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questions and/or hypotheses. page 12 Research awareness in nursing and midwifery: a workbook Aims The aims of a piece of research are often expressed in a broad statement of intent, such as a description of the factors that may influence clinical outcome and satisfaction in patients treated for urinary incontinence. Objectives Objectives break aims down into specific elements to determine: • what treatments patients have received for their incontinence; • whether each treatment was given by a doctor, nurse, physiotherapist or other worker; • the perceived effectiveness of each treatment; • patients’ satisfaction with each treatment; • factors contributing to satisfaction or lack of satisfaction with each treatment; and • the clinical outcome of and patients’ satisfaction with their overall treatment. Research questions The term “research question” is sometimes used synonymously with “research topic” or “research problem”. More often, however, it is used to describe a specific question to be answered by the research. There may be a number of these questions for any one research project. The aims and objectives above could be expressed in terms of research questions of the following type. • What are the factors that influence clinical outcome and satisfaction in patients treated for urinary incontinence? • What treatments have patients received for their incontinence? • Was the treatment carried out by a doctor, nurse, physiotherapist or other worker? Hypotheses Certain questions may be phrased as research hypotheses. A hypothesis is a tentative statement about the relationship between two or more variables. The formulation of hypotheses is characteristic of quantitative rather than qualitative research (these types of research are defined in the discussion on choice of research methods below). A variable is any characteristic of a person, thing or situation that can vary. Age, weight, type of medication taken, smoking behaviour, life experiences and beliefs, for example, are all variables. In a hypothesis, a variable may be described as independent or dependent. The independent variable is the “presumed cause” and the dependent variable is the “presumed effect” (11). In the study on incontinence described above, factors related to treatment would be independent variables and clinical outcome and patient satisfaction would be dependent variables. In some studies, researchers manipulate the independent variable in order to produce an effect on the dependent variable. Examples of research hypotheses are that: • wounds heal more quickly by using lotion A than by using lotion B; and • cigarette smokers have higher rates of lung cancer than nonsmokers. In the above examples, type of lotion and smoking behaviour are the independent variables, while speed of wound healing and rates of lung cancer are the dependent variables. In Reading and evaluating research reports page 13 the first example, the researchers aim to manipulate the independent variable by using two different types of lotion that can then be compared. Certain variables may need to be defined. For example, when is a wound to be considered healed; and is a woman who has smoked one cigarette in her entire life to be classified as a smoker? If a hypothesis is to be subjected to statistical testing, a null hypothesis is sometimes formulated. This process is described in the discussion on data analysis below. Exercise 3 Read the Introduction to Allen et al., the subsection marked Aims in McBride and the opening (untitled) section of King & Jensen. How easily can you find the aims of each study and how clearly are the aims expressed? Are the aims stated in terms of objectives, research questions or hypotheses? Make some notes on your answers to these questions and then read the relevant discussion in Section 6. 3.7 The literature review Reviewing the literature allows researchers to set their research topic in the context of existing data and ideas. This enables them to demonstrate how their own work has added to knowledge on the subject. The literature review is usually presented in a specific section of the research document, but sometimes forms part of an introductory section or chapter. The review should discuss material relevant to the aims of the research. Occasionally, a literature search may reveal insufficient (or no) relevant nursing literature. In such cases the researchers should make this lack of nursing literature explicit, and may choose to review parallel literature from another discipline such as medicine or education. Similarly, international literature may be reviewed when there are no relevant documents from the researchers’ own country. Matters of context, such as differing work practices in medicine and nursing or the differences in health systems existing in different countries, should be acknowledged and their possible effects discussed. A good quality literature review should concentrate on reviewing original research documents (known as “primary sources”) rather than research described in other literature reviews (“secondary sources”). If all the references are more than five years old this may suggest that the researchers have failed to carry out a recent literature search or, more worryingly, that they have ignored recent documents because they provide new data that conflict with the researchers’ beliefs. It may, however, be difficult to
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