Page 97 - Encyclopedia of Nursing Research

64 n CLInICAL nURSInG RESEARCH

methods to exploratory/descriptive methods, change also may be required. This has
such as grounded theory. Guided by the resulted in the need for many investigators
C meta-paradigm of nursing (person, nursing, to incorporate techniques such as time series
health, and environment), nurse scientists analysis and individual regression into their
began focusing on discovering and naming research.
the concepts of relevance for study in nursing, Understanding the human responses of
delineating the structure of these concepts, concern to nurses can also require an under-
and hypothesizing about the relationships of standing of cellular mechanisms that are best
these concepts in theoretical systems. studied in animal models and a coupling of
More recently, clinical nursing research biological techniques such as radioimmu-
has become clearly defined as a cumula- noassay and electron microscopy, with psy-
tive, evolutionary process. Investigators are chosocial techniques such as neurocognitive
still advised to derive questions from clini- assessment or self-report of psychological
cal problems, but the focus is on knowledge states. In addition, measurement of differ-
generation, specifically the generation and ent units of analysis (e.g., individual, family,
testing of middle-range theory (a theory organization) may be required, along with
that explains a class of human responses), strategies for understanding the effect of care
for example, self-help responses, symptom contexts (e.g., social, physical, organizational
experience and management, and family environments) on the human response of
responses to caregiving. Because knowledge concern. needless to say, single investigators
is viewed as cumulative, investigators usu- rarely have all the skills needed to advance
ally study various aspects of one particular the understanding of a particular concept.
concept or response; studies build on one As a consequence, single investigators are
another, and each study adds a new dimen- becoming more and more a thing of the past
sion of understanding about the concept of as teams of scientists, including nurses and
interest. This approach to clinical nursing individuals from other disciplines, collabo-
research requires investigators to use mul- rate in the knowledge-building endeavor.
tiple methodologies in their programs of nursing is concerned with human
research, including (a) inductive techniques responses and is based on the assumption
to discover knowledge from data, (b) deduc- that humans are holistic and embedded in
tive techniques to test hypotheses that are history and various environments. Clinical
either induced or deduced, and (c) instru- nursing research is about generating a body
mentation to increase the sensitivity, reliabil- of knowledge on which nurses can base prac-
ity, and validity of the measurement system tice. It is about assuring the efficacy and safety
designed for the concept. of nursing actions, substantiating the effect
The methodologies being used include of nursing actions on patient outcomes, and
qualitative methods such as ethnometh- conserving resources (costs, time, and effort)
odology, grounded theory, and phenome- while effecting the best possible results. It is
nology and quantitative methods, ranging about identifying strategies for improving
from traditional experimental methods and the health of the population and promoting
designs to less traditional methods, such as humanization within a health care environ-
path analysis and latent variable modeling. ment that has a natural tendency to be mech-
Because human responses change over time anistic, compartmentalized, and focused on
on the basis of contextual factors or treat- short-term rather than long-term gain. It is
ments (independent variables) applied by the about client advocacy, client protection, and
nurse investigator and because understand- client empowerment. The challenge of clini-
ing the nature of change often is at the crux cal nursing research is to develop an under-
of the theory building, skills in measuring standing of human response through theory