Development of a research question

Development of a research question.

  E V I D E N C E – B A S E D P R A C T I C E T I P A well-developed research question guides a focused search for scientific evidence about assessing, diagnosing, treating, or providing patients with information about their prognosis related to a specific health problem.

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Beginning the literature review The literature review should reveal a relevant collection of studies and systematic reviews that have been critically examined. Concluding sections in such articles (i.e., the recommendations and implications for practice) often identify remaining gaps in the literature, the need for replication, or the need for additional knowledge about a particular research focus (see Chapter 3). In the previous example, the researcher may have conducted a preliminary review of books and journals for theories and research studies on factors apparently critical to vaccine completion rates for preventable health problems like HAV and HBV, as well as risk factors contributing to the disproportionate impact of HAV and HBV on the homeless, such as risky sexual activity, drug use, substandard living conditions, and older age. These factors, called variables, should be potentially relevant, of interest, and measurable.


  E V I D E N C E – B A S E D P R A C T I C E T I P The answers to questions generated by qualitative data reflect evidence that may provide the first insights about a phenomenon that has not been previously studied.

Other variables, called demographic variables, such as race, ethnicity, gender, age, education, and physical and mental health status, are also suggested as essential to consider. Example: ➤ Despite the availability of the HAV and HBV vaccines, there has been a low completion rate for the three- dose core of the accelerated vaccine series, particularly following release from prison. This information can then be used to further define the research question and continue the search of the literature to identify effective intervention strategies reported in other studies with similar high-risk populations (e.g., homeless) that could be applied to this population. Example: ➤ One study documented the effectiveness of a nurse case management program in improving vaccine completion rates in a group of homeless adults, but no studies were found about the effectiveness of peer coaching. At this point, the researcher could write the tentative research question: “What is the effectiveness of peer coaching and nursing case management on completion of an HAV and HBV vaccine series among homeless men on parole?” You can envision the interrelatedness of the initial definition of the question area, the literature review, and the refined research question.

H E L P F U L H I N T Reading the literature review or theoretical framework section of a research article helps you trace the development of the implied research question and/or hypothesis.

Examining significance When considering a research question, it is crucial that the researcher examine the question’s potential significance for nursing. This is sometimes referred to as the “so what” question, because the research question should have the potential to contribute to and extend the scientific body of nursing knowledge. Guidelines for selecting research questions should meet the following criteria:

• Patients, nurses, the medical community in general, and society will potentially benefit from the knowledge derived from the study.

• Results will be applicable for nursing practice, education, or administration.

• Findings will provide support or lack of support for untested theoretical concepts.

• Findings will extend or challenge existing knowledge by filling a gap or clarifying a conflict in the literature.

• Findings will potentially provide evidence that supports developing, retaining, or revising nursing practices or policies.

If the research question has not met any of these criteria, the researcher is wise to extensively revise the question or discard it. Example: ➤ In the previously cited research question, the significance of the question includes the following facts:

• HAV and HBV are vaccine preventable.

• Viral hepatitis disproportionately impacts the homeless.

• Despite its availability, vaccine completion rates are low among high-risk and incarcerated populations.

• Accelerated vaccine programs have shown success in RCT studies.

• The use of nurse case management programs in accelerated vaccine programs also provides evidence of effectiveness.

• Little is known about vaccine completion among ex-offender populations on parole using varying


intensities of nurse case management and peer coaches.

• This study sought to fill a gap in the related literature by assessing whether seronegative parolees randomized to one of three intervention conditions were more likely to complete the vaccine series as well as to identify predictors of HAV/HBV vaccine completion.

  H I G H L I G H T It is helpful to collaborate with colleagues from other professions to identify an important clinical question that provides data for a quality improvement on your unit.

The fully developed research question When a researcher finalizes a research question, the following characteristics should be evident:

• It clearly identifies the variables under consideration.

• It specifies the population being studied.

• It implies the possibility of empirical testing.

Because each element is crucial to developing a satisfactory research question, the criteria will be discussed in greater detail. These elements can often be found in the introduction of the published article; they are not always stated in an explicit manner.

Variables Researchers call the properties that they study “variables.” Such properties take on different values. Thus a variable, as the name suggests, is something that varies. Properties that differ from each other, such as age, weight, height, religion, and ethnicity, are examples of variables. Researchers attempt to understand how and why differences in one variable relate to differences in another variable. Example: ➤ A researcher may be concerned about the variable of pneumonia in postoperative patients on ventilators in critical care units. It is a variable because not all critically ill postoperative patients on ventilators have pneumonia. A researcher may also be interested in what other factors can be linked to ventilator-acquired pneumonia (VAP). There is clinical evidence to suggest that elevation of the head of the bed and frequent oral hygiene are associated with decreasing risk for VAP. You can see that these factors are also variables that need to be considered in relation to the development of VAP in postoperative patients.

When speaking of variables, the researcher is essentially asking, “Is X related to Y? What is the effect of X on Y? How are X1 and X2 related to Y?” The researcher is asking a question about the relationship between one or more independent variables and a dependent variable. (Note: In cases in which multiple independent or dependent variables are present, subscripts are used to indicate the number of variables under consideration.)

An independent variable, usually symbolized by X, is the variable that has the presumed effect on the dependent variable. In experimental research studies, the researcher manipulates the independent variable (see Chapter 9). In nonexperimental research, the independent variable is not manipulated and is assumed to have occurred naturally before or during the study (see Chapter 10).

The dependent variable, represented by Y, varies with a change in the independent variable. The dependent variable is not manipulated. It is observed and assumed to vary with changes in the independent variable. Predictions are made from the independent variable to the dependent variable. It is the dependent variable that the researcher is interested in understanding, explaining, or predicting. Example: ➤ It might be assumed that the perception of pain intensity (the dependent variable) will vary in relation to a person’s gender (the independent variable). In this case, we are trying to explain the perception of pain intensity in relation to gender (i.e., male or female). Although variability in the dependent variable is assumed to depend on changes in the independent variable, this does not imply that there is a causal relationship between X and Y, or that changes in variable X cause variable Y to change.

Table 2.2 presents a number of examples of research questions. Practice substituting other


variables for the examples in Table 2.2. You will be surprised at the skill you develop in writing and critiquing research questions with greater ease.

TABLE 2.2 Research Question Format

HBHC, Hospital-based home care.

Although one independent variable and one dependent variable are used in the examples, there is no restriction on the number of variables that can be included in a research question. Research questions that include more than one independent or dependent variable may be broken down into subquestions that are more concise.

Finally, it should be noted that variables are not inherently independent or dependent. A variable that is classified as independent in one study may be considered dependent in another study. Example: ➤ A nurse may review an article about depression that identifies depression in adolescents as predictive of risk for suicide. In this case, depression is the independent variable. When another article about the effectiveness of antidepressant medication alone or in combination with cognitive behavioral therapy (CBT) in decreasing depression in adolescents is considered, change in depression is the dependent variable. Whether a variable is independent or dependent is a function of the role it plays in a particular study.

Population The population is a well-defined set that has certain characteristics and is either clearly identified or implied in the research question. Example: ➤ In a retrospective cohort study studying the number of ED visits and hospitalizations in two different transition care programs, a research question may ask, “What is the differential effectiveness of nurse-led or physician-led intensive home visiting program providing transition care to patients with complex chronic conditions or receiving palliative care (Morrison, Palumbo, & Rambur, 2016)? Does a relationship exist between type of transition care model (nurse-led focused on chronic disease self-management or physician-led focused on palliative care and managing complex chronic conditions) and the number of ED visits and rehospitalizations 120 days pre- and posttransitional care interventions?” This question suggests that the population includes community-residing adults with complex chronic conditions or receiving palliative care who participated in either a nurse or physician-led transitional care program.

  E V I D E N C E – B A S E D P R A C T I C E T I P Make sure that the population of interest and the setting have been clearly described so that if you were going to replicate the study, you would know exactly who the study population needed to be.

Testability The research question must imply that it is testable, measurable by either qualitative or quantitative methods. Example: ➤ The research question “Should postoperative patients control how much


pain medication they receive?” is stated incorrectly for a variety of reasons. One reason is that it is not testable; it represents a value statement rather than a research question. A scientific research question must propose a measureable relationship between an independent and a dependent variable. Many interesting and important clinical questions are not valid research questions because they are not amenable to testing.

H E L P F U L H I N T Remember that research questions are used to guide all types of research studies but are most often used in exploratory, descriptive, qualitative, or hypothesis-generating studies.

The question “What are the relationships between vaccine completion rates among the ex- offender population and use of varying intensities of nurse case management and peer coaches?” is a testable research question. It illustrates the relationship between the variables, identifies the independent and dependent variables, and implies the testability of the research question. Table 2.3 illustrates how this research question is congruent with the three research question criteria.

TABLE 2.3 Components of the Research Question and Related Criteria

This research question was originally derived from a general area of interest: health-seeking behavior and coping (HAV and HBV vaccine completion rates) in a high-risk population (ex- offenders on parole, homeless), factors related to vaccine completion (age, education, race/ethnicity, marital, and parental status), and potential strategies (nurse case management and peer coaching) to improve protective behaviors and health outcomes. The question crystallized further after a preliminary literature review (Nyamathi et al., 2015).

H E L P F U L H I N T • Remember that research questions are often not explicitly stated. The reader has to infer the

research question from the title of the report, the abstract, the introduction, or the purpose.

• Using your focused question, search the literature for the best available answer to your clinical question.

Study purpose, aims, or objectives The purpose of the study encompasses the aims or objectives the investigator hopes to achieve with the research. These three terms are synonymous. The researcher selects verbs to use in the purpose statement that suggest the planned approach to be used when studying the research question as well as the level of evidence to be obtained through the study findings. Verbs such as discover, explore, or describe suggest an investigation of an infrequently researched topic that might appropriately be guided by research questions rather than hypotheses. In contrast, verb statements indicating that the purpose is to test the effectiveness of an intervention or compare two alternative nursing strategies suggest a hypothesis-testing study for which there is an established knowledge base of the topic.

Remember that when the purpose of a study is to test the effectiveness of an intervention or compare the effectiveness of two or more interventions, the level of evidence is likely to have more


strength and rigor than a study whose purpose is to explore or describe phenomena. Box 2.1 provides examples of purpose, aims, and objectives. BOX 2.1

E x a m p l e s o f P u r p o s e S t a t e m e n t s • The purpose of this study was to explore the relationship between future expectations, attitude

toward use of violence to solve problems, and self-reported physical and relational bullying perpetration in a sample of seventh grade students (Stoddard, Varela, & Zimmerman, 2015). The aim of this study was to determine knowledge, awareness, and practices of Turkish hospital nurses in relation to cervical cancer, HPV, and HPV (Koc & Cinarli, 2015).

• The purposes of this longitudinal study with a sample composed of Hispanic, Black non- Hispanic, and White non-Hispanic bereaved parents were to test the relationships between spiritual/religious coping strategies and grief, mental health, and personal growth for mothers and fathers at 1 and 3 months after the infant/child’s death in the NICU/PICU (Hawthorne et al., 2016). The goals of the current study were to examine psychological functioning and coping in parents and siblings of adolescent cancer survivors (Turner-Sack et al., 2016).

  E V I D E N C E – B A S E D P R A C T I C E T I P The purpose, aims, or objectives often provide the most information about the intent of the research question and hypotheses, and suggest the level of evidence to be obtained from the findings of the study.

Developing the research hypothesis Like the research question, hypotheses are often not stated explicitly in a research article. You will often find that hypotheses are embedded in the data analysis, results, or discussion section of the research report. Similarly, the population may not be explicitly stated, but will have been identified in the background, significance, and literature review. It is then up to you to figure out the hypotheses and population being tested. Example: ➤ In a study by Turner-Sack and colleagues (2016) (see Appendix B), the hypotheses are embedded in the “Data Analysis” and “Results” sections of the article. You must interpret that the statement, “Independent sample t-tests were conducted to compare the survivors, siblings, and parents on measures of psychological distress, life satisfaction, posttraumatic growth (PTG), and that of their matched parents” to understand that it represents hypotheses used to compare psychological functioning, PTG, coping, and cancer- related characteristics of adolescent cancer survivors’ parents and siblings.

Hypotheses flow from the study’s purpose, literature review, and theoretical framework. Fig. 2.2 illustrates this flow. A hypothesis is a declarative statement about the relationship between two or more variables. A hypothesis predicts an expected outcome of a study. Hypotheses are developed before the study is conducted because they provide direction for the collection, analysis, and interpretation of data.


FIG 2.2 Interrelationships of purpose, literature review, theoretical framework, and hypothesis.

H E L P F U L H I N T When hypotheses are not explicitly stated by the author at the end of the introduction section or just before the methods section, they will be embedded or implied in the data analysis, results, or discussion section of a research article.

Relationship statement The first characteristic of a hypothesis is that it is a declarative statement that identifies the predicted relationship between two or more variables: the independent variable (X) and a dependent variable (Y). The direction of the predicted relationship is also specified in this statement. Phrases such as greater than, less than, positively, negatively, or difference in suggest the directionality that is proposed in the hypothesis. The following is an example of a directional hypothesis: “Nurse staff members’ perceptions of transformational leadership among their nurse leaders (independent variable) is that it is negatively associated with nurse staff burnout (dependent variable)” (Lewis & Cunningham, 2016). The dependent and independent variables are explicitly identified, and the relational aspect of the prediction in the hypothesis is contained in the phrase “negatively associated with.”

The nature of the relationship, either causal or associative, is also implied by the hypothesis. A causal relationship is one in which the researcher can predict that the independent variable (X) causes a change in the dependent variable (Y). In research, it is rare that one is in a firm enough position to take a definitive stand about a cause-and-effect relationship. Example: ➤ A researcher might hypothesize selected determinants of the decision-making process, specifically expectation, socio-demographic factors, and decisional conflict would predict postdecision satisfaction and regret about their choice of treatment for breast cancer in Chinese-American women (Lee & Knobf, 2015). It would be difficult for a researcher to predict a cause-and-effect relationship, however, because of the multiple intervening variables (e.g., values, culture, role, support from others, personal resources, language literacy) that might also influence the subject’s decision making about treatment for their breast cancer diagnosis.

Variables are more commonly related in noncausal ways; that is, the variables are systematically related but in an associative way. This means that the variables change in relation to each other. Example: ➤ There is strong evidence that asbestos exposure is related to lung cancer. It is tempting to state that there is a causal relationship between asbestos exposure and lung cancer. Do not overlook the fact, however, that not all of those who have been exposed to asbestos will have lung cancer, and not all of those who have lung cancer have had asbestos exposure. Consequently, it would be scientifically unsound to take a position advocating the presence of a causal relationship between these two variables. Rather, one can say only that there is an associative relationship between the variables of asbestos exposure and lung cancer, a relationship in which there is a strong systematic association between the two phenomena.

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