All posts by Martha "Marty" Farrar Highfield PhD RN

It is difficult to be simple! Research can be understood if explained well. That's my aim.

“How many articles are enough?” Is that even the right question?

How do you know when you have found enough research evidence on a topic to be able to use the findings in clinical practice? How many articles are enough? 5? 50? 100? 1000? Good question!

You have probably heard general rules like these for finding enough applicable evidence: Stick close to your key search terms derived from PICOT statement of problem; Use only research published in the last 5-7 years unless it is a “classic; & Find randomized controlled trials (RCTs), meta-analyses, & systematic reviews of RCTs that document cause-and-effect relationships. Yes, those are good strategies. The only problem is that sometimes they don’t work!

Unfortunately, some clinical issues are “orphan topics.” No one has adequately researched them. And while there may be a few, well-done, valuable published studies on the topic, those studies may simply describe bits of the phenomenon or focus on how to measure the phenomenon (i.e., instrument development). They may give us little to no information on correlation and causation. There may be no RCTs. This situation may tempt us just to discard our clinical issue and to wait for more research (or of course to do research), but either could take years.

In her classic 1998 1-page article, “When is enough, enough?” Dr. Carol Deets, argues that asking how many research reports we need before applying the evidence may be the wrong question! Instead, she proposes, we should ask, “What should be done to evaluate the implementation of research findings in the clinical setting?”

When research evidence is minimal, then careful process and outcome evaluation of its use in clinical practice can: 1) Keep patient safety as the top priority, 2) Document cost-effectiveness and efficacy of new interventions, and 3) Facilitate swift, ethical use of findings that contributes to nursing knowledge. At the same time, Deets recognizes that for many this idea may be revolutionary, requiring us to change the way we think.

So back to the original question…How many articles are enough? Deets’ answer? “One study is enough” if we build in strong evaluation as we translate it into practice.

Reference: Deets, C. (1998). When is enough, enough? Journal of Professional Nursing, 14(4), 196. doi.org/10.1016/S8755-7223(98)80058-6

“Remember our sons & Daughters:” an analysis of Igbo women’s petitionary letters to US missionary nurses

This is the link to a Panopto video that was to be presented at the International Nurse Christian Fellowship Conference July 10. https://csun.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=c1ed56b0-4c4c-4c85-9a94-ad0e016f7323

Unfortunately technical difficulties interfered. Let me know if you have difficulty accessing. My email martha.highfield@csun.edu

simply put: the step-by-step research process

Research is not all white lab coats and test tubes. Simply put, research is a systematic way to ask and answer your questions by looking for patterns in new or existing data. Typical steps are clockwise are in Figure 1 below.

Begin by identifying your problem clearly and concisely. A great way to do that is using the acronym PICO. (Learn how to use PICO by clicking here.)

In the Figure 1 below, I’ve included the step of IRB review. Remember that an IRB (institutional review board/ AKA human subjects review board) must review all research procedures for your compliance with federal ethical and legal rules before you begin any data collection or subject contact.

Search discoveringyourinnerscientist.com for what I’ve already written on some of these steps, and watch for more in upcoming posts.

Figure 1. Research Process Summary 

Get the answer you Need. Not necessarily the one you want

Sampling Bias

Why does every little kid, who doesn’t get the answer they want from Mom, then go and ask Dad or Grandma or Auntie hoping to get a different response? Because kids know that the answer you get to your question depends on who you ask!!

In research it’s the same. Sometimes the answer you get depends on who you ask. Thus, it’s not only important to write out a well-formulated research question, but you need to ask the right persons! Unlike little children, however, you need to ask a representative sample that will give you an accurate scientific answer–not just an answer that matches your preconceived notions of the answer you want. The answer you need is not necessarily the one you want…or expect.

What research sample will give you a more accurate, scientific answer? It’s a sample that represents the population of interest. NO sampling method guarantees a representative sample from the population, but some sort of random selection of participants from the population is likely to be best. Sometimes, however, it’s not possible or affordable to do random sampling and so researchers pick their sample using a different sampling method.

A concise 5 minute summary of some sampling methods is here: https://www.youtube.com/watch?v=be9e-Q-jC-0

Remember that the BEST samples are REPRESENTATIVE. That may or may not mean they are randomly selected.

Whatever sampling method is used, be clear yourself about the strengths and weaknesses of that sampling method. Report your sampling method in the procedures section of your final report. That way your readers can tell whether you asked subjects who were the equivalent of “Mom,” “Dad,” or both.

Research: What it is and isn’t

WHAT RESEARCH IS

Research is using the scientific process to ask and answer questions by examining new or existing data for patterns. The data are measurements of variables of interest. The simplest definition of a variable is that it is something that varies, such as height, income, or country of origin. For example, a researcher might be interested in collecting data on triceps skin fold thickness to assess the nutritional status of preschool children. Skin fold thickness will vary.

Research is often categorized in different ways in terms of: data, design, broad aims, and logic.

Qualitative Data
  • Design. Study design is the overall plan for conducting a research study, and there are three basic designs: descriptive, correlational, and experimental.
    1. Descriptive research attempts to answer the question, “What exists?” It tells us what the situation is, but it cannot explain why things are the way they are. e.g., How much money do nurses make?
    2. Correlational research answers the question: “What is the relationship” between variables (e.g., age and attitudes toward work). It cannot explain why those variables are or are not related. e.g., relationship between nurse caring and patient satisfaction
    3. Experimental research tries to answer “Why” question by examining cause and effect connections. e.g., gum chewing after surgery speeds return of bowel function. Gum chewing is a potential cause or “the why”
  • Aims. Studies, too, may be either applied research or basic research. Applied research is when the overall purpose of the research is to uncover knowledge that may be immediately used in practice (e.g., whether a scheduled postpartum quiet time facilitates breastfeeding). In contrast, basic research is when the new knowledge has no immediate application (e.g., identifying receptors on a cell wall).
  • Logic. Study logic may be inductive or deductive. Inductive reasoning is used in qualitative research; it starts with specific bits of information and moves toward generalizations [e.g., This patient’s pain is reduced after listening to music (specific); that means that music listening reduces all patients pain (general)]. Deductive reasoning is typical of quantitative research; it starts with generalizations and moves toward specifics [e.g., If listening to music relaxes people (general), then it may reduce post-operative pain (specific)]. Of course the logical conclusions in each case should be tested with research!

WHAT RESEARCH IS NOT:

Research as a scientific process is not going to the library or searching online to find information. It is also different from processes of applying research and non-research evidence to practice (called Evidence-Based Practice or EBP). And it is not the same as Quality Improvement (QI). See Two Roads Diverged for a flowchart to help differentiate research, QI and EBP.

Learning from those who went before

I am pleased to announce publication of A Time to Heal: Missionary Nurses in Churches of Christ, Southeastern Nigeria (1953-1967). (Los Angeles: Sulis Academic, 2020).

It is original history that holds lessons for nurses today. What is it that we learn from the women, whose stories are within this book?

I think it’s mainly this: “Do not let your personal limitations stop you from doing the good that you see to do in the world.”

This book contains the previously untold story of how a remarkable set of lay and professional nurses shaped Church of Christ (COC) missions in southeastern Nigeria. No archive of their work existed, and I enjoyed the privilege of compiling the story from the memories, bags, basements, and boxes of the women who lived this story and those who knew them. The book was 10 years in the making.

Missionary student technical nurse learning to give injection (ca 1966). Private collection with permission.

These women’s decisions and actions occurred within a broader shift of COC perspectives away from missionary healthcare as incidental volunteer women’s work, and toward healthcare missions as a Christian duty. For each being a missionary nurse meant delivering healthcare as part of Christian evangelism. To that end they executed multiple roles: healer, educator, revolutionary, advocate, good-will ambassador, protector, administrator, evangelist, role model, fund-raiser, friend, and colleague. We did “everything that needed to be done that there was nobody to do,” reflected missionary Nancy Petty RN.

Enjoy the read, and pursue the good that you can do in this world.

[Featured image: August 23, 1965. The Nigerian Christian Hospital Outpatient Clinic opens. Photographer JR Morgan. Used with permission from JRM private collection]

Writing up Research!

A new article on the Nurse Author & Editor website :

Reporting Nursing Research, An Essay on Style: Beginnings

I highly recommend the Nurse Author & Editor website if you are writing anything from an abstract for a conference to a book from your thesis or dissertation. Keep disseminating your good work!

“A Vivid Testimony”

“History provides current nurses with the same intellectual and political tools that determined nursing pioneers applied to shape nursing values and beliefs to the social context of their times. Nursing history is not an ornament to be displayed on anniversary days, nor does it consist of only happy stories to be recalled and retold on special occasions. Nursing history is a vivid testimony, meant to incite, instruct, and inspire today’s nurses as they bravely tread the winding path of a reinvented health care system.” (American Association for History of Nursing)

SHINING A LIGHT ON THE PRESENT AND FUTURE

We need nurse historians–those researchers who can help us understand the present and future by examining the past!

ebook cover

MY PROJECT just published (amazon/apple books/kindle): A Time to Heal: Missionary Nurses in Churches of Christ, Southeastern Nigeria (1953-1967). I like to think of the work as accessible history told from the point of view of those who lived it. A take-away for me from their story is: Don’t let your current inexperience or limited knowledge stop you from doing the good you see to do.

MORE INFO: Check out the resources of the American Association for History of Nursing. “Talking History” events online are the current norm, so check them out and join us.

Sat Jan 23, 2021Webinar | Public Health and DisasterCategory: Webinar
Fri Jan 29, 2021PhD Student Networking CallCategory: Events
Sat Feb 20, 2021Webinar | Midwifery and RaceCategory: Webinar
Fri Mar 19, 2021Webinar | Nursing EductationCategory: Webinar
Fri Apr 16, 2021Webinar | War and NursingCategory: Webinar

reposting: dispelling the nice or naughty myth–retrospective observational study of santa claus

Check out this re-post of my Christmas-y blog:

https://discoveringyourinnerscientist.com/2018/01/04/dispelling-the-nice-or-naughty-myth-retrospective-observational-study-of-santa-claus/