Best Scientific Paper Award 2016

Best Scientific Paper Award

I have presented a scientific paper on "Longitudinal investigation of lived experience among disaster victims of South Indian floods 2015: To develop a Concatenated Disaster Crisis (CDC) model using phenomenographical framework analysis" in an International Conference on disaster risk reduction and role of nurse, conducted by College of Nursing, Christian Medical College, Vellore, Tamilnadu, India on 17.11.2016 & 18.11.2016. I have received "Best Paper Award" for my presentation. Thank you very much for your help and support.

Qualitative research

Qualitative research
Qualitative research is a process of putting data together from many sources in an effort to arrive at a holistic understanding of a phenomenon.

A qualitative design;

• is flexible and elastic
• can combine various data collection strategies
• strives to understand the whole
• requires ongoing analysis of the data formulate strategies

Preparation for a qualitative research

A researcher has to prepare themselves for conducting qualitative research in advance;

• Selection of title of the study or problem to be studied
• Plan design and data collection methods
• Select the setting and decide the nature of the participants
• Identify the ‘gate keepers’ who can provide access to important sources of data
• Determine time, money and resources availability for data collection

Phases in a qualitative study
The researcher conducts a qualitative study in three phases: orientation phase, exploration phase and confirmation phase.

• Orientation phase

The qualitative researcher enters into a study ‘not knowing what is not known’ that will make the researcher to drive forward.

• Exploration phase

The researcher explores the different aspects of the phenomenon. The questions to be asked to participants are shaped by the researcher.

• Confirmation phase

To confirm their findings trustworthy, the researcher often goes back and discusses their understanding with the study participants. 

Types of data collection strategies
The data collection strategies can be cross sectional or longitudinal. In cross sectional research, the data collection will be conducted at one point of time. In longitudinal research, the researcher conducts multiple data collection points over an extended time period.

Setting for qualitative research study
The qualitative researchers prefer natural setting to collect data; however, they conduct study in a variety of natural contexts to study phenomena extensively. 

Major types of qualitative research studies
The qualitative research traditions derived mainly from anthropology (culture), philosophy (lived experience), psychology (behavior), sociology (socially related) and socio linguistics (human communication). The major traditions which the qualitative researchers followed are;

• Ethnography
• Phenomenology
• Grounded theory

Ethnography
This research tradition focuses on the culture of a group of people. The main objective is to learn about a specific culture. The ethnographic researchers should use either one of perspectives; emic perspective or etic perspective. An emic perspective is the view of the culture as an insider or member of the community. An etic perspective is the view of the culture by an outsider. However, the ethnographers focus to acquire from emic perspectives. Some cultural experience is deeply embedded and members may not consciously aware of it. In this scenario, the researcher use ‘tactic knowledge’ to acquire information about the culture. Ethnography is time consuming and may take several months to get overall understanding of a culture. The researchers have to actively participated in a cultural group to develop intimacy with them. The ethnographers strive to acquire three types of information:

• Cultural behavior (What members do?)
• Cultural artifacts (What members do make and use?)
• Cultural speech (What people say?)

These study results provide an insight on health belief and practices.
The ethnography can be divided into two:

• Macro ethnography; study on culture broadly, for example: culture of a village
• Micro ethnography; study on culture which is narrowly defined, for example: culture of a tribal women.

Phenomenology
This approach strives to explore about people’s life experiences. The researcher conducts an enquiry regarding the experiences by the people in a given phenomena. The phenomenologist investigates subjective phenomena in the belief that reality is grounded in people’ lived experiences. There are two aspects of phenomenology: descriptive and interpretive phenomenology. In descriptive phenomenology, the researcher explores what people experience in regards to a phenomenon. In interpretive phenomenology, the researcher investigates how they interpret those experiences. The investigators believed that lived experience gives an idea to each person’s perception of a particular phenomenon. The phenomenologists are interested in four aspects of lived experience: lived space/spatiality, lived body/ corpeality, lived time/temporality and lived human relation/relationality.
In a phenomenologic study, the main data source is in depth conversations with the researcher and informant as participants. The researcher facilitates the informants to describe lived experience in a series of interview sessions. The sample size can be limited from 10 to 20, based on attaining of data saturation. The other data collection methods in phenomenology are participation, observation and introspective reflection.
The data analysis involves the following steps; bracketing, intuiting, analyzing and describing. Bracketing refers to the process of identifying and holding in abeyance pre conceived beliefs and opinions about the phenomena under study. Intuiting occurs when the researcher remains open to the meaning attributed to the phenomenon by those who have experienced it. Then, the researcher can proceed to analysis phase includes extracting significant statements, categorizing and making sense of the essential meaning of the phenomenon. Finally, the researcher defines the phenomenon with quotes.

Grounded theory
The grounded theory roots on social interaction and the interpretation they attach to social symbols like language. It is the study of social process and social structures. It explains the social and psychological stages that characterize a particular event. It also generates comprehensive explanation of phenomena that are grounded in reality. During data collection, the research questions are emerged from the data. The data collection, data analysis and sampling of participants occur simultaneously. A procedure referred to as constant comparison is used to develop and refine theoretically relevant categories and to identify the basic problems. The categories are compared with data so that commonalities and variations can be determined. In depth interviews and observation methods can be used for data collection. Typically, a grounded theory study involves interviews with a sample of about 20-50 informants.

Techniques of research control

Techniques of research control
Research control eliminates the influences of extraneous variables in the study so that true relationship between the independent and dependent variables can be understood. It excludes the contaminating factors that might affect the relationship between the variables. For example, the researcher wants to study depression among post partum women; the dependent variable is level of depression and independent variable is past partum women. There are other possibilities which affect the level of depression among post partum women such as age, socio economic status and marital status. If a researcher wants to study true relationship between independent and dependent variable, the extraneous variable has to be controlled. The extraneous factors can be divided into two;

• External factors
• Internal factors

Control of external factors
The external factors to be controlled in research are environment, time, culture and so on. To control the environmental influence on data collection, the researcher has to select the environment in natural or artificial setting according to the problem to be studied. Depending on the research topic, the relationship between dependent and independent variable may be influenced by the time of day, month and year. In these cases, the researcher should ensure the constancy of time during data collection.
Control of internal factors
Controlling internal factors such as gender, hereditary is doubtful in research. There are a few methods formulated o control subject characteristics to protect the research topic from the contamination of extraneous variables.
Methods are;

• Randomization
• Homogeneity
• Matching

Randomization
It means the selection of participants randomly, without any conscious decisions by the researcher. Randomization of study participants controls all possible sources of extraneous variables. For example, random assignment of subjects to experimental and control group would equalize the distribution of variables such as age, gender and neutralizes the influences of extraneous variables.
Homogeneity
When randomization is not feasible, the researcher can select the subjects who are homogenous with respect to extraneous variables are included in the study. Homogeneity means the researcher selects the study participants based on important extraneous variables such as specific age group, gender, education and so on. The main limitation of the homogeneity is that results of the study can be generalized only to the type of subjects participated.
Matching
During case control study, the researcher selects the study participants based on relevant extraneous variables and randomly divided into case control groups. This technique used to form comparable groups in case control design.

Classification of research design based on purpose

Classification of research design based on purpose
Survey research
The researcher collects the data regarding incidence, prevalence and distribution of variables of with in population through survey. The survey reports are based on self reports and respondents answer to the questions raised by the researcher. The common method for data collection is personal, face to face interview, interview by telephone and self administered questionnaire. The survey research is suitable for extensive data collection among large population and can focus on wide range of topics at a time.
Evaluation research
It helps to evaluate a process, program, treatment or policy. It can be cross sectional, longitudinal or experimental/non experimental. Based on the aim of evaluation, it can be classified into three;

1. Process analysis
2. Outcome analysis
3. Impact analysis

• Process analysis

A process analysis evaluates the process of implementing a new program or procedure and assesses the functioning in actual situation.

• Outcome analysis

An outcome analysis evaluates the final goals of the program, which are achieved after an implementation of program or process.

• Impact analysis

Impact analysis evaluates the net effects or impacts of the program after implementation of program or process.
Outcome research
Outcome research evaluates the effectiveness of health care services in an organization. This research conducts usually as part of global assessment. This types of assessment helps to appraise and document the quality of nursing care in an organization.

Classification of research design based on time dimension

Classification of research design based on time dimension
The designs can be classified based on when and how often data will be collected in a study. The data can be collected at a single point in time or more than one occasion. 

There are four situations in which it is a appropriate to design a study with multiple points of data collection.
1. Time related process- Depends on how phenomena evolved over time, for example, wound healing process.
2. Time sequenced phenomena- It is very important to ascertain the sequencing of phenomena. For example, the researcher has to make sure that pregnancy contributes to diabetes mellitus and not diabetes mellitus precedes pregnancy.
3. Comparative purposes- Here, multiple data points are used to compare phenomena over time.
4. Enhancement of research control- The researcher collects data at multiple points to enhance the interpretability of the results. For example, the collection of pre test data with demographic variables allows the researcher to detect for initial group difference. 

Cross sectional design
The researchers collect the data at one point in time and describe the status of phenomena or relationships among phenomena. For example, the researchers assess the level of depression among post partum women and test the relationship between independent (age, socio economic status and level of education) and dependent variables (level of depression). Advantages of cross sectional designs are economical and easy to conduct the studies for the researcher. A major disadvantage of conducting a cross sectional study is that problems arise when society changes rapidly. The researcher can not generalize the cross sectional study findings to a rapid changing society.
Longitudinal design
In this design, the researcher collects the data over an extended time period, identifies changes over time and sequence phenomena like a chain, which is an essential to establish causality.
Longitudinal studies are three types;

1. Trend studies
2. Panel studies
3. Follow up studies

Trend studies
Trend studies help the researcher to collect the data by drawing samples from general population over time with respect to a phenomenon. The researcher draws different samples from same population at repeated intervals, examines the changes at present and makes predictions about future. Foe example,predicting nursing shortage in coming years.
Panel studies
The researcher collects the data from the same participants at different period of time. With the same participants, the researcher examines the changes and identify the reasons fro change. The major problem with the panel studies are subject attrition. Subject attrition is defined as dropping of study participants during the study.
Follow up studies
In follow up studies, the researcher collects the data subsequently, especially after an intervention. In non experimental studies, the sample may be followed periodically to assess the changes in the variables. For example, weight gain among premature infants.

Best Scientific Paper Award 2016

Best Scientific Paper Award

I have presented a scientific paper on "A qualitative study to explore social burden among the wives of alcoholics in tribal area" in a National Conference, conducted by Sree Balaji College of Nursing, Bharath University, Chennai, Tamilnadu, India on 27.06.2016 & 28.06.2016. I have received "Best Paper Award" for my presentation. Thank you very much for your help and support.

Non experimental research

Non experimental research
There are many research problems that can be conducted using experimental or quasi experimental designs. In non experimental research, the independent variable is non-manipulate or unethical to manipulate, however, gives answers for research questions. 

Types of non experimental research
Correlational or Expost facto research has been conducted to study the relationships among variables after variation in the independent variable has occurred. It is designed to assess causal relationship between variables. it is divided into two types; Prospective study and Retrospective study

• Prospective study

In prospective study, the researcher looks forward to assess the effect and study is started with an examination of presumed cause. For example, the researcher selects samples of chronic alcoholics and non alcoholics and continues assessment for a period of time and later assesses the effect.

• Retrospective study

In retrospective study, the researcher observed at the effect of present and looks on to past history of the samples to collect and compare antecedent factors that have caused it.
Another class of non experimental research is descriptive research. The purpose of descriptive research studies is to observe, describe and document aspects of a situation. The researcher uses percentages or proportions to present the results. In descriptive correlational study, the researcher describes relationships among variables, but not causal connection.
Disadvantages of non experimental research
The major disadvantage is its inability to reveal casual relationships conclusively. It may be having false interpretation because the researcher works with known groups.

Quasi experimental research

Quasi experimental research
It involves manipulation of an independent variable, lacks either the randomization or control group features.
Types
There are two types most commonly used in nursing research;
1. Non equivalent control group design
2. Time series design

• Non equivalent control group design

It involves a treatment and two or more groups of subjects observed before and after its implementation. This design is useful, where the researcher is not able to do randomization due to unavoidable ethical reasons. This design is weak without randomization. On the other hand, the design is strong due to collection of pretest data allows us to determine whether the groups had similar morale initially by collecting pretest data, if the two groups are comparable with regard to demographic variables, the researcher could be relatively confident that any post test difference is self reported morale was the result of experimental treatment.

• Time series design

It involves the collection of data over an extended time period and introduction of treatment during that period. The researcher is able to collect measures of outcome variables before the intervention, during the intervention, after a period of intervention and so on.
Advantages of quasi experimental research
It seems to be more practical than the experimental designs. Nursing researchers conduct studies in natural settings, where it is unethical to deliver an innovative treatment to a cluster of people through randomization.
Disadvantages of quasi experimental research
With these types of experiments, there are alternative explanations for observed results. A researcher wants to evaluate the effectiveness of weight gain among infants, if there is no comparison group to observe weight gain, one can easily ask question that: Is the weight gain among infants would have occurred without intervention? These types of questions called as rival hypothesis. If the answer is yes, inferences about treatment effectiveness are weakened.
In research reports, the researcher does not mention regarding random assignment or comparison group, probably it is safe to conclude that the design is quasi experimental and pre experimental.

Experimental Research

Experimental Research
In experimental research, the researcher is an active agent rather than a passive observer. To do an experimental research, the researcher has to follow these principles such as
1. Manipulation
2. Control
3. Randomization

• Manipulation

It means the researcher intervenes something in the group and analyze the outcome. In other words, the researcher varies the independent variable by administering an intervention or treatment and analyzes its effects on the dependent variable. For example, the researcher analyzes the level of knowledge (dependent variable) before and after video teaching programme (intervention).

• Using control group

Control group refers to a group of participants whose performance on dependent variable is used as a basis for evaluating the performance of the experimental group (a group which receives intervention) on the same dependent variable. The researcher keeps the control group (a group with no intervention or administers an alternative or false intervention such as placebo) parallel to experimental group. For example, to evaluate the effectiveness of nutritional supplements, the researcher divides the newborns into two groups with different mode of strategies.
Strategy I: A group of newborns receiving nutritional supplements daily (experimental group) and other group without any nutritional supplements (control group).
Strategy II: A group of newborns receiving nutritional supplements daily (experimental group) and other group with alternatives to nutritional supplements such as glucose powder called a group with placebo intervention (control group).

• Randomization

Randomization means the researcher randomly select the participants in the study without any bias. Through randomization, the every participant gets an equal chance to participate in the study. The methods of randomization may vary from flipping a coin to computerized randomization method.

Experimental designs
Basic Designs
The researcher assigns the subjects randomly into experimental and control group, intervenes the intervention in the experimental group and collects the data after intervention from experimental and control group. This is also called as after only or post test only design. In another way, the researcher collects the information from experimental and control group before and after intervention is called as before-after design or pretest-post test design.
Factorial design

Factorial Design

In factorial design, the researchers manipulate two or more variables together on the study subjects and evaluate the main effects and also interaction effects. Here, the subjects are assigned at random to a combination of treatments. The term cell represents in a schematic diagram as a box. The independent variables are referred to as factors. Each factor is exposing in different levels. For example, a study to assess the effectiveness of supplementary feeding versus normal feeding among toddlers on weight gain. Here, the researcher designs the study on 2×2 table with two factors such as type of feeding A (Supplementary feeding (A1) and normal feeding (A2) and frequency of feeding B one time/day (B1) and two times per day (B2). The researchers assign the toddlers randomly to one of the cells, which consist of combination of treatments. The results will show the best mode of feeding and also the interaction effects resulting from the combination of treatment methods.
Repeated measures design/ Cross over design
The researchers intervene two or more interventions among the same subjects called within subjects design or cross over design. It involves the exposure of the same study participants to more than one treatment. The study subjects are randomly assigned to receive different ordering of treatment. For example, to compare the effects of auditory and tactile stimulation on infants, some subjects would like to randomly assign to receive auditory stimulation first and others would receive tactile stimulation first with the subjects serving as their own control group.  It prevents participant bias by achieving possible equivalence among subjects exposed to different conditions. There is an expected disadvantage of carryover effects of first treatment among study participants. When the researcher introduces two or more treatments and intervenes the treatments in the randomized order is called as experimental repeated measures design.
Clinical trials
The researcher evaluates the effectiveness of new treatment through a randomized clinical trial. It involves the testing of a clinical treatment, random assignment of subjects to experimental and control groups and assesses the effectiveness of treatment. Clinical trials can be done using before – after or after only design.
Advantages of experiments
These are the most powerful designs for testing hypothesis of cause and effect relationships. It also meets the criteria of causality, by Lazarsfield (1955).
1. A cause must precede an effect in time. For example, to test the hypothesis- smoking causes lung cancer; subjects should not have developed cancer before exposure to smoking.
2. There must be an empirical relationship between the presumed cause and effect. For example, in case of smoking and lung cancer, the researcher should collect the evidences regarding higher incidence of lung cancer is directly related to occurrence of smoking.
3. The relationship of presumed cause and effect should not affect by a third variable. For example, a relationship between smoking and lung cancer might reflect an underlying causal relationship between prolonged dust exposure and lung cancer.
Through manipulation, presence of control groups and randomization, an alternative explanation to a causal interpretation can be ruled out.
Disadvantages of experiments
All variables can not be manipulated such as race, ethnicity and history of diseases.
There are many variables, which can not be manipulated ethically. For example, withdrawal of vaccines from control group to test the effectiveness of vaccines in experimental and control group.
Hawthorne effect- Awareness of being in a study may alter the participant’s behavior, which affects the study results.
Double hawthorne effect- Those who administer the treatment know the subjects who are in experimental and control group; alters the study results. In a double blind experiment, neither the subjects nor those administering the treatment know who is in the experimental or control group; are so powerful.

Quantitative research designs

Quantitative research designs
Research designs in quantitative approach refer to the researcher’s overall plan for answering the research questions and/or testing the research hypothesis. It guides the researcher to adopt well defined strategies based on the decisions. 

There are some areas the researcher has to look on it before reflecting research design;
-Need of implementing any interventions
-Need of compare groups
-Need of control factors extraneous to research
-Need of collecting data at different time periods
-The nature of setting, in which the study takes place.

The researcher has to select an appropriate design based on dimensions of research question.

• Dimension; Control over independent variables

Appropriate designs are;
Experimental–manipulation of independent variables, control group and randomization
Quasi experimental –manipulation of independent variables but no randomization or control group
Non experimental –no manipulation of independent variables

• Dimension –Type of group comparisons

Appropriate designs are;
Between subjects –participants in groups being compared are different people
Within subjects –participants in groups being compared are the same people

• Dimension –Number of data collection points

Appropriate designs are;
Cross sectional design- one time data collection
Longitudinal design- multiple points data collection

• Dimension –Occurrence of independent and dependent variables

Appropriate designs are;
Retrospective – a study begins with dependent variable and looks the past for a cause
Prospective –study begins with independent variables and looks forward to identify the effect

• Dimension –Setting

Appropriate designs are;
Naturalistic-data collected in real world setting
Laboratory – data collected in artificial setting

What may be the sixth sense, which can be applicable in nursing?

Dear colleagues,

I am Mrs.Ponnambily Jobin, working as Asst.Lecturer in College of Nursing. This is to bring to your kind information that I have published a conceptual model (under mid range theory) in 2015, addressing 'child sex abuse' as a problem domain. (Please see PCSA Model &List of nursing theories). Now, I am working on a grand theory focusing on 'Inter-sensory Perception in Nursing Care'. I have attempted to develop a classification of senses based on a specific criteria, which highlights sixth sense, in addition to five traditional senses such as vision, hearing, smell, touch and taste. I would like to gather suggestions from you to accept or to refute the theory. I humbly request you to have a response on 'what may be the sixth sense, which can be applicable in nursing?'. 

Disclaimer:  

• If you are interested, please forward it and discuss among your co-workers. If not, kindly ignore the post.
• This blog does not represent any institutions and any organizations that the owner may be or may not be associated professionally and personally.The aim of this blog is informational purpose only.

Nursing research and theory

Nursing research and theory
Theory
A theory is a broad and abstract characterization of phenomena. The theories are two types; classical and descriptive theories. Classical theory refers to an abstract generalization that presents a systematic explanation about how phenomena are interrelated. The theory explains about the phenomena and their interrelationship.
Descriptive theory describes a single phenomenon which means that describing a specific characteristic of individual or events by summarizing commonalities found in discrete observation.
Theories allow the researcher to order the observations together. It guides the researcher’s understanding not only of the ‘what’ of natural phenomena but also of the ‘why’ of their occurrence. Theories are abstractions that are created or invented by humans through observations and experiments. It shows the theorist’s ingenuity in pulling those facts together, drawing conclusion and making sense of them. It represents a theorist’s efforts to describe and explain phenomena. Based on level of generality, the theories are two types; grand (macro theories) and middle range theories. Grand theories are intended to explain large segments of the human experience (foe example, stress adaptation among human being). Middle range theories are purported to explain a portion of the human experience (for example; stress adaptation among post operative patients).
Conceptual model
Conceptual models are loosely structured and concepts are assembled based on their relevance to common theme. It presents an understanding of the phenomenon of interest and reflects the assumptions and philosophical views of the model’s designer. The conceptual models are two types: Statistical models and Schematic models. Statistical models are mathematic equations that express the nature and magnitude of relationships among a set of variables. A schematic model represents a phenomenon of interest and expresses the relationships in a diagram. Concepts are represented in boxes and relationship is represented by using directional and non directional arrows and/or symbols.
Conceptual Framework
A framework is the conceptual base of all the studies. If a study based on a theory, the framework is referred to as theoretical framework and a study based on a conceptual model, a framework called as conceptual framework. The conceptual framework helps the researcher to understand how concepts are defined and operationalised. 

Developing and testing of theory
Research plays a vital role in theory developing and testing.  Theory guides the research and researcher to assess the theory, thus, it provides a foundation for new ones.
Developing theory using qualitative research
Through qualitative research, researcher identifies patterns, communalities and its relationship among events. During the data analysis, the researcher moves from specific pieces of data to abstractions that synthesize and give structure to the observed phenomena. The main purpose is to derive a data which is grounded in reality, to provide explanation of events as they occur in reality and it should not be conceptualized in preexisting theories. 

Testing theory using quantitative research
The researchers deduce concepts in the form of hypothesis and do test through quantitative research. Then, hypotheses are predictions about how the variables would be related, if theories were correct. The researchers cannot test the theory directly, as it’s a combination of testable and non testable concepts into the form of hypothesis and test it through quantitative research. The comparison between the observed outcomes of research and the relationship predicted by the hypothesis are the major focus of the testing process. 

Review of literature

Review of literature
A research literature review is a written summary of the state of existing knowledge on a research problem. It helps the researches to seek knowledge on a topic of interest and synthesize evidence based information to gain knowledge and improve nursing practice. 

The purposes of review of literature among researchers are:
It helps to;
-assemble knowledge on a topic
-identification of relevant research problem
-refine research questions
-gain insight to what is known and not known about an area of inquiry
-determine gaps in a body of research
-determine he need of replication of many nursing studies
- identify the suitable methodology to carry out a study
-interpret study findings and in developing implications and recommendations
The research reviews also included in research proposals, documents that describe what a researcher is planning to study, how the study will be conducted and how much will cost to complete the study. 

The purposes of review of literature among non researchers
The nurses involved in policy making organizations are depended on review of literature to review and synthesize evidence based information.
It helps to;
-gain knowledge on a topic
-gather evidence to critique of existing nursing practice or recommend or implement the new nursing interventions
-develop proposals
-develop a theory or conceptual framework
-revise curriculum of nursing
-develop policy statements and practice guidelines

Sources of literature reviews 

• Electronic literature reviews

Most of the universities offer electronic data base with bibliographic files that can be accessed either through an online research. Nurses can access the data through online search, CD-ROM (Compact disks that store the bibliographic information) or commercial vendors (Ovid, Silver platter and so on). These services provide trial run for a few months for testing accessibility before subscribing. For example, CINAHL (Cumulative index to nursing and allied health literature), MEDLINE (Medical literature online), AIDSLINE (AIDS information online), CANCERLIT (Cancer literature) and CHID (Combined health information data base). In the electronic research data base, the studies can be searched by the key words, variables and researcher’s name.

• Print resources

These sources are overshadowed by electronic resources. The main disadvantages are time consuming due to manual search and unable to access to all researchers widely. The main advantage is one can access to reports before 1982, as it is not published in electronic sources.
Print indexes are books used to locate research reports in journals and published periodically with an annual cumulative index. For example, International nursing index, Index Medicus and so on. When using a print index, you need to first identify the appropriate subject heading. It can be located in Index’s thesaurus, which lists commonly used terms or key words. Abstract journals are useful for researchers, as they provide a summary if a study rather than lengthy report.

Writing a literature review
Researcher can collect reviews from two sources such as primary and secondary sources. The primary sources are written by the researchers who conducted them. The secondary sources are description of research articles prepared by some one. The review articles help the researcher to gin insight on what is known and what is unknown or related topic. 

The steps of preparing a written research review are:
Step 1: Identify the key words/concepts to be searched
Step 2: Identify the potential references through electronic/manual search
Step 3: Retrieve promising references
Step 4: Screen references for relevance and appropriateness
Step 5: Read relevant articles and concise the reports
Step 6: Organize the reports based on subject/year/nature of the results
Step 7: Write a review

Types of literature references
There are varieties of literature such as empirical literature, conceptual literature and others include opinion articles, anecdotes, incident reports or clinical impressions.
Empirical literature is objective and addresses the research questions with evidence based information. It increases the strength of the study.
Conceptual literature is based on a theory or conceptual model. In the conceptual literature, a primary source is a description of theory, written by the developer of the theory and a secondary source is a discussion or critique of the theory. Opinion article, anecdotes, incident reports and clinical impressions are mostly subjective; an expression of point of view by the researcher and it does not address any research questions. However, it plays an important role in formulating research ideas. 

Organizing the review
After collecting the relevant articles, the researcher should read carefully till she understands the research. The researcher prepares a summary of article by highlighting the main points such as author, year of the study, place of the study, type of approach and design, sample, data collection, data analysis, results, interpretation, implications, inconsistencies in the results, faults in the research and weakness of the research.

Types of literature reviews
There are several types of review that can be used to support evidence based practice such as:
1. Traditional narrative reviews
This type of review synthesizes and summarizes, in narrative terms, a body of research literature. These reviews are frequently published in nursing journals. It provides the state of the art research based information and foundation for the development of innovations for clinical practice.
2. Meta analysis
It is a method of integrating quantitative research findings statistically. Here, the writer will consider the individual studies are the unit of analysis in a meta-analysis. The writer will review the findings from multiple studies on the same topic are then combined to create a data set that can be analyzed. While reading meta-analysis, the reader gets an idea of strength and weakness of association of dependent and independent variable on related topic. 

3.Qualitative meta-synthesis
It is an integration of narrative information and summary of qualitative findings. It has been defined as the ‘theories, grand narratives, generalizations or interpretive translations produced from integration or comparison of findings from qualitative studies. 

To conclude, the nurses have to read literature reviews to gain insight on the various problem statements and its findings that is existed in the society, which helps to equip them to explore from known to unknown world.

Research Problem

Research Problem
A research problem is a state or source of troubling and perplexing situation or condition. The purpose of the disciplined research is to solve the problem in the reality by exploring and identifying the contributing factors. A problem statement reveals the nature of the problem. A research question is the statement about what the researchers want to answer. Hypothesis is the statement, in which the researcher predicts the answer before data collection and is tested empirically. A statement of purpose is summary of specific objectives and the researcher hopes to achieve by conducting the study. 

An example of the research problem is ‘level of stress among adolescent girls’.
An example of the problem statement is ‘a quantitative study to assess the level of stress among adolescent girls in urban area, India’.
An example of the research question is ‘what is the level of stress among adolescent girls?’
An example of the hypothesis is ‘there is an association between the level of stress and socio demographic variables’.
An example of the statement of purpose is ‘the purpose of the study is to assess the level of stress among adolescent girls and test association between level of stress and socio demographic variables’.
Examples of the objectives are ‘to assess the demographic variables of adolescent girls, to assess the level of stress among adolescent girls and to associate the level of stress and socio demographic variables of adolescent girls’.

The developments of an interesting and innovative research process, researchers begin with a topic of interest, explore its relevance in the current scenario, having discussion with experts and then develop the topic into a more specific problem.

Sources of research problem
The researchers can identify and develop research problem from own clinical experience, thorough review of literature, current political and societal issues, testing and validating theory and emerges ideals from external sources such as conference, interviews, brain storming session with other faculties and so on. The researcher can select an appropriate approach such as qualitative and quantitative, based on the nature of the problem to be explored in detail. For example; (1)if the researcher wants to assess the level of stress among adolescent girls, he/she has to select quantitative approach, which gives the results in numeric terms, in which, the researcher can assess the level of stress in terms of low, moderate and high level of stress. (2) If the researcher wants to explore the stress and its contributing factors among adolescent girls, he/she has to proceed with qualitative approach, which gives the narrative details of information regarding stress and its contributing factors. Thus, the researcher can develop a theory or conceptual model from related qualitative study.

Problem statement
A problem statement is an expression of troubling situation that needs investigation. It identifies the nature of the problem being studied, the population, setting, its content and its significance. In general, in qualitative study, problem statement shows the nature of the problem in terms of concepts, population being studied and setting being carried out in the study, for example; a study to assess the knowledge on child abuse among the mothers of under five children in rural area in India.
In qualitative study, the problem statement expresses the phenomena to be explored, population being studied and setting being carried out in the study. For example; a qualitative study to explore social burden among wives of alcoholics in tribal area, India.

Statement of purpose
It is vital to articulate the researcher’s goals as a broad statement of purpose in declarative form. In a quantitative study, a well worded statement or purpose identifies the key study variables and their possible interrelationship as well as the nature of the population of interest. For example; the purpose of the study was to assess the knowledge on child abuse among the mother’s of under-five children. The statement identifies the population of interest (mothers of under-five children), independent variables (socio demographic variables) and dependent variables (knowledge on child abuse).
In qualitative study, the statement of purpose indicates the nature of the inquiry (exploration), the phenomenon under investigation (social burden), the group (wives of alcoholics) and the setting (tribal area) under study. For example; the purpose of the study was to explore the social burden among wives of alcoholics in tribal area. In quantitative study, the researcher uses verbs of ‘assess, test or compare’ to show the degree of purpose of research. In qualitative research, they use ‘explore, describe, understand and develop’ verbs to show the nature of the purpose of the study. 

Research questions
Research questions are rewording of statement of purpose which phrased interrogatively. This questions help to focus on the data needed to give the answer. In qualitative study, research questions identify key variables (most often dependent and independent variables), the relationships among them and the population under study.
Is there any relationship between knowledge (dependent variable) and education level of participants (independent variable)?
In qualitative study, the researcher starts the study and evolves questions during the study period. 

Research hypothesis
A hypothesis is a statement of prediction about the relationship between two or more variables.

• Hypothesis and qualitative research

In a qualitative study, the researchers don’t begin with hypothesis because the study is guided by the participant’s view points rather than researcher’s view points. Some qualitative studies may lead to the formulation of hypothesis.

• Hypothesis and quantitative research

In quantitative research, a hypothesis is the translation of research question into a prediction of possibilities of outcomes.
Research question: Is there any relationship between weight bearing exercises and loss of weight among women?
Hypothesis: There is a relationship between weight bearing exercises and loss of weight among women.

The theory is too abstract and not able to be tested. However, predictions based on the theory can be tested. For example, theory of reinforcement tells that behavior is positively reinforced (rewarded) tends to be learned. The researcher can develop hypothesis based on the reinforcement theory to test the validity of the predictions such as nursing students who are praised by nursing authority are more hardworking than who are not praised. This proposition can be tested in the real world. The theory gains support if the hypothesis is confirmed.

Testable research hypothesis states the expected relationship between the independent variable (presumed cause) and the dependent variable (the presumed effect with in a population). It is otherwise called as simple hypothesis. A complex hypothesis is the prediction of relationship between two or more independent variables or two or more dependent variables. A directional hypothesis is one that specifies the expected direction of the relationship between the variables. For example, lower level of exercise in post partum is associated with greater weight retention. A non directional hypothesis does not stipulate the direction of relationship, for example, there is a relationship between post partum exercise and weight retention. Research hypotheses are statements of expected relationship between variables. For example, there is a relationship between antenatal exercises and stress reduction among women.

Null hypothesis states that there is no relationship between the independent and dependent variable. For example, there is no relationship between antenatal exercises and stress reduction among women. 

To conclude, hypotheses are never proved through hypothesis testing rather they are accepted or supported. The study results are always vary if the same findings are replicated in many study projects, greater confidence can be placed in the conclusions. The strength of the supported hypothesis depends on the replication of the same results in numerous researches.

Nursing Research Ethics

Nursing Research Ethics 

Most of the professions have established their own code of ethics. The American Nurses Association has formulated ‘human rights guidelines for nurses in clinical and other research’.
In the United States, the National Commission for the Protection of Human Subjects of Bio medical and Behavioral Research issued a report, referred it as Belmont report and served as a model for many of the guidelines adopted by discipline. The Belmont report tells about three primary ethical principles on which standards of ethical conduct in research are based.

I. Beneficence
II. Respect for human dignity
III. Justice

 
I. Principle of Beneficence

 
The principle of beneficence aims at ‘do not harm’. It includes freedom from harm, freedom from exploitation and risk/benefit ratio.
1. Freedom from harm
It is not permitted to harm the study participants during the research. Before proceeds with humans, a new medical procedure or drug is being tested with animals or tissue culture. The psychological harm of the study participants during the study requires close attention and sensitivity, for example, interviewing a rape victim. The psychological harm can be minimized by carefully phrasing questions, obtain informed consent, assure of confidentiality and anonymity, significance of conducting research on the related topic, provide privacy, gain mutual trust, frequent counseling sessions and so on.
2. Freedom from exploitation
The researcher should not place participants at a disadvantage or expose them to situations for which they have not been explicitly prepared. The researcher maintains a relationship and it is crucial that this relationship not to be exploited, for example, sexual exploitation. It is not advisable to utilize the study participants under poor economic circumstances, for example, conducting experimental studies in developing countries by offering free treatment. In qualitative research, the risk of exploitation may be less because that gap between the investigator and participants decrease as the study progresses.
3. Risk/Benefit ratio
The researcher should weigh the potential risks to participants to benefit to society and nursing profession. The degree of risk to be taken by those participating in the research should never exceed the potential humanitarian benefits of the knowledge to be gained. Major potential benefits are accessibility of the treatment when they are in need monetary gains through incentives and so on. The potential risks are physical harm, loss of time, fatigue, boredom, loss of privacy and fear of disclosure. 

II. Principle of respect for human dignity
This principle includes right of self determination, right of full disclosure and informed consent.
4. Right to self determination
The researcher has to respect the study participants for their self determination. The participants have the right to decide voluntarily whether to participate in a study without the risk of increasing any penalty or prejudicial treatment. The participants have the right to ask questions, clarify the doubts, if they do not want to proceed, can terminate their participation. The researcher should be very carful to not to be coercive in the study. Coercion involves implying threats of penalty for failing to participate in a study or excessive rewards from agreeing to participate, for example; rewarding excess internal marks to students, who agreed to participate.
5. Right to full disclosure
The researcher has to describe the study participants regarding the nature of the study, the participant’s right to refuse participation, the researcher’s responsibilities and the potential risks and benefits that would be incurred.
6. Right to obtain informed consent
Informed consent means that the researcher provides adequate information regarding the research to the participants includes study purposes, time period, voluntary nature of the participants, potential risks and benefits and so on. The researcher asks the study participants to sign a consent form prior to the study. In qualitative research, the researcher asks the study participants to sign a process consent, which means consent is viewed as ongoing and transactional process and the researcher continuously negotiates the consent, allowing participants to play a collaborative role in the decision making process regarding their ongoing participation.
Problems related to the principle of respect
There are two biases can be expected in relation to full disclosure to the study participants during the research such as the bias resulting from distorted information and the bias resulting from failure to recruit a good sample. Sometimes, the principle of respect will be questioned while the researcher use two methods in data collection approach such as covert data collection (concealment) and deception technique. If the researcher wanted to observe people’s behavior in real world setting and the informed consent would result in changes in the behavior of interest. Deception is a technique in which, the researcher deliberately withholding information about the study or providing participants with false information. For example, the researcher conduct a study on adolescent drug abuse, might describe the research as a study of student’s health practices. Deception and concealment are problematic from an ethical stand point, if there are anticipated benefits to the society and minimal risk to the participants may be justified to enhance the validity of the findings. 

III. Principle of justice
The principle of justice includes the participant’s right to fair treatment, right to privacy and right to protect vulnerable groups.
7. Right to fair treatment
Participants have the right to fair and equitable treatment before, during and after their participation in the study.
It includes;
-selection of participants non discriminatory
-clarify the doubts of participants
-provide assistance to participants for accessing treatment
-respect their beliefs, habits and life styles
-courteous and tactful treatment at all time
8.  Right to privacy
The researcher should maintain anonymity and confidentiality through out the study. Anonymity occurs when ever the researcher can not link a participant with his or her data. Confidentiality occurs when the researcher promises the participant that any information will not be publicly reported or made accessible to other parties not involved in the research. In qualitative study, the researcher has to take extra precaution to safe guard participant’s identity as the number of participants is small by withholding information about the characteristics of the informant such as age and occupation.
9. Right to protect vulnerable groups
Vulnerable groups such as children, mentally disabled people, physically disabled, institutionalized people, pregnant women, old age groups and patients in unconscious stage are at high risk of unintended side effects because of their circumstances. The researcher should pay extra attention to the ethical dimensions of the study when vulnerable people are involved.

 It includes;
-obtain informed consent from the study participant or guardian of study participant
-explain the procedure to the study participants including benefits and risks
-allow withholding from the study when they wanted
-protect their privacy
-respect their beliefs and practices
Obtain approval of permission from the Institution Review Board or Human Subjects Committee to carry out the study among the vulnerable groups.

Research reports/ Writing a research abstract or research manuscript

Research reports
A research report is a document that summarizes the study including research questions, need of the study, methodology, relevant findings, interpretation and implication of the findings.
Types of research reports
A research report describes what was studied, how it was conducted and what was found. Researchers can communicate their research findings through various ways such as theses and dissertation, books, presentation at conferences and journal articles.

• Theses and dissertation

Most masters and doctoral degrees are granted on the completion of a study that is described in a theses or dissertation.

• Books

A research can be published in books under related topic.

• Presentation at conferences

There are two methods to present a study in the conferences: oral and poster presentation. Oral report of the study is to be presented with in allotted time (10-20 minutes) with visual displays summarizing their studies and proceed to discuss between researcher and conference attendees. During poster presentation, the researcher displays the summary of the study on the poster and can ask questions to help them better understand how they were conducted or what the findings mean.

• Research journal article

Research journal article are reports in professional journals that summarize an investigation. The researcher has to condense a lot of information about the study purpose, methods, findings, interpretation and clinical significance into a short report. The research articles are reviewed by blind peer reviewers who make recommendation about whether the article should be accepted, rejected, revised or reviewed. These are usually blind reviews, the reviewers are not told the name of researchers and the researchers are not told the identity of the reviewers.
Method of writing a manuscript for publication

General instructions

1. Identify a journal (national/international) which is indexed, peer reviewed and has ISSN (International Standard Serial Number) number.
2. Send an email or letter to the publisher by enquiring any need of article and give a detailed summary of your research.
3. If they replied, you have to go through general instructions to authors given in the journal regarding abstract, content, bibliography style and way of submission (online or post). Prepare a manuscript and send it for publication.

Content of research journal article
Research reports begin with a title (less than 15 words) conveys the nature of the study. In qualitative study, the title includes phenomena and group under investigation and in a quantitative study, the title indicates independent and dependent variables and population under study.

Research report often consists of 8 sections: AK-IMRAD-B. Abstract and Key words-Introduction, Methodology, Results and Discussion-Bibliography.

• Abstract

Abstract is a brief description of the study placed at the beginning of the journal article. The abstract has to be written with in 100-200 words by summarizing the key features of the study such as research questions, methods, results, interpretation and implication for nursing practice.

• Introduction

The introduction part introduces the topic to the readers, points out the need of the study. The introduction usually describes the phenomenon, concepts, variables, statement of purpose, objectives and tested hypothesis. A brief description of the review of related literature can give under the introduction part so that readers can understand how the study fits in with previous findings and can assess the contribution of the new study.

• Method section

The method section communicates what methods the researchers used to achieve research objectives. In quantitative study, the method section describes the subjects, the research design and data collection methods. In qualitative study, this section provides information about research setting, context of the study, sampling methods and data collection procedures.

• Results section

This section presents research findings, often with tables and figures that highlight main results. In quantitative study, the researcher provides basic description information for the key variables, using simple statistics. It also describes the name of the statistical tests used, the value of the calculated statistic and its significance. The most important information is whether the results of the statistical tests were significant. If a researcher reports that the results have statistical significance, it means that, based on the statistical test, the findings are probably valid and replicable with a new sample. For example, if a report indicates that a finding was significant at the 0.05 level, this means that only 5 times out of 100 would the obtained result be spurious or 95 times out of 100, similar results would be obtained in new studies.
Both the researchers and readers can have a high degree of confidence but not total assurance that the findings are reliable. In qualitative reports, the researcher organizes the findings according to the major themes and sub themes with direct quotes from the study participants. It also presents researchers emerging theory about the phenomena under study.

• Discussion

In the discussion, the researcher draws conclusions about the meaning and implications of the findings. It also consists of interpretation of results and implications. It can be included with possible study limitations such as sample deficiencies, design problem, errors in data collection and weakness in statistical analysis.

• References

It can be concluded with a list of books, reports and journal articles that were referenced in the text of the report.
The style of research journal articles
The researcher concentrates on four factors while writing an article for publication. 

• Compactness – The space of journal is limited. Hence, authors compress ideas and concepts into a short space. In qualitative study, important supporting quotes can be included.

• Jargon – The authors use research terms that are part of the reader’s vocabulary.

• Objectivity- Quantitative researchers avoid subjective description of the results, express in numeric forms. But, qualitative reports are personal and subjective ideas are written in conversational style.

• Statistical information- The researcher maintains the accuracy of the statistical reports and explains it in simple way to the readers, who do not have strong mathematic interest or training.

Reading and summarizing research reports
Tips to read and sumarize reports are:
-read it frequently whether you understand or not
-highlight the important portions
-read it slowly
-if you do not understand, read it frequently till you get the idea of author
-refer in detail about unfamiliar terms and concepts
-do not be scared of statistical information
-when you attain a reasonable level of comprehension of research reports, next step is to write a brief synopsis of the study. A synopsis summarizes the purpose of the study, research questions, methods, findings, its interpretation and implication of practice.
Critiquing research reports
A research critique is a careful, critical appraisal of the strengths and limitation of a study.
The aspects of the critique are:
-Is the problem significant to nursing?
-Is it sound theoretically?
-Are the methods appropriate?
-Did the researcher interpret data with rationales?
-Were the rights of the subjects protected?
-Is the report clearly written, grammatical and well organized?
A critique on the clinical ability of a study focuses on whether findings are accurate, believable and clinically meaningful. If the findings can not be trusted, it makes a little sense to incorporate them into nursing practice.

Basic research terminology

Basic research terminology

• The study investigation or Research project

When researcher addresses a problem or states a question and answers it through a disciplined research called study investigation or project.

• Researcher/Investigator/Scientist

Person who does a project is called as researcher/investigator/scientist.

• Subjects / Study participants

The people who are being studied in a quantitative study called as subjects. When subjects answer questions by the researcher called as respondents. In qualitative study, the individuals cooperating in the study play an active role referred to as informants.

• Phenomena or Concepts

The abstractions of particular aspects of human behavior such as pain, coping and so on called as concepts. In qualitative research, these abstractions are phenomena.

• Constructs

These are abstractions that invented or constructed by researcher, for example, ‘self care’ in Orem’s model or ‘stress adaptation’ in Roy’s model.

• Theory

A theory is systematic, abstract explanation of reality. Here, concepts are arranged together and explains the reality. In quantitative study, the researcher starts with a theory or a conceptual model and makes predictions about how phenomena will behave if the theory were true using deductive reasoning. In qualitative research, information from the participants gathered in which the researcher begins to conceptualize, seeking to explain patterns from the researcher- participant interactions. The goal is to arrive at a theory that explains phenomena as they occur, not as they are preconceived.

• Variables

In a quantitative study, concepts are referred as variables. The researcher attempts to understand how or why things vary and to learn about relationship. For example, a research focuses on lung cancer as a variable and the researcher studies the factors linked to lung cancer and to reach a conclusion that smoking causes lung cancer.
A variable has values continuously (height or weight) called continuous variable. The variable that expressed under category called categorical variables (male/female).

• Dependent and Independent variable

Many researchers focus on determination of cause and effect of phenomena. The presumed cause is independent variable and presumed effect is dependent variable. Variation of dependent variable is presumed to depend on variation in the independent variable. In a study, the researcher experiments the effect of coconut oil (the independent variable) on weight gain in premature infants (the dependent variable). These two variables are used to designate the direction of influence among them.
Example: A study to assess the effect of timing of sponge bath on axillary temperature
Independent variable: Timing of sponge bath
Dependent variable: Axillary temperature

• Conceptual definition and Operational definition

The variable will be defined as concepts universally called conceptual definition. The same variable will be defined by researcher indicating how the variable will be observed and measured in the actual research situation called as operational definition. The operational definition of a concept specifies the operations that the researcher must perform to collect the required information. The variable ‘weight’ can be operationally defined as ‘the amount that an object weighs in terms of pounds’.

• Data

The research datum (data) is the pieces of information obtained in a study. In quantitative study, the researcher identifies variables, develops operational definition of variables and collects the relevant data from the subjects related to variables. The researcher collects information as numerical data. The results show that 36% of study subjects have adequate knowledge regarding mammography and 64% of them are unaware of it.
In qualitative studies, the researcher collects the data as narrative descriptions called qualitative data. It can be obtained through conversations in naturalistic setting or obtaining narrative records such as diaries.
 For example: Question 1- Have you felt depressed in the morning?
           Participant 1- I have had a few ups and downs in the morning.

• Relationships

Researchers study phenomena in relation to other phenomena as they explore or test relationships. A relationship is a bond or connection between phenomena. For example; relationship between smoking and lung cancer. Both quantitative and qualitative researches help to examine the relationships. In a quantitative study, the researcher is interested in relationship between independent and dependent variables. Variation in the dependent variable is presumed to be related to variation in the independent variable. For example:  When education level of study subjects increase, the knowledge regarding prevention of non communicable diseases increases. Most quantitative research is conducted to determine the existence of relationship between the variables and often to quantify the strength of relationship.
Among variables, a variable acts as a cause and it leads to an effect called cause and effect (causal) relationship. Foe example, there is a relationship between calorie intake and weight gain.  An increase of one variable leads to increase in another variable called functional (associative) relationship. When pulmonary artery temperature increases, the tympanic temperature increases, but not in vice versa.
Qualitative researchers seek patterns of association such as meaning and dimensionality of phenomena of interest. Patterns of interconnected themes and processes are identified as a means of understanding the whole.
Major steps in a quantitative study
In quantitative study, researchers find a significant problem with related questions and hypothesis and try to obtain the answers at the end. It has logical sequence of steps that is similar across studies.

• Phase 1:Identification Phase

This phase includes identify the problem, discuss with experts, understand the relevance of the problem based research in current scenario, review the related literature, identify and formulate a theoretical framework, research objectives, research questions and hypotheses.
Step 1: Formulate and delimit the problem
The first step is to identify a research problem and consider various aspects of conducting research.
For example; Is this research important in the present scenario?
              Is it possible to conduct with in limitations?
              Are adequate resources available to conduct this research?
              Does it harm the study subjects?
Step 2: Review the related literature
The research is to be conducted with in the context of previous knowledge. To build on existing theory or research, the researcher understands about known facts of the topic. A thorough literature review might guide the researcher to conduct the study without any errors.
Step 3: Defining the theoretical framework
The ultimate aim of science is theory; it transcends the specifics of a particular time, place and group of people and aims to identify irregularities in the relationship among the variables. Using a theoretical framework during the study helps to achieve findings with broad significance and utility.
Step 4: Formulating hypothesis
A hypothesis predicts the relationship among the variables by the researcher. For example, is pregnancy induced hypertension in pregnant women related to stress factors present during pregnancy? The hypothesis is; the pregnant women with pregnancy induced hypertension has higher incidence of stressful events during pregnancy then pregnant women who don’t have symptoms.

• Phase II: The design and planning phase

In the second phase of research, the investigator makes decisions regarding the methods to be used to address research question. It consists of selecting a design, population, samples and conducts pilot study. This phase mainly focuses on methodological decisions.
Step 5: Selecting a research design
The research designs are highly structured and reduce the contamination of results. The researcher will select an appropriate design for obtaining answers to the questions being studied. 
Step 6: Identifying the population to be studied
During this phase, the researcher has to identify the population to be studied which meets the inclusion criteria for example; staff nurses, pregnant women and so on.
Step 7: Designing the sampling plan
The sampling plan suggests that the number of samples to be selected and how they are selected. Using a sample is more practical than collecting data from the population.
Step 8: Specifying methods to measure the research variables
Quantitative researchers develop or borrow methods to measure the research variables as accurately as possible. The researcher can use a variety of quantitative data collection approaches such as bio physiological measurements, interviews, formal observations and so on. The task of maintain accuracy during this phase is complex and challenging.
Step 9: Finalizing and reviewing research plan
The research plan has to be reviewed before proceeding to the implementation of the plan. The researcher has to develop a formal research proposal and get the approval from Institution Board Committee to conduct the study. In case of an experimental study, researchers my need approval from Human Subjects Committee to ensure that the research plan does not violate ethical principles.
Step 10: Conducting a pilot study and making revisions
Pilot study is a small scale trial run of the study to obtain information for improving the project or assessing its feasibility. After pilot study, the researcher can asses the feasibility of design, availability of participants, resources and time.

• Phase III: Empirical phase

It involves collecting of data and preparation of data for analysis.
Step 11: Data collection
The phase includes recruiting the sample, explain the study to participants, obtain informed consent, giving training to data collectors and collecting the data.
Step 12: Preparing the data for analysis
This step involves the transferring the data from written documents to compute files for analysis. Coding is the process of translating data into numeric form, for example; male-1 and female-2.

• Phase IV: Analytic phase

The phase consists of analyzing the data and interpreting the results.
Step 13: Analyzing the data
The quantitative data can be analyzed through statistical procedures, covers a broad range of techniques, including some simple procedures as well as complex and sophisticated methods.
Step 14: Interpreting the results
Interpretation is the process of making sense of the results and examining the implications of the findings with in a broader context. Interpretation of the results means researcher’s attempt to explain the findings in the light of what is known about theory and previous findings in the area and in light of adequacy of the methods used in the investigation.

• Phase V: Dissemination phase

The main aim of the phase is communicating and utilizing the findings.
Step 15: Communicating the findings
This is the phase of preparing a manuscript with an abstract and research report and publishes it in indexed journals.
Step 16: Utilizing the findings
The main aim of a high quality study is to plan for its utilization in the real world.
Major steps in a qualitative study
The qualitative researcher has a flexible approach to collect and analyze the data, it is impossible to define the flow of activities precisely, the flow varies from one study to another and researches do not know ahead of time how the study will proceed.

• Phase I: Conceptualizing and planning a qualitative study

The qualitative researchers begin with a topic which is poorly understood and about which is little known, and they do not develop hypotheses before going into the field. During the planning phase, the qualitative researches must also identify a study site that is consistent with the research topic. The researcher has to identify the type of setting such ad homes, clinics or community. The researchers need to gain entrée into the setting to ensure cooperation and access to informants.

• Phase II: Conducting qualitative study

The qualitative researcher begins by talking with or observing people who have first hand experiences with the phenomena under study. The discussions and observations are loosely structured, allowing for the expression of a full range of beliefs, feelings and behaviors.
As analysis and interpretation progress, the researcher begins to identify themes and categories, which are used to build a descriptive theory of the phenomenon. The principles of saturation will be used by the researchers, when themes and categories in the data become repetitive and redundant such that no new information can be gathered by further data collection.
The main highlight of qualitative study is that findings accurately reflect the experiences and view points of the participants, rather than the perception of the researcher in the quantitative study.

• Phase III: Disseminating qualitative findings

Qualitative reports are raw data, filled with rich verbatim passages directly from the participants. Qualitative findings often are used as the basis for the formulation of hypothesis that is tested by quantitative researcher.