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Inflammatory Bowel Disease Nursing Manual pp 395–403 Cite as

Nursing Research

Lars-Petter Jelsness-Jørgensen 3 , 4
First Online: 24 January 2019

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Nurses play an increasingly active role in clinical research in IBD. By reviewing existing literature on the topic, this chapter provides a brief overview of some main concepts related to research in nursing. In addition, the chapter provides some general advice in relation to implementing evidence-based practice, as well as carrying out independent research.

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Jelsness-Jørgensen, LP. (2019). Nursing Research. In: Sturm, A., White, L. (eds) Inflammatory Bowel Disease Nursing Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-75022-4_42

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1 Author Affiliation: Director, Magnet Recognition Program®, American Nurses Credentialing Center, Silver Spring, Maryland.
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DOI: 10.1097/NNA.0000000000001005

Increasingly, nursing research is considered essential to the achievement of high-quality patient care and outcomes. In this month's Magnet® Perspectives column, we examine the origins of nursing research, its role in creating the Magnet Recognition Program®, and why a culture of clinical inquiry matters for nurses. This column explores how Magnet hospitals have built upon the foundation of seminal research to advance contemporary standards that address some of the challenges faced by healthcare organizations around the world. We offer strategies for nursing leaders to develop robust research-oriented programs in their organizations.

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NURSING RESEARCH

Chapter 4 NURSING RESEARCH OBJECTIVES • Define the key terms/concepts • Define nursing research • Explain the importance of research in nursing • Compare the various ways to acquire knowledge • Understand the basic differences between qualitative and quantitative approaches in research • Outline the steps in conducting research • Describe the way research, education and practice relate to each other • Identify the importance of critical thinking and critical reading when undertaking a research project • Discuss the importance of informed consent and ethics in relation to research • Define evidence-based practice • Explain how Enrolled Nurses (ENs) can participate in nursing research • Identify future trends in nursing research KEY TERMS/CONCEPTS data analysis data collection ethical principles hypothesis informed consent nursing research qualitative research quantitative research reliability research design research problem research question validity variables CHAPTER FOCUS Nursing theory and education are recognised as the main contributors to the development of an accountable and professional nurse in the health care environment. Research is also recognised by health care professionals as being equally important in influencing practice by informing decisions about the delivery of care to clients and their families. Today’s evidence-based nursing practice integrates education, theory, practice and the findings from research to provide quality health care. Nurses are also acknowledging the need to develop skills in critically appraising research literature to enable consideration of its application to clinical practice (Beanland et al 2004). The purpose of this chapter is to enable Enrolled Nurses (ENs) to develop an appreciation of the significance of research to them as nurse practitioners. It introduces the principles of nursing research, basic components of a research proposal, guidelines to critiquing a research article, and an overview of both qualitative and quantitative research. LIVED EXPERIENCE I always thought that research was something that academics did working in universities or laboratories. But I got excited when we started learning about evidence-based research in class, as I can now see how to use it in the clinical area and I also know that I will be giving the very latest nursing care to clients in my care. Melissa, Enrolled Nurse student NURSING RESEARCH The term ‘research’ refers to a systematic way of studying or examining issues so that the knowledge about that issue is validated. It requires an understanding of the existing knowledge about the issue so that new knowledge can be developed. There are many words and terms specifically related to research referred to in this chapter, which are covered in Table 4.1 (later in the chapter). TABLE 4.1 Common research terms Bias Any influence that may alter the outcomes of a research study Clinical nursing research Nursing research that has a direct impact on nursing interventions with clients Data Measurable bits of information collected for the purpose of analysis Data collection Gathering of information necessary to address the research problem Deductive reasoning Logical system of thinking that starts with the whole and breaks it down into its component parts Dependent variable A variable that is affected by the action of the independent variable Ethics committee Committee responsible for review of research proposals to ensure that human subjects are protected from harm Hypothesis Statement of a predicted relationship or difference between two or more variables. A hypothesis contains at least one independent and one dependent variable Independent variable A variable that causes a change in the dependent variable Inductive reasoning Logical system of thinking that begins with the component parts and builds them into a whole Informed consent An agreement by a research subject to participate voluntarily in a study after being fully informed about the study and the risks and benefits of participation Instrument Device or technique used to collect data in a research study, e.g., questionnaires or interviews Literature review A critical summary of available theoretical and research literature on the selected research topic. It places the research problem for a particular study in the context of what is currently known about the topic Nursing research Research usually conducted by nurses to generate knowledge that informs and develops the discipline and practice of nursing Population All known subjects that possess a common characteristic of interest to a researcher Problem statement A statement that describes the purpose of a research study, identifies key concepts and sets study limits Qualitative research Used to examine subjective human experiences by using non-statistical methods of analysis Quantitative research The systematic process used to gather and statistically analyse information that has been measured by an instrument and converted to numerical data Reliability Characteristic of a good instrument; the assessed degree of consistency and dependability Research A systematic process using both inductive and deductive reasoning to confirm and refine existing knowledge and to build new knowledge Research design The overall plan for collecting data in a research study Research process An orderly series of phrases identifying steps that allow the researcher to move from asking a question to finding an answer Research question Use of an interrogative format to identify the variables to be studied and possible relationships or differences between those variables Sample A subset of a population selected to participate in a research study Validity A characteristic of a good instrument; the extent of an instrument’s ability to measure what it states it will measure Variable A concept, characteristic or trait that varies within an identified population in a research study ( Borbasi et al 2008 ) Nursing research involves a systematic search for and validation of knowledge about issues important to the nursing profession and links theory, education and practice. Nursing research is important for: • Validating nursing as a profession • Documenting the effectiveness of nursing interventions • Providing a scientific knowledge base for practice • Demonstrating accountability for the profession. Research-based or evidence-based practice is essential if the nursing profession is to deliver safe, effective and efficient care. The ultimate goal of nursing is to provide evidence-based care that promotes quality outcomes for clients, families, health care providers and the health care system. Burns and Grove (2004) describe evidence-based practice as involving the use of collective research findings in: • Promoting the understanding of clients’ and families’ experiences with health and illness • Implementing effective nursing interventions to promote client health • Providing quality, cost-effective care within the health care system. EVIDENCE-BASED PRACTICE Evidence-based nursing is a clinical activity based on the belief that decisions about the delivery of care to clients should be informed by the best available and current scientific evidence (Beanland et al 2004). Another definition of evidence-based practice is that it is a process within which clinical decisions are made by practitioners using the best available research evidence, their clinical expertise and client preferences, with consideration also of available and finite resources (Schneider et al 2007). The five steps universally accepted as being necessary for evidence-based practice are presented in Clinical Interest Box 4.1 . Clinical Interest Box 4.2 explains evidence-based practice. CLINICAL INTEREST BOX 4.1 Steps in evidence-based practice 1. Ask a focused question. 2. Assess appropriate evidence. 3. Appraise evidence for validity, impact and precision. 4. Apply evidence accounting for patient values/preferences, clinical and policy issues. 5. Audit your practice/personal skills. (Source: Jackson et al 2006; Sackett et al 2000 as modified in Schneider et al 2007: 305) CLINICAL INTEREST BOX 4.2 Evidence-Based Practice What Is Evidence-Based Practice? A process of: • synthesising research evidence • designing clinical practice guidelines • implementing practice changes • evaluating outcomes Why Do We Need Evidence-Based Practice? • Rapid increase in amount of information • Rapid increase in healthcare costs • Determination of efficient and effective healthcare practices • Increased emphasis on performance and outcome standards Where Is Evidence Found? • Published research • Systematic reviews (e.g. Cochrane Collaboration; available: http://www.cochrane.org/ ) * • Special collections of EBP resources (e.g. The Joanna Briggs Institute; available: http://www.joannabriggs.edu.au ) * Descriptions can be found at this website, but access to systematic reviews is by subscription only. (Brown et al 2008: 13) THE EVOLUTION OF NURSING RESEARCH As early as 1854, Florence Nightingale demonstrated the importance of research in the delivery of nursing care. When Nightingale arrived in the Crimea in 1854, she found the military hospital barracks overcrowded, filthy and lacking in food, drugs and essential medical supplies. Men were dying from starvation and diseases such as cholera and typhus because of these conditions. By systematically collecting, organising and reporting data, Nightingale was able to implement sanitary reforms and prove a significant reduction in mortality rates. This is considered to be the first nursing research study (Kozier et al 2007). Research was slow to develop in nursing, with little formal research carried out by nurses until the late 1940s. Nursing schools evolved from military and religious roots and stressed order and obedience. Training was viewed as an apprenticeship, with long hours, and nurses had little say in their own training or work. Only when nursing began to move towards advanced education and affiliation with university settings did nursing research begin to emerge. This move began in the USA. In the 1960s and 1970s the number of nurses with advanced degrees and research skills increased and the push for doctoral preparation in nursing began. Nurses began to turn to nursing care and clinical practice to provide questions for research. Nursing theories evolved that attempted to describe and explain the practice of nursing and these theories began to be tested by nurse researchers. Practice-related research flourished and by the end of the 1970s two new research journals were launched in the USA to handle the nursing research explosion (Borbasi et al 2004). In Australia and New Zealand, nursing research awareness remained relatively low until nursing moved into the tertiary education sector in the 1970s and 1980s. This move was accompanied by a major increase in the level of research activity, which was directed at educational, disciplinary or professional issues, and research into other disciplinary areas of relevance to nursing. It is only recently that research education delivered to nurses in Australia and New Zealand has begun to prepare nurses to understand the relationship between research evidence and nursing practice, and how to go about incorporating research findings into practice (Crisp & Taylor 2005). Some ideas that have been tested and demonstrated to be useful in practice are: moist wound healing; pressure-relieving devices for the prevention of pressure ulcers; client information to improve self care and healthy lifestyles; communication with people who are dying; and nutritional support of older people in hospital (Brown et al 2008). THE FUTURE OF NURSING RESEARCH The value of research studies that increase understanding of clinical phenomena and provide direction for defining programs of research is well recognised and flourishing in Australia and New Zealand. Nurse researchers and nurse leaders are visibly involved at the national level, participating in policy making, representing nursing on expert panels and organisations such as the National Health and Medical Research Council (NHMRC) and lobbying for funding (Beanland et al 2004). Magnet Hospitals are emerging in both Australia and New Zealand. The concept of a ‘Magnet Hospital’ is to develop and sustain an environment where nursing- and midwifery-related evidence-based practice and practice change are more likely to occur. Magnet Hospitals aim to provide a commitment to staff development and training, effective systems for implementing and evaluating quality-based treatment and care, and sustainable long term resourcing (Schneider et al 2007). Borbasi et al (2004) state that, with the development of a national organisation for nursing research, research priorities in the 21st century are likely to be directed at nursing practice and that there will be an increased emphasis on building on the results of completed studies. They also believe that there will also be a greater emphasis on finding ways to utilise the results of nursing research in the course of day-to-day practice. RESEARCH METHODS Nursing research focuses on the full range of human experiences and responses and is directed towards helping well individuals improve their health status and stay healthy, as well as assisting clients who are sick or disabled by an illness to maintain or improve their health (Crisp & Taylor 2005). The major factor that affects whether a nursing researcher uses systematic, controlled methods for studying events or problems is the extent to which he or she wishes to study the way that characteristics or variables (see Table 4.1 ) are different, or the way that one variable is predictive of (causally associated with) another. These studies are well organised and follow a specific procedure to enable other researchers to reproduce the study or examine the evidence and achieve the same outcomes. To guide the design of a research study, nurse researchers may create a hypothesis or statement about what they expect to see before conducting the study (Crisp & Taylor 2005). Nurse researchers use many methods because nurses are interested in acquiring knowledge about a wide range of human needs and responses to health problems. For example, a different research method may be used by a nursing researcher interested in developing a deeper understanding of a phenomenon and how it may be experienced by clients, such as helping women deal with the consequences of incontinence after childbirth. Most methods used are either quantitative or qualitative in nature (Crisp & Taylor 2005). QUANTITATIVE METHODS Quantitative research methods involve the use of numbers and statistical analysis. This is a process used to gather and analyse information that has been measured by an ‘instrument’, such as a questionnaire, and converted to numerical data. Quantitative nursing research is the investigation of nursing phenomena that lend themselves to a precise measurement, such as pain severity, rate of wound healing, etc (Crisp & Taylor 2005). Box 4.1 describes different ways of using quantitative methods. Box 4.1 Types of research that use quantitative methods CORRELATIONAL RESEARCH Studies that explore the patterns of interrelationships among variables of interest, without any active intervention by the researcher. Correlational methods are used in testing predictive relationships among variables, for testing models or theories that seek to explain complex patterns of relationships, and for testing the most effective and efficient means of achieving positive health outcomes. DESCRIPTIVE RESEARCH Studies in which the aim is to accurately portray characteristics of individuals, situations or groups and the frequency with which certain events or characteristics occur. The major goal of this form of research is simply to describe what is seen in order to identify variables that may be of interest in future investigations. EXPERIMENTAL OR QUASI-EXPERIMENTAL RESEARCH Studies in which the investigator controls the independent variable and randomly assigns subjects to different conditions. The major goal of this research is to determine causal relationships among the variables through a controlled investigation in which only the independent variable can be the cause of changes in the dependent variable. EXPLORATORY RESEARCH Studies designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about the relationships among phenomena. The major goal of this research is to explore what is seen in order to identify relationships among variables that might be of interest in future investigations. EVALUATION RESEARCH Studies that test how well a program, practice or policy is working. The major goal of this form of research is determining the success of a program. This type of research can determine specifically why a program was successful. When programs are unsuccessful, evaluation research can assist in identifying problems with the program, why it was not successful or even barriers to implementation of programs. SURVEY RESEARCH Studies designed to obtain information from populations regarding prevalence, distribution and interrelation of variables within the study population. They may be conducted for the general purposes of obtaining information about practices, opinions, attitudes and other characteristics of individuals. The major goal of this form of research is simple description or the accumulation of a large amount of data to describe the population being studied, as well as the topic of study. ( Crisp & Taylor 2005 ) In quantitative research, the researcher changes one set of variables and observes the outcome or its influence on other variables. Variables are changeable qualities, such as characteristics of people or situations that can change or vary for many reasons. Temperature, pulse, respiration, blood pressure, height and weight are examples of variables. The variable that the researcher controls or manipulates is called the independent variable. The variable that varies or changes because of this is called the dependent variable. For example, consider the statement: ‘Sitting upright in bed does not make breathing easy in a client with asthma’. The independent variable relates to sitting the client in different positions, such as lying flat, semi-recumbent, lateral and upright positions. This is the variable the researcher can manipulate to study its influence on the dependent variable. The dependent variable is the measurement of breathing. QUALITATIVE METHODS Qualitative research is used to describe information obtained in a non-numerical form, such as data obtained from interviews. Qualitative nursing research is the investigation of phenomena that are not easily quantified or categorised, in which inductive reasoning is used to develop generalisations or theories from specific observations or interviews (Crisp & Taylor 2005). See Box 4.2 for the different ways of using qualitative methods. Box 4.2 Types of research that use qualitative methods ( Crisp & Taylor 2005 ) ACTION RESEARCH Studies that attempt to make qualitative research more humanistic, holistic and relevant to the lives of human beings. The major goal of this research is working in collaboration with participants in a manner that brings about desired change(s). CRITICAL SOCIAL RESEARCH Studies that empower individuals involved in this research by attempting to confront unjust power structures within a specific context or society. The major goal of this research is the challenging of dominant constructions of reality and the societal structures that maintain the status quo and determine allocation of power and resources. DESCRIPTIVE RESEARCH Studies in which the objective is to accurately portray characteristics of individuals, situations or groups and the frequency with which certain events or characteristics occur. The major goal of this research is to describe what is seen in order to detect phenomena that might be of interest in future research. EXPLORATORY RESEARCH Studies designed to develop or refine the dimensions of phenomena or to develop or refine a hypothesis about the relationships among phenomena. The major goal of this research is to explore what is seen in order to identify relationships among phenomena that might be of interest in future research. HISTORICAL RESEARCH Systematic studies designed to establish facts and relationships concerning past events. The major goal of this research may be either a descriptive account of what occurred and the facts surrounding the event(s), or a critical approach may be taken in which the researchers challenge the dominant interpretations of facts. INTERPRETATIVE RESEARCH Studies in which human experience is investigated to generate deeper understanding of the phenomena of interest. The major goal of this research is the exploration of the numerous ways human beings experience the complex world in which they live. Qualitative researchers may wish to examine individual lives and their stories and behaviour, organisations and their functioning, or cultures and their interactions and social movement. As the study methodology embraces the examination of subjective phenomena, these findings are only considered to be representative of a particular person or group of people, and in a particular setting, and not reflective of other people or other settings (Borbasi et al 2004). There are strengths in both quantitative and qualitative approaches. The quantitative approach can support a theory or argue to disprove it, and can be very useful, for example, when hospitals or governments want to introduce policy changes. The qualitative approach, by contrast, has a human focus and allows researchers to know their subjects and collect information about attitudes and satisfaction levels that are vital to improve care provided by nurses. THE RESEARCH PROCESS There are several steps in conducting either quantitative or qualitative research. STEP 1. THE RESEARCH PROBLEM The research problem is refined through a process that proceeds from identifying a general idea of interest to defining a specific topic. A preliminary literature review reveals related factors that appear critical to the research topic. The significance of the research problem must be identified in terms of its potential contribution to clients, nurses and the medical community (Beanland et al 2004). Choosing the topic of interest may develop from: • Discussing an issue of common interest with a colleague • Reading about an issue in a journal, text or newspaper • An aspect of practice being introduced for the first time • An aspect of practice that may have been observed but needs to be validated • Areas of work that may need to change • Wanting to repeat a study that has already been conducted, to check the results. STEP 2. THE PURPOSE The purpose of the study states the aims or goals that the investigator hopes to achieve with the research. It also suggests the way in which the researcher sought to study the problem. STEP 3. LITERATURE REVIEW The overall purpose of conducting a review of the literature is to develop a strong knowledge base to carry out research and other consumer research activities in the educational and clinical practice settings. It is a broad, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communications (Beanland et al 2004). The literature review provides a way of checking what has already been studied in relation to the proposed study. It can also provide an understanding of the procedures, methods of analysis and variables that can influence the study (see Box 4.3 ). Box 4.3 Overall purpose of a literature review • Determines what is known and not known about a subject, concept or problem. • Determines gaps, consistencies and inconsistencies in the literature about a subject, concept or problem. • Discovers unanswered questions about a subject, concept or problem. • Discovers conceptual traditions used to examine problems. • Uncovers a new practice intervention(s) or provides evidence for current practice intervention(s). • Generates useful research questions and hypotheses for the discipline. • Describes the strengths and weaknesses of designs or methods of enquiry and instruments used in earlier works. • Determines an appropriate research design or method (instruments, data collection and analysis methods) for answering the research question(s). • Determines the need for replication of a well-designed study or refinement of a study. • Promotes development of new or revised practice protocols, policies and projects or activities related to nursing practice and to the discipline. ( Schneider et al 2007 ) How to search successfully for information To conduct a successful search for information about a particular subject, the researcher needs to define the topic of interest, select appropriate search resources and selectively review and evaluate the materials produced by a search (Borbasi et al 2004). A search is conducted using indexes, abstracts and catalogues to find information about specific subjects. Books tend to give standard accepted information and practices. They provide good baseline data on a subject. Journals, however, provide more current information than books. They report changing trends and practices. Several electronic indexes are used for nursing journals ( Box 4.4 ), including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Index Medicus (a comprehensive index of peer-reviewed medical journals compiled by the US National Library of Medicine) and its online counterpart, MEDLINE (Medical Literature Analysis and Retrieval System [MEDLARS] online). Each index has a primary area of focus and advantages and limits. Electronic databases operate with a special vocabulary. However, the computer helps the researcher to define the preferred terms to use in a search. It is important to make the search as precise as possible; if there are several key terms, they should be used. Other limits such as gender, age and/or time factors, should also be set. Ask for assistance from the librarian if there is difficulty finding information. Many professional information sources are also available on the internet, where there is access to a wide variety of databases, client and nursing education resources, as well as some nursing journals (see Online Resources at the end of this chapter). Box 4.4 Examples of nursing research journals • Australian Journal of Advanced Nursing

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Defining the Question: Foreground & Background Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what kind of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground Questions

A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence.

Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question.

Across most frameworks, you’ll often be considering:

a who (who was studied - a population or sample)
a what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
a how ([how] did the [what] affect the [who] - an outcome, an effect).

PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

PICO (Problem/Population, Intervention, Comparison, Outcome)

Appropriate for : clinical questions, often addressing the effect of an intervention/therapy/treatment

Example : For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations (C) improve blood sugar control (O)?

Framing Different Types of Clinical Questions with PICO

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements. The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

"Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?"

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?"

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Beyond PICO: Other Types of Question Frameworks

PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews. Also consider:

PEO (Population, Exposure, Outcome)

Appropriate for : describing association between particular exposures/risk factors and outcomes

Example : How do preparation programs (E) influence the development of teaching competence (O) among novice nurse educators (P)?

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type)

Appropriate for : questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)

Example : What are the experiences and perspectives (E) of undergraduate nursing students (S) in clinical placements within prison healthcare settings (PI)?

SPICE (Setting, Perspective, Intervention/phenomenon of Interest, Comparison, Evaluation)

Appropriate for : evaluating the outcomes of a service, project, or intervention

Example : What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?

PCC (Problem/population, Concept, Context)

Appropriate for : broader (scoping) questions

Example : How do nursing schools (Context) teach, measure, and maintain nursing students ' (P) technological literacy (Concept))throughout their educational programs?

Background Questions

To craft a strong and reasonable foreground research question, it is important to have a firm understanding of the concepts of interest. As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc.

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations improve blood sugar control ?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
What are the measures of effective blood sugar control?
What kinds of interventions would fall under the umbrella of 'telehealth'?
What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?
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Home » Research Problem – Examples, Types and Guide

Research Problem – Examples, Types and Guide

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Research Problem

Definition:

Research problem is a specific and well-defined issue or question that a researcher seeks to investigate through research. It is the starting point of any research project, as it sets the direction, scope, and purpose of the study.

Types of Research Problems

Types of Research Problems are as follows:

Descriptive problems

These problems involve describing or documenting a particular phenomenon, event, or situation. For example, a researcher might investigate the demographics of a particular population, such as their age, gender, income, and education.

Exploratory problems

These problems are designed to explore a particular topic or issue in depth, often with the goal of generating new ideas or hypotheses. For example, a researcher might explore the factors that contribute to job satisfaction among employees in a particular industry.

Explanatory Problems

These problems seek to explain why a particular phenomenon or event occurs, and they typically involve testing hypotheses or theories. For example, a researcher might investigate the relationship between exercise and mental health, with the goal of determining whether exercise has a causal effect on mental health.

Predictive Problems

These problems involve making predictions or forecasts about future events or trends. For example, a researcher might investigate the factors that predict future success in a particular field or industry.

Evaluative Problems

These problems involve assessing the effectiveness of a particular intervention, program, or policy. For example, a researcher might evaluate the impact of a new teaching method on student learning outcomes.

How to Define a Research Problem

Defining a research problem involves identifying a specific question or issue that a researcher seeks to address through a research study. Here are the steps to follow when defining a research problem:

Identify a broad research topic : Start by identifying a broad topic that you are interested in researching. This could be based on your personal interests, observations, or gaps in the existing literature.
Conduct a literature review : Once you have identified a broad topic, conduct a thorough literature review to identify the current state of knowledge in the field. This will help you identify gaps or inconsistencies in the existing research that can be addressed through your study.
Refine the research question: Based on the gaps or inconsistencies identified in the literature review, refine your research question to a specific, clear, and well-defined problem statement. Your research question should be feasible, relevant, and important to the field of study.
Develop a hypothesis: Based on the research question, develop a hypothesis that states the expected relationship between variables.
Define the scope and limitations: Clearly define the scope and limitations of your research problem. This will help you focus your study and ensure that your research objectives are achievable.
Get feedback: Get feedback from your advisor or colleagues to ensure that your research problem is clear, feasible, and relevant to the field of study.

Components of a Research Problem

The components of a research problem typically include the following:

Topic : The general subject or area of interest that the research will explore.
Research Question : A clear and specific question that the research seeks to answer or investigate.
Objective : A statement that describes the purpose of the research, what it aims to achieve, and the expected outcomes.
Hypothesis : An educated guess or prediction about the relationship between variables, which is tested during the research.
Variables : The factors or elements that are being studied, measured, or manipulated in the research.
Methodology : The overall approach and methods that will be used to conduct the research.
Scope and Limitations : A description of the boundaries and parameters of the research, including what will be included and excluded, and any potential constraints or limitations.
Significance: A statement that explains the potential value or impact of the research, its contribution to the field of study, and how it will add to the existing knowledge.

Research Problem Examples

Following are some Research Problem Examples:

Research Problem Examples in Psychology are as follows:

Exploring the impact of social media on adolescent mental health.
Investigating the effectiveness of cognitive-behavioral therapy for treating anxiety disorders.
Studying the impact of prenatal stress on child development outcomes.
Analyzing the factors that contribute to addiction and relapse in substance abuse treatment.
Examining the impact of personality traits on romantic relationships.

Research Problem Examples in Sociology are as follows:

Investigating the relationship between social support and mental health outcomes in marginalized communities.
Studying the impact of globalization on labor markets and employment opportunities.
Analyzing the causes and consequences of gentrification in urban neighborhoods.
Investigating the impact of family structure on social mobility and economic outcomes.
Examining the effects of social capital on community development and resilience.

Research Problem Examples in Economics are as follows:

Studying the effects of trade policies on economic growth and development.
Analyzing the impact of automation and artificial intelligence on labor markets and employment opportunities.
Investigating the factors that contribute to economic inequality and poverty.
Examining the impact of fiscal and monetary policies on inflation and economic stability.
Studying the relationship between education and economic outcomes, such as income and employment.

Political Science

Research Problem Examples in Political Science are as follows:

Analyzing the causes and consequences of political polarization and partisan behavior.
Investigating the impact of social movements on political change and policymaking.
Studying the role of media and communication in shaping public opinion and political discourse.
Examining the effectiveness of electoral systems in promoting democratic governance and representation.
Investigating the impact of international organizations and agreements on global governance and security.

Environmental Science

Research Problem Examples in Environmental Science are as follows:

Studying the impact of air pollution on human health and well-being.
Investigating the effects of deforestation on climate change and biodiversity loss.
Analyzing the impact of ocean acidification on marine ecosystems and food webs.
Studying the relationship between urban development and ecological resilience.
Examining the effectiveness of environmental policies and regulations in promoting sustainability and conservation.

Research Problem Examples in Education are as follows:

Investigating the impact of teacher training and professional development on student learning outcomes.
Studying the effectiveness of technology-enhanced learning in promoting student engagement and achievement.
Analyzing the factors that contribute to achievement gaps and educational inequality.
Examining the impact of parental involvement on student motivation and achievement.
Studying the effectiveness of alternative educational models, such as homeschooling and online learning.

Research Problem Examples in History are as follows:

Analyzing the social and economic factors that contributed to the rise and fall of ancient civilizations.
Investigating the impact of colonialism on indigenous societies and cultures.
Studying the role of religion in shaping political and social movements throughout history.
Analyzing the impact of the Industrial Revolution on economic and social structures.
Examining the causes and consequences of global conflicts, such as World War I and II.

Research Problem Examples in Business are as follows:

Studying the impact of corporate social responsibility on brand reputation and consumer behavior.
Investigating the effectiveness of leadership development programs in improving organizational performance and employee satisfaction.
Analyzing the factors that contribute to successful entrepreneurship and small business development.
Examining the impact of mergers and acquisitions on market competition and consumer welfare.
Studying the effectiveness of marketing strategies and advertising campaigns in promoting brand awareness and sales.

Research Problem Example for Students

An Example of a Research Problem for Students could be:

“How does social media usage affect the academic performance of high school students?”

This research problem is specific, measurable, and relevant. It is specific because it focuses on a particular area of interest, which is the impact of social media on academic performance. It is measurable because the researcher can collect data on social media usage and academic performance to evaluate the relationship between the two variables. It is relevant because it addresses a current and important issue that affects high school students.

To conduct research on this problem, the researcher could use various methods, such as surveys, interviews, and statistical analysis of academic records. The results of the study could provide insights into the relationship between social media usage and academic performance, which could help educators and parents develop effective strategies for managing social media use among students.

Another example of a research problem for students:

“Does participation in extracurricular activities impact the academic performance of middle school students?”

This research problem is also specific, measurable, and relevant. It is specific because it focuses on a particular type of activity, extracurricular activities, and its impact on academic performance. It is measurable because the researcher can collect data on students’ participation in extracurricular activities and their academic performance to evaluate the relationship between the two variables. It is relevant because extracurricular activities are an essential part of the middle school experience, and their impact on academic performance is a topic of interest to educators and parents.

To conduct research on this problem, the researcher could use surveys, interviews, and academic records analysis. The results of the study could provide insights into the relationship between extracurricular activities and academic performance, which could help educators and parents make informed decisions about the types of activities that are most beneficial for middle school students.

Applications of Research Problem

Applications of Research Problem are as follows:

Academic research: Research problems are used to guide academic research in various fields, including social sciences, natural sciences, humanities, and engineering. Researchers use research problems to identify gaps in knowledge, address theoretical or practical problems, and explore new areas of study.
Business research : Research problems are used to guide business research, including market research, consumer behavior research, and organizational research. Researchers use research problems to identify business challenges, explore opportunities, and develop strategies for business growth and success.
Healthcare research : Research problems are used to guide healthcare research, including medical research, clinical research, and health services research. Researchers use research problems to identify healthcare challenges, develop new treatments and interventions, and improve healthcare delivery and outcomes.
Public policy research : Research problems are used to guide public policy research, including policy analysis, program evaluation, and policy development. Researchers use research problems to identify social issues, assess the effectiveness of existing policies and programs, and develop new policies and programs to address societal challenges.
Environmental research : Research problems are used to guide environmental research, including environmental science, ecology, and environmental management. Researchers use research problems to identify environmental challenges, assess the impact of human activities on the environment, and develop sustainable solutions to protect the environment.

Purpose of Research Problems

The purpose of research problems is to identify an area of study that requires further investigation and to formulate a clear, concise and specific research question. A research problem defines the specific issue or problem that needs to be addressed and serves as the foundation for the research project.

Identifying a research problem is important because it helps to establish the direction of the research and sets the stage for the research design, methods, and analysis. It also ensures that the research is relevant and contributes to the existing body of knowledge in the field.

A well-formulated research problem should:

Clearly define the specific issue or problem that needs to be investigated
Be specific and narrow enough to be manageable in terms of time, resources, and scope
Be relevant to the field of study and contribute to the existing body of knowledge
Be feasible and realistic in terms of available data, resources, and research methods
Be interesting and intellectually stimulating for the researcher and potential readers or audiences.

Characteristics of Research Problem

The characteristics of a research problem refer to the specific features that a problem must possess to qualify as a suitable research topic. Some of the key characteristics of a research problem are:

Clarity : A research problem should be clearly defined and stated in a way that it is easily understood by the researcher and other readers. The problem should be specific, unambiguous, and easy to comprehend.
Relevance : A research problem should be relevant to the field of study, and it should contribute to the existing body of knowledge. The problem should address a gap in knowledge, a theoretical or practical problem, or a real-world issue that requires further investigation.
Feasibility : A research problem should be feasible in terms of the availability of data, resources, and research methods. It should be realistic and practical to conduct the study within the available time, budget, and resources.
Novelty : A research problem should be novel or original in some way. It should represent a new or innovative perspective on an existing problem, or it should explore a new area of study or apply an existing theory to a new context.
Importance : A research problem should be important or significant in terms of its potential impact on the field or society. It should have the potential to produce new knowledge, advance existing theories, or address a pressing societal issue.
Manageability : A research problem should be manageable in terms of its scope and complexity. It should be specific enough to be investigated within the available time and resources, and it should be broad enough to provide meaningful results.

Advantages of Research Problem

The advantages of a well-defined research problem are as follows:

Focus : A research problem provides a clear and focused direction for the research study. It ensures that the study stays on track and does not deviate from the research question.
Clarity : A research problem provides clarity and specificity to the research question. It ensures that the research is not too broad or too narrow and that the research objectives are clearly defined.
Relevance : A research problem ensures that the research study is relevant to the field of study and contributes to the existing body of knowledge. It addresses gaps in knowledge, theoretical or practical problems, or real-world issues that require further investigation.
Feasibility : A research problem ensures that the research study is feasible in terms of the availability of data, resources, and research methods. It ensures that the research is realistic and practical to conduct within the available time, budget, and resources.
Novelty : A research problem ensures that the research study is original and innovative. It represents a new or unique perspective on an existing problem, explores a new area of study, or applies an existing theory to a new context.
Importance : A research problem ensures that the research study is important and significant in terms of its potential impact on the field or society. It has the potential to produce new knowledge, advance existing theories, or address a pressing societal issue.
Rigor : A research problem ensures that the research study is rigorous and follows established research methods and practices. It ensures that the research is conducted in a systematic, objective, and unbiased manner.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Nursing Notes

Nursing Research Definition: The Importance and Nurses Roles

The Art of Knowing More

The moment you ask a question and look for answers, you are simply engaging yourself into research. This “everyday research” continuously aims for the betterment of our day to day life. Our quest for change is an endless challenge to unearth knowledge, it is human nature to know more. Everybody has their innate ability to become a researcher, but only a formal research education and training can unleash that researcher within you.

Research originated from its meaning literally “to search again” or “to examine carefully”. Hence, Grove and colleagues (2015) define research as a diligent, systematic inquiry, or study that validates and refines existing knowledge to develop new knowledge. Fundamentally speaking, research is a discipline utilizing the systematic body of knowledge and organized methods of inquiry to answer questions and solve problems, which aims to gain knowledge for the benefit of the people (Polit & Beck, 2018).

The research applied to nursing practice, describes as the systematic inquiry designed to develop trustworthy evidence on issues of importance to the nursing profession such as nursing practice, administration and informatics (Polit & Beck, 2018). Nieswiadomy & Bailey (2018), refers to nursing research as a systematic objective process of analyzing phenomena of importance to nursing which includes practice, education and administration. Grove, et al. (2015) elaborates nursing research as a scientific process that validates and refines existing knowledge to generates new knowledge through planning, organization, and persistence focuses on nursing education, administration, health care delivery, characteristics of nurses, and their roles.

Nursing research directly or indirectly influences clinical nursing practice. Primarily, clinical nursing research rooted in the questions and problems encountered from our day to day living to acclimate the changing needs of the people it serves.

Importance of Research in the Nursing Profession

The Northeastern State University in Oklahoma (2020) stated three major significance of research in the nursing profession, such as:

1. Information Literacy

Information literacy is the comprehension to understand information and the ability to transform it into a new knowledge of higher-level which you can utilize for development and improvement. This skill is not only reading comprehension but the ability to effectively process information for interpretation, study comparison, analyze results and think critically which can aid nurses on their problem-solving and decision-making competencies.

2. Teaching Information Literacy

Teaching information literacy will bring the academe into a higher level of learning using different modes of teaching and instructions. Research is being utilized by nursing schools to strengthen research departments in helping the students to be more competent in acquiring information literacy. Problem-based learning modality allows the students to develop critical thinking skills and problem-solving ability when they are challenged clinically to prepare them for their practice in the future.

3. Evidence-Based Practice

Research will correct misconceptions, improve patient care, upgrade the health care system, revamp health workers working condition and develop new treatment protocols and clinical pathways for safe and efficient nursing practice. The safe and efficient nursing practice must have a scientific basis that undergoes rigid study and experimentation. A safe practice must be the results of research proving its safety and efficacy to establish best practices in the profession.

As research adapts to the changing needs of the society in terms of health care delivery, health care environment, patient care needs, population health demands and health-related regulations of the government — breakthroughs make the practice continuously evolves. Research brings constant change, forcing nurses to keep themselves abreast to changes for them to stay in their field. Research brings no room for stagnation in the practice.

History of Nursing Research

Research burgeon along with the beginning of nursing in the 1800s (Mackey & Bassendowski, 2017). It was Florence Nightingale who pioneered evidence-based practice corroborated by her documentation on notes on nursing. Advances in technology are the major catapult of nursing research to evolve as the nursing discipline makes headway in the medical community.

A long time had passed before the nursing community put the research activity into cognizance. In the year 1950’s, Division of Nursing Resources started to fund research studies with the first journal publication of Nursing Research in 1952 and put up several research centers around the United States of America which eventually leads to the construction of National Center for Nursing Research in 1985 (Tappen, 2016).

After the introduction of research into publications, nurses were involved in the development of models, conceptual frameworks, and theories to guide nursing practice. It was late 1960s and 1970s when nursing theorists’ were born, with the first publication of nursing theorists’ work and related researches on the journal Advances in Nursing Science in 1978 (Grove, et al., 2015). The nursing theorists’ work gives rise to a clear pathway for future nursing researches.

The 1990s became the era of journals for nurse researchers wherein speciality journals launched to publish research articles, and evidence-based practice was integrated to nursing (Polit & Beck, 2018).

Roles of Nurses’ in Research

The prestige of being a researcher coined around with academics as work of the intelligent mind. However, the wide acceptance of the evidence-based practice in the nursing profession seemingly attracts an increasing demand for nurse practitioners conducting research studies to improve patient care and working condition.

Polit & Beck (2018) elaborated the continuum of research participation of nurses in an evidence-based practice environment that includes research consumers and research producers. They refer nursing research consumers or users for the nurses who read studies and stay up-to-date on the latest researches to apply it in their practice. On the other hand, are the producers of nursing research who diligently and patiently formulate, design and undertake research studies.

Conversely, Polit & Beck (2018) added the roles of the contributors on the continuum of research activities such as:

Contribute an idea for a clinical inquiry
Assist in collecting research information
Offer advice to clients about participating in a study
Search for research evidence
Discuss the implications of a study

A research team is a group of researchers in association with a research project. Nieswiadomy & Bailey (2018) enumerates the composition of a research team wherein nurses can assume many roles, and these include:

Principal investigator
Member of a research team
Identifier of researchable problems
Evaluator of research findings
User of research findings
Patient/client advocate during studies
Subject/participant in studies

Participation of all nurses in different research activities plays a vital role in generating a scientific knowledge basis in an evidence-based practice environment. Research will free the nurses from the limitations set by the four-cornered room of the hospital. It will open new doors of opportunities to go beyond our traditional scope. Reaching beyond your reach is the “art of knowing more”.

Grove, S.K., Gray, J.R. & Burns, N. (2015). Understanding Nursing Research: Building An Evidence-Based Practice, 6 th Missouri: Elsevier Saunders.
Polit, D.F. & Beck, C.T. (2018). Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 9 th Wolters Kluwer.
Nieswiadomy, R. & Bailey, C. (2018). Foundations of Nursing Research, 7 th New York: Pearson Education, Inc.
Northeastern State University, Oklahoma. (2020). Why do nurses need research? Retrieved on 13 September 2020 from https://nursingonline.nsuok.edu/articles/rnbsn/why-nurses-need-research.aspx#:~:text=It%20is%20important%20for%20nurses,to%20develop%20their%20own%20conclusions.
Mackey, A. & Bassendowski, S. (2017). The History of Evidence-Based Practice in Nursing Education and Practice. Journal of Professional Nursing, 33(1), 51-55. https://doi.org/10.1016/j.profnurs.2016.05.009
Tappen, R. (2016). Advanced Nursing Research: From Theory to Practice, 2nd ed. Jones & Bartlett Learning.

The influencing factors of clinical nurses’ problem solving dilemma: a qualitative study

a Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China

b Tongji University School of Medicine, Shanghai, China

c Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Problem solving has been defined as “a goal-directed sequence of cognitive and affective operations as well as behavioural responses to adapting to internal or external demands or challenges. Studies have shown that some nurses lack rational thinking and decision-making ability to identify patients’ health problems and make clinical judgements, and have poor cognition and response to some clinical problems, easy to fall into problem-solving dilemma. This study aimed to understand the influencing factors of clinical nurses’ problem solving dilemma, to provide a basis for developing training strategies and improving the ability of clinical nurses in problem solving.

A qualitative research was conducted using in-depth interviews from August 2020 to December 2020. A total of 14 participants from a tertiary hospital in Shanghai, China were recruited through purposive sampling combined with a maximum variation strategy. Data were analysed with the conventional content analysis method.

Three themes and seven subthemes were extracted: nurse’s own factors (differences in knowledge structure and thinking, differences in professional values, poor strain capacity); improper nursing management (low sense of organizational support, contradiction between large workload and insufficient manpower allocation); patient factors (the concept of emphasizing medicine and neglecting to nurse, individual differences of patients).

The influencing factors of clinical nurses’ problem-solving dilemma are diverse. Hospital managers and nursing educators should pay attention to the problem-solving of clinical nurses, carry out a series of training and counselling of nurses by using the method of situational simulation, optimize the nursing management mode, learn to use new media technology to improve the credibility of nurses to provide guarantee for effective problem-solving of clinical nurses.

Introduction

Nursing education in China can be divided into two main levels: vocational education and higher education. Vocational education includes technical secondary schools and junior colleges, while higher education includes undergraduate, master’s and doctoral education. Vocational education aims at training students to master basic nursing service skills and to be able to take the post to engage in daily nursing work (Sun & Zong, 2017 ). Higher nursing education started late, and undergraduate education has always followed the “three-stage” education model of clinical medicine (basic medical courses, specialized courses and clinical practice). Most courses are centred on subject knowledge, and all clinical practice takes the form of centralized practice (Li, 2012 ). The training goal of nursing postgraduates is gradually expanding from academic master to professional master. The curriculum mainly includes classroom teaching and clinical practice. The classroom teaching contents include public courses (political theory, foreign languages, etc.), professional basic courses (advanced health assessment, pharmacotherapy, pathophysiology, evidence-based nursing, medical statistics or clinical epidemiology), specialized courses (advanced nursing practice theory) and Academic activities . The goal of nursing doctoral training is to cultivate high-level nursing research talents, focusing on the cultivation of scientific research ability rather than clinical practice ability. The curriculum includes ideology and politics, basic theory, research methods, specialized courses, development frontier, scientific writing, etc (Luo et al., 2018 ). There are some problems in the training mode and curriculum, such as theory and practice are out of touch, traditional lecture-based classroom teaching makes students passively accept knowledge, students attach importance to theory over practice, knowledge input to ability output, professional study to humanities knowledge. Nursing students receive no theoretical and/or practical training in problem solving before entering the clinical setting, so there is not a starting point for these nurses to clinical dilemmas in their professional life.

With the development of medicine, people pay more attention to health and have higher requirements for nursing service ability (Yang, Ning, et al., 2018). The National Nursing Development Plan (National Development and Reform Commission, 2017 ) points out that it is necessary to strengthen the construction of nurse teams, establish nurse training mechanisms and improve the professional quality and service ability of nurses. However, in the face of increasingly complex and changeable clinical environment, nurses are still lacking in problem-solving thinking and ability, and often fall into the dilemma of problem solving (Li et al., 2020 ).

Typical decision theory approaches to the identification of problem solving in nursing have viewed the process as a series of decision formulations that include: decisions about what observations should be made in the patient situation; decisions about deriving meaning from the data observed (clinical inferences); and decisions regarding the selection of action to be taken that will be of optimal benefit to the patient (McGuire, 1985 ). Information processing theory describes problem solving as an interaction between the information processing system (the problem-solver) and a task environment, which can be analysed as two simultaneously occurring sub-processes of “understanding” and “search” (VanLehn, 1989 ). Individuals collect the stimulus that poses the problem in the understanding process, forming the internal representation of the problem, transforming the problem stimulus into the initial information needed in the search process, and then producing mental information structures for the understanding of the problem, which making individuals distinguish the nature of the problem and clarify the goal of the problem. The mental information structures drive the search process that enables the individual to find or calculate the solution to the problem. This process starts with the nurse identifying the clinical problem and continues until the decision is made to resolve the problem (Taylor, 2000 ). Clinical problem solving requires nurses to have a variety of cognitive strategies, which involves nurses’ knowledge, experience, and memory process. Nurses must recognize the current problem and use all available knowledge and experience to transform the problem into their internal problem representation, and then set goals and search for strategies that can achieve the goal (Mayer & Wittrock, 1992 ). In today’s complex clinical environment, nurses need to be able to solve problems accurately, thoroughly, and quickly. Nurses who can solve problems efficiently have fewer medical errors (Babaei et al., 2018 ), and the level of nursing skills and empathy are higher (Ay et al., 2020 ; Bayindir Çevik & Olgun, 2015 ). To cultivate nurses’ problem solving thinking and ability, it is necessary to better understand the influencing factors of problem solving dilemma. However, these cannot be obtained by observing nurses’ behaviour in their work, and cannot be obtained through quantitative research either. Exploring the thinking process involved in nurses’ work through qualitative interviews is an effective way to understand the influencing factors of nurses’ problem solving. Given this, this study used qualitative research methods to deeply analyse the influencing factors of clinical front-line nurses’ problem solving dilemma, to provide a basis for making relevant strategies to cultivate nurses’ thinking and ability of problem solving.

Study design

A qualitative study based on in-depth interviews was conducted to obtain influencing factors of nurses’ problem-solving dilemma.

Settings and participants

Purposive sampling combined with a maximum variation strategy was used to identify and select information-rich participants related to the research phenomenon. Maximum variation was achieved in terms of participants’ gender, education level, professional title, marital status, seniority, and administrative office, respectively. The study was conducted between August 2020 to December 2020 in a tertiary hospital in Shanghai, China. The inclusion criteria were a nurse practicing certificate of the People’s Republic of China and within the valid registration period; having been engaged in clinical nursing work for at least 1 year and still engaged in clinical nursing work; clear language expression, able to clearly describe the solution and feelings of clinical problem solving; informed consent to this study and voluntary participation. The exclusion criterion were on leave during the study period (personal leave, maternity leave, sick leave, etc.); out for further study or came to the hospital for further study; confirmed or suspected mental illness and psychotropic medicine users. Purposive sampling continued until thematic saturation was reached during data analysis.

Data collection

Face-to-face, a semi-structured interview was used to collect information. All interviews were conducted in the lounge to ensure quiet and undisturbed by a female postgraduate nursing student with the guidance of her master tutor. Initially, an interview guide was developed based on literature review and expert consultation including about five predetermined questions: What thorny problems have you encountered in clinical work or have a great impact on you? How did you solve it? Why take such a solution? What is the biggest difficulty encountered in the process of problem solving? How does it affect you? How do you feel in the process of problem solving? Before the interview, the consent of the interviewee was obtained and then the researcher fully explains to the interviewees and starts with a friendly chat to allay the interviewees’ worries. During the interview, the researcher listened carefully and responded in time, always maintaining a neutral attitude, without any inducement or hint, if necessary, giving encouragement and praise to support the expression of the interviewees, and to record the interviewees’ facial expressions, physical movements and emotional responses in time. At the same time, a recording pen was used to ensure that the interview content was recorded accurately and without omission. The interview time for each person was 30 to 40 minutes.

Data analysis

After each interview, the researcher wrote an interview diary in time to reflect on the interview process and transcribed the interview content into words within 24 hours, then the researcher made a return visit by phone the next day to confirm that the information is correct. The seven-step method of Colaizzi’s phenomenological analysis method ( Table I ) was adopted to analyse the collected data(Colaizzi, 1978 ). Two researchers collated the original data, independently coded, summarized this information as themes, and organized a research group meeting once a week to discuss and reach a consensus.

7 steps of Colaizzi’s phenomenological analysis method.

Ethical considerations

This study was approved by the Ethics Committee of the Shanghai Pulmonary Hospital, Affiliated to Tongji University, project number: K16-252. Before the interview, the researcher explained the purpose and significance of the study to each interviewee in detail and obtained the informed consent of them on a voluntary basis and all of the interviewees signed informed consent forms. To protect the privacy of each interviewee, their names are replaced by numbers (e.g., N1, N2), and the original materials and transcribed text materials involved are kept by the first author himself, and all materials are destroyed after the completion of the study.

There was no new point of view when the 13th nurse was interviewed, and there was still no new point of view when one more nurse was interviewed, the interview was over, 14 nurses were interviewed. Three themes and seven subthemes were extracted. The characteristics of the participants ( N = 14) are provided in Table II .

Participant characteristics (N = 14).

Nurses’ own factors

Differences in knowledge structure and thinking.

Differences in the structure of prior knowledge and way of thinking will affect nurses’ processing of clinical data, thus affecting their clinical decision-making. The nurses made a wrong judgement of the condition because of the solidified thinking that postoperative nausea and vomiting symptoms were side effects of narcotic drugs and the lack of overall control and understanding of the patient’s condition.

There was a patient who came back after surgery with nausea and vomiting, the first thing that went through my mind, is the drug side effects, so I didn’t pay much attention, as is often the case, the most common cause of postoperative nausea and vomiting is anesthetic drug side effects, but later found to be cerebral infarction, this kind of situation I find it hard to recognize.

Differences in professional values

Professional values of nurses are accepted codes of conduct internalized by nursing professionals through training and learning (Pan, 2016 ). Negative professional values are easy to lead to problem solving dilemma. Some nurses think nursing is just a service.

The work is difficult to do, everything is the nurse’s fault, the nurse must apologize and put up with the patient’s scolding, nursing is a service industry, sometimes I am really wronged.” There are also nurses who believe that nursing work can reflect their personal value, and solving problems successfully will bring them a sense of achievement.

Although the nursing work is very intense, I live a full life every day. I feel a sense of accomplishment and pride that I can solve the problems of patients and discharge them smoothly through my work.

Poor strain capacity

Nursing work is patient-centred holistic nursing, the current clinical situation is complex and changeable, requiring nurses must have good strain capacity, and can “be anxious about what the patient needs, think what the patient thinks, and solve the patient’s difficulties.”

All patients are self-centered, and they don’t care whether you (the nurse) are busy or not. For example, once I gave oral medicine to a patient, a patient in the same ward was in a hurry and asked me to help him call his son. I was busy handing out the medicine and did not help. As a result, the patient was very dissatisfied and complained to the head nurse.

The 20-bed patient went through the discharge formalities but was still lying in the hospital bed. when the new patient arrived and she didn’t leave, I went to urge her to leave the hospital, she suddenly got angry and scolded me, I don’t know what to do.

Improper nursing management

Low sense of organizational support.

Organizational support is an important resource for clinical nurses in the process of problem solving (Poghosyan et al., 2020 ). Low sense of organizational support will hinder nurses’ problem solving.

The style of leadership and the atmosphere of the department are very important. in a department I rotated before, the leader was too strict to listen to your explanation, and the atmosphere of the department was not good. I couldn’t find help when I encountered problems. When I have a conflict with a patient, the leader will only criticize me, which makes me feel helpless.

Sometimes there will be a conflict with patients due to the bed turnover problem, and the patient will not listen to your explanation and turn around to complain, the nurse will be responsible for such things. In severe cases, even violent incidents will be encountered and the personal safety can not be guaranteed.

Insufficient allocation of manpower

Although the total number of nurses has increased substantially, there is still a shortage of human resources under the rapidly increasing workload (Guo et al., 2021 ).

When I was on the night shift and I encountered the critical moment of rescuing patients, I had to call an anesthesiologist, a doctor on duty, a nurse on duty simultaneously, an observation of the patient’s condition to prevent accidents was needed, I also have to race against time to give the patient ECG monitoring and oxygen inhalation. When the doctor came, he also criticized me that the first-aid equipment was not in place (crying).

According to the normal nurse-patient ratio, each nurse takes care of eight patients, and now there are not only eight patients, but also with extra beds and a fast turnover, and sometimes a nurse is responsible for more than 12 patients

Patient factors

The concept of emphasizing medicine and neglecting to nurse.

There is a deviation in society’s cognition of the profession of nurses, which believes that nurses are the “legs” of doctors, and nurses’ work is to help doctors run errands, give injections and give fluids. This concept not only leads to nurses’ lack of due respect, but also hinders nurses’ professional identity, and has a great negative impact on nurses’ problem-solving (Gao et al., 2015 ).

The patient did not dare to tell the doctor something he was not satisfied with, but complained directly to the nurse. For example, if the patient did not want to do some tests, he would scold the nurse. The nurse explained to him that he would not listen. But when the doctor came, he smiled and refused to admit that he cursed nurses, and he would frame the nurse. 90% of the patients would be willing to listen to the doctor.

Sometimes the patient says he was not feeling well, and I know the patient’s condition. I will give her some reasonable explanations, but the patient does not accept it. She is satisfied only when the doctor come to see her. In the final analysis, the patient just don’t believe us. No matter how much I explain to her, it is not as effective as the doctor’s glance at her.

Individual differences of patients

There are differences in patients’ personality characteristics, cultural background, views on nurses and state of an illness, these individual differences are also the reasons for nurses’ problem-solving dilemma (Chan et al., 2018 ).

Some cancer patients are in a period of anger, and it is very difficult to communicate with him. When I see him angry and lose his temper, I will not talk to him and just leave.”

Patients have different cultural levels and different social backgrounds. Sometimes I can’t talk too deeply. If patients are a little more educated, it will be easier for us to communicate with them, and some patients can’t understand anything we say.”

Multiple factors affecting clinical nurses’ problem-solving dilemma

The reasons for nurses’ failure in problem solving are mainly in the process of understanding the problem, the search process driven by the psychological information structure, and the problem or loss of balance in the process of implementing the plan. In the process, the three factors of nurses, management and patients all played an important role. Nurses’ knowledge structure and thinking loopholes led to the deviation of nurses’ internal representation of the problem (Jonassen, 2005 ). Poor professional values and low sense of organizational support can lead to nurses’ negative orientation and attitude towards problems (Poghosyan et al., 2020 ; X. Wang et al., 2018 ). The manpower allocation of nurses, patients’ emphasis on medical treatment over nursing care, and individual differences mainly increase the complexity and difficulty of nurses’ problem-solving task environment as external factors. The three factors work together on the problem-solving of clinical nurses, which leads to the dilemma of problem-solving.

Implementing situational simulation training to improve the comprehensive quality of nurses

At present, the overall quality and ability of nurses cannot meet the requirements of systematic, effective and rapid problem-solving. It is necessary to strengthen the construction of nurses to improve nurses’ problem-solving ability. Some studies have shown that situational simulation class can improve students’ knowledge, experience, psychological quality and other abilities (Mohammad, 2020 ). It is suggested that nursing educators should explore targeted situational simulation teaching and strengthen the relationship between classroom teaching and clinical practice through situational simulation, and to build a novel, perfect and clinical knowledge network for nurses. Secondly, emergency situational simulation teaching should be carried out to enable nurses to experience emergency situations from different angles, so as to improve their thinking, skills and timeliness in dealing with emergencies (Zhang et al., 2019 ). The content of professional values training should also be added to the situational simulation class in order to cultivate nurses’ positive, accessible and stable professional values and promote their positive orientation and attitude when facing problems (Skeriene, 2019 ).

Optimize nursing management and improve nurses’ working experience

Through interviews, it is found that nursing management factors have caused nurses’ problem-solving dilemma to a certain extent, which needs to be optimized according to the specific problems existing in nursing management to help nurses deal with the problems and solve the dilemma effectively. The total number of registered nurses in China exceeded 4.7 million in 2021, an increase of 1.46 million from 3.24 million in 2015, an increase of 45% (Deng et al., 2019 ]. However, there is still a large workload and underallocation of manpower, which may be due to the unreasonable distribution of human resources between time periods and departments. Hospitals and nursing managers can use the hospital information system to evaluate the nursing workload, and allocate nursing human resources reasonably according to the evaluation results (H. Yang et al., 2019 ), so as to avoid nurses falling into the dilemma of problem solving due to long-term overloaded work. In addition, it is necessary to create a harmonious departmental atmosphere for nurses, create a supportive departmental environment (Aghaei et al., 2020 ), and strictly ensure the safety of nurses’ practice and put an end to the occurrence of violence. Timely and strong organizational support can reduce the painful feelings of nurses caused by adverse events (Stone, 2020 ). and help them to solve problems actively.

Using new media to improve the image and credibility of nurses

There is a bias in social cognition of the profession of nurses, and some negative media reports mislead patients, resulting in social stereotypes of nurses (L. Q. Wang et al., 2021 ). It is necessary to make full use of new media to objectively introduce the nursing profession to the public, publicize outstanding nursing figures and typical deeds, make the public realize the important role of nurses in health care, and create an atmosphere of understanding and supporting nurses in the whole society to enhance the image and credibility of nurses and help nurses deal with problems and solve difficulties effectively (Falkenstrom, 2017 ).

Limitations and strengths of the study

The limitation is that the transferability of this study’s results may be limited as a result of including a small number of participants and the participants all worked in the same hospital in Shanghai. More participants in different cities and hospitals could have increased the variety of the descriptions and experiences. The strength is that the use of purposive sampling facilitated inclusion of participants from a range of demographic groups. The use of maximum variation strategy facilitated that the participants covered different gender, education level, professional title, marital status, seniority and department, which helped to increase the representativeness of sample.

Implications for practice

This study provides an in-depth exploration of the problem solving dilemmas of clinical nurses in China and provides valuable insights into the continuing education of nurses. These insights shine a light on areas that warrant further investigation and need to be improved in continuing education of nurses. It is of great significance to improve nurses’ problem-solving ability, improve nurses’ professional quality, effectively solve patients’ medical treatment and health problems, and improve patients’ experience of seeking medical treatment.

Through the semi-structured interview, it is found that the problem-solving dilemma of clinical nurses is affected by many factors. Nurses themselves should be confident, self-improvement, constantly learning and enterprising to improve their own ability, and be good at using new media to improve nurses’ image and credibility. Hospitals, nursing administrators and nursing educators should take corresponding measures to improve the knowledge structure of nurses, cultivate nurses’ positive professional values and adaptability, and give full organizational support to nurses. optimize the allocation of nursing human resources to provide a strong guarantee for nurses to deal with problems solving dilemma.

Biographies

Yu Mei Li : associate chief nurse, master degree, master supervisor, engaged in nursing of tumor patients.

Yifan Luo : nurse, master degree, engaged in clinical nursing.

Funding Statement

This work was supported by the Graduate Education Research and Reform Education Management program of Tongji University [2021YXGL09].

Disclosure statement

No potential conflict of interest was reported by the author(s).

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