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Research Methods 850 Week 3,2011/12Daphne Cockwell School of Nursing, Post Diploma Degree Program, Ryerson University
Reviewing the Literature, Defining the ResearchProblem, Purpose & Question
and Ethics in ResearchLoiselle et al. (2011) chapter 5, 6 & 7.
Prepared by Dr. Elaine Santa Mina
1
Learning Objectives
1. To describe the purpose of a literature review
2. To identify the steps of a literature review
3. To be able to conduct a literature search
4. Describe how the literature review supports the researchproblem, question (s) and
5. hypothesis (es)
6. To describe the standards of ethical research practice
7. To describe the underlying ethical principles of the
Tri Council
2
Literature Review
is the background to the research topic
includes a thorough empirical literature
review of key concepts of the research
question.
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Literature Review:
research purposes
• to efficiently and accurately assemble knowledge onthe topic; for researchers and clinicians
• to inform the researcher of current knowledge anddetermine implications for questions
• to identify methodological problems in relevantresearch literature
4
Literature Reviews:
research purposes
• to identify the research problem, refine the
research question, and establish hypotheses
• to reveal need for research replication with
different populations, under different
conditions or with different methodologies
5
Literature Reviews:
purposes for non researchers
• to inform and guide practice
• to develop evidence based protocols
• to revise nursing curricula
• to develop policy statements and practice
guidelines
• to keep current with practice
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Where and How is the Relevant Literature
Located
the traditional method of literature searches is
the manual search through card catalogues.
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Where and How is the Relevant Literature
Located
computer based searches are making manual
searches obsolete.
literature searches are an important professional skill
to acquire as a foundation of academic work and to
facilitate the clinician to seek and critique the current
literature to support best practices.
8
Where and How is the Relevant Literature
Located
electronic searches are most frequently done online
via the internetcan also be done with a CD ROM.
but files of references on a CD ROM are limited to thedate of production,
whereas the online catalogues and journals areupdated as frequently as every week.
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Where and How is the Relevant Literature
Located
Ryerson library is online for your literature searches
and can be reached through this web sitehttp://www.ryerson.ca/library.
in addition to electronic and manual searches alsosearch the references at the back of articles, texts,and books.
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Where and How is the Relevant Literature
Located
the online library has numerous search
engines:
eg OVID and indexes that are subject based
eg. CINAHL.
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Where and How is the Relevant Literature
Located
Examples of other specialty indexes are: PUBMED,
Medline, Proquest Nursing, Ageline, AIDSLINE. Child
Abuse and Neglect, Contemporary Women’s Issues,
CPI.Q (Canadian Periodical Index Quarterly),
Dissertations Abstract, Health Star, Ingenta,
PsychINFO, Cochrane Library,
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What are the Relevant References for a
Topic?
How does an investigator determine which
references of literature are appropriate for the
specified topic?
a process with a bit of a trial and error
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What are the Relevant References for a
Topic?
but start with a systematic approach and keep notes
so that if your search is not as fruitful as you expect,
then you can make decisions about how to modify it.
Document your plan and findings and plan revisions
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What are the Relevant References for a
Topic?
authors can expect to be asked to explain the
search strategy so others will be able to follow
your decision making plan
it is comparable to an audit trail.
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Search strategy example
Research Question:
What is the effect of diabetic education on the compliancewith diet and medication in patients with diabetes?
*Note:literature searches are time consuming;
anticipate that until you become skilled in the search process itis time consuming,
even for a skilled researcher, it takes time, trial and someerror
16
Step 1. Key Terms.
Identify the key terms in the research
question.
include all concepts and any common
synonyms in the search to ensure
inclusiveness
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Step 1. Key Terms
Eg. key terms are probably ‘diabetic education’,
‘compliance’, diet, medication, & ‘diabetes’.
Is population of interest young or old, or with
Type I or II diabetes?
Are there synonyms for ‘diabetic education’?
How do we allow for these criteria in the search?
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Step 2. Search Engine
Choose a search engine and a data base
For this particular question the OVID searchengine and CINAHL data base would beappropriate
Why?
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Step 3. Enter search with limits
List the key terms in the search words
section.
set limits for your search by looking at the topic andkey terms and make decisions
regarding the limits
Full text? English only? human subjects only, yearlimits?
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Step 3. Enter search with limits
eg diabetes is a broad topic and has been generally
well researched so there may be many articles on
this subject. ---
You may decide you want only the most recent
literature on this topic. Why might you decide this?
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limits are important!
for either too many articles or not enough, or
the content retrieved is not complete, you
may want to edit your search and try again
with different limits, or a different database or
even revise the key search terms.
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limits are important!
You can also search the terms separately if a
only a few articles are found. Then you can
use the ‘Boolean’
operator term at the top of the search and
combine search findings from each key term
with either ‘and’ or ‘or’ to limit or expand the
combinations
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Step 4. Notes on retrievals
Make note of the number of articles or ‘hits’
retrieved from the search.
gives an idea of the breadth or narrowness of
your findings
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Step 4. Notes on retrievals
you may want to go back to the beginning
(yes to step 1) and revise the topic, terms, and search
strategy to either expand or limit your findings.This is a skill that takes time and practice to develop
The more you know your topic area the more adeptyou will be at efficiently searching for relevantliterature.
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Step 5. Save search strategy
. Save a copy of your search on your computer
so you will be able to retrieve it
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Step 6. Retrieve Article
Step 6. (and most fun step!) Retrieve the
article!
save or print, and read and enjoy!!!
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Step 7. Preparation of the Articles
from a Literature Review
Literature reviews can be large and overwhelming
Organize a plan to gather, collate and retrieve
pertinent information from the articles
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Preparation of the Articles from a
Literature reviewThe following is a suggested series of steps to follow:
• identify references as per process above
• screen references: title, abstract, conclusion, references
• decide if it is a primary source (written by the original author)or a secondary source
(reports by other authors)
• summarize key findings for each article
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Preparation of the Articles from a
Literature review
then: with your topic in mind and key concepts:
create a table: for each article list the pertinentinformation such as:
author (s), year, key concepts and content, studydesign, the problem, question, hypotheses, thepopulation and sample, what is known, thedescription of the findings, what are the gaps,problems, implications for practice or futureresearch, any other measure of comparisonappropriate to the reason for your search
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Preparation of the Articles from a
Literature review
• save and print a copy of your table
• write your narrative from the points of
comparison and the data in the cells
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Style of the Review
• not a subjective or emotional value laden exercise
(avoid “I think, I feel, I believe” statements)
• is an objective accounting of what is present and
what is absent in the research and or theoretical
literature.
• Key attributes of a literature review are:
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Style of the Review
• Objective: the reader could go back to the
original article and find the same information
and draw similar conclusions
• Hypotheses from research are not proved, but
they may be supported or refuted by the
findings
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Style of the Review
• Theories also are not verified, but may be either
supported or refuted by the findings.
• The review is written with the language of
tentativeness: ‘suggests’, ‘indicates’, ‘documents’,
‘demonstrates’ rather than ‘proves’.
• It is not value laden.
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How long should it be??
The length of the review depends on its purpose:
Eg: i) a thesis is lengthy;
ii) proposals are comprehensive;
iii) journal articles are succinct;
iv) meta analyses are extensive as they integrate
statistical research findings across studies, each
study is the unit of analysis
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From the Literature Review to the
Problem, Purpose and Question
the research problem is the broad issue to be pursued
the literature review develops the argument that
defines the specific problem statement that the
study will address
the literature review presents the case that supports
the presence of a problem
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Example of a literature review to
support a BPGRead RNAO BPG for Assessment and care of adults at risk of
suicide p 15 – 18
to see complexity of a literature review to support thedevelopment of a BPG for evidence based practice rather than
to support one research study.
37
From the Research
Problem Statement to the Research
Purpose
from the identification of the research problem,
the overall aim of the study or its goal is clarified…this
is the research purpose….
…yet this in itself is not measurable…so…
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From the Research Purpose to the
Research Question
the purpose is then reframed as a question to be
answered,
that question must be worded in congruence with the
chosen paradigm for the study:
either the qualitative paradigm or the quantitative
paradigm.
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Qualitative questions
are broadly worded, with the general
phenomenon of interest, and can be
answered by a narrative format and the
population specified
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Quantitative Questions
are very specifically worded, with the
relationship between or among independent
and dependent variables articulated
the wording must direct objective, numeric
measures.
41
Quantitative Questions
each word in the question,
and its placement in the question,
can have a profound change in the intent of the
question and subsequent hypotheses …and if slightly
rephrased will infer completely different
relationships among the variables
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From the Research Question to the
Hypothesis
Hypotheses are only found in quantitative studies,
never in qualitative studies.
a hypothesis tests the relationship between the
variables with statistical significance…more on that in
the next few weeks
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From the question to an ethically
conducted study
All research questions,
qualitative and quantitative,
must be investigated ethically.
44
A Definition of Ethics
Health care ethics, also known as“bioethics” has been defined as “thesystematic study of the moral dimensions—including moral vision, decisions, conductand policies—of the life sciences and healthcare, employing a variety of ethicalmethodologies in an interdisciplinarysetting”. Reich, W.T. (1995). Encyclopedia of Bioethics. New York:
Simon & Schuster MacMillan (p. xxi).
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What are some ethical dilemmas
facing nurses?
Can you suggest some ethical dilemmas that
confront you in your practice?
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What are some ethical
dilemmas facing nurses?• Tube feedings
• Testing of new products
• Prolonging life by artificial means
• Research with human subjects
(medications, treatments, etc.)
• Use of restraints
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Ethical dilemmas facing nurses
conducting research?
Amount, nature of information about the study to
share with nurses
Capitalizing on vulnerable clients/family toconduct research during stressful times
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What are some ethical dilemmas facing
nurses conducting research?
Providing a research intervention to selectedgroups only
Establishing relationships with researchparticipants that may lead to sharing of privilegedinformation
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Codes of Ethics
International Standards
– Nuremberg Code (1949) post Nazi atrocities
– Declaration of Helsinki (1964) by World MedicalAssembly
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Codes of Ethics
US: Belmont Report (1978)
National Commission for the Protection of HumanSubjects and Behavioral Research
Principles of: beneficence, human dignity, justice
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Canadian Standards
Canadian Nurses Association Centennial
Edition(2008):
Code of Ethics for Registered Nurses
—available on website:http://www.cna-
nurses.ca/CNA/practice/ethics/code/default_e
.aspx
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Content of Code of Ethics for RNs
(CNA)Values
• Safe, competent and ethical care
• Health and well-being
• Choice, informed consent
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Content of Code of Ethics for RNs
(CNA)• Dignity
• Privacy and Confidentiality
• Justice and Inclusiveness
• Accountability
• Quality Practice Environments
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Codes of Ethics (cont’d)
Policy Statement: “Ethical Conduct for
Research Involving Humans”
Tri-Council
(Canadian Institute of Health Research [CIHR];
Social Sciences and Humanities Research Council
of Canada [SSHRC] & National Sciences and
Engineering Research Council of Canada [NSERC])Note a revision may be released during the delivery of this course
• http://www.pre.ethics.gc.ca/policy-politique/tcps-
eptc/docs/TCPS%20October%202005_E.pdf
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Principles underlying
Tri Council GuidelinesRespect for Free and Informed Consent
Respect for Vulnerable Persons
Respect for Privacy and Confidentiality
Respect for Justice and Inclusiveness
Balancing Harms and Benefits
Respect for Human Dignity
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College of Nurses of Ontario
Ethical Framework for RNs and RPNs in Ontario (2009)
http://www.cno.org/docs/prac/41034_Ethics.pdf
Client well-being
Client choice
Privacy and confidentiality
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College of Nurses of Ontario
Respect for life
Maintaining commitments (To clients, to oneself; tonursing colleagues, to the nursing profession; to healthteam members, to quality practice settings)
Truthfulness
Fairness
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Ethical Principles Guiding Research
The 8 ethical principles are
summarized in 3 core values:
1. Beneficence
2. Respect for Human Dignity
3. Justice
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1. Beneficence:
“above all, do no harm”
Freedom from Harm
• Physical and/or psychological
Freedom from exploitation
• Assurance that participation in a study willnot disadvantage subjects
Risk/benefit ratio
• Degree of risk to participants should neverexceed potential benefits.
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2. Respect for Human Dignity
Right to self-determination
• Voluntary participation
• No coercion
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2. Respect for Human Dignity
Right to full disclosure
• Full nature of the study has been described
to participants.
Informed consent
• Participants have adequate information,
comprehend the information, and have
power of choice, can withdraw at any time
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3. Justice
Right to fair treatment
• Fair selection of participants
• Non-prejudicial treatment of people who decline
Right to privacy
• Anonymity
• Confidentiality
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Consent
Must include:
Information that it is a research project,
Statement of the
1. research purpose,
2. identity of the researcher,
3. expected duration
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Consent
• nature of participation, confidentiality
• a description of research procedures;
A description of harms and benefits
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Consent cont’d.
An assurance that prospective subjects are
1. free not to participate,
2. have the right to withdraw at any time withoutpenalty
3. will be given continuing opportunities fordeciding whether or not to continue toparticipate.
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Consent cont’d.
The possibility of commercialization of researchfindings, and the presence of any apparent oractual or potential conflict of interest on thepart of researchers, their institutions orsponsors.
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Institutional Review Boards
• Formal committees that review research protocols,
• May be called Human subjects committees
(In Canada called Ethics Review Boards or ResearchEthics Boards),
• Studies must be approved by REB before they canproceed,
• REB at Ryerson
http://www.ryerson.ca/ORS
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Critiquing Ethical Aspects of A
studyWere subjects exposed to any harm?
Did benefits outweigh risks?
Was there any coercion?
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Critiquing Ethical Aspects of A
studyWere vulnerable populations used?
Were participants deceived?
Was privacy safeguarded?
Was research approved and monitored by an IRB or
ERB?
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CNO Professional Standards (2008)
A nurse in a researcher role demonstrates ethicalpractice by:
• Ensuring the safety & well-being of the client aboveall other objectives, including the search forknowledge
• Ensuring client has all information necessary tomake informed decisions,
• Advocating for nursing involvement on ethicalreview boards,
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CNO Professional Standards (2008)
• Participating in ethical review of research
• Ensuring ethical guidelines are followed to protectresearch participants.
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CNO Professional Standards (2008)
• Identifying research methods useful to the nursingprofession; Identifying resources to answer
research questions; & sharing knowledge gainedthrough research
• Supporting & evaluating practice through research;facilitating the involvement of others in theresearch process; ensuring high standards are usedin the research process
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CNO Professional Standards (2008)
• Communicating research findings; promoting nursingresearch; educating staff about the research process;promoting nursing through research that improves orvalidates professional practice & advocating fornursing representation on research reviewcommittees
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References
Burns, N., Grove, S. K. (2001). The Practice of Nursing Research:
Conduct, Critique, & Utilization 4th
Edition. Philadelphia: W. B.Saunders.
Loiselle, C.G., Profetto-McGrath, J., Polit, D., F. & Beck, C. T.(2011). Canadian Essentials of Nursing Research 3rd Edition.Philadelphia: Lippincott Williams & Wilkins.
Polit, D., F. & Beck, C. T. (2004). Nursing Research: Principles and Methods 7 th Edition. Philadelphia: Lippincott Williams &Wilkins.
Reich, W.T. (1995). Encyclopedia of Bioethics. New York: Simon &Schuster MacMillan
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