502675
research-article2013
NASXXX10.1177/1942602X13502675NASN School NurseNASN School Nurse
Research
An Overview of Nursing Research and Relevance to School Nursing Practice Cheryl A. Krause-Parello, PhD, RN, CSN Keywords: research; qualitative; quantitative
N
important for school nurses to have the best current evidence to guide their health care decisions and clinical practice.
ursing research is defined as a systematic investigation that uses rigorous methods and produces new knowledge or validates existing knowledge (Burns & Grove, 2009). Research is often used to synthesize findings, explore and describe phenomena, find solutions, and test approaches to patient care (Houser, 2008). The process of scientific inquiry provides researchers with a systematic way for acquiring knowledge that directs practice. Moreover, the purpose of research in school nursing is to generate evidence that provides school nurses with an evidenced blueprint for practice. Research on school nursing practice is advancing from two main sources: academia and school setting research. In academia, school nurse educators are working closely with practicing school nurses with a common objective to answer questions that improve school health. In school setting research, practicing school nurses are using the evidence to guide health care decision making and school health policies. Since school nurses are typically the only health care professional in the school during the school day, they are held accountable for health outcomes related to the school community at large. Therefore, it is
294 NASN School Nurse | November 2013
Research Methodologies In the research arena, there are two research methodologies—qualitative and quantitative—and they have very unique and different perspectives and reason techniques. It is important for school nurses to understand the differences when conducting or interpreting research. Qualitative methodologies are used when researchers are trying to uncover the lived experience from the participant’s point of view using a subjective approach versus quantitative methodologies that are used when researchers are trying to describe, examine, and predict relationships among variables of interest using a subjective approach (Burns & Grove, 2009). Quantitative methodologies are used when investigating a phenomenon in order to describe and test relationships between and among variables (Burns & Grove, 2009; Polit & Beck, 2012). Qualitative research has an emic perspective and uses inductive reasoning while quantitative research as an etic perspective and uses deductive reasoning (Tilley, 2007). An emic perspective can be described as an insider’s viewpoint building from the participant’s
perspective versus an etic approach that can be described as an outsider’s viewpoint building from a researcher’s inquiry via a research question or hypothesis in relation to a phenomenon. Moreover, inductive reasoning moves the logic from specific to general, compared to deductive, which moves the logic from general to specific. Qualitative research can also be described as narrative description compared to quantitative being described as information in a numeric form (Polit & Beck, 2012). There also is a mixed-method approach that incorporates both qualitative and quantitative research methodologies. This approach can be used when the researcher wants to generate broad knowledge about a phenomenon, usually done through participant interviews and observations. It is from these interpretations that an understanding of the phenomenon is discovered. Once this interpretive explanation is generated, the researcher can then objectively explore or examine the relationships of interest. A mixedmethod design can be done concurrently or sequentially, meaning that the qualitative and the quantitative data are collected in succession or in tandem. A prime example of a sequential mixedmethod design was conducted by researchers Krause-Parello and Samms
DOI: 10.1177/1942602X13502675 For reprints and permission queries visit SAGE’s Web site, http://www.sagepub.com/journalsPermissions.nav. Downloaded from nas.sagepub.com at Mount Royal University on June 8, 2015 © 2013 The Author(s)
(2009, 2010) to better understand the roles and responsibilities of school nurses in New Jersey. The study began with a qualitative component where school nurses were interviewed on the current role and responsibilities of school nurses in the school setting. The data from those interviews provided the researchers with a subjective understanding of the roles and responsibilities from the perspective of the practicing school nurses interviewed. From those data, the researchers (employed in a university setting) along with school nursing students created and developed a school nurse survey based on what was uncovered during the interviews. The survey was then distributed to a cross section of practicing school nurses in New Jersey. The results from the survey provided objective data on the roles and responsibilities of the school nurses in New Jersey. The evidence generated from this study can be translated to school nursing practice and school health policy in New Jersey (e.g., school nurse to student ratio). The survey was then edited and distributed to school nurses across the United States (KrauseParello & Samms, 2011). Another example of how research influenced school nursing practice was the evolution of the no-nit exclusion policy. In 2007, Sciscione and Krause-Parello conducted a review of the literature on the no-nit policy established in U.S. schools. The evidence from the review uncovered that there was no scientific evidence to support the policy to exclude children from school due to nits. This information helped to change school health policy from an evidencebased school nurse perspective.
Research Designs There are specific research designs that correspond to qualitative and quantitative methodologies (Polit & Beck, 2012). Researchers conducting a qualitative study must choose the method that would most appropriately help to understand the phenomenon of interest. There are several qualitative methodologies—phenomenology,
Table 1. Overview of Research Methodologies Qualitative
Quantitative
Phenomenological—explores the lived experience of study participants
Descriptive—describes and explores concepts
Grounded theory—uncovers concern that may exist in a social context
Correlational—tests relationships between and among variables
Ethnographic—tells a story of the participants’ activities in a cultural context
Predictive—foresees outcomes based on evidence
Historical—descriptive account of events that took place in the past
Quasi-experimental—intervention studied (not randomized)
Experimental—intervention research (randomized, e.g., clinical drug trials)
grounded theory, ethnography, and historical—each with its own goal. The goal of phenomenology is to explore the lived experience of the study participants. In grounded theory research, the researcher uncovers concerns that may exist in a social context and the process that the participants use to cope with the concerns. In an ethnographic study, the researcher tells a story of the participants’ activities of daily living in a cultural context. Historical research is a descriptive account of events that took place in the recent or distant past. It must be noted that each design has rigorous steps that must be followed in order for the study and the results to be deemed reliable and valid. Quantitative studies, on the other hand, have different research methodologies. There are several quantitative methodologies—descriptive, correlational, predictive, quasiexperimental, and experimental—and each method has its own indications. A descriptive design is often used when there is little known about the concept or phenomenon of interest. Correlational designs are used to test relationships among and/or between variables. Predictive research is used to foresee or predict outcomes based on data. Quasi-experimental designs are often used for intervention studies, and
participants are not randomized by treatment condition. Experimental designs are used when the researcher controls the intervention, and participants are randomized by treatment condition (see Table 1). Again, each method has specific criteria that must be followed to have a reliable and valid study and results. According to Polit and Beck (2012), in general, there are five phases in a quantitative study: conceptual, design and planning, empirical, analytic, and dissemination. Each phase builds upon the previous one and it is referred to as a general flow of activities.
School Nurse Research and Evidence-Based Practice A literature review revealed that minimal research has been conducted on school nursing practice per se. It is imperative for school nurses to ask questions and seek answers in order to provide the evidence to support school nursing practice and, for that matter, registered professional nurses in the school setting. Formulating the questions that need to be answered is the first step in undertaking school nursing research. Next, unless school nurses have the education required (typically a PhD level), they should partner with those who do to ensure that the research design and plan are carried out
Downloaded from nas.sagepub.com at Mount Royal University on June 8, 2015
November 2013 | NASN School Nurse 295
appropriately. For example, a question that may be best answered using a qualitative approach could be exploring the feelings of school-age children with reading difficulties. In contrast, a question that may be best answered by using a quantitative approach may be measuring the outcomes (such as changes in a child’s reading skills) of a child reading literacy program that uses therapy dogs as an intervention in the school setting. Remember, there is no “I” in research. Lastly, school nurses who are familiar with and understand research are well-prepared to synthesize research being published and translate that evidence to promote quality health outcomes in the school setting. ■
References Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis,
296 NASN School Nurse | November 2013
and generation of evidence. St. Louis, MO: Saunders Elsevier. Houser, J. (2008). Nursing research: Reading, using, and creating evidence. Sudbury, MA: Jones & Bartlett Publishers. Krause-Parello, C. A., & Samms, K. (2009). The US model: The role of school nurses in New Jersey. British Journal of School Nursing, 4(6), 287–292. Krause-Parello, C. A., & Samms, K. (2010). School nurses in New Jersey: A quantitative inquiry on roles and responsibilities. Journal for Specialists in Pediatric Nursing, 15(3), 217–222. Krause-Parello, C. A., & Samms, K. (2011). School nursing in a contemporary society: What are the roles and responsibilities? Issues in Comprehensive Pediatric Nursing, 34, 26–39. Pawson, R., & Tilley, N. (1997). Realistic evaluation. London: Sage. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Downloaded from nas.sagepub.com at Mount Royal University on June 8, 2015
Sciscione, P., & Krause-Parello, C. A. (2007). No-nit policies in schools: Time for change. Journal of School Nursing, 23(1), 13–20.
Cheryl A. Krause-Parello PhD, RN, CSN Associate Professor, College of Nursing University of Colorado Denver Aurora, CO Dr. Krause-Parello is an editorial board member for the Journal of School Nursing and a certified school nurse in New Jersey. Dr. Krause-Parello’s program of research focuses on the effects of human-animal interaction on human health outcomes in vulnerable populations.
research-article2013
NASXXX10.1177/1942602X13502675NASN School NurseNASN School Nurse
Research
An Overview of Nursing Research and Relevance to School Nursing Practice Cheryl A. Krause-Parello, PhD, RN, CSN Keywords: research; qualitative; quantitative
N
important for school nurses to have the best current evidence to guide their health care decisions and clinical practice.
ursing research is defined as a systematic investigation that uses rigorous methods and produces new knowledge or validates existing knowledge (Burns & Grove, 2009). Research is often used to synthesize findings, explore and describe phenomena, find solutions, and test approaches to patient care (Houser, 2008). The process of scientific inquiry provides researchers with a systematic way for acquiring knowledge that directs practice. Moreover, the purpose of research in school nursing is to generate evidence that provides school nurses with an evidenced blueprint for practice. Research on school nursing practice is advancing from two main sources: academia and school setting research. In academia, school nurse educators are working closely with practicing school nurses with a common objective to answer questions that improve school health. In school setting research, practicing school nurses are using the evidence to guide health care decision making and school health policies. Since school nurses are typically the only health care professional in the school during the school day, they are held accountable for health outcomes related to the school community at large. Therefore, it is
294 NASN School Nurse | November 2013
Research Methodologies In the research arena, there are two research methodologies—qualitative and quantitative—and they have very unique and different perspectives and reason techniques. It is important for school nurses to understand the differences when conducting or interpreting research. Qualitative methodologies are used when researchers are trying to uncover the lived experience from the participant’s point of view using a subjective approach versus quantitative methodologies that are used when researchers are trying to describe, examine, and predict relationships among variables of interest using a subjective approach (Burns & Grove, 2009). Quantitative methodologies are used when investigating a phenomenon in order to describe and test relationships between and among variables (Burns & Grove, 2009; Polit & Beck, 2012). Qualitative research has an emic perspective and uses inductive reasoning while quantitative research as an etic perspective and uses deductive reasoning (Tilley, 2007). An emic perspective can be described as an insider’s viewpoint building from the participant’s
perspective versus an etic approach that can be described as an outsider’s viewpoint building from a researcher’s inquiry via a research question or hypothesis in relation to a phenomenon. Moreover, inductive reasoning moves the logic from specific to general, compared to deductive, which moves the logic from general to specific. Qualitative research can also be described as narrative description compared to quantitative being described as information in a numeric form (Polit & Beck, 2012). There also is a mixed-method approach that incorporates both qualitative and quantitative research methodologies. This approach can be used when the researcher wants to generate broad knowledge about a phenomenon, usually done through participant interviews and observations. It is from these interpretations that an understanding of the phenomenon is discovered. Once this interpretive explanation is generated, the researcher can then objectively explore or examine the relationships of interest. A mixedmethod design can be done concurrently or sequentially, meaning that the qualitative and the quantitative data are collected in succession or in tandem. A prime example of a sequential mixedmethod design was conducted by researchers Krause-Parello and Samms
DOI: 10.1177/1942602X13502675 For reprints and permission queries visit SAGE’s Web site, http://www.sagepub.com/journalsPermissions.nav. Downloaded from nas.sagepub.com at Mount Royal University on June 8, 2015 © 2013 The Author(s)
(2009, 2010) to better understand the roles and responsibilities of school nurses in New Jersey. The study began with a qualitative component where school nurses were interviewed on the current role and responsibilities of school nurses in the school setting. The data from those interviews provided the researchers with a subjective understanding of the roles and responsibilities from the perspective of the practicing school nurses interviewed. From those data, the researchers (employed in a university setting) along with school nursing students created and developed a school nurse survey based on what was uncovered during the interviews. The survey was then distributed to a cross section of practicing school nurses in New Jersey. The results from the survey provided objective data on the roles and responsibilities of the school nurses in New Jersey. The evidence generated from this study can be translated to school nursing practice and school health policy in New Jersey (e.g., school nurse to student ratio). The survey was then edited and distributed to school nurses across the United States (KrauseParello & Samms, 2011). Another example of how research influenced school nursing practice was the evolution of the no-nit exclusion policy. In 2007, Sciscione and Krause-Parello conducted a review of the literature on the no-nit policy established in U.S. schools. The evidence from the review uncovered that there was no scientific evidence to support the policy to exclude children from school due to nits. This information helped to change school health policy from an evidencebased school nurse perspective.
Research Designs There are specific research designs that correspond to qualitative and quantitative methodologies (Polit & Beck, 2012). Researchers conducting a qualitative study must choose the method that would most appropriately help to understand the phenomenon of interest. There are several qualitative methodologies—phenomenology,
Table 1. Overview of Research Methodologies Qualitative
Quantitative
Phenomenological—explores the lived experience of study participants
Descriptive—describes and explores concepts
Grounded theory—uncovers concern that may exist in a social context
Correlational—tests relationships between and among variables
Ethnographic—tells a story of the participants’ activities in a cultural context
Predictive—foresees outcomes based on evidence
Historical—descriptive account of events that took place in the past
Quasi-experimental—intervention studied (not randomized)
Experimental—intervention research (randomized, e.g., clinical drug trials)
grounded theory, ethnography, and historical—each with its own goal. The goal of phenomenology is to explore the lived experience of the study participants. In grounded theory research, the researcher uncovers concerns that may exist in a social context and the process that the participants use to cope with the concerns. In an ethnographic study, the researcher tells a story of the participants’ activities of daily living in a cultural context. Historical research is a descriptive account of events that took place in the recent or distant past. It must be noted that each design has rigorous steps that must be followed in order for the study and the results to be deemed reliable and valid. Quantitative studies, on the other hand, have different research methodologies. There are several quantitative methodologies—descriptive, correlational, predictive, quasiexperimental, and experimental—and each method has its own indications. A descriptive design is often used when there is little known about the concept or phenomenon of interest. Correlational designs are used to test relationships among and/or between variables. Predictive research is used to foresee or predict outcomes based on data. Quasi-experimental designs are often used for intervention studies, and
participants are not randomized by treatment condition. Experimental designs are used when the researcher controls the intervention, and participants are randomized by treatment condition (see Table 1). Again, each method has specific criteria that must be followed to have a reliable and valid study and results. According to Polit and Beck (2012), in general, there are five phases in a quantitative study: conceptual, design and planning, empirical, analytic, and dissemination. Each phase builds upon the previous one and it is referred to as a general flow of activities.
School Nurse Research and Evidence-Based Practice A literature review revealed that minimal research has been conducted on school nursing practice per se. It is imperative for school nurses to ask questions and seek answers in order to provide the evidence to support school nursing practice and, for that matter, registered professional nurses in the school setting. Formulating the questions that need to be answered is the first step in undertaking school nursing research. Next, unless school nurses have the education required (typically a PhD level), they should partner with those who do to ensure that the research design and plan are carried out
Downloaded from nas.sagepub.com at Mount Royal University on June 8, 2015
November 2013 | NASN School Nurse 295
appropriately. For example, a question that may be best answered using a qualitative approach could be exploring the feelings of school-age children with reading difficulties. In contrast, a question that may be best answered by using a quantitative approach may be measuring the outcomes (such as changes in a child’s reading skills) of a child reading literacy program that uses therapy dogs as an intervention in the school setting. Remember, there is no “I” in research. Lastly, school nurses who are familiar with and understand research are well-prepared to synthesize research being published and translate that evidence to promote quality health outcomes in the school setting. ■
References Burns, N., & Grove, S. K. (2009). The practice of nursing research: Appraisal, synthesis,
296 NASN School Nurse | November 2013
and generation of evidence. St. Louis, MO: Saunders Elsevier. Houser, J. (2008). Nursing research: Reading, using, and creating evidence. Sudbury, MA: Jones & Bartlett Publishers. Krause-Parello, C. A., & Samms, K. (2009). The US model: The role of school nurses in New Jersey. British Journal of School Nursing, 4(6), 287–292. Krause-Parello, C. A., & Samms, K. (2010). School nurses in New Jersey: A quantitative inquiry on roles and responsibilities. Journal for Specialists in Pediatric Nursing, 15(3), 217–222. Krause-Parello, C. A., & Samms, K. (2011). School nursing in a contemporary society: What are the roles and responsibilities? Issues in Comprehensive Pediatric Nursing, 34, 26–39. Pawson, R., & Tilley, N. (1997). Realistic evaluation. London: Sage. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Downloaded from nas.sagepub.com at Mount Royal University on June 8, 2015
Sciscione, P., & Krause-Parello, C. A. (2007). No-nit policies in schools: Time for change. Journal of School Nursing, 23(1), 13–20.
Cheryl A. Krause-Parello PhD, RN, CSN Associate Professor, College of Nursing University of Colorado Denver Aurora, CO Dr. Krause-Parello is an editorial board member for the Journal of School Nursing and a certified school nurse in New Jersey. Dr. Krause-Parello’s program of research focuses on the effects of human-animal interaction on human health outcomes in vulnerable populations.
