigms are therefore sets of beliefs and practices shared by all researchers which serve to govern inquiry within disciplines (Weaver & Olson 2006). This research paradigm world-view shapes a researcher’s approach to a variety of research-related activities. A paradigm, therefore, guides the direction of research. Which paradigm position a researcher adopts depends on a number of factors, such as profession, ‘tradition’, understanding (knowledge-base), cultural beliefs and hierarchy. No single theory, paradigm or framework alone can address all aspects of nursing and midwifery research nor is any superior to another. Therefore, ‘theoretical pluralism’ exists where many factors decide which position the researcher adopts and the nature of the research undertaken (Graham 2003; Weaver & Olson 2006). One of the main aims of this chapter is to introduce the reader to the different perspectives of quantitative and qualitative research. The basic principles and distinguishing features of both the qualitative and quantitative paradigms are explored noting the differences and similarities of theoretical and philosophical origins, terminology and evaluation criteria. The chapters in Section 2 of this book explore different aspects of these two paradigms in far more depth than this chapter. Section 2 is purposely divided separately to cover the paradigms of qualitative and quantitative methods. In Chapter 14, the rapidly emerging phenomenon of ‘mixedmethods research’, which aims to ‘mix and marry’ the processes of both qualitative and quantitative research, is reviewed. In generating knowledge, researchers can use methods from different paradigms. Selection of the paradigm and the resulting research design (plan) are dependent on the following starting points: • the purpose of the research and the question/s being asked • the nature of the issue/s or problem/s being investigated • what is likely to offer the ‘best fit’ for process and outcomes • the knowledge and experience of the researcher • the need, or not, for generalisability (the application of research findings from a smaller group of research participants to much larger groups).

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Regardless of approach, research is conducted to examine and expand current knowledge and understanding of different concepts and phenomena within a particular philosophical framework. Research is therefore guided by the following concepts (and related questions): • Ontology is the study of existence. It provides the ‘world-view’ that guides the study (e.g. ‘What is the nature of reality?’; ‘What kind of being is the human being?’) • Epistemology is the theoretical study of knowledge involved in the search for knowledge and truth. It provides a focus for the study (e.g. ‘What is the relationship between the researcher and the area of study?’) • Methodology provides a framework (process) for conducting the study (e.g. ‘How do we know the world, or gain knowledge of it?’) (Parse 2001; Denzin & Lincoln 2005) Other less commonly used terms may also present themselves related to theoretical and philosophical positions in research. This is not a problem, merely an acknowledgment that no single chapter of a research text can cover all theoretical and philosophical eventualities. Where the reader does come across this, it is usually the case that some background investigation will solve the issue. For instance, parsimony is a relatively common philosophical research term that refers to a principle concerned with explaining theory by means of the fewest number of possible conceptual elements in favour of simplicity (Cutcliffe & Harder 2009). Clearly, philosophical ideas such as those just described are based on singular values and beliefs which is why there is always the potential for contention and difference. However, internal consistency and logic are achieved in a study when the links between the three just-mentioned concepts are clear (Parse 2001). Differing views exist regarding these concepts and the ways they interrelate. This difference is to be celebrated because it challenges what we do and why we do it, and helps us to mould, redefine and manipulate our knowledge base and, subsequently, guide how we conduct our practice. From a health professional perspective, the study of individuals’ responses to disease, treatment and recovery is a large part of our role. Philosophical beliefs about human/environment

relationships, and what defines knowledge of these areas, are vital to such practice (Leddy 2000). Unique experiences or transferable findings form the basis of decision-making for identifying if a qualitative or quantitative (or both) research method is used. Further delineation (separating out) is outlined in more common classifications of research paradigms; these being: • positivist — reductionist, empirical • critical — emancipatory • interpretive — naturalistic.

Positivist approach The term positivist or ‘positivism’ refers to a philosophical position which reflects the traditional scientific approach of objective observation, prediction and testing of causal relationships (Maggs-Rapport 2001). This paradigm is representative of quantitative research approaches. Positivism (or modernism) is a broad cultural reflection of rationality and known science. The related term ‘determinism’ (reductionism) describes the fact that certain investigated phenomena do not occur by chance. Instead, they have predisposing causes that are known to us. A midwifery example concerning cognition in pregnancy will help to clarify. From the point of view of determinism, it accepts that changes in a person’s physical status causes changes in the person’s psychological status. Therefore, any change in the cognitive status of a pregnant woman must have its source in the physiological change brought about by pregnancy. ‘Empirical-analytical’ or ‘logical positivism’ are equivalent terms used to describe the origins and belief system of the quantitative research paradigm. Another related concept of quantitative research is that of ‘deductive reasoning’. This describes a logical thought process whereby research hypotheses (see Chapter 4) are derived from theory, and where reasoning moves from the general (what is already known) to the particular (what is being tested/measured). Chapters 9 through to 13 offer a detailed account of quantitative research. Some see that the weakness of the deterministic (or reductionist) viewpoint is that it does not take account of a person’s individuality or subjective human experience within a cultural or situational framework in 23

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which human beings exist (Pepitone 1981). This concept, however, is not favoured by all, especially where supporters of determinism adhere to strict and rigid principles whereby ‘pure’ positivism is championed. Labels attached to this paradigm, such as ‘proper’, ‘realist’ ‘hard’ and ‘scientific’, compound this critique. Consequently, the ‘post-positivism’ (or postmodernism) movement has developed as a less rigid position that acknowledges the limited nature of ‘complete or total objectivity’.

Critical approach Critical approaches generally use qualitative methods to examine phenomena of interest. Both critical and interpretive (see next section) approaches are viewed as post-positivist. They developed from researchers wishing to find alternatives to counter and balance out the positivist tradition already described. These approaches generally use research methods operating within a social-change context and, therefore, often with a post-modern stance that includes questioning the status quo of social institutions. Consequently, the researcher adopts a position that is free from the limitations of tradition and seeks to minimise the ‘distance’ between the researcher and the study participants. Critical approaches usually look to encourage empowerment and equality for research participants and to challenge and change social structures. Action research, for instance, is a critical inquiry that describes and interprets social situations and, in doing so, aims to improve social division/inequality through participant involvement. It is essentially a critique of existing social situations, via collaboration and partnership, in order to generate social change (Williamson & Prosser 2002). Chapter 14 expands on the critical processes of action research. Critical approaches are also referred to as ‘emancipatory’. In nursing, emancipation has emerged from a longstanding history of social oppression addressed through critical social theory and, in particular, through feminist theory and research (Wittmann-Price 2004; Turris 2005). According to Arslanian-Engoren (2002), feminist research aims to explore issues that are known to cause discrepancies and inequities in women’s

healthcare and nursing/midwifery, preventing them from receiving or delivering comprehensive care and treatment. In doing so, feminist research adopts a ‘post-structural’ position by first exposing and then changing power structures that are present within social and political institutions. It is obviously worthwhile to investigate issues that expose any form of marginalisation purely based on issues such as gender. It should be noted though that, while it is a useful approach for investigating related issues in nursing, midwifery and women’s healthcare generally, feminist research represents a small body of research work in these disciplines overall. For instance, in Edin and Högberg’s (2002) midwifery-based study investigating the incidence of physical and sexual violence encountered by pregnant women, their extensive review of the literature unveiled many surveybased research studies, but uncovered no feminist studies. To help overcome issues like this, some contemporary authors have sought to combine feminist approaches with newer methods. For instance, Corbett et al. (2007) put forward the case for an alliance of feminist-informed participatory action research (see Chapter 14). For these types of reasons, this book acknowledges the place of feminist research here, but does not include it elsewhere. Those who wish to know more about feminist theory and research are directed to the references just cited for a theoretical perspective, as well as others that demonstrate actual research examples (i.e. Yam 2000; Arslanian-Engoren 2001; Aranda 2006).

RESEARCH IN BRIEF Brodie (2002) conducted a study over a 2-year period using a critical feminist approach with groups of Australian midwives attending 28 separate professional conferences. She found that the system of midwifery care (at the time) was medically dominated, not evidence-based, restricted women’s choice, and that midwifery autonomy was not recognised or supported. She identified a need to reform through strengthening the organisation and system of midwifery care while forging strong links with women and consumer organisations and the expansion of well-informed and skilful midwifery leadership.

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TABLE 2.1 A simplified comparison of positivist, critical and interpretive approaches POSITIVIST

CRITICAL

INTERPRETIVE

Position

Empirico-analytical, reductionist

Post-positive, postmodern, post-structural, emancipatory

Post-positive, post-modern, naturalistic

Methodology

Experimental, quasi-experimental, correlational etc

Feminist research, action research, critical ethnology etc

Phenomenology, grounded theory, ethnography, exploratory/descriptive, case study, historical, Delphi

Data collection

Experiments, closed surveys and interviews

Open observation or interviews, focus groups

Open observation or interviews, focus groups

Researcher position

Distant

Close

Close

Point to ponder Some disciplines will lend themselves more to feminist research than others. This would certainly potentially be the case for midwifery, although it is relevant to all those who work with women and on issues of women’s health. A search of the midwifery-based research literature, to date, uncovers scant feminist research examples. The previous ‘Research in brief’ box is one example.

Interpretive approach Interpretive approaches to research aim to describe, explore and generate meaning within a social or practice context. The most common post-positivist examples of this approach are phenomenology (hermeneutics), grounded theory and ethnography (see Chapter 6). They are also referred to as occurring within a naturalistic (or constructivist) paradigm. In effect, ‘reality’ is not fixed and is constructed according to naturally occurring events and situations. For the interpretive researcher, then, reality is a flexible position whereby the phenomenon being investigated exists within contexts that have many different possibilities and meanings. Meanings are therefore located in a particular context or situation and time and, generally, meanings emerge from the study process. Interpretive methods ensure dialogue between the researcher and those with whom they interact in order to collaboratively construct a meaningful reality. The rationality of this perspective is that the researcher is not and

cannot be separated from the people and processes involved. The goal is a deep and self-reflexive engagement with the phenomena being studied. Another related concept of qualitative research is that of ‘inductive reasoning’. This describes a logical thought process whereby generalisations are developed from specific observations — and where reasoning moves from the particular to the general (the opposite to quantitative research). Chapters 6 through to 8, which deal primarily with descriptive exploratory, phenomenology, grounded theory and ethnography approaches, further add to the understanding of interpretive qualitative methods. Table 2.1 offers a simplified comparison between positivist, critical and interpretive approaches.

CHOOSING A PARADIGM The reasons for selecting a qualitative paradigm position rather than a quantitative one, or vice versa, are based on the research question and the purpose of the study. The formulation of the research problem (research question, problem statement or hypothesis) is an initial and key step in the process of research, regardless of the method used (see Chapter 4). At this stage, the research consumer examines the consistency between the research problem and the methods used to address that problem. Critical appraisal/ evaluation skills are required to effectively review research studies and judge if the findings could be applied to practice or not (see Chapters 3 and 15). Recognition of the differences of the characteristics of qualitative research from quantitative research means that the nurse or 25

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TABLE 2.2 A comparison of qualitative and quantitative approaches CONCEPTS

QUALITATIVE

QUANTITATIVE

Origins

Search for meaning; interactive approach

Search for truth in an objective, controlled manner

Beliefs

Complex beings who attribute unique meanings to situations

Biopsychosocial beings with measurable components

Truth

Subjective with multiple realities

Objective reality

Basis of knowing

Meaning, discovery

Cause and effect relationships

Focus

Complex and broad

Concise and narrow

Level

Holistic

Reductionist

Reasoning

Dialectic, inductive

Logistical, deductive

Setting

Occurs in uncontrolled naturalistic (social or human) settings

Investigator seeks experimental control of the setting

Purpose

Develops theory by exploring meaning and describing relationships

Tests hypotheses, theories by control and observation

Sample

People in the sample are referred to as participants or, in ethnographic studies, informants

People in a group are termed the sample, and are referred to as subjects, cases or respondents

Researcher position

An active and interactive participant, immersed in the setting

Uses measuring instruments or tools (e.g. questionnaires)

Data elements

Written form (words)

Numerical form (numbers)

Analyses

Interpretive analysis usually undertaken manually

Statistical analysis using software (e.g. SAS, SPSS, Minitab, Statview)

Outcomes

Are often thematic or conceptual, but not quantifiable and are expressed in words

Must be measurable and are reported in numerical terms

Clinical application

Exploration of unique experiences of individuals or groups

Findings able to be generalised to similar groups

midwife is better able to interpret the research report findings and identify ways they might be applied. Articles, such as ones written by Cambell and Roden (2010), offer simplified detail in explaining the relationships, similarities and differences between quantitative and qualitative research approaches. The origins and belief systems for the qualitative and quantitative paradigms are also described and compared in Table 2.2. Researchers may sometimes be under the impression that the differences between qualitative and quantitative paradigms are so wide that one paradigm position is incompatible with the other (Weaver & Olson 2006). While not intended, the information in Table 2.2 may exaggerate the apparent division between them. It is important, however, to acknowledge their

obvious ‘connectedness’ and inter-relationships. Both approaches are complementary, not competitive. Broadly speaking, both paradigms are scientific, rigorous and follow very similar process, design and methodology. Neither quantitative nor qualitative research can occur by chance: both are governed by systematic attention to the method and design of the research process (explained later in this chapter).

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Tutorial Trigger

Before reading on, from what you currently understand, which do you believe is the best method to use for conducting nursing or midwifery research — qualitative or quantitative? Can you justify your decision?

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A ‘paradigm tension’ in research? A ‘traditional’ paradigm tension has existed for some time within a number of research communities. Essentially, in research terms, the paradigms of qualitative and quantitative research have been (and often still are) viewed as being in direct competition with each other. Conventional/traditional researchers and the research ‘communities’ they represent have often started and continued this situation, rather than any particular fault lying with the paradigms themselves. Take, for instance, the fact that medical research is predominantly quantitative in nature, while nursing and midwifery research leans heavily towards conducting qualitative research. This situation has often resulted in unhelpful, limiting and limited outcomes for healthcare research and created unnecessary division between and within these health professions. Weaver and Olson (2006) suggest that such a state of affairs within nursing and midwifery research has, in places, introduced notable confusion, intolerance and competition. More recently, this has notably changed with a more reasoned and practical approach to healthrelated research which now often includes research collaboration between all health professional disciplines (including nurses, midwives and doctors). There is now also a wider acknowledgment of the equal and important place of qualitative research, and the recent contribution of ‘mixed-methods’ research adds to this (see Chapter 14).

Point to ponder Medical-based research on women’s health issues (e.g. childbirth, osteoporosis) is often criticised for its positivist medicalised orientation, male dominance perspective, and its tendency to reduce all health events (such as childbirth) to a disease state or illness orientation. Interestingly, some midwifery and nursing-specific research has been accused of the same.

The existence of ‘hierarchies of research evidence’, popularised in the late 1970s in Canada, has contributed (intentionally or not) to

the mentioned paradigm tension. The ‘hidden’ suggestion of these hierarchies is that some methods of research (especially positivist approaches) are better (or more important) than others. Evans (2003) offers a more reasoned interpretation of these hierarchies, in that different research methods are needed to answer different clinical questions. Therefore effectiveness, appropriateness and feasibility of method are more important indicators than hierarchy. The Australian Health Advisory Committee (HAC), as part of the National Health and Medical Research Council (NHMRC 2009), has more recently identified with this type of thinking and, accordingly, developed levels of evidence and grades for recommendations for developers of clinical practice guidelines (www.nhmrc. gov.au/ publications/synopses/cp65syn.htm). Table 2.3 highlights the current proposal for the NHMRC hierarchies of research evidence, although it is important to note that they represent a quantitative hierarchy only.

Point to ponder Looking at Table 2.3, what would be best evidence for practice; a poorly constructed systematic review or a well-constructed case series study?

TABLE 2.3 Designations of levels of evidence according to type of research question LEVEL

INTERVENTION

1

Systematic reviews of level 2 studies

2

Randomised controlled trials (RCTs), or pseudo RCTs

3a

Comparative studies with concurrent controls

3b

Comparative studies without concurrent controls

4

Case series

(Source: National Health and Medical Research Council (NHMRC) 2009 NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines NHMRC, Australia)

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Most researchers are now realising the limitations of championing or rejecting one research paradigm at the expense of another (Morgan 2007). It is now accepted by many, as both naïve and simplistic, to suggest either that one research approach is better than another, or that they are so different that researchers can only adopt one or the other. It is also acknowledged now that, in many instances, adopting a single research approach or method might prove inadequate when it comes to answering research questions/hypotheses. The key issue really is that the researcher, instead, chooses the most appropriate method for the actual task at hand. Different research methods will always produce different results. One of the main tasks, for the critical reviewer of research, is that they can determine if research studies have adopted the correct method and design for the intended purpose or predicted outcomes (see Chapter 15).

THEORETICAL AND CONCEPTUAL FRAMEWORKS Research theory and theoretical and conceptual frameworks are often used in the language of researchers to represent similar things, but there are subtle differences in meaning (Wu & Volker 2009). Research frameworks provide the knowledge and theory basis for research studies. Theoretical research frameworks represent known and tested theories. There are many ‘tried and tested’ theories in nursing and midwifery that researchers can cross-reference against. Therefore, this foundational knowledge serves as a ‘frame of reference’ from which researchers can either predict or explain their study outcomes. For instance, Lee and Holroyd (2009) effectively used a mixed-methods approach to evaluate the effect of childbirth education classes. This two-phase study adopted Donabedian’s model as a theoretical framework. In phase 1 the women completed a questionnaire: descriptive statistics summarised participants’ responses. In phase 2, six of the original 40 women were purposively selected for a semi-structured interview. These researchers believe that ‘using a mixed-method design guided by a theoretical framework is essential when evaluating patient education activity’ (p 367).

Where studies are unique, however, and are exploring either unknown or previously unexplored issues, it may be that there is no theoretical framework to guide the researcher. In this case, conceptual frameworks identify single or multiple concepts that are related but remain untested. They are still useful as a frame of reference, but the degree of interpretation is looser and wider than with theoretical frameworks. Verification of an untested nursing theory provides an area from which research problems can be derived (see the next ‘Research in brief ’).

RESEARCH IN BRIEF Here we can see that, as well as most research possessing a theoretical basis, research can be used to generate new theories. Dalton (2003) extends Kim’s theory of collaborative decisionmaking in nursing practice, in constructing and testing a new theory that moves from Kim’s dyadic theory towards a triadic theory, by means of a modified version of Walker and Avant’s theory-derivation process.

Evidence-based practice tip While research theory, philosophy, paradigms, frameworks and concepts can be separately defined, they are closely related and, therefore, it is not uncommon to see the terms used interchangeably. This can cause confusion about their meaning and how the different terms relate to research overall. To avoid such confusion, it is recommended that the reader becomes familiar with the terms used so far in this chapter.

RESEARCH PROCESS AND RESEARCH DESIGN Research process If we look at a series of ‘typical’ research studies overall, regardless of which paradigm is used, we should note that they all abide by the same process. By paying attention to this methodological process, critical research consumers can appreciate the logical nature of

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research methods and the relevance of certain guiding forces on the outcomes of research (Maggs-Rapport 2001). To clarify the forces, drivers and process of research, this book is designed to take the reader step-by-step through a sequential process-driven research journey — chapter by chapter. The order of the chapters in this book are mostly designed to follow the sequence of the ‘research process’. The research process then typically follows this structure: 1) identifying the clinical problem/issue 2) critically searching and reviewing the available primary (research-based) and conceptual (theory-based) literature 3) identifying research ideas, questions, statements or hypotheses 4) determining ethical issues and procedures 5) identifying and justifying an appropriate research methodology and method 6) sampling (choosing) appropriate research populations (participants/elements) 7) collecting research data from participants/ elements 8) analysing collected research data 9) determining and making sense of research results/findings 10) disseminating (sharing) research findings to wider audiences. We can note from the research process list that a number of factors determine the nature and extent of conducted research which, in turn, influence the choice of research method or approach. Regardless of research approach though, the process remains constant. This can also be seen by looking at the decision path for selecting a research approach as outlined in Figure 2.1.

Research design Research design takes a specific portion of the research process that is more concerned with the actual conducting of the research. In essence, it is the ‘doing’ part of research. This is the part where the researcher plans and designs specific methods for conducting research; these being: 1) the specific methodology and method/ methods to be used i.e. qualitative– phenomenology or quantitative–experimental;

or potentially both in the case of mixedmethods research (see Chapters 6, 9 and 14) 2) ethical consent and approval is sought (see Chapter 5) 3) a sampling framework and technique i.e. the rationale for choosing an appropriate population of research participants, subjects or elements to study, such as a random sample of first-year nursing or midwifery students (see Chapters 7 and 10) 4) for quantitative research, variables are operationally defined (see Chapter 11) 5) mostly for quantitative research, measuring instruments are developed or selected and evaluated (see Chapter 12) 6) data collection techniques are employed (see Chapters 7 and 11) 7) the collected data are analysed (see Chapters 8 and 13) 8) results/findings are evaluated (see Chapter 15). If we look at published research in academic journals it should be noted that they also closely follow this process in disseminating published research findings (see Chapter 19). The research then is usually reported in a certain logical fashion. Hudson-Barr (2004) notes the way that nursing and midwifery-related academic journal articles are presented in this very systematic way (an interpretation of likely headings is included in the following list in parentheses): 1) the identification of a research problem, idea or issue (introduction) 2) a review of previous research and conceptual work on the identified topic (literature review/ background) 3) specification of the research question, statement or hypothesis (aim) 4) a description of how the study was conducted (design, method or approach — to include the possible subheadings of sampling, ethical procedure, data collection and data analysis) 5) discussion on the results of the research (results/findings) 6) the interpretation of the research findings (discussion — to potentially include limitations, recommendations and conclusion/ summary). 29

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NURSING AND MIDWIFERY RESEARCH 4E If your beliefs are: Researcher beliefs

Humans are biopsychosocial beings, known by their biological, psychological and social characteristics.

or

Truth is objective reality that can be experienced with the senses and measured by the researcher.

Humans are complex beings who attribute unique meaning to their life situations. They are known by their personal expressions. Truth is the subjective expression of reality as perceived by the participant and shared with the researcher. Truth is context-laden.

then you'll ask questions, such as: Example questions

What is the difference in blood pressure and heart rate for adolescents who are angry compared to those who are not angry?

or

What is the structure of the lived experience of anger for adolescents?

and select approaches: Approaches

Quantitative/deductive

Qualitative/inductive

or

leading to research activities Research activities

Researcher selects a representative (of population) sample and determines size before collecting data.

or

Researcher uses an extensive approach to collect data. Questionnaires and measurement devices are, according to a standard protocol, administered to control for extraneous (unexpected) variables. Primarily deductive analysis is used, generating a numerical summary that allows the researcher to reject or accept the null hypothesis.

Researcher selects participants who are experiencing the phenomenon of interest and collects data until saturation is reached. Researcher uses an intensive approach to collect data. Researcher conducts interviews and participant or non-participant observation in environments where participants usually spend their time. Researcher bias is acknowledged and set aside. Primarily inductive analysis is used, leading to a narrative summary which synthesises participant information, creating a description of human experience.

Figure 2.1 Decision path for selecting a research approach

Point to ponder The terms research process, design, method, methodology and approach are often used interchangeably. While there are subtle differences between some of them, generally, they are terms used to describe the same thing. For instance, methodology usually refers to the philosophical basis that informs what approach is adopted, while method mainly refers to how actual processes (i.e. data collection and analysis) are adopted and applied. Ofi et al. (2008), in their study, found that nearly a quarter of the nurses they surveyed did not have a basic knowledge of research methodological concepts. 30

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SUMMARY Understanding how research works and what methods and processes it adopts is a part of becoming a knowledgeable research consumer. Without understanding these early steps of research, it is unlikely that the beginning research novice will progress to become a knowledgeable consumer of research. While some of the theoretical and philosophical terms might initially appear somewhat confusing they need to be understood to grasp the whys and wherefores of conducting research. Following on

from this, a good understanding serves as a springboard to advance the novice towards the first steps of the already outlined research process. Much of the available research literature routinely use the terminology and concepts highlighted in this chapter and, to a degree, expects the reader to already be familiar with this material. The next chapter is devoted to the initial, yet vital, research process steps of critically searching for, retrieving and reviewing the existing research literature.

KEY POINTS • Research originates from, and is underpinned by, a number of theoretical and philosophical positions. These positions create the ‘world-view’ of the researcher and help determine the research approach that needs to be adopted. • The two major paradigms of research are qualitative and quantitative research (although some now refer to the third paradigm of ‘mixed-methods’ research; see Chapter 14). All research paradigms have their differences and similarities but, ultimately, which paradigm is chosen (if not all of them) by researchers should be determined on the basis of which approach is the most appropriate for the task at hand and most likely to produce the best possible outcomes for health clients and services. • Conducted research necessarily is conducted according to established scientific, systematic and structured processes. These must be fully understood before the research consumer can start to apply research findings, or actually conduct research in practice.

Learning activities 1. The first step in becoming a knowledgeable research consumer involves: a) understanding how to conduct research b) understanding the ‘language’ of research c) understanding how research works, its underpinning theories and what methods and processes it adopts d) understanding how research impacts on nursing practice. 2. Research is guided by the following concepts (and related questions): a) ontology, epistemology and methodology b) ontology, epistemology and oncology c) ontology, pedagogy and methodology d) ontology, pedagogy and dermatology.

3. Further delineation of qualitative and quantitative research is outlined in a common classification of research paradigms. These being: a) deductive, inductive and productive b) positivist, critical and interpretive c) negativist, uncritical and interpretive d) positivist, critical and productive.

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4. The term positivist or ‘positivism’ refers to: a) philosophical position reflecting the traditional scientific approach of subjective observation and causal relationships b) philosophical position reflecting the traditional scientific approach of objective observation and nursing relationships c) philosophical position reflecting the traditional scientific approach of objective observation and causal relationships d) philosophical position reflecting the traditional scientific approach of subjective observation and nursing relationships. 5. Critical and interpretive research paradigms generally use: a) qualitative methods to examine phenomena of interest b) quantitative methods to examine phenomena of interest c) qualitative methods to examine hypotheses d) quantitative methods to examine hypotheses. 6. The most likely cause for ‘paradigm tension’ is: a) a researcher feeling anxious about research b) a representation that one research paradigm is more superior over another c) when two different paradigms are used in one study d) when only one paradigm is used.

7. Research frameworks serve as a frame of reference from which researchers can either predict or explain their: a) study methods b) study designs c) study inputs d) study outcomes. 8. The first part of the research process involves: a) identifying the problem/issue b) critically searching and reviewing the available primary (research-based) and conceptual (theory-based) literature c) identifying research ideas, questions, statements or hypotheses d) all of the above. 9. The last part of the research process involves: a) analysing collected research data b) determining research results/findings c) disseminating research findings d) all of the above. 10. The research design (plan) is dependent upon the following starting points: a) the purpose and the question/s being asked b) the nature of the issue or problem being investigated c) what is likely to offer the ‘best fit’ and potential outcomes d) all of the above.

Additional resources

References

Beckstead J W, Beckstead L G 2006 A multidimensional analysis of the epistemic origins of nursing theories, models, and frameworks. International Journal of Nursing Studies 43:113–22 French B 2005 The process of research use in nursing. Journal of Advanced Nursing 49:125–34

Aranda K 2006 Postmodern feminist perspectives and nursing research: a passionately interested form of inquiry. Nursing Inquiry 13:135–43 Arslanian-Engoren C 2001 Gender and age differences in nurses’ triage decisions using vignette patients. Nursing Research 50:61–6

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Arslanian-Engoren C 2002 Feminist poststructuralism: a methodological paradigm for examining clinical decision-making. Journal of Advanced Nursing 37:512–17 Brodie P 2002 Addressing the barriers to midwifery — Australian midwives speak out. Australian Journal of Midwifery 15:5–14 Cambell S, Roden J 2010 Research approaches for novice nephrology nurse researchers. Renal Society of Australasia Journal 6:114–20 Cody W K 2003 Nursing theory as a guide to practice. Nursing Science Quarterly 16:225–31 Corbett A M, Francis K, Chapman Y 2007 Feministinformed participatory action research: a methodology of choice from examining critical nursing issues. International Journal of Nursing Practice 13:81–8 Cutcliffe J R, Harder H G 2009 The perpetual search for parsimony: enhancing the epistemological and practical utility of qualitative research findings. International Journal of Nursing 46:1401–10 Dalton J M 2003 Development and testing of the theory of collaborative decision-making in nursing practice for triads. Journal of Advanced Nursing 41:22–33 Denzin N K, Lincoln Y S (eds) 2005 Handbook of Qualitative Research, 3rd ed. Sage Publications, Thousand Oaks, California, USA Edin K E, Högberg U 2002 Violence against pregnant women will remain hidden as long as no direct questions are asked. Midwifery 18:268–78 Edwards H, Chapman H, Davis L M 2002 Utilization of research evidence by nurses. Nursing and Health Sciences 4:89–95 Evans D 2003 Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing 12: 77–84 Fawcett J, Watson J, Neuman B, et al 2001 On nursing theories and evidence. Journal of Nursing Scholarship 33:115–19 Forbes A 2009 Clinical intervention research in nursing. International Journal of Nursing Studies 46:557–68 French B 2005 Contextual factors influencing research use in nursing. Worldviews on Evidence-Based Nursing 2:172–83 Graham I W 2003 The relationship of nursing theory to practice and research within the British context: identifying a way forward. Nursing Science Quarterly 16:346–50 Hudson-Barr D 2004 Scientific inquiry: how to read a research article. Journal for Specialists in Pediatric Nursing 9:70–2 Hutchinson A M, Johnston L 2004 Bridging the divide: a survey of nurses’ opinions regarding

barriers to, and facilitators of, research utilization in the practice setting. Journal of Clinical Nursing 13:304–15 Ip W-Y, Tang C S K, Goggins W B 2009 An educational intervention to improve women’s ability to cope with childbirth. Journal of Clinical Nursing 18:2125–35 Kitson A 2001 Approaches used to implement research findings into nursing practice. Report of a study tour to Australia and New Zealand. International Journal of Nursing Practice 7:392–405 Leddy S K 2000 Towards a complementary perspective on worldviews. Nursing Science Quarterly 13:225–33 Lee P Y K, Holroyd E 2009 Evaluating the effect of childbirth education class: a mixed-method study. International Nursing Review 56:361–8 Maggs-Rapport F 2001 ‘Best research practice’: in pursuit of methodological rigour. Journal of Advanced Nursing 35:373–83 Marrs J-A, Lowry L W 2006 Nursing theory and practice: connecting the dots. Nursing Science Quarterly 19:44–50 Morgan D L 2007 Paradigms lost and pragmatism regained: methodological implications of combining qualitative and quantitative methods. Journal of Mixed Methods Research 1:48–76 National Health and Medical Research Council (NHMRC) 2009 NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines. NHMRC, Australia Ofi B, Sowunmi L, Edet D, Anarado N 2008 Professional nurses’ opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. International Journal of Nursing Practice 14: 243–55 Olade R A 2003 Attitudes and factors affecting research utilization. Nursing Forum 38:5–15 Parse R R (ed) 2001 Qualitative Inquiry. Jones & Bartlett, Boston, USA Pepitone A 1981 Lessons From the History of Social Psychology. American Psychologist 36(9):972–85 Roxburgh M 2006 An exploration of factors which constrain nurses from research participation. Journal of Clinical Nursing 15:535–45 Turris S A 2005 Unpacking the concept of patient satisfaction: a feminist analysis. Journal of Advanced Nursing 50:293–8 Veeramah V 2004 Utilization of research findings by graduate nurses and midwives. Journal of Advanced Nursing 47:183–91 Wallin L 2009 Knowledge translation and implementation research in nursing. International Journal of Nursing Studies 46:576–87 33

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Weaver K, Olson J K 2006 Understanding paradigms used for nursing research. Journal of Advanced Nursing 53:459–69 Williamson G R, Prosser S 2002 Action research: politics, ethics and participation. Journal of Advanced Nursing 40:587–93 Wittmann-Price R A 2004 Emancipation in decisionmaking in women’s healthcare. Journal of Advanced Nursing 47:437–45

Wu H-L, Volker D L 2009 The use of theory in qualitative approaches to research: application to end-of-life studies. Journal of Advanced Nursing 65:2719–32 Yam M 2000 Seen but not heard: battered women’s perceptions of the ED experience. Journal of Emergency Nursing 26:464–70

For further content associated with this chapter visit http://evolve.elsevier.com/AU/Schneider/research/

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