define nursing research problem

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Snapshot:  This document provides an overview of nursing research, a summary of the research process, including discussion of the popular “Iowa Model,” in addition to research terminology and a library of links.

Nursing Research: Overview & Scope

• As is true for other healthcare professionals, many nurses rely upon custom, habit or institutional norms to guide nursing practice. One of the central goals of nursing research is to subject such practice to rigorous, scientific inquiry.
• An example of basic research would be investigating the way cancer cells use signaling pathways to multiply. The research might or might not subsequently yield insights into the pathophysiology of cancer, and to new cancer treatments.
• An example of EBP would be encouraging early ambulation as tolerated for post-surgical patients because a randomized control trial demonstrated that this practice led to a statistically significant reduction in rates of pneumonia and shorter hospital stays.
• An example of QI/PI would be formulating a set of clinically validated guidelines for reducing falls, such as mandating that RN’s complete a fall-risk assessment on admission, and then measuring and re-measuring over time the implementation and impacts of such a tool on fall rates within the organization.
• Nursing research – in all its various forms – comprises one ‘leg’ of the ‘three-legged stool’ of nursing education, nursing practice, and nursing research. Ideally, these three activities are interdependent: each is mutually dependent upon the other, and contributes to betterment of the profession.

The Research Process

Research is not simply a body of knowledge. It is a dynamic process with distinct steps and phases. Below is a broad overview of that process.

• Formulate the Question. The first step in any research project is to decide what will be investigated. The best research questions are clear, concise and focused. For example, the research question “what challenges do new nurses face?” is too broad, and would be very difficult to investigate. A better question might be, “what are the leading challenges to retaining bachelors-prepared nurses in their first year of practice in a major academic medical center?”
• Define the Purpose or Goal. Nursing research is an inherently applied discipline: its purpose is to improve the breadth and depth of nursing knowledge, and to thereby improve nursing practice. When you conduct research, keep in mind your intended audience, and what you hope to achieve with your research. If you cannot answer these questions, you should return to your research question and re-formulate it.
• Choose a Theoretical Framework & Research Design. While nursing research is typically ‘practice oriented,’ it is nonetheless important to be cognizant of how the themes and concepts in your research fit together, and to spell out how you will investigate your topic for your audience. Will you be investigating individuals’ feelings and narratives? Will you be measuring the statistical significance of a particular clinical intervention? Will you be synthesizing the results of previous studies, or conducting original research? Your answers to these questions will help determine the purpose, methods, assumptions and limits of your research.
• Perform a Literature Review. Research never exists in a vacuum, and any research project should survey existing research. A competent literature review, however, is not simply a dry recitation of past findings. Rather, it should be a dynamic summary and analysis of existing knowledge that points out the links between this past work and the new research being conducted. The literature review is a useful introduction for the research audience that both situates the author’s research in a broader context, and helps to justify the importance of and need for the research question the author investigates.
• Select the Population and Sample. Regardless of your research goals, framework or methodology, you will need to define who will be included in your study, and who will not. The population or sample you investigate needs to match your research question, and just as importantly, must be available for you to study. Populations may be defined by any number of variables, such as age, gender, clinical role/status, or professional setting.
• Perform Ethical Review & Obtain Approval. An essential part of the research process is to ensure that your research topic is ethically sound, and to obtain clearances from your organization or institution to conduct the research. This concern is always important, but perhaps especially so for nurses, who often deal with private and highly sensitive medical data, access to which may be restricted by HIPAA and other regulations. You will probably need to present your research proposal to an Institutional Review Board (IRB), or other similar institution for approval. Plan ahead, because review and approval can be a lengthy process, and the panel may require that you make revisions or otherwise alter your research design.
• Collect & Analyze Data. Once you know your research design and methodology, you’ll need to gather and interpret your data. This data may be qualitative or quantitative, or a mix of both. Before you do your collection, make sure you have the knowledge and means to make sense of your data. You may need to use statistical analysis for quantitative research, or determine your methodology for analyzing subjective feelings, values and narratives for qualitative research. Again, allow time: data collection and analysis is often challenging and time-consuming.
• Organize, Write & Edit. Your research question, methodology, and population sample should help you structure your write-up of the project. One way to structure your paper is to think in terms of broad categories: introduction, methods, results, discussion, and conclusions and recommendations. Using headings and sub-headings to ‘break up’ your research is often helpful to readers. Also be sure to acknowledge the limitations of your research and areas for further inquiry.
• Compose Citations, Sources & Bibliography. Every research study must clearly acknowledge sources and properly cite them. To do so is not only important for reasons of intellectual integrity, but also because readers should be able to reference your sources should they choose to do further reading and investigation. Follow your organization or institution’s accepted format; one commonly used format in nursing research is the American Psychological Association (APA) style.
• Communicate Findings. This final stage in the research process is a crucial one. After all, research that never finds its way to its intended audience is inert. Communicating your findings often includes publication; it may also include speaking about and presenting your research to professional audiences and to the public. However this communication occurs, be open to feedback. The questions and debates your research inspires may form the basis for your next investigation, or for research conducted by others in conversation with your own.

The Iowa Model

• The Iowa Model of Evidence-Based Practice to Promote Quality Care is a practice-driven research framework that has become a standard in professional nursing and nursing research.
• The topic should be aligned with an organizational priority. If it is not, the Model prompts the nurse researcher to consider a different “trigger,” or basis for the research.
• Once a topic has been selected, the next steps in the Model dictate forming a team, and then assembling, synthesizing, reviewing and critiquing the available research on the topic.
• Should the pilot project prove successful or encouraging, the practice change can then be ‘rolled out’ and gradually integrated within the organization on a larger scale.
• The team must continue to communicate and collaborate throughout this process to select evidence-based practice driven goals, collect data, monitor processes and outcomes, and modify the practice change as appropriate.
• The team is encouraged to communicate internally to implement the change, and externally with other organizations and stakeholders to expand nursing knowledge and to encourage the wider adoption of evidence-based practice driven changes in nursing.
• First, the team could choose to pursue the practice change on the basis of weaker forms of evidence, such as case reports and expert opinion. Alternately, the team could also choose to conduct its own research, and once further research has been completed, then return to the question of whether there exists a sufficient research basis for piloting and potentially implementing the proposed practice change.
• The Iowa Model integrates theory and practice to help professional nurses discover, formulate and advocate for evidence-based practice changes. It also possesses the great advantage of never leaving practitioners without a ‘next step.’ No matter what the professional nurse and his or her team encounter, the Model has clear recommendations and guidelines for a course of action.

Research Concepts & Terminology

• Research Hypothesis. The supposition or proposed explanation a researcher wishes to investigate or test. The hypothesis should propose a relationship between two or more variables.
• Null hypothesis. The supposition that there is no relationship between the variables or phenomena a researcher is investigating.
• Control group. The group of individuals in an experiment who are not subjected to the experimental intervention. The control group serves as a benchmark for measuring the effects of the experimental intervention on the treatment group.
• Independent vs. dependent variable. In experimental research, the independent variable is the “input” variable that is believed to influence or affect the dependent variable, or “output” variable. The independent variable is therefore unchanged by experimental manipulation, whereas the dependent variable is changed by such manipulation.
• Inductive vs. deductive reasoning. Inductive reasoning is the “bottom up” process of reasoning from specific examples or observations to formulate general principles. In contrast, deductive reasoning is a “top down” process of reasoning from the basis of one or more general principles to formulate more specific hypotheses, predictions, or explanations of phenomena.
• Qualitative vs. quantitative analysis. Qualitative analysis is a way of interpreting non-numerical data to draw out the themes, meanings and relationships between phenomena. In contrast, quantitative analysis is a way of interpreting numerical data, often using statistical analysis, to assess the significance and magnitude of the causal relationships among variables.
• Observational studies. An observational study is one in which the researcher observes the behaviors of a group of subjects without intervening in the group in order to draw inferences or conclusions. Observational studies stand in contrast with experiments, such as randomized control trials, which have treatment and control groups. Observational studies include panel studies, cohort studies and case-control studies.
• Cohort study. A cohort study is a type of forward-looking observational study in which a cohort (group) of individuals is followed over time. The cohort is usually investigated at regular intervals, and the characteristics or behaviors of the cohort are compared with the general population from which the cohort is drawn.
• Case-control study. A case-control study is a type of backward-looking observational study in which a group of individuals who share a common characteristic such as a disease or medical condition (“the cases”) are compared with one or more groups who do not possess the characteristic (“the controls”) in order to identify what caused the condition in “the cases”.
• Statistical vs. practical significance. In research, a statistically significant result is one that is not the result of chance or sampling error, thereby allowing the researcher to reject the null hypothesis. However, a statistically significant result may lack practical significance if the size or impact of the finding is not large or clinically significant.
• Type I vs. Type II error. In statistics, a Type I Error or “false positive result,” is defined as incorrectly rejecting a true null hypothesis. A Type II Error or “false negative result” is defined as failing to reject a false null hypothesis. Consequently, a Type I Error will lead a researcher to falsely conclude that a meaningful relationship or effect exists, whereas a Type II Error will lead a researcher to fail to detect a meaningful relationship or effect.
• Hierarchy of Evidence. A hierarchy of evidence is a way of grading the quality and relative authority of various types of research studies. Systematic reviews and meta-analyses are typically at the top of the hierarchy, followed by randomized control trials, cohort, case control and cross sectional studies; case studies, expert opinion and anecdotal observations are typically at the bottom. Many researchers believe clinical guidelines should be based on the highest possible level of evidence.
• Meta-Analysis. A meta-analysis is “review of reviews,” or an analysis of multiple research studies in order to draw out the studies’ most well-supported findings and conclusions. Meta-analysis is employed in many systemic reviews, and according to many researchers occupies the highest level of evidence in the hierarchy of evidence.
• Double-Blind Experiment. A double-blind experiment is one in which neither the person conducting the experiment (the researcher) or the subjects of the experiment know information about the experiment that could lead to conscious or unconscious bias. For example, if a researcher was evaluating whether a drug was more effective than a placebo, in a double-blind experiment neither the researcher nor the test subjects would know which group of patients received the drug under investigation, and which received the placebo.
• External vs. internal validity. In research, a study with findings that can be easily generalized to the general population is said to possess external validity. A study with high internal validity is one in which confounding variables have been successfully eliminated, and the causal relationship under investigation has been clearly established by the researcher. These forms of validity each exist on a continuum, and a study may be high in both kinds of validity, low in both, or high in one but not in the other.
• Reliability vs. validity. Reliability is concept in statistics and psychometrics that refers to the overall consistency of a given type or method of measurement. There are several different kinds or reliability, such as inter-method reliability (the degree to which different methods for measuring a given variable are consistent), inter-rater reliability (the degree to which the measurements or ratings made by different individuals of a given variable are consistent), and test-retest reliability (the degree to which a given test yields the same results when repeated over time). In contrast, validity measures the degree to which a given measurement is measuring what a researcher intends to measure.

Links & Resources

• NINR funds and promotes professional nursing research, and trains and educates current and future nurse research professionals.
• The website has a repository of video and audio resources for nurse researchers, provides news of interest to the nursing and broader medical research community, and offers summaries of the latest funded NINR research. Check out the website’s Grant Development and Management Resources page, which includes valuable information, links and resources for both research grant applicants and funded nurse researchers.
• The organization also offers both “intramural” (on-site) and “extramural” (off-site) research programs. Research encompasses a wide range of professional nursing and practice concerns, from health disparities to disease prevention to end of life care. NINR staff can also assist in each stage of the grant application process – from preparation, to review, to funding and post-grant management.
• The American Nursing Association (ANA) offers a Research Toolkit that offers a valuable overview of and introduction to nursing research and evidence based practice. The Toolkit offers links to numerous research resources, and access to a repository of reviews of research articles. You have register as a member on the site to get access.
• Essential Nursing Resources (ENR) provides a compilation of print and online resources of interest to nurse researchers. The Table of Contents clearly breaks down resources by category, and each resource is helpfully flagged as online or print, and fee- or no-free required for access.
• The National Database of Nursing Quality Indicators (NDNQI), part of the ANA’s National Center for Nursing Quality (NCNQ), is a national nursing quality measurement program that offers hospitals nursing unit-level performance data, benchmarked against state, regional and national averages. Such data is often valuable to nurse researchers. NDNQI currently has over 1,500 participating U.S. hospitals.
• The AHRQ supports research to subject clinical practice to critical, evidence-based standards, and to improve health outcomes. AHRQ is making a concerted effort to encourage contributions to nurse researchers to this broader mission of health research.
• Nursing research funded by AHRQ is summarized on the AHRQ Nursing Research web page. AHRQ provides extramural (off-site) funding for nursing-related health research, and follows the same peer-review process as NIH (the National Institutes of Health).
• The agency offers a Research Activities Online Newsletter that summarizes study findings of interest to professional nurses and nurse researchers.

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• How to Define a Research Problem | Ideas & Examples

How to Define a Research Problem | Ideas & Examples

Published on November 2, 2022 by Shona McCombes and Tegan George. Revised on May 31, 2023.

A research problem is a specific issue or gap in existing knowledge that you aim to address in your research. You may choose to look for practical problems aimed at contributing to change, or theoretical problems aimed at expanding knowledge.

Some research will do both of these things, but usually the research problem focuses on one or the other. The type of research problem you choose depends on your broad topic of interest and the type of research you think will fit best.

This article helps you identify and refine a research problem. When writing your research proposal or introduction , formulate it as a problem statement and/or research questions .

Table of contents

Why is the research problem important, step 1: identify a broad problem area, step 2: learn more about the problem, other interesting articles, frequently asked questions about research problems.

Having an interesting topic isn’t a strong enough basis for academic research. Without a well-defined research problem, you are likely to end up with an unfocused and unmanageable project.

You might end up repeating what other people have already said, trying to say too much, or doing research without a clear purpose and justification. You need a clear problem in order to do research that contributes new and relevant insights.

Whether you’re planning your thesis , starting a research paper , or writing a research proposal , the research problem is the first step towards knowing exactly what you’ll do and why.

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As you read about your topic, look for under-explored aspects or areas of concern, conflict, or controversy. Your goal is to find a gap that your research project can fill.

Practical research problems

If you are doing practical research, you can identify a problem by reading reports, following up on previous research, or talking to people who work in the relevant field or organization. You might look for:

• Issues with performance or efficiency
• Processes that could be improved
• Areas of concern among practitioners
• Difficulties faced by specific groups of people

Examples of practical research problems

Voter turnout in New England has been decreasing, in contrast to the rest of the country.

The HR department of a local chain of restaurants has a high staff turnover rate.

A non-profit organization faces a funding gap that means some of its programs will have to be cut.

Theoretical research problems

If you are doing theoretical research, you can identify a research problem by reading existing research, theory, and debates on your topic to find a gap in what is currently known about it. You might look for:

• A phenomenon or context that has not been closely studied
• A contradiction between two or more perspectives
• A situation or relationship that is not well understood
• A troubling question that has yet to be resolved

Examples of theoretical research problems

The effects of long-term Vitamin D deficiency on cardiovascular health are not well understood.

The relationship between gender, race, and income inequality has yet to be closely studied in the context of the millennial gig economy.

Historians of Scottish nationalism disagree about the role of the British Empire in the development of Scotland’s national identity.

Next, you have to find out what is already known about the problem, and pinpoint the exact aspect that your research will address.

Context and background

• Who does the problem affect?
• Is it a newly-discovered problem, or a well-established one?
• What research has already been done?
• What, if any, solutions have been proposed?
• What are the current debates about the problem? What is missing from these debates?

Specificity and relevance

• What particular place, time, and/or group of people will you focus on?
• What aspects will you not be able to tackle?
• What will the consequences be if the problem is not resolved?

Example of a specific research problem

A local non-profit organization focused on alleviating food insecurity has always fundraised from its existing support base. It lacks understanding of how best to target potential new donors. To be able to continue its work, the organization requires research into more effective fundraising strategies.

Once you have narrowed down your research problem, the next step is to formulate a problem statement , as well as your research questions or hypotheses .

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

Methodology

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

All research questions should be:

• Focused on a single problem or issue
• Researchable using primary and/or secondary sources
• Feasible to answer within the timeframe and practical constraints
• Specific enough to answer thoroughly
• Complex enough to develop the answer over the space of a paper or thesis
• Relevant to your field of study and/or society more broadly

Research questions anchor your whole project, so it’s important to spend some time refining them.

In general, they should be:

• Focused and researchable
• Answerable using credible sources
• Complex and arguable
• Feasible and specific
• Relevant and original

Your research objectives indicate how you’ll try to address your research problem and should be specific:

A research aim is a broad statement indicating the general purpose of your research project. It should appear in your introduction at the end of your problem statement , before your research objectives.

Research objectives are more specific than your research aim. They indicate the specific ways you’ll address the overarching aim.

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Demystifying nursing research: defining the problem to be studied

Affiliation.

• 1 Oregon Health and Sciences University, School of Nursing, Portland, OR, USA.
• PMID: 12861742

Determining potential areas to examine for researchable nursing practice problems, stating the problem/question for study, and areas to consider after tentatively selecting a problem for study are all fundamental elements of sound research study design. At this point, if you have a problem in mind, write it in a declarative sentence beginning with: "The purpose of this study is to...". After the word "to" place an active verb such as examine, describe, determine, compare, or explore. This is only a suggested short list, but after writing the verb, go on to say what will be compared, explored, etc. Now you have declared how to begin your research "journey" and where you expect it to lead. It may take several tries before clearly capturing and stating the study problem. After you are satisfied with the problem statement, you are ready to conduct a focused literature review on the topic. Suggestions for efficient ways to do this will be covered in the next article in this series.

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The university of tulsa Online Blog

Trending topics in the tu online community

Nursing Research: What It Is and Why It Matters

When people think about medical research, they often think about cutting-edge surgical procedures and revolutionary new medications. As important as those advancements are, another type of research is just as vital: nursing research.

This type of research informs and improves nursing practice. In many cases, it’s focused on improving patient care. Experienced nurses who have advanced nursing degrees and training in research design typically conduct this research.

Nurse research can explore any number of topics, from symptomology to patient diet. However, no matter the focus of a research project, nurse research can improve health care in an impressive number of ways. As experts in their field, nurse researchers can pursue a wide range of unique career advancement opportunities .

Why Nursing Research Matters: Examples of Research in Action

Research drives innovation in every industry. Given that nurses are on the front line of the health care industry, the research they do can be particularly impactful for patient outcomes. 

It Can Improve Patients’ Quality of Life

Patients diagnosed with life-threatening chronic diseases often undergo intense treatments with sometimes debilitating side effects. Nursing research is vital to helping such patients maintain a high quality of life.

For example, a 2018 study led by a nurse scientist explored why cancer patients undergoing chemotherapy frequently experience severe nausea. While the physical toll of chemotherapy contributes to nausea, the study found that patients who have factors such as children to take care of, high psychological stress, and trouble performing day-to-day tasks are often much more likely to experience nausea.

By identifying the root causes of nausea and which patients are more likely to experience it, this research allows health care professionals to develop evidence-based care practices . This can include prescribing anti-nausea medications and connecting patients to mental health professionals.

It’s Central to Making Health Care More Equitabl

A Gallup survey reports that about 38% of Americans put off seeking medical treatment due to costs. Unfortunately, cost is only one factor that prevents people from seeking treatment. Many Americans don’t live close to medical providers that can meet their needs, aren’t educated about health, or encounter discrimination.

As complex as this issue is, the National Institute of Nursing Research (NINR) asserts that the country’s nurse researchers can lead the charge in tackling it. In its strategic plan for 2022 to 2026, the institute highlights the following:

• Nursing has long been one of the most trusted professions in the country.
• Nurses often interact with patients, patients’ families, and communities more frequently than other health care professionals.
• The care that nurses provide must often take environmental and social factors into account.

These traits put nurses in the position to not only research health inequity but also put their research to work in their organizations. To help make that happen, NINR often funds nurse-led research projects focused on equity and social determinants of health. With that kind of backing, the field may become more transformative than ever.

It Can Strengthen the Health Care Workforce

While nursing research can be used to improve patient care, it can also be leveraged to solve issues health care professionals face daily. Research about the state of the health care workforce during the COVID-19 pandemic is a perfect illustration.

In 2022, a team of nurse researchers published a report called Nursing Crisis: Challenges and Opportunities for Our Profession After COVID-19 in the International Journal of Nursing Practice . In it, the authors provided concrete statistics about the following:

• Mental and physical health issues many nurses encountered
• Effects of increased workloads and decreased nurse-to-patient ratios
• How many nurses were planning to leave the profession altogether

As nurses themselves, the authors also offer actionable, evidence-based solutions to these issues, such as streamlining patient documentation systems and implementing employee wellness programs.

However, this type of research isn’t just important to solving workforce issues stemming from specific emergencies, such as the COVID-19 pandemic. By publishing quantifiable data about the challenges they face, nurse researchers empower other nurses and professional nursing organizations to advocate for themselves. This can help employers enact effective policies, support their nursing staff, and draw more talented people into the profession.

Career Opportunities in Nursing Research

Nurse researchers can work in any number of administrative, direct care, and academic roles. However, because nurse research often requires clinical care and data analysis skills, jobs in this field typically require an advanced degree, such as a Master of Science in Nursing (MSN).

While many more nurse research career opportunities exist, here are four career paths nurses with research experience and advanced degrees can explore.

Nurse Researcher

Nurse researchers identify issues related to nursing practice, collect data about them, and conduct research projects designed to inform practice and policy. While they often work in academic medical centers and universities, they can work for any type of health care provider as well as health care advocacy agencies.

In addition to conducting research, these professionals typically provide direct patient care. Many also write papers for peer-reviewed journals and make presentations about their work at conferences.

Clinical Research Nurse

Despite having a similar title to nurse researchers, clinical research nurses have slightly different responsibilities. These professionals are usually in charge of providing care to patients participating in medical research projects, including clinical trials and nursing research initiatives. They also typically collect data about patient progress, coordinate care between different team members, and contribute to academic papers.

Occupational Health Nurse

Also referred to as environmental health nurses, occupational health nurses serve specific communities, such as professionals in a particular industry or people who live in a particular area. They often educate their communities about relevant health risks, advocate for stronger health and safety regulations, and run wellness programs.

To carry out their duties, occupational and environmental health nurses must typically research health trends about the people they serve, including living and working conditions that put them at risk for illness or injury. They can work for private companies and government agencies.

Nurse Educator

Nurse educators prepare new nurses to enter the workforce or train experienced nurses in more advanced techniques. This can include teaching classes and providing on-the-job training. They often work for colleges, universities, and large health care providers.

While their duties don’t always include research, nurse educators must keep up with the health care industry’s needs and new patient care practices. This is so they can provide relevant education themselves and help their organizations design up-to-date curricula.

Make Nursing Research a Part of Your Journey

Conducting and implementing nurse research is a collaborative effort. It takes a team of informed leaders, skilled analysts, and creative educators to create effective, evidence-based policies. Those interested in pursuing nurse research should consider The University of Tulsa’s online MSN program , which can prepare you to fill any one of those roles and more.

All of TU’s MSN students take classes on research and evidence-based practices. However, the program’s specialty tracks allow students to take their studies in multiple research-oriented directions. For instance, if you’re interested in collecting and interpreting clinical data, you can choose the Informatics and Analysis track. If you have a passion for public health policy, the Public Health and Global Vision track includes classes on population health and epidemiology.

Delivered in a flexible online format, this program can be a great option for working nurses and nontraditional students alike. To find out more, read about TU’s admission policies and request more information today.

Recommended Readings

A Nurse Educator’s Role in the Future of Nursing

How Global Health Nursing Supports Population Health

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NURSING RESEARCH

Chapter 4 NURSING RESEARCH OBJECTIVES • Define the key terms/concepts • Define nursing research • Explain the importance of research in nursing • Compare the various ways to acquire knowledge • Understand the basic differences between qualitative and quantitative approaches in research • Outline the steps in conducting research • Describe the way research, education and practice relate to each other • Identify the importance of critical thinking and critical reading when undertaking a research project • Discuss the importance of informed consent and ethics in relation to research • Define evidence-based practice • Explain how Enrolled Nurses (ENs) can participate in nursing research • Identify future trends in nursing research KEY TERMS/CONCEPTS data analysis data collection ethical principles hypothesis informed consent nursing research qualitative research quantitative research reliability research design research problem research question validity variables CHAPTER FOCUS Nursing theory and education are recognised as the main contributors to the development of an accountable and professional nurse in the health care environment. Research is also recognised by health care professionals as being equally important in influencing practice by informing decisions about the delivery of care to clients and their families. Today’s evidence-based nursing practice integrates education, theory, practice and the findings from research to provide quality health care. Nurses are also acknowledging the need to develop skills in critically appraising research literature to enable consideration of its application to clinical practice (Beanland et al 2004). The purpose of this chapter is to enable Enrolled Nurses (ENs) to develop an appreciation of the significance of research to them as nurse practitioners. It introduces the principles of nursing research, basic components of a research proposal, guidelines to critiquing a research article, and an overview of both qualitative and quantitative research. LIVED EXPERIENCE I always thought that research was something that academics did working in universities or laboratories. But I got excited when we started learning about evidence-based research in class, as I can now see how to use it in the clinical area and I also know that I will be giving the very latest nursing care to clients in my care. Melissa, Enrolled Nurse student NURSING RESEARCH The term ‘research’ refers to a systematic way of studying or examining issues so that the knowledge about that issue is validated. It requires an understanding of the existing knowledge about the issue so that new knowledge can be developed. There are many words and terms specifically related to research referred to in this chapter, which are covered in Table 4.1 (later in the chapter). TABLE 4.1 Common research terms Bias Any influence that may alter the outcomes of a research study Clinical nursing research Nursing research that has a direct impact on nursing interventions with clients Data Measurable bits of information collected for the purpose of analysis Data collection Gathering of information necessary to address the research problem Deductive reasoning Logical system of thinking that starts with the whole and breaks it down into its component parts Dependent variable A variable that is affected by the action of the independent variable Ethics committee Committee responsible for review of research proposals to ensure that human subjects are protected from harm Hypothesis Statement of a predicted relationship or difference between two or more variables. A hypothesis contains at least one independent and one dependent variable Independent variable A variable that causes a change in the dependent variable Inductive reasoning Logical system of thinking that begins with the component parts and builds them into a whole Informed consent An agreement by a research subject to participate voluntarily in a study after being fully informed about the study and the risks and benefits of participation Instrument Device or technique used to collect data in a research study, e.g., questionnaires or interviews Literature review A critical summary of available theoretical and research literature on the selected research topic. It places the research problem for a particular study in the context of what is currently known about the topic Nursing research Research usually conducted by nurses to generate knowledge that informs and develops the discipline and practice of nursing Population All known subjects that possess a common characteristic of interest to a researcher Problem statement A statement that describes the purpose of a research study, identifies key concepts and sets study limits Qualitative research Used to examine subjective human experiences by using non-statistical methods of analysis Quantitative research The systematic process used to gather and statistically analyse information that has been measured by an instrument and converted to numerical data Reliability Characteristic of a good instrument; the assessed degree of consistency and dependability Research A systematic process using both inductive and deductive reasoning to confirm and refine existing knowledge and to build new knowledge Research design The overall plan for collecting data in a research study Research process An orderly series of phrases identifying steps that allow the researcher to move from asking a question to finding an answer Research question Use of an interrogative format to identify the variables to be studied and possible relationships or differences between those variables Sample A subset of a population selected to participate in a research study Validity A characteristic of a good instrument; the extent of an instrument’s ability to measure what it states it will measure Variable A concept, characteristic or trait that varies within an identified population in a research study ( Borbasi et al 2008 ) Nursing research involves a systematic search for and validation of knowledge about issues important to the nursing profession and links theory, education and practice. Nursing research is important for: • Validating nursing as a profession • Documenting the effectiveness of nursing interventions • Providing a scientific knowledge base for practice • Demonstrating accountability for the profession. Research-based or evidence-based practice is essential if the nursing profession is to deliver safe, effective and efficient care. The ultimate goal of nursing is to provide evidence-based care that promotes quality outcomes for clients, families, health care providers and the health care system. Burns and Grove (2004) describe evidence-based practice as involving the use of collective research findings in: • Promoting the understanding of clients’ and families’ experiences with health and illness • Implementing effective nursing interventions to promote client health • Providing quality, cost-effective care within the health care system. EVIDENCE-BASED PRACTICE Evidence-based nursing is a clinical activity based on the belief that decisions about the delivery of care to clients should be informed by the best available and current scientific evidence (Beanland et al 2004). Another definition of evidence-based practice is that it is a process within which clinical decisions are made by practitioners using the best available research evidence, their clinical expertise and client preferences, with consideration also of available and finite resources (Schneider et al 2007). The five steps universally accepted as being necessary for evidence-based practice are presented in Clinical Interest Box 4.1 . Clinical Interest Box 4.2 explains evidence-based practice. CLINICAL INTEREST BOX 4.1 Steps in evidence-based practice 1. Ask a focused question. 2. Assess appropriate evidence. 3. Appraise evidence for validity, impact and precision. 4. Apply evidence accounting for patient values/preferences, clinical and policy issues. 5. Audit your practice/personal skills. (Source: Jackson et al 2006; Sackett et al 2000 as modified in Schneider et al 2007: 305) CLINICAL INTEREST BOX 4.2 Evidence-Based Practice What Is Evidence-Based Practice? A process of: • synthesising research evidence • designing clinical practice guidelines • implementing practice changes • evaluating outcomes Why Do We Need Evidence-Based Practice? • Rapid increase in amount of information • Rapid increase in healthcare costs • Determination of efficient and effective healthcare practices • Increased emphasis on performance and outcome standards Where Is Evidence Found? • Published research • Systematic reviews (e.g. Cochrane Collaboration; available: http://www.cochrane.org/ ) * • Special collections of EBP resources (e.g. The Joanna Briggs Institute; available: http://www.joannabriggs.edu.au ) * Descriptions can be found at this website, but access to systematic reviews is by subscription only. (Brown et al 2008: 13) THE EVOLUTION OF NURSING RESEARCH As early as 1854, Florence Nightingale demonstrated the importance of research in the delivery of nursing care. When Nightingale arrived in the Crimea in 1854, she found the military hospital barracks overcrowded, filthy and lacking in food, drugs and essential medical supplies. Men were dying from starvation and diseases such as cholera and typhus because of these conditions. By systematically collecting, organising and reporting data, Nightingale was able to implement sanitary reforms and prove a significant reduction in mortality rates. This is considered to be the first nursing research study (Kozier et al 2007). Research was slow to develop in nursing, with little formal research carried out by nurses until the late 1940s. Nursing schools evolved from military and religious roots and stressed order and obedience. Training was viewed as an apprenticeship, with long hours, and nurses had little say in their own training or work. Only when nursing began to move towards advanced education and affiliation with university settings did nursing research begin to emerge. This move began in the USA. In the 1960s and 1970s the number of nurses with advanced degrees and research skills increased and the push for doctoral preparation in nursing began. Nurses began to turn to nursing care and clinical practice to provide questions for research. Nursing theories evolved that attempted to describe and explain the practice of nursing and these theories began to be tested by nurse researchers. Practice-related research flourished and by the end of the 1970s two new research journals were launched in the USA to handle the nursing research explosion (Borbasi et al 2004). In Australia and New Zealand, nursing research awareness remained relatively low until nursing moved into the tertiary education sector in the 1970s and 1980s. This move was accompanied by a major increase in the level of research activity, which was directed at educational, disciplinary or professional issues, and research into other disciplinary areas of relevance to nursing. It is only recently that research education delivered to nurses in Australia and New Zealand has begun to prepare nurses to understand the relationship between research evidence and nursing practice, and how to go about incorporating research findings into practice (Crisp & Taylor 2005). Some ideas that have been tested and demonstrated to be useful in practice are: moist wound healing; pressure-relieving devices for the prevention of pressure ulcers; client information to improve self care and healthy lifestyles; communication with people who are dying; and nutritional support of older people in hospital (Brown et al 2008). THE FUTURE OF NURSING RESEARCH The value of research studies that increase understanding of clinical phenomena and provide direction for defining programs of research is well recognised and flourishing in Australia and New Zealand. Nurse researchers and nurse leaders are visibly involved at the national level, participating in policy making, representing nursing on expert panels and organisations such as the National Health and Medical Research Council (NHMRC) and lobbying for funding (Beanland et al 2004). Magnet Hospitals are emerging in both Australia and New Zealand. The concept of a ‘Magnet Hospital’ is to develop and sustain an environment where nursing- and midwifery-related evidence-based practice and practice change are more likely to occur. Magnet Hospitals aim to provide a commitment to staff development and training, effective systems for implementing and evaluating quality-based treatment and care, and sustainable long term resourcing (Schneider et al 2007). Borbasi et al (2004) state that, with the development of a national organisation for nursing research, research priorities in the 21st century are likely to be directed at nursing practice and that there will be an increased emphasis on building on the results of completed studies. They also believe that there will also be a greater emphasis on finding ways to utilise the results of nursing research in the course of day-to-day practice. RESEARCH METHODS Nursing research focuses on the full range of human experiences and responses and is directed towards helping well individuals improve their health status and stay healthy, as well as assisting clients who are sick or disabled by an illness to maintain or improve their health (Crisp & Taylor 2005). The major factor that affects whether a nursing researcher uses systematic, controlled methods for studying events or problems is the extent to which he or she wishes to study the way that characteristics or variables (see Table 4.1 ) are different, or the way that one variable is predictive of (causally associated with) another. These studies are well organised and follow a specific procedure to enable other researchers to reproduce the study or examine the evidence and achieve the same outcomes. To guide the design of a research study, nurse researchers may create a hypothesis or statement about what they expect to see before conducting the study (Crisp & Taylor 2005). Nurse researchers use many methods because nurses are interested in acquiring knowledge about a wide range of human needs and responses to health problems. For example, a different research method may be used by a nursing researcher interested in developing a deeper understanding of a phenomenon and how it may be experienced by clients, such as helping women deal with the consequences of incontinence after childbirth. Most methods used are either quantitative or qualitative in nature (Crisp & Taylor 2005). QUANTITATIVE METHODS Quantitative research methods involve the use of numbers and statistical analysis. This is a process used to gather and analyse information that has been measured by an ‘instrument’, such as a questionnaire, and converted to numerical data. Quantitative nursing research is the investigation of nursing phenomena that lend themselves to a precise measurement, such as pain severity, rate of wound healing, etc (Crisp & Taylor 2005). Box 4.1 describes different ways of using quantitative methods. Box 4.1 Types of research that use quantitative methods CORRELATIONAL RESEARCH Studies that explore the patterns of interrelationships among variables of interest, without any active intervention by the researcher. Correlational methods are used in testing predictive relationships among variables, for testing models or theories that seek to explain complex patterns of relationships, and for testing the most effective and efficient means of achieving positive health outcomes. DESCRIPTIVE RESEARCH Studies in which the aim is to accurately portray characteristics of individuals, situations or groups and the frequency with which certain events or characteristics occur. The major goal of this form of research is simply to describe what is seen in order to identify variables that may be of interest in future investigations. EXPERIMENTAL OR QUASI-EXPERIMENTAL RESEARCH Studies in which the investigator controls the independent variable and randomly assigns subjects to different conditions. The major goal of this research is to determine causal relationships among the variables through a controlled investigation in which only the independent variable can be the cause of changes in the dependent variable. EXPLORATORY RESEARCH Studies designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about the relationships among phenomena. The major goal of this research is to explore what is seen in order to identify relationships among variables that might be of interest in future investigations. EVALUATION RESEARCH Studies that test how well a program, practice or policy is working. The major goal of this form of research is determining the success of a program. This type of research can determine specifically why a program was successful. When programs are unsuccessful, evaluation research can assist in identifying problems with the program, why it was not successful or even barriers to implementation of programs. SURVEY RESEARCH Studies designed to obtain information from populations regarding prevalence, distribution and interrelation of variables within the study population. They may be conducted for the general purposes of obtaining information about practices, opinions, attitudes and other characteristics of individuals. The major goal of this form of research is simple description or the accumulation of a large amount of data to describe the population being studied, as well as the topic of study. ( Crisp & Taylor 2005 ) In quantitative research, the researcher changes one set of variables and observes the outcome or its influence on other variables. Variables are changeable qualities, such as characteristics of people or situations that can change or vary for many reasons. Temperature, pulse, respiration, blood pressure, height and weight are examples of variables. The variable that the researcher controls or manipulates is called the independent variable. The variable that varies or changes because of this is called the dependent variable. For example, consider the statement: ‘Sitting upright in bed does not make breathing easy in a client with asthma’. The independent variable relates to sitting the client in different positions, such as lying flat, semi-recumbent, lateral and upright positions. This is the variable the researcher can manipulate to study its influence on the dependent variable. The dependent variable is the measurement of breathing. QUALITATIVE METHODS Qualitative research is used to describe information obtained in a non-numerical form, such as data obtained from interviews. Qualitative nursing research is the investigation of phenomena that are not easily quantified or categorised, in which inductive reasoning is used to develop generalisations or theories from specific observations or interviews (Crisp & Taylor 2005). See Box 4.2 for the different ways of using qualitative methods. Box 4.2 Types of research that use qualitative methods ( Crisp & Taylor 2005 ) ACTION RESEARCH Studies that attempt to make qualitative research more humanistic, holistic and relevant to the lives of human beings. The major goal of this research is working in collaboration with participants in a manner that brings about desired change(s). CRITICAL SOCIAL RESEARCH Studies that empower individuals involved in this research by attempting to confront unjust power structures within a specific context or society. The major goal of this research is the challenging of dominant constructions of reality and the societal structures that maintain the status quo and determine allocation of power and resources. DESCRIPTIVE RESEARCH Studies in which the objective is to accurately portray characteristics of individuals, situations or groups and the frequency with which certain events or characteristics occur. The major goal of this research is to describe what is seen in order to detect phenomena that might be of interest in future research. EXPLORATORY RESEARCH Studies designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about the relationships among phenomena. The major goal of this research is to explore what is seen in order to identify relationships among phenomena that might be of interest in future research. HISTORICAL RESEARCH Systematic studies designed to establish facts and relationships concerning past events. The major goal of this research may be either a descriptive account of what occurred and the facts surrounding the event(s), or a critical approach may be taken in which the researchers challenge the dominant interpretations of facts. INTERPRETATIVE RESEARCH Studies in which human experience is investigated to generate deeper understanding of the phenomena of interest. The major goal of this research is the exploration of the numerous ways human beings experience the complex world in which they live. Qualitative researchers may wish to examine individual lives and their stories and behaviour, organisations and their functioning, or cultures and their interactions and social movement. As the study methodology embraces the examination of subjective phenomena, these findings are only considered to be representative of a particular person or group of people, and in a particular setting, and not reflective of other people or other settings (Borbasi et al 2004). There are strengths in both quantitative and qualitative approaches. The quantitative approach can support a theory or argue to disprove it, and can be very useful, for example, when hospitals or governments want to introduce policy changes. The qualitative approach, by contrast, has a human focus and allows researchers to know their subjects and collect information about attitudes and satisfaction levels that are vital to improve care provided by nurses. THE RESEARCH PROCESS There are several steps in conducting either quantitative or qualitative research. STEP 1. THE RESEARCH PROBLEM The research problem is refined through a process that proceeds from identifying a general idea of interest to defining a specific topic. A preliminary literature review reveals related factors that appear critical to the research topic. The significance of the research problem must be identified in terms of its potential contribution to clients, nurses and the medical community (Beanland et al 2004). Choosing the topic of interest may develop from: • Discussing an issue of common interest with a colleague • Reading about an issue in a journal, text or newspaper • An aspect of practice being introduced for the first time • An aspect of practice that may have been observed but needs to be validated • Areas of work that may need to change • Wanting to repeat a study that has already been conducted, to check the results. STEP 2. THE PURPOSE The purpose of the study states the aims or goals that the investigator hopes to achieve with the research. It also suggests the way in which the researcher sought to study the problem. STEP 3. LITERATURE REVIEW The overall purpose of conducting a review of the literature is to develop a strong knowledge base to carry out research and other consumer research activities in the educational and clinical practice settings. It is a broad, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communications (Beanland et al 2004). The literature review provides a way of checking what has already been studied in relation to the proposed study. It can also provide an understanding of the procedures, methods of analysis and variables that can influence the study (see Box 4.3 ). Box 4.3 Overall purpose of a literature review • Determines what is known and not known about a subject, concept or problem. • Determines gaps, consistencies and inconsistencies in the literature about a subject, concept or problem. • Discovers unanswered questions about a subject, concept or problem. • Discovers conceptual traditions used to examine problems. • Uncovers a new practice intervention(s) or provides evidence for current practice intervention(s). • Generates useful research questions and hypotheses for the discipline. • Describes the strengths and weaknesses of designs or methods of enquiry and instruments used in earlier works. • Determines an appropriate research design or method (instruments, data collection and analysis methods) for answering the research question(s). • Determines the need for replication of a well-designed study or refinement of a study. • Promotes development of new or revised practice protocols, policies and projects or activities related to nursing practice and to the discipline. ( Schneider et al 2007 ) How to search successfully for information To conduct a successful search for information about a particular subject, the researcher needs to define the topic of interest, select appropriate search resources and selectively review and evaluate the materials produced by a search (Borbasi et al 2004). A search is conducted using indexes, abstracts and catalogues to find information about specific subjects. Books tend to give standard accepted information and practices. They provide good baseline data on a subject. Journals, however, provide more current information than books. They report changing trends and practices. Several electronic indexes are used for nursing journals ( Box 4.4 ), including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Index Medicus (a comprehensive index of peer-reviewed medical journals compiled by the US National Library of Medicine) and its online counterpart, MEDLINE (Medical Literature Analysis and Retrieval System [MEDLARS] online). Each index has a primary area of focus and advantages and limits. Electronic databases operate with a special vocabulary. However, the computer helps the researcher to define the preferred terms to use in a search. It is important to make the search as precise as possible; if there are several key terms, they should be used. Other limits such as gender, age and/or time factors, should also be set. Ask for assistance from the librarian if there is difficulty finding information. Many professional information sources are also available on the internet, where there is access to a wide variety of databases, client and nursing education resources, as well as some nursing journals (see Online Resources at the end of this chapter). Box 4.4 Examples of nursing research journals • Australian Journal of Advanced Nursing

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Nursing Research Definition: The Importance and Nurses Roles

The Art of Knowing More

The moment you ask a question and look for answers, you are simply engaging yourself into research. This “everyday research” continuously aims for the betterment of our day to day life. Our quest for change is an endless challenge to unearth knowledge, it is human nature to know more. Everybody has their innate ability to become a researcher, but only a formal research education and training can unleash that researcher within you.

Research originated from its meaning literally “to search again” or “to examine carefully”. Hence, Grove and colleagues (2015) define research as a diligent, systematic inquiry, or study that validates and refines existing knowledge to develop new knowledge. Fundamentally speaking, research is a discipline utilizing the systematic body of knowledge and organized methods of inquiry to answer questions and solve problems, which aims to gain knowledge for the benefit of the people (Polit & Beck, 2018).

The research applied to nursing practice, describes as the systematic inquiry designed to develop trustworthy evidence on issues of importance to the nursing profession such as nursing practice, administration and informatics (Polit & Beck, 2018). Nieswiadomy & Bailey (2018), refers to nursing research as a systematic objective process of analyzing phenomena of importance to nursing which includes practice, education and administration. Grove, et al. (2015) elaborates nursing research as a scientific process that validates and refines existing knowledge to generates new knowledge through planning, organization, and persistence focuses on nursing education, administration, health care delivery, characteristics of nurses, and their roles.

Nursing research directly or indirectly influences clinical nursing practice. Primarily, clinical nursing research rooted in the questions and problems encountered from our day to day living to acclimate the changing needs of the people it serves.

Importance of Research in the Nursing Profession

The Northeastern State University in Oklahoma (2020) stated three major significance of research in the nursing profession, such as:

1. Information Literacy

Information literacy is the comprehension to understand information and the ability to transform it into a new knowledge of higher-level which you can utilize for development and improvement. This skill is not only reading comprehension but the ability to effectively process information for interpretation, study comparison, analyze results and think critically which can aid nurses on their problem-solving and decision-making competencies.

2. Teaching Information Literacy

Teaching information literacy will bring the academe into a higher level of learning using different modes of teaching and instructions. Research is being utilized by nursing schools to strengthen research departments in helping the students to be more competent in acquiring information literacy. Problem-based learning modality allows the students to develop critical thinking skills and problem-solving ability when they are challenged clinically to prepare them for their practice in the future.

3. Evidence-Based Practice

Research will correct misconceptions, improve patient care, upgrade the health care system, revamp health workers working condition and develop new treatment protocols and clinical pathways for safe and efficient nursing practice. The safe and efficient nursing practice must have a scientific basis that undergoes rigid study and experimentation. A safe practice must be the results of research proving its safety and efficacy to establish best practices in the profession.

As research adapts to the changing needs of the society in terms of health care delivery, health care environment, patient care needs, population health demands and health-related regulations of the government — breakthroughs make the practice continuously evolves. Research brings constant change, forcing nurses to keep themselves abreast to changes for them to stay in their field. Research brings no room for stagnation in the practice.

History of Nursing Research

Research burgeon along with the beginning of nursing in the 1800s (Mackey & Bassendowski, 2017). It was Florence Nightingale who pioneered evidence-based practice corroborated by her documentation on notes on nursing. Advances in technology are the major catapult of nursing research to evolve as the nursing discipline makes headway in the medical community.

A long time had passed before the nursing community put the research activity into cognizance. In the year 1950’s, Division of Nursing Resources started to fund research studies with the first journal publication of Nursing Research in 1952 and put up several research centers around the United States of America which eventually leads to the construction of National Center for Nursing Research in 1985 (Tappen, 2016).

After the introduction of research into publications, nurses were involved in the development of models, conceptual frameworks, and theories to guide nursing practice. It was late 1960s and 1970s when nursing theorists’ were born, with the first publication of nursing theorists’ work and related researches on the journal Advances in Nursing Science in 1978 (Grove, et al., 2015). The nursing theorists’ work gives rise to a clear pathway for future nursing researches. 

The 1990s became the era of journals for nurse researchers wherein speciality journals launched to publish research articles, and evidence-based practice was integrated to nursing (Polit & Beck, 2018). 

Roles of Nurses’ in Research

The prestige of being a researcher coined around with academics as work of the intelligent mind. However, the wide acceptance of the evidence-based practice in the nursing profession seemingly attracts an increasing demand for nurse practitioners conducting research studies to improve patient care and working condition.

Polit & Beck (2018) elaborated the continuum of research participation of nurses in an evidence-based practice environment that includes research consumers and research producers. They refer nursing research consumers or users for the nurses who read studies and stay up-to-date on the latest researches to apply it in their practice. On the other hand, are the producers of nursing research who diligently and patiently formulate, design and undertake research studies.

Conversely, Polit & Beck (2018) added the roles of the contributors on the continuum of research activities such as:

• Contribute an idea for a clinical inquiry
• Assist in collecting research information
• Offer advice to clients about participating in a study
• Search for research evidence
• Discuss the implications of a study

A research team is a group of researchers in association with a research project. Nieswiadomy & Bailey (2018) enumerates the composition of a research team wherein nurses can assume many roles, and these include:

• Principal investigator
• Member of a research team
• Identifier of researchable problems
• Evaluator of research findings
• User of research findings
• Patient/client advocate during studies
• Subject/participant in studies

Participation of all nurses in different research activities plays a vital role in generating a scientific knowledge basis in an evidence-based practice environment. Research will free the nurses from the limitations set by the four-cornered room of the hospital. It will open new doors of opportunities to go beyond our traditional scope. Reaching beyond your reach is the “art of knowing more”.

• Grove, S.K., Gray, J.R. & Burns, N. (2015). Understanding Nursing Research: Building An Evidence-Based Practice, 6 th Missouri: Elsevier Saunders.
• Polit, D.F. & Beck, C.T. (2018). Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 9 th Wolters Kluwer.
• Nieswiadomy, R. & Bailey, C. (2018). Foundations of Nursing Research, 7 th New York: Pearson Education, Inc.
• Northeastern State University, Oklahoma. (2020). Why do nurses need research? Retrieved on 13 September 2020 from https://nursingonline.nsuok.edu/articles/rnbsn/why-nurses-need-research.aspx#:~:text=It%20is%20important%20for%20nurses,to%20develop%20their%20own%20conclusions.
• Mackey, A. & Bassendowski, S. (2017). The History of Evidence-Based Practice in Nursing Education and Practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009
• Tappen, R. (2016). Advanced Nursing Research: From Theory to Practice, 2nd ed. Jones & Bartlett Learning.

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Nursing Research

• First Online: 24 January 2019

Cite this chapter

• Lars-Petter Jelsness-Jørgensen 3 , 4  

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Nurses play an increasingly active role in clinical research in IBD. By reviewing existing literature on the topic, this chapter provides a brief overview of some main concepts related to research in nursing. In addition, the chapter provides some general advice in relation to implementing evidence-based practice, as well as carrying out independent research.

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Jelsness-Jørgensen, LP. (2019). Nursing Research. In: Sturm, A., White, L. (eds) Inflammatory Bowel Disease Nursing Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-75022-4_42

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Why has research-based practice become so important and why is everyone talking about evidence-based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?

Part of the difficulty is that although nurses perceive research positively, 2 they either cannot access the information, or cannot judge the value of the studies which they find. 3 This journal has evolved as a direct response to the dilemma of practitioners who want to use research, but are thwarted by overwhelming clinical demands, an ever burgeoning research literature, and for many, a lack of skills in critical appraisal. Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4

Tiptoeing in the wake of the movement for evidence-based medicine, however, we must ensure that evidence-based nursing attends to what is important for nursing. Part of the difficulty that practitioners face relates to the ambiguity which research, and particularly “scientific” research, has within nursing. Ambiguous, because we need to be clear as to what nursing is, and what nurses do before we can identify the types of evidence needed to improve the effectiveness of patient care. Then we can explore the type of questions which practitioners need answers to and what sort of research …

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Educational resources and simple solutions for your research journey

What is a Research Problem? Characteristics, Types, and Examples

A research problem is a gap in existing knowledge, a contradiction in an established theory, or a real-world challenge that a researcher aims to address in their research. It is at the heart of any scientific inquiry, directing the trajectory of an investigation. The statement of a problem orients the reader to the importance of the topic, sets the problem into a particular context, and defines the relevant parameters, providing the framework for reporting the findings. Therein lies the importance of research problem s.  

The formulation of well-defined research questions is central to addressing a research problem . A research question is a statement made in a question form to provide focus, clarity, and structure to the research endeavor. This helps the researcher design methodologies, collect data, and analyze results in a systematic and coherent manner. A study may have one or more research questions depending on the nature of the study.   

Identifying and addressing a research problem is very important. By starting with a pertinent problem , a scholar can contribute to the accumulation of evidence-based insights, solutions, and scientific progress, thereby advancing the frontier of research. Moreover, the process of formulating research problems and posing pertinent research questions cultivates critical thinking and hones problem-solving skills.   

Table of Contents

What is a Research Problem ?  

Before you conceive of your project, you need to ask yourself “ What is a research problem ?” A research problem definition can be broadly put forward as the primary statement of a knowledge gap or a fundamental challenge in a field, which forms the foundation for research. Conversely, the findings from a research investigation provide solutions to the problem .  

A research problem guides the selection of approaches and methodologies, data collection, and interpretation of results to find answers or solutions. A well-defined problem determines the generation of valuable insights and contributions to the broader intellectual discourse.  

Characteristics of a Research Problem  

Knowing the characteristics of a research problem is instrumental in formulating a research inquiry; take a look at the five key characteristics below:  

Novel : An ideal research problem introduces a fresh perspective, offering something new to the existing body of knowledge. It should contribute original insights and address unresolved matters or essential knowledge.   

Significant : A problem should hold significance in terms of its potential impact on theory, practice, policy, or the understanding of a particular phenomenon. It should be relevant to the field of study, addressing a gap in knowledge, a practical concern, or a theoretical dilemma that holds significance.  

Feasible: A practical research problem allows for the formulation of hypotheses and the design of research methodologies. A feasible research problem is one that can realistically be investigated given the available resources, time, and expertise. It should not be too broad or too narrow to explore effectively, and should be measurable in terms of its variables and outcomes. It should be amenable to investigation through empirical research methods, such as data collection and analysis, to arrive at meaningful conclusions A practical research problem considers budgetary and time constraints, as well as limitations of the problem . These limitations may arise due to constraints in methodology, resources, or the complexity of the problem.  

Clear and specific : A well-defined research problem is clear and specific, leaving no room for ambiguity; it should be easily understandable and precisely articulated. Ensuring specificity in the problem ensures that it is focused, addresses a distinct aspect of the broader topic and is not vague.  

Rooted in evidence: A good research problem leans on trustworthy evidence and data, while dismissing unverifiable information. It must also consider ethical guidelines, ensuring the well-being and rights of any individuals or groups involved in the study.

Types of Research Problems  

Across fields and disciplines, there are different types of research problems . We can broadly categorize them into three types.  

• Theoretical research problems

Theoretical research problems deal with conceptual and intellectual inquiries that may not involve empirical data collection but instead seek to advance our understanding of complex concepts, theories, and phenomena within their respective disciplines. For example, in the social sciences, research problem s may be casuist (relating to the determination of right and wrong in questions of conduct or conscience), difference (comparing or contrasting two or more phenomena), descriptive (aims to describe a situation or state), or relational (investigating characteristics that are related in some way).  

Here are some theoretical research problem examples :   

• Ethical frameworks that can provide coherent justifications for artificial intelligence and machine learning algorithms, especially in contexts involving autonomous decision-making and moral agency.  
• Determining how mathematical models can elucidate the gradual development of complex traits, such as intricate anatomical structures or elaborate behaviors, through successive generations.  
• Applied research problems

Applied or practical research problems focus on addressing real-world challenges and generating practical solutions to improve various aspects of society, technology, health, and the environment.  

Here are some applied research problem examples :   

• Studying the use of precision agriculture techniques to optimize crop yield and minimize resource waste.  
• Designing a more energy-efficient and sustainable transportation system for a city to reduce carbon emissions.  
• Action research problems

Action research problems aim to create positive change within specific contexts by involving stakeholders, implementing interventions, and evaluating outcomes in a collaborative manner.  

Here are some action research problem examples :   

• Partnering with healthcare professionals to identify barriers to patient adherence to medication regimens and devising interventions to address them.  
• Collaborating with a nonprofit organization to evaluate the effectiveness of their programs aimed at providing job training for underserved populations.  

These different types of research problems may give you some ideas when you plan on developing your own.  

How to Define a Research Problem  

You might now ask “ How to define a research problem ?” These are the general steps to follow:   

• Look for a broad problem area: Identify under-explored aspects or areas of concern, or a controversy in your topic of interest. Evaluate the significance of addressing the problem in terms of its potential contribution to the field, practical applications, or theoretical insights.
• Learn more about the problem: Read the literature, starting from historical aspects to the current status and latest updates. Rely on reputable evidence and data. Be sure to consult researchers who work in the relevant field, mentors, and peers. Do not ignore the gray literature on the subject.
• Identify the relevant variables and how they are related: Consider which variables are most important to the study and will help answer the research question. Once this is done, you will need to determine the relationships between these variables and how these relationships affect the research problem . 
• Think of practical aspects : Deliberate on ways that your study can be practical and feasible in terms of time and resources. Discuss practical aspects with researchers in the field and be open to revising the problem based on feedback. Refine the scope of the research problem to make it manageable and specific; consider the resources available, time constraints, and feasibility.
• Formulate the problem statement: Craft a concise problem statement that outlines the specific issue, its relevance, and why it needs further investigation.
• Stick to plans, but be flexible: When defining the problem , plan ahead but adhere to your budget and timeline. At the same time, consider all possibilities and ensure that the problem and question can be modified if needed.

Key Takeaways  

• A research problem concerns an area of interest, a situation necessitating improvement, an obstacle requiring eradication, or a challenge in theory or practical applications.   
• The importance of research problem is that it guides the research and helps advance human understanding and the development of practical solutions.  
• Research problem definition begins with identifying a broad problem area, followed by learning more about the problem, identifying the variables and how they are related, considering practical aspects, and finally developing the problem statement.  
• Different types of research problems include theoretical, applied, and action research problems , and these depend on the discipline and nature of the study.  
• An ideal problem is original, important, feasible, specific, and based on evidence.  

Frequently Asked Questions  

Why is it important to define a research problem?  

Identifying potential issues and gaps as research problems is important for choosing a relevant topic and for determining a well-defined course of one’s research. Pinpointing a problem and formulating research questions can help researchers build their critical thinking, curiosity, and problem-solving abilities.   

How do I identify a research problem?  

Identifying a research problem involves recognizing gaps in existing knowledge, exploring areas of uncertainty, and assessing the significance of addressing these gaps within a specific field of study. This process often involves thorough literature review, discussions with experts, and considering practical implications.  

Can a research problem change during the research process?  

Yes, a research problem can change during the research process. During the course of an investigation a researcher might discover new perspectives, complexities, or insights that prompt a reevaluation of the initial problem. The scope of the problem, unforeseen or unexpected issues, or other limitations might prompt some tweaks. You should be able to adjust the problem to ensure that the study remains relevant and aligned with the evolving understanding of the subject matter.

How does a research problem relate to research questions or hypotheses?  

A research problem sets the stage for the study. Next, research questions refine the direction of investigation by breaking down the broader research problem into manageable components. Research questions are formulated based on the problem , guiding the investigation’s scope and objectives. The hypothesis provides a testable statement to validate or refute within the research process. All three elements are interconnected and work together to guide the research.  

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Try R Discovery Prime FREE for 1 week or upgrade at just US$72 a year to access premium features that let you listen to research on the go, read in your language, collaborate with peers, auto sync with reference managers, and much more. Choose a simpler, smarter way to find and read research – Download the app and start your free 7-day trial today !  

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Nursing Research

Nursing research worldwide is committed to rigorous scientific inquiry that provides a significant body of knowledge to advance nursing practice, shape health policy, and impact the health of people in all countries. The vision for nursing research is driven by the profession's mandate to society to optimize the health and well-being of populations (American Nurses Association, 2003; International Council of Nurses, 1999). Nurse researchers bring a holistic perspective to studying individuals, families, and communities involving a biobehavioral, interdisciplinary, and translational approach to science. The priorities for nursing research reflect nursing's commitment to the promotion of health and healthy lifestyles, the advancement of quality and excellence in health care, and the critical importance of basing professional nursing practice on research.

As one of the world leaders in nursing research, it is important to delineate the position of the academic leaders in the U.S. on research advancement and facilitation, as signified by the membership of the American Association of Colleges of Nursing (AACN). In order to enhance the science of the discipline and facilitate nursing research, several factors need to be understood separately and in interaction: the vision and importance of nursing research as a scientific basis for the health of the public; the scope of nursing research; the cultural environment and workforce required for cutting edge and high-impact nursing research; the importance of a research intensive environment for faculty and students; and the challenges and opportunities impacting the research mission of the discipline and profession.

Approved by AACN Membership: October 26, 1998 Revisions Approved by the Membership: March 15, 1999 and March 13, 2006

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The influencing factors of clinical nurses’ problem solving dilemma: a qualitative study

a Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China

b Tongji University School of Medicine, Shanghai, China

c Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Problem solving has been defined as “a goal-directed sequence of cognitive and affective operations as well as behavioural responses to adapting to internal or external demands or challenges. Studies have shown that some nurses lack rational thinking and decision-making ability to identify patients’ health problems and make clinical judgements, and have poor cognition and response to some clinical problems, easy to fall into problem-solving dilemma. This study aimed to understand the influencing factors of clinical nurses’ problem solving dilemma, to provide a basis for developing training strategies and improving the ability of clinical nurses in problem solving.

A qualitative research was conducted using in-depth interviews from August 2020 to December 2020. A total of 14 participants from a tertiary hospital in Shanghai, China were recruited through purposive sampling combined with a maximum variation strategy. Data were analysed with the conventional content analysis method.

Three themes and seven subthemes were extracted: nurse’s own factors (differences in knowledge structure and thinking, differences in professional values, poor strain capacity); improper nursing management (low sense of organizational support, contradiction between large workload and insufficient manpower allocation); patient factors (the concept of emphasizing medicine and neglecting to nurse, individual differences of patients).

The influencing factors of clinical nurses’ problem-solving dilemma are diverse. Hospital managers and nursing educators should pay attention to the problem-solving of clinical nurses, carry out a series of training and counselling of nurses by using the method of situational simulation, optimize the nursing management mode, learn to use new media technology to improve the credibility of nurses to provide guarantee for effective problem-solving of clinical nurses.

Introduction

Nursing education in China can be divided into two main levels: vocational education and higher education. Vocational education includes technical secondary schools and junior colleges, while higher education includes undergraduate, master’s and doctoral education. Vocational education aims at training students to master basic nursing service skills and to be able to take the post to engage in daily nursing work (Sun & Zong, 2017 ). Higher nursing education started late, and undergraduate education has always followed the “three-stage” education model of clinical medicine (basic medical courses, specialized courses and clinical practice). Most courses are centred on subject knowledge, and all clinical practice takes the form of centralized practice (Li, 2012 ). The training goal of nursing postgraduates is gradually expanding from academic master to professional master. The curriculum mainly includes classroom teaching and clinical practice. The classroom teaching contents include public courses (political theory, foreign languages, etc.), professional basic courses (advanced health assessment, pharmacotherapy, pathophysiology, evidence-based nursing, medical statistics or clinical epidemiology), specialized courses (advanced nursing practice theory) and Academic activities . The goal of nursing doctoral training is to cultivate high-level nursing research talents, focusing on the cultivation of scientific research ability rather than clinical practice ability. The curriculum includes ideology and politics, basic theory, research methods, specialized courses, development frontier, scientific writing, etc (Luo et al., 2018 ). There are some problems in the training mode and curriculum, such as theory and practice are out of touch, traditional lecture-based classroom teaching makes students passively accept knowledge, students attach importance to theory over practice, knowledge input to ability output, professional study to humanities knowledge. Nursing students receive no theoretical and/or practical training in problem solving before entering the clinical setting, so there is not a starting point for these nurses to clinical dilemmas in their professional life.

With the development of medicine, people pay more attention to health and have higher requirements for nursing service ability (Yang, Ning, et al., 2018). The National Nursing Development Plan (National Development and Reform Commission, 2017 ) points out that it is necessary to strengthen the construction of nurse teams, establish nurse training mechanisms and improve the professional quality and service ability of nurses. However, in the face of increasingly complex and changeable clinical environment, nurses are still lacking in problem-solving thinking and ability, and often fall into the dilemma of problem solving (Li et al., 2020 ).

Typical decision theory approaches to the identification of problem solving in nursing have viewed the process as a series of decision formulations that include: decisions about what observations should be made in the patient situation; decisions about deriving meaning from the data observed (clinical inferences); and decisions regarding the selection of action to be taken that will be of optimal benefit to the patient (McGuire, 1985 ). Information processing theory describes problem solving as an interaction between the information processing system (the problem-solver) and a task environment, which can be analysed as two simultaneously occurring sub-processes of “understanding” and “search” (VanLehn, 1989 ). Individuals collect the stimulus that poses the problem in the understanding process, forming the internal representation of the problem, transforming the problem stimulus into the initial information needed in the search process, and then producing mental information structures for the understanding of the problem, which making individuals distinguish the nature of the problem and clarify the goal of the problem. The mental information structures drive the search process that enables the individual to find or calculate the solution to the problem. This process starts with the nurse identifying the clinical problem and continues until the decision is made to resolve the problem (Taylor, 2000 ). Clinical problem solving requires nurses to have a variety of cognitive strategies, which involves nurses’ knowledge, experience, and memory process. Nurses must recognize the current problem and use all available knowledge and experience to transform the problem into their internal problem representation, and then set goals and search for strategies that can achieve the goal (Mayer & Wittrock, 1992 ). In today’s complex clinical environment, nurses need to be able to solve problems accurately, thoroughly, and quickly. Nurses who can solve problems efficiently have fewer medical errors (Babaei et al., 2018 ), and the level of nursing skills and empathy are higher (Ay et al., 2020 ; Bayindir Çevik & Olgun, 2015 ). To cultivate nurses’ problem solving thinking and ability, it is necessary to better understand the influencing factors of problem solving dilemma. However, these cannot be obtained by observing nurses’ behaviour in their work, and cannot be obtained through quantitative research either. Exploring the thinking process involved in nurses’ work through qualitative interviews is an effective way to understand the influencing factors of nurses’ problem solving. Given this, this study used qualitative research methods to deeply analyse the influencing factors of clinical front-line nurses’ problem solving dilemma, to provide a basis for making relevant strategies to cultivate nurses’ thinking and ability of problem solving.

Study design

A qualitative study based on in-depth interviews was conducted to obtain influencing factors of nurses’ problem-solving dilemma.

Settings and participants

Purposive sampling combined with a maximum variation strategy was used to identify and select information-rich participants related to the research phenomenon. Maximum variation was achieved in terms of participants’ gender, education level, professional title, marital status, seniority, and administrative office, respectively. The study was conducted between August 2020 to December 2020 in a tertiary hospital in Shanghai, China. The inclusion criteria were a nurse practicing certificate of the People’s Republic of China and within the valid registration period; having been engaged in clinical nursing work for at least 1 year and still engaged in clinical nursing work; clear language expression, able to clearly describe the solution and feelings of clinical problem solving; informed consent to this study and voluntary participation. The exclusion criterion were on leave during the study period (personal leave, maternity leave, sick leave, etc.); out for further study or came to the hospital for further study; confirmed or suspected mental illness and psychotropic medicine users. Purposive sampling continued until thematic saturation was reached during data analysis.

Data collection

Face-to-face, a semi-structured interview was used to collect information. All interviews were conducted in the lounge to ensure quiet and undisturbed by a female postgraduate nursing student with the guidance of her master tutor. Initially, an interview guide was developed based on literature review and expert consultation including about five predetermined questions: What thorny problems have you encountered in clinical work or have a great impact on you? How did you solve it? Why take such a solution? What is the biggest difficulty encountered in the process of problem solving? How does it affect you? How do you feel in the process of problem solving? Before the interview, the consent of the interviewee was obtained and then the researcher fully explains to the interviewees and starts with a friendly chat to allay the interviewees’ worries. During the interview, the researcher listened carefully and responded in time, always maintaining a neutral attitude, without any inducement or hint, if necessary, giving encouragement and praise to support the expression of the interviewees, and to record the interviewees’ facial expressions, physical movements and emotional responses in time. At the same time, a recording pen was used to ensure that the interview content was recorded accurately and without omission. The interview time for each person was 30 to 40 minutes.

Data analysis

After each interview, the researcher wrote an interview diary in time to reflect on the interview process and transcribed the interview content into words within 24 hours, then the researcher made a return visit by phone the next day to confirm that the information is correct. The seven-step method of Colaizzi’s phenomenological analysis method ( Table I ) was adopted to analyse the collected data(Colaizzi, 1978 ). Two researchers collated the original data, independently coded, summarized this information as themes, and organized a research group meeting once a week to discuss and reach a consensus.

7 steps of Colaizzi’s phenomenological analysis method.

Ethical considerations

This study was approved by the Ethics Committee of the Shanghai Pulmonary Hospital, Affiliated to Tongji University, project number: K16-252. Before the interview, the researcher explained the purpose and significance of the study to each interviewee in detail and obtained the informed consent of them on a voluntary basis and all of the interviewees signed informed consent forms. To protect the privacy of each interviewee, their names are replaced by numbers (e.g., N1, N2), and the original materials and transcribed text materials involved are kept by the first author himself, and all materials are destroyed after the completion of the study.

There was no new point of view when the 13th nurse was interviewed, and there was still no new point of view when one more nurse was interviewed, the interview was over, 14 nurses were interviewed. Three themes and seven subthemes were extracted. The characteristics of the participants ( N = 14) are provided in Table II .

Participant characteristics (N = 14).

Nurses’ own factors

Differences in knowledge structure and thinking.

Differences in the structure of prior knowledge and way of thinking will affect nurses’ processing of clinical data, thus affecting their clinical decision-making. The nurses made a wrong judgement of the condition because of the solidified thinking that postoperative nausea and vomiting symptoms were side effects of narcotic drugs and the lack of overall control and understanding of the patient’s condition.

There was a patient who came back after surgery with nausea and vomiting, the first thing that went through my mind, is the drug side effects, so I didn’t pay much attention, as is often the case, the most common cause of postoperative nausea and vomiting is anesthetic drug side effects, but later found to be cerebral infarction, this kind of situation I find it hard to recognize.

Differences in professional values

Professional values of nurses are accepted codes of conduct internalized by nursing professionals through training and learning (Pan, 2016 ). Negative professional values are easy to lead to problem solving dilemma. Some nurses think nursing is just a service.

The work is difficult to do, everything is the nurse’s fault, the nurse must apologize and put up with the patient’s scolding, nursing is a service industry, sometimes I am really wronged.” There are also nurses who believe that nursing work can reflect their personal value, and solving problems successfully will bring them a sense of achievement.

Although the nursing work is very intense, I live a full life every day. I feel a sense of accomplishment and pride that I can solve the problems of patients and discharge them smoothly through my work.

Poor strain capacity

Nursing work is patient-centred holistic nursing, the current clinical situation is complex and changeable, requiring nurses must have good strain capacity, and can “be anxious about what the patient needs, think what the patient thinks, and solve the patient’s difficulties.”

All patients are self-centered, and they don’t care whether you (the nurse) are busy or not. For example, once I gave oral medicine to a patient, a patient in the same ward was in a hurry and asked me to help him call his son. I was busy handing out the medicine and did not help. As a result, the patient was very dissatisfied and complained to the head nurse.

The 20-bed patient went through the discharge formalities but was still lying in the hospital bed. when the new patient arrived and she didn’t leave, I went to urge her to leave the hospital, she suddenly got angry and scolded me, I don’t know what to do.

Improper nursing management

Low sense of organizational support.

Organizational support is an important resource for clinical nurses in the process of problem solving (Poghosyan et al., 2020 ). Low sense of organizational support will hinder nurses’ problem solving.

The style of leadership and the atmosphere of the department are very important. in a department I rotated before, the leader was too strict to listen to your explanation, and the atmosphere of the department was not good. I couldn’t find help when I encountered problems. When I have a conflict with a patient, the leader will only criticize me, which makes me feel helpless.

Sometimes there will be a conflict with patients due to the bed turnover problem, and the patient will not listen to your explanation and turn around to complain, the nurse will be responsible for such things. In severe cases, even violent incidents will be encountered and the personal safety can not be guaranteed.

Insufficient allocation of manpower

Although the total number of nurses has increased substantially, there is still a shortage of human resources under the rapidly increasing workload (Guo et al., 2021 ).

When I was on the night shift and I encountered the critical moment of rescuing patients, I had to call an anesthesiologist, a doctor on duty, a nurse on duty simultaneously, an observation of the patient’s condition to prevent accidents was needed, I also have to race against time to give the patient ECG monitoring and oxygen inhalation. When the doctor came, he also criticized me that the first-aid equipment was not in place (crying).

According to the normal nurse-patient ratio, each nurse takes care of eight patients, and now there are not only eight patients, but also with extra beds and a fast turnover, and sometimes a nurse is responsible for more than 12 patients

Patient factors

The concept of emphasizing medicine and neglecting to nurse.

There is a deviation in society’s cognition of the profession of nurses, which believes that nurses are the “legs” of doctors, and nurses’ work is to help doctors run errands, give injections and give fluids. This concept not only leads to nurses’ lack of due respect, but also hinders nurses’ professional identity, and has a great negative impact on nurses’ problem-solving (Gao et al., 2015 ).

The patient did not dare to tell the doctor something he was not satisfied with, but complained directly to the nurse. For example, if the patient did not want to do some tests, he would scold the nurse. The nurse explained to him that he would not listen. But when the doctor came, he smiled and refused to admit that he cursed nurses, and he would frame the nurse. 90% of the patients would be willing to listen to the doctor.

Sometimes the patient says he was not feeling well, and I know the patient’s condition. I will give her some reasonable explanations, but the patient does not accept it. She is satisfied only when the doctor come to see her. In the final analysis, the patient just don’t believe us. No matter how much I explain to her, it is not as effective as the doctor’s glance at her.

Individual differences of patients

There are differences in patients’ personality characteristics, cultural background, views on nurses and state of an illness, these individual differences are also the reasons for nurses’ problem-solving dilemma (Chan et al., 2018 ).

Some cancer patients are in a period of anger, and it is very difficult to communicate with him. When I see him angry and lose his temper, I will not talk to him and just leave.”

Patients have different cultural levels and different social backgrounds. Sometimes I can’t talk too deeply. If patients are a little more educated, it will be easier for us to communicate with them, and some patients can’t understand anything we say.”

Multiple factors affecting clinical nurses’ problem-solving dilemma

The reasons for nurses’ failure in problem solving are mainly in the process of understanding the problem, the search process driven by the psychological information structure, and the problem or loss of balance in the process of implementing the plan. In the process, the three factors of nurses, management and patients all played an important role. Nurses’ knowledge structure and thinking loopholes led to the deviation of nurses’ internal representation of the problem (Jonassen, 2005 ). Poor professional values and low sense of organizational support can lead to nurses’ negative orientation and attitude towards problems (Poghosyan et al., 2020 ; X. Wang et al., 2018 ). The manpower allocation of nurses, patients’ emphasis on medical treatment over nursing care, and individual differences mainly increase the complexity and difficulty of nurses’ problem-solving task environment as external factors. The three factors work together on the problem-solving of clinical nurses, which leads to the dilemma of problem-solving.

Implementing situational simulation training to improve the comprehensive quality of nurses

At present, the overall quality and ability of nurses cannot meet the requirements of systematic, effective and rapid problem-solving. It is necessary to strengthen the construction of nurses to improve nurses’ problem-solving ability. Some studies have shown that situational simulation class can improve students’ knowledge, experience, psychological quality and other abilities (Mohammad, 2020 ). It is suggested that nursing educators should explore targeted situational simulation teaching and strengthen the relationship between classroom teaching and clinical practice through situational simulation, and to build a novel, perfect and clinical knowledge network for nurses. Secondly, emergency situational simulation teaching should be carried out to enable nurses to experience emergency situations from different angles, so as to improve their thinking, skills and timeliness in dealing with emergencies (Zhang et al., 2019 ). The content of professional values training should also be added to the situational simulation class in order to cultivate nurses’ positive, accessible and stable professional values and promote their positive orientation and attitude when facing problems (Skeriene, 2019 ).

Optimize nursing management and improve nurses’ working experience

Through interviews, it is found that nursing management factors have caused nurses’ problem-solving dilemma to a certain extent, which needs to be optimized according to the specific problems existing in nursing management to help nurses deal with the problems and solve the dilemma effectively. The total number of registered nurses in China exceeded 4.7 million in 2021, an increase of 1.46 million from 3.24 million in 2015, an increase of 45% (Deng et al., 2019 ]. However, there is still a large workload and underallocation of manpower, which may be due to the unreasonable distribution of human resources between time periods and departments. Hospitals and nursing managers can use the hospital information system to evaluate the nursing workload, and allocate nursing human resources reasonably according to the evaluation results (H. Yang et al., 2019 ), so as to avoid nurses falling into the dilemma of problem solving due to long-term overloaded work. In addition, it is necessary to create a harmonious departmental atmosphere for nurses, create a supportive departmental environment (Aghaei et al., 2020 ), and strictly ensure the safety of nurses’ practice and put an end to the occurrence of violence. Timely and strong organizational support can reduce the painful feelings of nurses caused by adverse events (Stone, 2020 ). and help them to solve problems actively.

Using new media to improve the image and credibility of nurses

There is a bias in social cognition of the profession of nurses, and some negative media reports mislead patients, resulting in social stereotypes of nurses (L. Q. Wang et al., 2021 ). It is necessary to make full use of new media to objectively introduce the nursing profession to the public, publicize outstanding nursing figures and typical deeds, make the public realize the important role of nurses in health care, and create an atmosphere of understanding and supporting nurses in the whole society to enhance the image and credibility of nurses and help nurses deal with problems and solve difficulties effectively (Falkenstrom, 2017 ).

Limitations and strengths of the study

The limitation is that the transferability of this study’s results may be limited as a result of including a small number of participants and the participants all worked in the same hospital in Shanghai. More participants in different cities and hospitals could have increased the variety of the descriptions and experiences. The strength is that the use of purposive sampling facilitated inclusion of participants from a range of demographic groups. The use of maximum variation strategy facilitated that the participants covered different gender, education level, professional title, marital status, seniority and department, which helped to increase the representativeness of sample.

Implications for practice

This study provides an in-depth exploration of the problem solving dilemmas of clinical nurses in China and provides valuable insights into the continuing education of nurses. These insights shine a light on areas that warrant further investigation and need to be improved in continuing education of nurses. It is of great significance to improve nurses’ problem-solving ability, improve nurses’ professional quality, effectively solve patients’ medical treatment and health problems, and improve patients’ experience of seeking medical treatment.

Through the semi-structured interview, it is found that the problem-solving dilemma of clinical nurses is affected by many factors. Nurses themselves should be confident, self-improvement, constantly learning and enterprising to improve their own ability, and be good at using new media to improve nurses’ image and credibility. Hospitals, nursing administrators and nursing educators should take corresponding measures to improve the knowledge structure of nurses, cultivate nurses’ positive professional values and adaptability, and give full organizational support to nurses. optimize the allocation of nursing human resources to provide a strong guarantee for nurses to deal with problems solving dilemma.

Biographies

Yu Mei Li : associate chief nurse, master degree, master supervisor, engaged in nursing of tumor patients.

Yifan Luo : nurse, master degree, engaged in clinical nursing.

Funding Statement

This work was supported by the Graduate Education Research and Reform Education Management program of Tongji University [2021YXGL09].

Disclosure statement

No potential conflict of interest was reported by the author(s).

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