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• Helen Noble 1 ,
• Allison Shorten 2
• 1 School of Nursing and Midwifery, Queens University Belfast , Belfast , UK
• 2 Department of Family, Community and Health Sciences , University of Alabama at Birmingham School of Nursing , Birmingham , Alabama , USA
• Correspondence to Dr Helen Noble, School of Nursing and Midwifery, Queens University Belfast, Belfast BT9 7BL, UK; helen.noble{at}qub.ac.uk

https://doi.org/10.1136/eb-2017-102850

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EBN perspectives bring together key issues from the commentaries in one of our nursing topic themes.

Introduction

This article is part of Evidence Based Nursing ( EBN ) Perspective series. In this series, published commentaries related to a specific nursing theme are collated and highlights are discussed. The topic for this edition is ‘nursing issues’, covering 21 commentaries published from October 2016 over a 12-month period. A summary of works is organised into key themes, research methods are identified and important implications for practice and future research are explored.

Evidence-Based Nursing commentaries on nursing issues (October 2016–October 2017)

Theme 1: professional issues—nursing workforce/workplace.

Staffing and nurse-perceived quality of care (http://ebn.bmj.com/content/20/1/19).

Greater nurse autonomy associated with lower mortality and failure to rescue rates (http://ebn.bmj.com/content/20/2/56).

Health, psychosocial and workplace characteristics may identify nurses and midwives at risk of high absenteeism (http://ebn.bmj.com/content/20/3/83).

Good peer relationships can attenuate the negative effect of horizontal violence on job satisfaction  (http://ebn.bmj.com/content/19/3/91).

Simple variations to traditional models of care can dramatically improve emergency department performance (http://ebn.bmj.com/content/20/3/87).

Emergency department nurses report high workload and management pressure to meet 4-hour treatment targets (http://ebn.bmj.com/content/19/3/90).

Information gaps in medication communication during clinical handover calls for a different approach (http://ebn.bmj.com/content/19/4/125).

Nurses require confidence, knowledge and communication skills for referrals to doctors (http://ebn.bmj.com/content/20/3/84).

Reporting of professional misconduct is influenced by nurses’ level of education and managerial experience (http://ebn.bmj.com/content/20/3/89).

Mindfulness training can reduce depression and anxiety among nurses (http://ebn.bmj.com/content/20/2/57).

Theme 2: Evidence-based nursing care—patient care/therapies

Earplugs could be an effective sleep hygiene strategy to reduce delirium …

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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Research Problem and Purpose

Chapter 5 Research Problem and Purpose   http://evolve.elsevier.com/Grove/practice/ We are constantly asking questions to better understand ourselves and the world around us. This human ability to wonder and ask creative questions about behaviors, experiences, and situations in the world provides a basis for identifying research topics and problems. Identifying a problem is the initial step, and one of the most significant, in conducting quantitative, qualitative, outcomes, and intervention research. The research purpose evolves from the problem and directs the subsequent steps of the research process. Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. Research topics contain numerous potential research problems, and each problem provides the basis for developing many purposes. Thus, the identification of a relevant research topic and a challenging, significant problem can facilitate the development of numerous study purposes to direct a lifetime program of research. However, the abundance of research topics and potential problems frequently is not apparent to nurses struggling to identify their first study problem. This chapter differentiates a research problem from a purpose, identifies sources for research problems, and provides a background for formulating a problem and purpose for study. The criteria for determining the feasibility of a proposed study problem and purpose are described. The chapter concludes with examples of research topics, problems, and purposes from current quantitative, qualitative, outcomes, and intervention studies. What Is a Research Problem and Purpose? A research problem is an area of concern where there is a gap in the knowledge base needed for nursing practice. Research is conducted to generate knowledge that addresses the practice concern, with the ultimate goal of providing evidence-based health care. A research problem can be identified by asking questions such as the following: What is wrong or is of concern in this clinical situation? What knowledge is needed to improve this situation? Will a particular intervention work in this clinical situation? What is known about this intervention’s effectiveness? Would another intervention be more effective in producing the desired outcomes? By questioning and reviewing the literature, researchers begin to recognize a specific area of concern and the knowledge gap that surrounds it. The knowledge gap, or what is not known about this clinical problem, determines the complexity and number of studies needed to generate essential knowledge for nursing practice ( Craig & Smyth, 2012 ; Creswell, 2009 ). In addition to the area of concern, the research problem identifies a population and sometimes a setting for the study. A research problem includes significance, background, and a problem statement. The significance of a problem indicates the importance of the problem to patients and families, nursing, healthcare system, and society. The background for a research problem briefly identifies what we know about the problem area. The problem statement identifies the specific gap in the knowledge needed for practice. A research problem from the study by Grady, Entin, Entin, and Brunye (2011) is presented as an example. This study was conducted to examine the effectiveness of educational messages or information on the knowledge, attitudes, and behaviors of people with diabetes. “Diabetes prevalence has reached epidemic proportions in this country. The health and economic consequences for Americans with this disease are overwhelming and expected to grow as our population continues to age. Approximately 23.6 million people in the United States have diabetes and, despite the disease being underreported as a cause of death, diabetes was listed as the seventh leading cause of death in the United States in 2006 ( Centers for Disease Control and Prevention, 2008a ). The direct medical costs of diabetes care and complications of $116 billion, together with indirect costs of $58 billion related to disability and reduced productivity, resulted in an estimated economic cost of diabetes totaling $174 billion in 2007 ( American Diabetes Association, 2009 ).… Complications contribute to a risk of death among individuals with diabetes that is about 2 times higher than that of individuals without diabetes ( Centers for Disease Control and Prevention, 2008a ). Amputations and foot ulcerations are the most common consequences of diabetic neuropathy and the major causes of morbidity and disability in people with diabetes. Approximately 2% to 3% of individuals with diabetes develop one or more foot ulcers each year, and an estimated 15% will develop a foot ulcer during their lifetime ( Singh, Armstrong, & Lipsky, 2005 ) [ problem significance ].… As the cornerstone of diabetes treatment and an integral part of a self-management regime, education of patients with diabetes takes place in both inpatient and outpatient venues.… Patient education takes time in the continuum of care that an already overworked staff is challenged to provide.… The research cited in the reviews of Boren et al. (2006) and Jackson et al. (2006) provides evidence that delivery of healthcare information can be accomplished effectively without involving diabetes educators or nurses and offers support for the use of information-technology-based education as an alternative way to provide information and guidance to persons with diabetes [ problem background ]. However, regardless of whether the information is presented in person or via technology, a relevant and still-open question is how to present the information so as to foster positive attitudinal and behavioral change and maximize the long-term effectiveness of health management education [ problem statement ].” ( Grady et al., 2011 , pp. 22-23) In this example, the research problem identifies an area of concern (incidence, costs, and complications of diabetes) for a particular population (persons with diabetes) in selected settings (inpatient and outpatient venues). Grady and colleagues (2011) clearly identified the significance of the problem, which is extensive and relevant to patients, families, nursing, healthcare system, and society. The problem background focuses on key research conducted to examine the effectiveness of health education on the management of diabetes. The last sentence in this example is the problem statement, which identifies the gap in the knowledge needed for practice. In this study, there is limited research on how to present diabetic education to maximize its effectiveness on attitudinal and behavioral change in people with this chronic illness. The research problem in this example includes concepts or research topics such as diabetes prevalence, economic consequences, complications of diabetes, consequences of diabetic neuropathy, health management education, self-management, and attitudinal and behavioral changes. Health management education is an abstract concept, and a variety of nursing actions or interventions could be implemented to determine their effectiveness in promoting long-term attitudinal and behavioral changes in persons with diabetes. Thus, each problem may generate many research purposes. The knowledge gap regarding how to present information to foster positive attitudinal and behavioral changes in persons with diabetes provides clear direction for formulating the research purpose. The research purpose is a clear, concise statement of the specific focus or aim of the study that is generated on the basis of the research problem. The purpose usually indicates the type of study (quantitative, qualitative, outcomes, or intervention) to be conducted and often includes the variables, population, and setting for the study. The goals of quantitative research include identifying and describing variables, examining relationships among variables, and determining the effectiveness of interventions in managing clinical problems ( Creswell, 2009 ; Shadish, Cook, & Campbell, 2002 ). The goals of qualitative research include exploring a phenomenon, such as depression as it is experienced by pregnant women; developing theories to describe and manage clinical situations; examining the health practices of certain cultures; describing health-related issues, events, and situations; and determining the historical evolution of the profession ( Marshall & Rossman, 2011 ; Munhall, 2012 ). The focus of outcomes research is to identify, describe, and improve the outcomes or end results of patient care ( Doran, 2011 ). Intervention research focuses on investigating the effectiveness of nursing interventions in achieving the desired outcomes in natural settings ( Forbes, 2009 ). Regardless of the type of research, every study needs a clearly expressed purpose statement to guide it. Grady et al. (2011) clearly identified their study purpose following their research problem statement of the gap in the knowledge base. Thus, the purpose of their study was to “examine the impact of information framing in an educational program about proper foot care and its importance for preventing diabetic complications on long-term changes in foot care knowledge, attitudes, and behavior” ( Grady et al., 2011 , p. 23). This research purpose indicates that these investigators conducted a quantitative quasi-experimental study to determine the effectiveness of an independent variable or intervention (information framing educational program about diabetic foot care and prevention of complications) on the dependent or outcome variables (foot care knowledge, attitudes, and behaviors). The researchers also identified two hypotheses to direct their study, which included the four variables identified (see Chapter 8 for a discussion of hypotheses). The study findings indicated that the gain-framed messages focused on the benefits of taking action were significantly more effective in promoting positive behavioral changes in people with diabetes than the loss-framed messages focused on the costs of not taking action. A gain-framed message might be stated as follows: “Achieving normal blood sugar increases your feelings of health and well being and promotes control of your illness.” A loss-framed message might be worded as follows: “Poorly controlled blood sugars can lead to complications of neuropathy, foot lesions, and amputation.” Grady et al. (2011) also found that changes in knowledge affected changes in attitudes and that attitudes were direct predictors of long-term behavior management of diabetes. The findings from this study and other research provide evidence of the effectiveness of information messages in sustaining health promoting behavior by people with diabetes. Sources of Research Problems Research problems are developed from many sources, but you need to be curious, astute, and imaginative to identify problems from the sources. The sources for research problems included in this text are (1) clinical practice, (2) researcher and peer interactions, (3) literature review, (4) theories, and (5) research priorities identified by funding agencies and specialty groups. Researchers often use more than one source to identify and refine their research problem. Clinical Practice The practice of nursing must be based on knowledge or evidence generated through research. Thus, clinical practice is an extremely important source for research problems. Problems can evolve from clinical observations. For example, while watching the behavior of a patient and family in crisis, you may wonder how you as a nurse might intervene to improve the family’s coping skills. A review of patient records, treatment plans, and procedure manuals might reveal concerns or raise questions about practice that could be the basis for research problems. For example, you may wonder: What nursing intervention will open the lines of communication with a patient who has had a stroke? What is the impact of home visits on the level of function, readjustment to the home environment, and rehospitalization pattern of a child with a severe chronic illness? What is the most effective treatment for acute and chronic pain? What is the best pharmacological agent or agents for treating hypertension in elderly, diabetic patients—angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), diuretic, beta blocker, calcium channel blocker, or alpha antagonist, or a combination of these drugs? What are the most effective pharmacological and nonpharmacological treatments for a patient with a serious and persistent mental illness? What are the needs of stroke survivors from their perspective? What are the cultural factors that promote better birth outcomes in Hispanic women? These clinical questions could direct you in identifying a significant research problem and purpose. Extensive patient data, such as diagnoses, treatments, and outcomes, are now computerized. Analyzing this information might generate research problems that are significant to a clinic, community, or national healthcare system. For example, you may ask: Why has adolescent obesity increased so rapidly in the past 10 years, and what treatments will be effective in managing this problem? What pharmacological and nonpharmacological treatments have been most effective in treating common acute illnesses such as otitis media, sinusitis, and bronchitis in your practice or nationwide? What are the outcomes (patient health status and costs) for treating such chronic illnesses as type 2 diabetes, hypertension, and dyslipidemia in your practice? Review of agency patient data often reveals patterns and trends in a clinical setting and helps nurses and students to identify patient care problems. Because health care is constantly changing in response to consumer needs and trends in society, the focus of current research varies according to these needs and trends. For example, research evidence is needed to improve practice outcomes for infants and new mothers, the elderly and residents in nursing homes, and persons from vulnerable and culturally diverse populations. Healthcare agencies would benefit from studies of varied healthcare delivery models. Society would benefit from interventions recognized to promote health and prevent illness. In summary, clinically focused research is essential if nurses are to develop the knowledge needed for evidence-based practice (EBP) ( Brown, 2009 ; Melnyk & Fineout-Overholt, 2011 ). Researcher and Peer Interactions Interactions with researchers and peers offer valuable opportunities for generating research problems. Experienced researchers serve as mentors and help novice researchers to identify research topics and formulate problems. Nursing educators assist students in selecting research problems for theses and dissertations. When possible, students conduct studies in the same area of research as the faculty. Faculty members can share their expertise regarding their research program, and the combined work of the faculty and students can build a knowledge base for a specific area of practice. This type of relationship could also be developed between an expert researcher and a nurse clinician. Because nursing research is critical for designation as a Magnet facility by the American Nurses Credentialing Center © (ANCC, 2012) , hospitals and healthcare systems employ nurse researchers for the purpose of guiding studies conducted by staff nurses. Building an EBP for nursing requires collaboration between nurse researchers and clinicians as well as with researchers from other health-related disciplines. Interdisciplinary research teams have the expertise to increase the quality and quantity of studies conducted. Being a part of a research team is an excellent way to expand your understanding of the research process. Beveridge (1950) identified several reasons for discussing research ideas with others. Ideas are clarified and new ideas are generated when two or more people pool their thoughts. Interactions with others enable researchers to uncover errors in reasoning or information. These interactions are also a source of support in discouraging or difficult times. In addition, another person can provide a refreshing or unique viewpoint, which helps avoid conditioned thinking, or following an established habit of thought. A workplace that encourages interaction can stimulate nurses to identify research problems. Nursing conferences and professional meetings also provide excellent opportunities for nurses to discuss their ideas and brainstorm to identify potential research problems. The Internet has greatly extended the ability of researchers and clinicians around the world to share ideas and propose potential problems for research. Most colleges or schools of nursing have websites that identify faculty research interests and provide mechanisms for contacting individuals who are conducting research in your area of interest. Thus, interactions with others are essential to broaden your perspective and knowledge base and to support you in identifying significant research problems and purposes. Literature Review Reviewing research journals, such as Advances in Nursing Science, Applied Nursing Research, Clinical Nursing Research, Evidence-Based Nursing, International Journal of Psychiatric Nursing Research, Journal of Nursing Scholarship, Journal of Advanced Nursing, Journal of Research in Nursing, Nursing Research, Nursing Science Quarterly, Research in Nursing & Health, Scholarly Inquiry for Nursing Practice: An International Journal, Southern Online Journal of Nursing Research, and Western Journal of Nursing Research , as well as theses and dissertations will acquaint novice researchers with studies conducted in an area of interest. The nursing specialty journals, such as American Journal of Maternal Child Nursing, Archives of Psychiatric Nursing, Dimensions of Critical Care, Heart & Lung, Infant Behavior and Development, Journal of Pediatric Nursing , and Oncology Nursing Forum, also place a high priority on publishing research findings. Reviewing research articles enables you to identify an area of interest and determine what is known and not known in this area. The gaps in the knowledge base provide direction for future research. (See Chapter 6 for the process of reviewing the literature.) At the completion of a research project, an investigator often makes recommendations for further study. These recommendations provide opportunities for others to build on a researcher’s work and strengthen the knowledge in a selected area. For example, the Grady et al. (2011 , p. 27) study, introduced earlier in this chapter, provided recommendations for further research to examine “the longer term eventualities of gain- and loss-framed messages on preventative behaviors.” They also recommended examining how long the gain-framed message might last and when it would be “necessary to provide another message presentation to bolster effective self-care behavior” (p. 27). These researchers also encouraged others to validate their findings through replication studies that varied the content and delivery format of educational messages provided persons with diabetes. Replication of Studies Reviewing the literature is a way to identify a study to replicate. Replication involves reproducing or repeating a study to determine whether similar findings will be obtained ( Fahs, Morgan, & Kalman, 2003 ). Replication is essential for knowledge development because it (1) establishes the credibility of the findings, (2) extends the generalizability of the findings over a range of instances and contexts, (3) reduces the number of type I and type II errors, (4) corrects the limitations in studies’ methodologies, (5) supports theory development, and (6) lessens the acceptance of erroneous results. Some researchers replicate studies because they agree with the findings and wonder whether the findings will hold up in different settings with different subjects over time. Others want to challenge the findings or interpretations of prior investigators. Some researchers develop research programs focused on expanding the knowledge needed for practice in an area. This program of research often includes replication studies that strengthen the evidence for practice. Four different types of replications are important in generating sound scientific knowledge for nursing: (1) exact, (2) approximate, (3) concurrent, and (4) systematic extension ( Haller & Reynolds, 1986 ). An exact (or identical) replication involves duplicating the initial researcher’s study to confirm the original findings. All conditions of the original study must be maintained; thus, “there must be the same observer, the same subjects, the same procedure, the same measures, the same locale, and the same time” ( Haller & Reynolds, 1986 , p. 250). Exact replications might be thought of as ideal to confirm original study findings, but these are frequently not attainable. In addition, one would not want to replicate the errors in an original study, such as small sample size, weak design, or poor-quality measurement methods. When conducting an approximate (or operational) replication , the subsequent researcher repeats the original study under similar conditions, following the methods as closely as possible. The intent is to determine whether the findings from the original study hold up despite minor changes in the research conditions. If the findings generated through replication are consistent with the findings of the original study, then the knowledge is considered more credible and has a greater probability of accurately reflecting the real world. If the replication fails to support the original findings, the designs and methods of both studies should be examined for limitations and weaknesses, and further research must be conducted. Conflicting findings might also generate additional theoretical insights and provide new directions for research. For a concurrent (or internal) replication , the researcher collects data for the original study and the replication study simultaneously thereby checking the reliability of the original study findings. The confirmation, through replication of the original study findings, is part of the original study’s design. For example, your research team might collect data simultaneously at two different hospitals to compare and contrast the findings. Consistency in the findings increases the credibility of the study and the likelihood that others will be able to generalize the findings. Some expert researchers obtain funding to conduct multiple concurrent replications, in which a number of individuals conduct repetitions of a single study, but with different samples in different settings. Clinical trials that examine the effectiveness of the pharmacological management of chronic illnesses, such as diabetes, hypertension, and dyslipidemia, are examples of concurrent replication studies. As each study is completed, the findings are compiled in a report that specifies the series of replications that were conducted to generate these findings. Some outcome studies involve concurrent replication to determine whether the outcomes vary for different healthcare providers and healthcare settings across the United States ( Brink & Wood, 1979 ; Brown, 2009 ; Doran, 2011 ). A systematic (or constructive) replication is done under distinctly new conditions. The researchers conducting the replication do not follow the design or methods of the original researchers; rather, the second investigative team identifies a similar problem but formulates new methods to verify the first researchers’ findings ( Haller & Reynolds, 1986 ). The aim of this type of replication is to extend the findings of the original study and test the limits of the generalizability of such findings. Intervention research might use this type of replication to examine the effectiveness of various interventions devised to address a practice problem. Nurse researchers need to actively replicate studies to develop strong research evidence for practice. However, the number of nursing studies replicated continues to be limited. The replications of studies might be limited because (1) some view replication as less scholarly or less important than original research, (2) the discipline of nursing lacks adequate resources and funding for conducting replication studies, and (3) editors of journals publish fewer replication studies than original studies ( Fahs et al., 2003 ). However, the lack of replication studies severely limits the generation of sound research findings needed for EBP in nursing. Thus, replicating a study should be respected as a legitimate scholarly activity for both expert and novice researchers. Funding from both private and federal sources is needed to support the conduct of replication studies, with a commitment from journal editors to publish these studies. Replication provides an excellent learning opportunity for the novice researcher to conduct a significant study, validate findings from previous research, and generate new research evidence about different populations and settings. Students studying for a master’s of science in nursing degree could be encouraged to replicate studies for their theses, possibly to replicate faculty studies. Expert researchers, with programs of research, implement replication studies to generate sound evidence for use in practice. When publishing a replication study, researchers need to designate the type of replication conducted and the contribution the study made to the existing body of knowledge. Theory Theories are an important source for generating research problems because they set forth ideas about events and situations in the real world that require testing ( Chinn & Kramer, 2008 ). In examining a theory, you may note that it includes a number of propositions and that each proposition is a statement of the relationship of two or more concepts. A research problem and purpose could be formulated to explore or describe a concept or to test a proposition from a theory. Middle range theories are the ones most commonly used as frameworks for quantitative studies and are tested as part of the research process ( Smith & Liehr, 2008 ). In qualitative research, the purpose of the study might be to generate a theory or framework to describe a unique event or situation ( Marshall & Rossman, 2011 ; Munhall, 2012 ). Some researchers combine ideas from different theories to develop maps or models for testing through research. The map serves as the framework for the study and includes key concepts and relationships from the theories that the researchers want to study. Frenn, Malin, and Bansal (2003 , p. 38) conducted a quasi-experimental study to examine the effectiveness of a “4-session Health Promotion/Transtheoretical Model-guided intervention in reducing percentage of fat in the diet and increasing physical activity among low- to middle-income culturally diverse middle school students.” The intervention was based on the “components of two behaviorally based research models that have been well tested among adults—Health Promotion Model ( Pender, 1996 ) and Transtheoretical Model ( Prochaska, Norcross, Fowler, Follick, & Abrams, 1992 )—but have not been tested regarding low-fat diet with middle school-aged children” ( Frenn et al., 2003 , p. 36). They developed a model of the study framework (see Figure 5-1 ) and described the concepts and propositions from the model that guided the development of different aspects of their study. Figure 5-1 The health promotion stage of change model: A synthesis of health promotion and transtheoretical models guiding low-fat diet intervention for students in an urban middle school. “A combined Health Promotion/Transtheoretical Model guided the intervention designed for this study [see Figure 5-1 ]. The first individual characteristic examined in this study was temptation (low self-efficacy), defined as the inability to overcome barriers in sustaining a low-fat diet … and an intervention helping adolescents develop behavioral control may enhance self-efficacy and improve health habits. The second characteristic common to both the Health Promotion and Transtheoretical Models was benefits/barriers. In a study of fifth- through seventh- grade children, Baranowski and Simons-Morton (1990) found the most common barriers to reducing saturated fat in the diet were (a) giving up preferred foods, (b) meals outside the home that contained fat, (c) not knowing what foods were low in fat, and (d) not wanting to take the time to read labels. The last individual characteristic used in this study was access to low-fat foods. This concept from the Health Promotion Model is important in a middle school-aged population, as they are, to some extent, dependent on others for the types of food available.” ( Frenn et al., 2003 , pp. 37-38) Frenn et al. (2003) used the Pender (1996) Health Promotion Model and the Transtheoretical Model ( Prochaska et al., 1992 ), which are middle range theories, to develop the following research questions to guide their study: “(a) Do demographic variables, access to low-fat foods, perceived self-efficacy, benefits/barriers, and stages of change predict percentage of fat reported in the diet by middle school-aged children? (b) Does the application of a Health Promotion/Transtheoretical Model intervention in 4 classroom sessions significantly improve adoption of a diet lower in fat and duration of physical activity as compared with a control group of students not engaged with the program?” ( Frenn et al., 2003 , p. 39) The findings from a study either support or do not support the relationships identified in the model. The study by Frenn et al. (2003) added support to the Health Promotion/Transtheoretical Model with their findings that the classroom intervention decreased dietary fat and increased physical activity for middle school–age adolescents. Further research is needed to determine whether classroom interventions over time reduce body mass index, body weight, and the percentage of body fat of overweight and obese adolescents. As a graduate student, you could use this model as a framework and test some of the relationships in your clinical setting. Research Priorities Since 1975, expert researchers, specialty groups, professional organizations, and funding agencies have identified nursing research priorities. The research priorities for clinical practice were initially identified in a study by Lindeman (1975) . Those original research priorities included nursing interventions related to stress, care of the aged, pain management, and patient education. Developing evidence-based nursing interventions in these areas continues to be a priority. Many professional nursing organizations use websites to communicate their current research priorities. For example, the American Association of Critical-Care Nurses (AACN) determined initial research priorities for this specialty in the early 1980s ( Lewandowski & Kositsky, 1983 ) and revised these priorities on the basis of patients’ needs and the changes in health care. The current AACN (2011) research priorities are identified on this organization’s website as (1) effective and appropriate use of technology to achieve optimal patient assessment, management, or outcomes, (2) creation of a healing, humane environment, (3) processes and systems that foster the optimal contribution of critical care nurses, (4) effective approaches to symptom management, and (5) prevention and management of complications. AACN (2011) has also identified future research needs under the following topics: medication management, hemodynamic monitoring, creating healing environments, palliative care and end-of-life issues, mechanical ventilation, monitoring of neuroscience patients, and noninvasive monitoring. If your specialty is critical care, this list of research needs might help you identify a priority problem and purpose for study. The American Organization of Nurse Executives (AONE, 2012) provides a discussion of their education and research priorities online at http://www.aone.org/education/index.shtml/ . For 2011-2012, AONE identified more than 25 research priorities in four strategic areas: (1) design of future patient care delivery systems, (2) healthful practice environments, (3) leadership, and (4) the positioning of nurse leaders as valued healthcare executives and managers. To promote the design of future patient care delivery systems, AONE encourages research focused on new technology, patient safety, and the work environment that allows strategies for improvement crucial to the success of the delivery system. In the area of healthful practice environments, AONE encourages research focused on practice environments that attract and retain nurses and that promote professional growth and continuous learning, including mentoring of staff nurses and nursing leaders. In the area of leadership, AONE encourages research focused on evidence-based leadership capacity, measurement of patient care quality outcomes, and technology to complement patient care. To promote the positioning of nurse leaders as valued healthcare executives and managers, AONE encourages research focused on patient safety and quality, disaster preparedness, and workforce shortages. AONE recognizes the importance of supporting education and research initiatives to create a healthy work environment, a quality healthcare system, and strong nurse executives. You can search online for the research priorities of other nursing organizations to help you identify priority problems for study. A significant funding agency for nursing research is the National Institute of Nursing Research (NINR). A major initiative of the NINR is the development of a national nursing research agenda that involves identifying nursing research priorities, outlining a plan for implementing priority studies, and obtaining resources to support these priority projects. The NINR has an annual budget of more than $90 million, with approximately 74% of the budget used for extramural research project grants, 7% for predoctoral and postdoctoral training, 6% for research management and support, 5% for the centers program in specialized areas, 5% for other research including career development, 2% for the intramural program, and 1% for contracts and other expenses (see NINR at http://www.ninr.nih.gov/ ). The NINR (2011) developed four strategies for building the science of nursing: “(1) integrating biological and behavior science for better health; (2) adopting, adapting, and generating new technologies for better health care; (3) improving methods for future scientific discoveries; and (4) developing scientists for today and tomorrow.” The areas of research emphasis include: (1) promoting health and preventing disease, (2) improving quality of life, (3) eliminating health disparities, and (4) setting directions for end-of-life research ( NINR, 2011 ). Specific research priorities were identified for each of these four areas of research emphasis and were included in the NINR Strategic Plan. These research priorities provide important information for nurses seeking funding from the NINR. Details about the NINR mission, strategic plan, and areas of funding are available on its website at http://www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan/ . Another federal agency that is funding healthcare research is the Agency for Healthcare Research and Quality (AHRQ). The purpose of the AHRQ is to enhance the quality, appropriateness, and effectiveness of healthcare services, and access to such services, by establishing a broad base of scientific research and promoting improvements in clinical practice and in the organization, financing, and delivery of healthcare services. Some of the current AHRQ funding priorities are research focused on prevention; health information technology; patient safety; long-term care; pharmaceutical outcomes; system capacity and emergency preparedness; and the cost, organization, and socioeconomics of health care. For a complete list of funding opportunities and grant announcements, see the AHRQ website at http://www.ahrq.gov/ . The World Health Organization (WHO) is encouraging the identification of priorities for a common nursing research agenda among countries. A quality healthcare delivery system and improved patient and family health have become global goals. By 2020, the world’s population is expected to increase by 94%, with the elderly population growing by almost 240%. Seven of every 10 deaths are expected to be caused by noncommunicable diseases, such as chronic conditions (heart disease, cancer, and depression) and injuries (unintentional and intentional). The priority areas for research identified by WHO are to (1) improve the health of the world’s most marginalized populations, (2) study new diseases that threaten public health around the world, (3) conduct comparative analyses of supply and demand of the health workforce of different countries, (4) analyze the feasibility, effectiveness, and quality of education and practice of nurses, (5) conduct research on healthcare delivery modes, and (6) examine the outcomes for healthcare agencies, providers, and patients around the world ( WHO, 2012 ). A discussion of WHO’s mission, objectives, and research policies can be found online at http://www.who.int/rpc/en . The Healthy People 2020 website identifies and prioritizes health topics and objectives for all age groups over the next decade ( U.S. Department of Health and Human Services, 2012 ). These health topics and objectives direct future research in the areas of health promotion, illness prevention, illness management, and rehabilitation and can be accessed online at http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx/ . In summary, funding organizations, professional organizations, and governmental healthcare organizations, both national and international, are sources for identifying priority research problems and offer opportunities for obtaining funding for future research.

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Research in Nursing Practice

Yates, Morgan BScN, RN

Morgan Yates works as an RN in the ED of Surrey Memorial Hospital, Surrey, British Columbia, Canada. Contact author: [email protected] . The author has disclosed no potential conflicts of interest, financial or otherwise.

Bridging the gap between clinicians and the studies they depend on.

Research provides the foundation for high-quality, evidence-based nursing care. However, there isn't a direct flow of knowledge from research into practice. When I ask nurses where the “evidence” to guide the development of “evidence-based care” comes from, I get an interesting array of answers, from “researchers” to blank stares, as if there's no connection between the worlds of researchers and bedside nurses.

If research evidence informs our nursing practice, why doesn't it come from all of us? Nurses are inquisitive, think critically about their patients’ care, and want to know the best treatments for their patients—all of which makes them perfectly suited for research. Though the majority of nurses don't have the training to conduct research projects without assistance, they know how to ask questions and they know which questions need answering.

Yet research is often perceived as something undertaken by others far removed from the front lines of nursing practice. I believe that many nurses’ notions about who does or doesn't do research are rooted in our identity as nurses, which often manifests in a belief that “good” nurses are not researchers but instead have excellent clinical skills and can manage any crisis on a unit. A 2007 study by Woodward and colleagues in the Journal of Research in Nursing found that nurse clinicians engaged in research often perceive a lack of support from nurse managers and resentment from colleagues who see the research as taking them away from clinical practice.

The distinction often drawn between nursing research and clinical practice is mirrored in the inconsistent translation of research evidence into practice. Despite widespread promotion of evidence-based practice in nursing, creation of new translational research roles for nurses in major medical centers, and Medicare reimbursement policies in the United States tied to implementation of specific evidence-supported practices, studies continue to suggest much room for improvement. In a September 2014 article in this journal, Yoder and colleagues noted that researchers have consistently found that “nurses who valued research were more likely to use research findings in practice.” Such observations suggest a need for a much stronger link between nurse clinicians and the development of research into best practices. Though this has been discussed for years, I do not yet see research as having infiltrated fundamental views of what constitutes “nursing work.”

My discussions with frontline nurses and nurses involved in research have led me to ask three key questions that need addressing before we can fully integrate research into our professional identity. These are:

• How can nurses strive for high-quality research without focusing on randomized controlled trials?
• What are the barriers to and challenges of being involved in research and how can we address these?
• How can nurses at varying education levels be involved in research?

Nurses could turn many quality improvement (QI) projects into research. Research may be viewed as a continuum, with formal projects at one end and QI projects somewhere along the continuum. Though nurses may not think that QI projects would be of interest to others, with increased understanding of the research process and greater institutional support, some QI projects could easily become research projects.

More bedside nurses are likely to engage in research if

• nursing education is strengthened.
• time away from direct care is allocated for conducting research activities.
• consultant resources such as methodologists and biostatisticians are available to staff.
• institutional and organizational support of research are strengthened.

Many nurses are intimidated by research, but change is possible if we stop seeing research as someone else's job and start making it a part of who we are and what we do. This will pave the way to evidence-based practice truly becoming the norm.

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Evidence-Based Practice for Nursing: Asking the Clinical Question

• What is Evidence-Based Practice?
• Asking the Clinical Question
• Finding Evidence
• Evaluating the Evidence
• Articles, Books & Web Resources on EBN

Identifying the Problem

Clinical questions arise from various cues, problems, and/or observations from patient care, nursing practice, or broader changes in healthcare knowledge and delivery. The most important step in Evidence-Based Nursing (EBN) is to correctly identify a problem through patient assessment or practice assessment, processes that require reflection by the nurse on clinical practice, in conjunction with a knowledge of the patient's present circumstances. The ability to identify the problem is the foundation for evidence-based nursing ; if a nurse fails to identify a problem correctly, then all the evidence she/he locates and the resulting decision-making will be irrelevant (Haddock, 2005).

The information below describes how to frame the question once the patient or practice assessment and the resulting problem identification have occurred.

Background vs. Foreground

An early step in framing the clinical question is to determine the type of question:  background  or  foreground . The type of question helps to determine the resource to access to answer the question.

• A question root (who, what, when, etc.) with a verb
• A disorder, treatment, test, or other aspect of healthcare
• e.g.  What causes migraines? How often do women over 40 need a mammogram?
• Books  are generally better resources for answering background questions.
• ​Patient/population characteristics, problem
• Interventions or Exposures 
• Articles are typically more specific and current, making them better suited for foreground questions.

Types of Questions

Clinical questions

Clinical questions typically fall into one of four main categories:

• Etiology (or harm/risk factors) : What causes the problem?
• Diagnosis: Does this patient have this problem?
• Therapy: What is the best treatment for this problem?
• Prognosis: What will the outcome of the problem be?

* Knowing the type of clinical question is important later in the EBN process--once the nurse goes to look for studies that will answer his/her question.

Nursing Practice Questions:

In nursing, many other questions about practice will also arise, with some of the questions resulting from the nursing principle of working with  rather than  on  the patient. These questions can be quantitative or qualitative in nature. Examples include:

• What other, validated instruments for measuring this condition or phenomenon (e.g. pain) exist and how do they compare to the one we currently use? 
• Should a nurse deliver patient education on the patient's disease/condition near the beginning or the end of an appointment or consultation?
• How do caregivers of patients with [x] cope with the burden of care and how can nurses assess the level of caregiver burden and/or support the caregivers?
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‘Efforts to tackle discrimination are laudable but more is needed’

STEVE FORD, EDITOR

• You are here: Hospital nurses

How research can improve patient care and nurse wellbeing

07 September, 2020

Research evidence can inform the delivery of nursing practice in ways that not only improve patient care but also protect nurses’ wellbeing. This article, the first in a four-part series, discusses four studies evaluating interventions to support the delivery of compassionate care in acute settings recommended by the findings of the Francis Inquiry report

This article, the first in a four-part series about using research evidence to inform the delivery of nursing care, discusses four studies that were funded following the two Francis inquiries into care failings at Mid Staffordshire NHS Foundation Trust. Each study evaluated an intervention method in an acute hospital setting that aimed to improve patient care and protect the wellbeing of nursing staff; these included a team-based practice development programme, a relational care training intervention for healthcare assistants, a regular bedside ward round (intentional rounding), and monthly group meetings during which staff discussed the emotional challenges of care. The remaining articles in this series will explore the results of the studies and how they can be applied to nursing care during, and after, the coronavirus pandemic.

Citation: Bridges J et al (2020) Research that supports nursing teams 1: how research can improve patient care and nurse wellbeing. Nursing Times [online]; 116: 10, 23-25.

Authors: Jackie Bridges is professor of older people’s care, University of Southampton; Ruth Harris is professor of health care for older adults, King’s College London; Jill Maben is professor of health services research and nursing, University of Surrey; Antony Arthur is professor of nursing science, University of East Anglia.

• This article is open access and can be freely distributed
• Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
• Click here to see other articles in this series

Introduction

When asked what would make their working life easier or how they could be better supported to deliver the care to which they aspire, nurses most often say “better staffing”, according to a body of research evidence linking nurse staffing with staff wellbeing, care quality and patient outcomes (Bridges et al, 2019; Aiken et al, 2012). What is not always given much attention by nursing teams and managers is the ‘taken-for-granted’ context in which individual nurses work – the way nursing care is organised, the learning opportunities available to the team and the attention paid to staff wellbeing. It may be possible to change these to support nurses and the care on which they lead and deliver, but opportunities may be missed to think differently about them. The evidence base is growing in this area but does not always reach those nurses who are managing and delivering care.

This is the first in a series of four articles highlighting nursing research findings that can directly inform the management and delivery of nursing care in acute hospital settings. The articles highlight four studies that were funded after publication of Francis’ (2013; 2010) reports on the independent and public inquiries into care failings at Mid Staffordshire NHS Foundation Trust. However, as this series will argue, the inquiries’ findings have relevance for nursing practice during, and beyond, the coronavirus pandemic, as nursing teams regroup and reset what they do in response to a rapidly changing care environment.

Using research evidence to improve patient care

Change in the complex, adaptive system of healthcare is usually incremental, rather than transformative, and it is unusual for events to lead to a ‘phase transition’, in which radical and transformative change occurs (Braithwaite et al, 2017). Arguably the coronavirus pandemic has stimulated a phase transition in healthcare (and in wider society), disrupting certainties about healthcare and how it should, and can, be delivered. As we move through this system shock, there are opportunities to think about new ways of working; however, it is also important to retain the valuable knowledge gained from other events that have affected the healthcare system.

The lessons learned from the care failings at Mid Staffordshire NHS Foundation Trust during the late 2000s and the inquiries that followed had an important impact on hospital nursing and the wider system, stimulating reflection, innovation and research to improve nursing care quality. The evidence generated as a result, some of which is explained below, is a reminder of aspects of care that are at risk of being overlooked during the current pandemic. These include the:

• Complexities of caring for older people;
• Importance of nurses’ relational work;
• Importance of nursing care, especially when there is no surgical/medical ‘cure’.

In the absence of a cure for Covid-19, nursing is at the forefront of the supportive care needed by people with the most severe symptoms. As such, it is important to draw on evidence that supports good nursing care and how best to support nurses’ wellbeing, which can be negatively affected by their caring work.

Research studies investigating intervention

The research world responded to the Francis inquiries: the National Institute for Health Research (NIHR) funded several studies to inform policy and practice improvements in this area. The research delivered through four such studies (Box 1) – each of which was led by an author of this article – is summarised below.

Box 1. The four studies

Creating Learning Environments for Compassionate Care (CLECC)

This study trialled a pilot intervention focusing on team building and understanding patient experiences. Participants felt it improved their capacity to be compassionate.

Chief investigator: Jackie Bridges

Full study report available here

Older People’s Shoes

This study trialled an interactive programme to help healthcare assistants (HCAs) get to know older people and understand the challenges they face. The programme was well received by participants, especially as HCAs’ training needs are often overlooked.

Chief investigator: Antony Arthur

Intentional Rounding

This study aimed to evaluate how intentional rounding works in diverse ward and hospital settings. Participants expressed concern that rounding oversimplifies nursing, and favoured a transactional and prescriptive approach over relational nursing care.

Chief investigator: Ruth Harris Full study report available here

Schwartz Center Rounds

This study aimed to understand the unique features of Schwartz Rounds, comparing them with 11 similar interventions. Attending rounds increased staff members’ empathy and compassion for colleagues and patients, and improved their psychological health.

Chief investigator: Jill Maben

Study 1: Creating Learning Environments for Compassionate Care

Bridges et al (2018) investigated the feasibility of implementing a team-based practice development programme into acute care hospital settings. Under the Creating Learning Environments for Compassionate Care (CLECC) programme, all registered nurses and healthcare assistants (HCAs) from participating teams attended a study day, with a focus on team building and understanding patient experiences. A senior nurse educator supported the teams to try new ways of working on the ward, including holding regular, supportive discussions on improving care. Each ward manager attended learning groups to develop their compassionate care leadership role, and two team members received additional training in carrying out observations of care and feeding back to colleagues.

The programme was piloted on four wards in two English hospitals, with two control wards continuing with business as usual. Researchers interviewed staff and observed activities related to the project to understand whether these could be easily put into practice and whether changes were needed. They also tested evaluation methods, including ways to measure compassion and ensuring enough older patients could be recruited to a future study.

The study found that the CLECC programme can be made to work with nursing teams on NHS hospital wards and that staff felt it improved their capacity to be compassionate. Researchers also learned they could improve the programme to help staff continue using it, for example, by helping senior nurses to understand their role in supporting staff with this.

Study 2: Older People’s Shoes

Arthur et al (2017) studied the feasibility of a relational care training intervention for HCAs to improve the relational care of older people in acute hospitals. They initially conducted a telephone survey of acute NHS hospitals in England to understand what training HCAs received. They undertook group interviews with older people and individual interviews with HCAs and staff working with them to establish what participants thought should be included in HCA training. Training was highly variable and focused on new, not existing, staff; relational care was not a high priority.

In response to their findings, the study team designed and produced an innovative interactive training programme called Older People’s Shoes, which aimed to encourage HCAs to consider how to get to know older people and understand the challenges they face. A train-the-trainer model was used to allow the intervention to be viable beyond the testing sites. To see whether they could formally test this new training, the team conducted a pilot cluster-randomised trial in 12 wards from three acute hospitals; it concluded that a larger study to examine whether changes in patient outcomes could be observed would be challenging, but possible.

Older People’s Shoes was well received by participants. This was particularly so for the HCAs, whose training needs were often overlooked or restricted to mandatory requirements, where the focus is almost exclusively on safety.

Study 3: Intentional Rounding

Originating in the US, intentional rounding is a timed, planned intervention that aims to address fundamental elements of nursing care through a regular bedside ward round. Harris et al’s (2019) study aimed to explain which aspects of intentional rounding work, for whom and under what circumstances. It aimed to do this by exploring how intentional rounding works when used with different types of patient, by different nurses, in diverse ward and hospital settings, and whether and how these differences influence outcomes. The study methods included:

• An evidence review to create a theory of why intentional rounding may work;
• A national survey of how intentional rounding had been implemented;
• A case study evaluation exploring the perspectives of senior managers, health professionals, patients and carers;
• Observations of intentional rounding being undertaken;
• An analysis of costs.

The national survey found that 97% of NHS trusts had implemented intentional rounding, although with considerable variation: fidelity to the intentional rounding protocol was observed to be low. All nursing staff thought intentional rounding should be tailored to individual patient need and not delivered in a standardised way. Few felt intentional rounding improved either the quality or frequency of their interactions with patients; they perceived the main benefit of intentional rounding to be the documented evidence of care delivery, despite concerns that documentation was not always reliable. Patients and carers valued the relational aspects of communication with staff, but this was rarely linked to intentional rounding. It is suggested these results should feed into a wider conversation and review of intentional rounding.

Study 4: Schwartz Center Rounds

These were developed in the US to support healthcare staff to deliver compassionate care by helping them to reflect on their work. Schwartz Rounds are monthly group meetings, in which staff discuss the emotional, social and ethical challenges of care in a safe environment. The number of organisations hosting Schwartz Rounds has increased markedly over recent years.

Maben et al (2018) conducted a study to evaluate Schwartz Rounds and understand how the system works. The study used mixed methods, including:

• An evidence review to understand the unique features of Schwartz Rounds;
• A comparison with 11 other similar interventions, such as action learning sets;
• A national survey of 48 staff running Schwartz Rounds in 46 organisations, using telephone interviews to discuss how these had been implemented;
• A survey of 500 staff in 10 organisations to examine how Schwartz Rounds affect work engagement and wellbeing;
• A case study evaluation investigating the perspectives of people who shared their stories at Schwartz Rounds (panellists), audience members who listened and contributed, facilitators, and people who did not attend.

The researchers also observed preparation meetings, actual Schwartz Rounds and steering group meetings to determine how the rounds worked, and under which circumstances they worked optimally.

Their survey found psychological health improved in those attending Schwartz Rounds but not in those who did not attend. Participants described Schwartz Rounds as interesting, engaging and supportive. How they were run varied, creating different levels of trust and safety, and who attended varied – frontline staff found attendance difficult.

It was concluded that Schwartz Rounds are a ‘slow intervention’ that increases its impact over time and creates a safe, reflective space for staff to talk together confidentially. In the staff observed, attending Schwartz Rounds increased their empathy and compassion for colleagues and patients, supported them in their work and helped them make changes in practice.

Applying research findings

The findings from the above studies not only tell us about the impact of each of these four interventions, but also highlight the changes required to better support nursing teams to deliver high-quality care. Written by nursing professors, who were the chief investigators on each of these studies, this series will bring together the findings from the four studies to:

• Highlight the impact of care organisation and related learning opportunities on nurses and on care delivery, as well as the need for staff wellbeing interventions to support nurses;
• Signpost to practical, evidence-based ways in which individuals and teams can improve support for nurses and nursing care;
• Pose questions that individuals and teams can ask in the context of the coronavirus pandemic to optimise support for nurses and care.

The series is part of a collaboration funded by the NIHR to bring the findings of the individual studies to a wider audience; more details about the collaboration and the individual projects can be found at go.soton.ac.uk/cn4. This work will culminate in an event, due to be held in spring 2021, to engage a range of stakeholders in considering how nursing policy and practice should respond to the findings. Readers interested in finding out more can register their interest at Bit.ly/NursingTeams.

The series aims to provide evidence to support nursing teams as they work to recover from the coronavirus pandemic, review ways of working to retain the better areas of nursing care that existed before it took hold and, also, to embrace any lessons learned through their experiences during the pandemic.

• Care failings at Mid Staffordshire NHS Foundation Trust generated the need for evidence about how to improve patient care
• In response to this, four studies have each investigated a different intervention method in acute hospital settings
• The studies’ findings highlight changes that can help nursing teams to deliver high-quality care and protect nurses’ wellbeing

Also in this series

• Learning opportunities that help staff to deliver better care
• Research that supports nursing teams, part 3 of 4
• Nursing interventions that promote team members’ psychological wellbeing
• The four featured studies were funded by NIHR Health Services and Delivery Research programme. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Health Services and Delivery Research programme, NIHR, NHS or the Department of Health and Social Care.

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Examples of Research Questions

Phd in nursing science program, examples of broad clinical research questions include:.

• Does the administration of pain medication at time of surgical incision reduce the need for pain medication twenty-four hours after surgery?
• What maternal factors are associated with obesity in toddlers?
• What elements of a peer support intervention prevent suicide in high school females?
• What is the most accurate and comprehensive way to determine men’s experience of physical assault?
• Is yoga as effective as traditional physical therapy in reducing lymphedema in patients who have had head and neck cancer treatment?
• In the third stage of labor, what is the effect of cord cutting within the first three minutes on placenta separation?
• Do teenagers with Type 1 diabetes who receive phone tweet reminders maintain lower blood sugars than those who do not?
• Do the elderly diagnosed with dementia experience pain?
•  How can siblings’ risk of depression be predicted after the death of a child?
•  How can cachexia be prevented in cancer patients receiving aggressive protocols involving radiation and chemotherapy?

Examples of some general health services research questions are:

• Does the organization of renal transplant nurse coordinators’ responsibilities influence live donor rates?
• What activities of nurse managers are associated with nurse turnover?  30 day readmission rates?
• What effect does the Nurse Faculty Loan program have on the nurse researcher workforce?  What effect would a 20% decrease in funds have?
• How do psychiatric hospital unit designs influence the incidence of patients’ aggression?
• What are Native American patient preferences regarding the timing, location and costs for weight management counseling and how will meeting these preferences influence participation?
•  What predicts registered nurse retention in the US Army?
• How, if at all, are the timing and location of suicide prevention appointments linked to veterans‘ suicide rates?
• What predicts the sustainability of quality improvement programs in operating rooms?
• Do integrated computerized nursing records across points of care improve patient outcomes?
• How many nurse practitioners will the US need in 2020?

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• How to Write a Problem Statement | Guide & Examples

How to Write a Problem Statement | Guide & Examples

Published on November 6, 2022 by Shona McCombes and Tegan George. Revised on November 20, 2023.

A problem statement is a concise and concrete summary of the research problem you seek to address. It should:

• Contextualize the problem. What do we already know?
• Describe the exact issue your research will address. What do we still need to know?
• Show the relevance of the problem. Why do we need to know more about this?
• Set the objectives of the research. What will you do to find out more?

Table of contents

When should you write a problem statement, step 1: contextualize the problem, step 2: show why it matters, step 3: set your aims and objectives.

Problem statement example

Other interesting articles

Frequently asked questions about problem statements.

There are various situations in which you might have to write a problem statement.

In the business world, writing a problem statement is often the first step in kicking off an improvement project. In this case, the problem statement is usually a stand-alone document.

In academic research, writing a problem statement can help you contextualize and understand the significance of your research problem. It is often several paragraphs long, and serves as the basis for your research proposal . Alternatively, it can be condensed into just a few sentences in your introduction .

A problem statement looks different depending on whether you’re dealing with a practical, real-world problem or a theoretical issue. Regardless, all problem statements follow a similar process.

Prevent plagiarism. Run a free check.

The problem statement should frame your research problem, giving some background on what is already known.

Practical research problems

For practical research, focus on the concrete details of the situation:

• Where and when does the problem arise?
• Who does the problem affect?
• What attempts have been made to solve the problem?

Theoretical research problems

For theoretical research, think about the scientific, social, geographical and/or historical background:

• What is already known about the problem?
• Is the problem limited to a certain time period or geographical area?
• How has the problem been defined and debated in the scholarly literature?

The problem statement should also address the relevance of the research. Why is it important that the problem is addressed?

Don’t worry, this doesn’t mean you have to do something groundbreaking or world-changing. It’s more important that the problem is researchable, feasible, and clearly addresses a relevant issue in your field.

Practical research is directly relevant to a specific problem that affects an organization, institution, social group, or society more broadly. To make it clear why your research problem matters, you can ask yourself:

• What will happen if the problem is not solved?
• Who will feel the consequences?
• Does the problem have wider relevance? Are similar issues found in other contexts?

Sometimes theoretical issues have clear practical consequences, but sometimes their relevance is less immediately obvious. To identify why the problem matters, ask:

• How will resolving the problem advance understanding of the topic?
• What benefits will it have for future research?
• Does the problem have direct or indirect consequences for society?

Finally, the problem statement should frame how you intend to address the problem. Your goal here should not be to find a conclusive solution, but rather to propose more effective approaches to tackling or understanding it.

The research aim is the overall purpose of your research. It is generally written in the infinitive form:

• The aim of this study is to determine …
• This project aims to explore …
• This research aims to investigate …

The research objectives are the concrete steps you will take to achieve the aim:

• Qualitative methods will be used to identify …
• This work will use surveys to collect …
• Using statistical analysis, the research will measure …

The aims and objectives should lead directly to your research questions.

Learn how to formulate research questions

You can use these steps to write your own problem statement, like the example below.

Step 1: Contextualize the problem A family-owned shoe manufacturer has been in business in New England for several generations, employing thousands of local workers in a variety of roles, from assembly to supply-chain to customer service and retail. Employee tenure in the past always had an upward trend, with the average employee staying at the company for 10+ years. However, in the past decade, the trend has reversed, with some employees lasting only a few months, and others leaving abruptly after many years.

Step 2: Show why it matters As the perceived loyalty of their employees has long been a source of pride for the company, they employed an outside consultant firm to see why there was so much turnover. The firm focused on the new hires, concluding that a rival shoe company located in the next town offered higher hourly wages and better “perks”, such as pizza parties. They claimed this was what was leading employees to switch. However, to gain a fuller understanding of why the turnover persists even after the consultant study, in-depth qualitative research focused on long-term employees is also needed. Focusing on why established workers leave can help develop a more telling reason why turnover is so high, rather than just due to salaries. It can also potentially identify points of change or conflict in the company’s culture that may cause workers to leave.

Step 3: Set your aims and objectives This project aims to better understand why established workers choose to leave the company. Qualitative methods such as surveys and interviews will be conducted comparing the views of those who have worked 10+ years at the company and chose to stay, compared with those who chose to leave.

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

Methodology

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

Once you’ve decided on your research objectives , you need to explain them in your paper, at the end of your problem statement .

Keep your research objectives clear and concise, and use appropriate verbs to accurately convey the work that you will carry out for each one.

I will compare …

All research questions should be:

• Focused on a single problem or issue
• Researchable using primary and/or secondary sources
• Feasible to answer within the timeframe and practical constraints
• Specific enough to answer thoroughly
• Complex enough to develop the answer over the space of a paper or thesis
• Relevant to your field of study and/or society more broadly

Research objectives describe what you intend your research project to accomplish.

They summarize the approach and purpose of the project and help to focus your research.

Your objectives should appear in the introduction of your research paper , at the end of your problem statement .

Your research objectives indicate how you’ll try to address your research problem and should be specific:

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Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Institute of Medicine (US) Committee on a Study of National Needs for Biomedical and Behavioral Research Personnel. Personnel Needs and Training for Biomedical and Behavioral Research: The 1983 Report. Washington (DC): National Academies Press (US); 1983.

Personnel Needs and Training for Biomedical and Behavioral Research: The 1983 Report.

• Hardcopy Version at National Academies Press

6. Nursing Research

Problems encountered in the practice of nursing are widely varied, important to the health care system, and deserving of a national research effort. Research on these problems, which cover issues ranging from methods to alleviate anxiety and pain to improving the prospects for high-risk infants, is conducted mainly by nurses with doctoral degrees in biomedical and behavioral fields. There were about 2,500 such individuals in 1980 but only 7 percent reported research as a major activity. The numbers are increasing, but a solid core of well-trained investigators has not yet been developed to address all nursing research issues.

• INTRODUCTION

The goal of nursing research is to facilitate the development of clinical nursing interventions which will improve health outcomes and contribute to the optimal delivery of care. To this end, according to the American Nurses' Association, nursing research “develops knowledge about health and the promotion of health over the full life span, care of persons with health problems and disabilities, and nursing actions to enhance the ability of individuals to respond effectively to actual or potential health problems. So defined, nursing research “complement[s] biomedical research, which is primarily concerned with causes and treatments of disease.” 1

• EXAMPLES OF NURSING RESEARCH

The scope of nursing research is very broad, including, for example:

• studies to reduce the complications of hospitalization and surgery (such as respiratory or circulatory problems) and factors that negatively influence recovery
• studies to improve the prospects for high risk infants and their parents (on prematurity, stress-induced complications in childbirth, child abuse, and developmental disabilities, for instance)
• studies of methods to alleviate anxiety, stress, and pain associated with illness or disability
• studies to facilitate the utilization of new technological developments in patient care (such as those concerned with nasogastric tube feeding of hospital patients and techniques for recovery and maintenance of eating and grasping abilities following stroke), (Jacox and Walike, 1975, pp. 2–5).

The Division of Nursing of the Bureau of Health Professions, Health Resources and Services Administration (DHHS) classifies nursing research into six categories: “fundamental,” nursing practice, nursing profession, delivery of nursing services, nursing education, and utilization. Although research in all these categories is likely to have an impact on health outcomes or improved patient care, those with the most direct impact are fundamental and nursing practice research, which jointly accounted for the bulk of all funded studies as of the end of FY 1981 (HRSA, 1983).

The distinction between fundamental and nursing practice research is important and is regarded both by the Division of Nursing and by the nursing profession generally as central to an understanding of the nature and scope of nursing research. Fundamental research is research which addresses or focuses on the biological and/or behavioral functioning of human beings, their environments, and their social systems. It constitutes the science base from which nursing or other clinical practice theories can be developed and tested. The findings and theories developed through fundamental research constitute the pool of knowledge and theories which health practitioners and researchers of various types, including nurses, can draw upon to develop clinical intervention strategies and/or to test the effectiveness and efficiency of different practice methods (Bloch, 1981, p. 87). Examples of fundamental biological and/or behavioral research deemed relevant to the field of nursing and funded by the Division of Nursing include studies on the responses of children to pain, the perceptions of the elderly as concerns their physical functioning and health care needs, the effects of radiotherapy on cancer patients, and the effects of caffeine on pregnancy outcomes.

Nursing practice research, on the other hand, specifically addresses issues related to the practice of nursing as a profession— with nursing interventions, procedures, techniques, and/or methods of patient care being the focus of inquiry. Research designs used in practice research are typically experimental, explicitly postulating and testing the linkages between one or more nursing interventions, procedures, or processes and patient outcomes in controlled experiments. The processes, procedures, techniques, or interventions which are “tested” may be technical, physical, verbal, cognitive, psychosocial, and/or interpersonal. Practice research funded by the Division of Nursing has included studies on endotracheal aspiration of critically ill patients, nurse attention to psychological distress among medical-surgical patients, the effect of nurse empathy on patients, the stress of radiation treatment for cancer patients, and the effectiveness of prenatal care provided to Navajo women, among many others.

While nursing research ultimately aims at improving patient care for persons with existing health impairments and reducing or preventing health-related problems for others, some nursing research explicitly addresses, or has implications for, the relative costs of different types of interventions, procedures, settings, and providers of care—that is, for cost-effective patient care. Fagin ( Am. J. Nursing , Dec. 1982), for example, reviews a number of studies conducted over the past 10 years which demonstrate that innovations in nursing practice and alternative methods of service delivery, treatment, and care can provide equivalent or superior patient outcomes at cost savings over more traditional or usual methods. Reducing hospital length of stay, preventing rehospitalization, reducing the number of outpatient visits, and reducing absenteeism have been among the cost savings demonstrated by some of these studies. Long- or short-term nursing intervention with mothers having a history of child abuse, for example, was found to result in a lower rate of child rehospitalization due to parental abuse or neglect; the addition of a nurse practitioner to a small industrial company's health service was found to reduce employee time lost from work; and patient education programs and educational counseling of patients with a variety of surgical or medical problems have been found to reduce hospital length of stay, hospital readmission rates, the number of outpatient visits, and so forth, compared to control groups not receiving such nursing interventions.

Home care as an alternative to hospitalization was the focus of a number of the studies Fagin reviewed, and all indicated potential or actual savings of home care over hospitalization. For example, training patients to administer intravenous antibiotics at home reduced hospitalization time and treatment expense. Likewise, the mean cost of home care for children dying of cancer with care coordinated by nurses and provided by parents (and physicians serving as consultants) was 18 times less expensive than that provided in a hospital setting for similar children.

• FUTURE NURSING RESEARCH AGENDA

The Commission on Nursing Research of the American Nurses' Association suggests an agenda for the 1980s that would give priority to research that will generate knowledge “to guide practice” in the following broad areas:

• promoting health and well-being, as well as competency for personal care and personal health, among all age groups (including identification of the determinants of wellness and health functioning in individuals and families)
• decreasing the negative impact of health problems on coping abilities, productivity, and life satisfaction of individuals and families
• designing and developing cost-effective health care systems in meeting the nursing needs of the population
• ensuring that the nursing care needs of “vulnerable groups” (including but not limited to racial and ethnic minorities and underserved populations, such as the elderly, the mentally ill, and the poor) are met ( Nursing Research , 1980).
• THE SUPPLY OF RESEARCH PERSONNEL AND DEMAND FOR NURSES WITH DOCTORATES

Nursing research is conducted by investigators trained in numerous disciplines, including general medicine, various medical specialties, various branches of biomedical research, and the behavioral sciences. This diffusion of investigators makes it hard to accurately estimate the number of investigators performing nursing research. However, most nursing research funded by the Division of Nursing, HRSA, is being conducted by nurses, of whom the vast majority have doctorates in nursing or other disciplines. 2 This report therefore focuses on the supply of nurses with doctorates.

The evolution of nursing from a nonacademic discipline relying on apprentice-type training to a recognized profession with its own academic credentials and body of research has been slow, and is still progressing. Until the early 1970s the majority of new Registered Nurses (RNs) were trained in hospital-based nursing schools that conferred diplomas and prepared students for Registered Nurse licensure. By 1981 that mode of preparation had fallen to less than 20 percent. Almost half of newly licensed RNs in 1981 were prepared in associate degree programs (usually in community colleges) and one-third were prepared in baccalaureate programs in 4-year colleges and universities (IOM, 1983, p. 55). Although diploma prepared RNs are declining both as a proportion of new RNs and in absolute numbers, in 1980 they still represented half the supply of employed RNs. Nurses trained in associate degree programs represented 20 percent and RNs with baccalaureate or higher degrees represented 29 percent (IOM, 1983, p. 77). This last group, numbering 364,400 nurses, is the actual and potential pool of nurse researchers since graduates of diploma and associate degree programs are not eligible for advanced degrees unless they upgrade their educational level 3 .

Number of Nurses with Doctorate Degrees

The most comprehensive and most recent study of nurses with doctoral degrees was conducted by the American Nurses' Association (1981). The study estimated that approximately 2,500 (0.15 percent of 1.66 million licensed RNs) held doctoral degrees in 1980. 4 However, although the number is still relatively small, it is increasing rapidly. Between 1963 and 1969 only about 30 nurses earned doctorates each year (ANA, 1981, p. 14). Today that figure is closer to 150 (NLN, 1981, Tables 72 and 73).

There has also been a radical change in the education of nurses with doctorates. The ANA study identified 17 different doctoral degrees obtained by nurses. Up to 1965 the most frequently earned degree was the Ed.D., which was succeeded by the Ph.D. in the 1970s. The professional nursing degree (DNS) was first awarded in the 1960s and has become increasingly represented in new doctoral degrees (ANA, 1981, p. 30). The increase in nursing doctoral degrees has been paralleled by an increase in the number of doctoral programs in nursing education departments—22 in 1981–82 compared to 2 in 1959–60 (NLN, 1983).

Time Spent in Research

However, not all nurses with doctorates are engaged in research activities. Table 6.1 shows that 75 percent of nurses with doctorates are employed in schools of nursing (largely those that offer baccalaureate and higher degrees). Not surprisingly, the amount of time spent in research varies according to the type and place of employment, but overall fewer than 7 percent of the nurses surveyed reported research as a major function (ANA, 1981, p. 44). Table 6.1 also shows that the nurses employed in nursing schools spend, on average, less time on research than nurses in some other settings—for example, other health professional schools. Since most nurses with doctorates work in schools of nursing, this is of concern to those attempting to generate increased nursing research.

Average Percent of Time Spent in Research by Work Setting and Percent of Nurses with Doctorates, 1980.

In 1970, an evaluation of a program designed to encourage faculty research noted that deans and directors of programs found it difficult to free faculty for research, and questioned how much could be expected from faculty in terms of a combined teaching and research load (Abdellah, 1970).

A comment of this sort indicates that research activity may have been regarded as a secondary activity for faculty in nursing schools. In the intervening decade, however, there has been a radical change. More recent data suggest that the expansion of nursing education has increased the demand for doctorally prepared faculty. A survey of 58 graduate nursing programs in 40 states found a need for 1,080 faculty with doctorates in the next 5 years. The survey found that the greatest need was for faculty with preparation that emphasized research and nursing theory development (McElmurry, et al. , 1982, pp. 5–10).

The Institute of Medicine in 1983 estimated that 5,800 nurses with doctorates would be working by the end of 1990–3,000 with doctorates from nursing programs and 2,800 with doctorates in other fields (IOM, 1983, p. 144). This represents an increase of 2,800 nurses with doctorates from the 1980 estimate of 3,000—probably just enough to fill the demand in the 40 states mentioned earlier, but far less than the 1990 projection of need for 14,000 doctorally prepared nurses made by the Health Resources and Services Administration, Division of Nursing (IOM, 1983, p. 145). The U.S. Department of Health and Human Services based its projections of the need for doctorally prepared nurses on the judgment-of-need criteria developed by the Western Interstate Commission on Higher Education. A national panel of expert consultants was convened to establish criteria for staffing patterns and the educational preparation of RNs to meet service needs in different health care settings (hospitals, nursing homes, home care, etc.) and in units within those settings (E.R., newborn units, etc.). If this estimate of demand is even approximately accurate, nurses with doctorates should have no problem finding employment for the next decade at least.

The Infrastructure for Research

A simple enumeration of the number of people qualified to conduct research and the amount of time spent in that activity does not encompass all the important variables that affect the amount of research being conducted. One of these is research funding, which will be discussed later. Another, which is a prerequisite for research, can be described as the infrastructure—the elements that need to be in place before a research area can become established and grow. For nursing research some of the infrastructure is still in the process of development. In 1977 this Committee noted that “even today there are less than 2,000 registered nurses who have completed doctoral education, scarely more than an average of one doctorally trained nurse for each school of nursing in the United States” (NRC, 1975–81, 1977 Report, p. 156). By 1980 only 7 percent of full-time nurse-faculty held doctoral degrees (NLN, 1982, p. 94). This compares unfavorably with other disciplines. Well over 50 percent of the faculty of 20 schools of public health held doctorates and more than 90 percent of faculty held doctorates in schools offering doctoral and other degrees in departments of psychology, physical sciences, biological sciences, mathematical and social sciences, and engineering (IOM, 1983, p. 136).

The relative scarcity of doctorally prepared faculty in nursing schools is likely to have several effects. First, nurses with new doctorates can find ready employment in schools of nursing and are less likely to pursue pure research careers where funding is hard to obtain. Second, as mentioned earlier, nursing school faculty with doctorates are likely to be heavily engaged in teaching and administration at the expense of research, and third, nurses being educated by faculty who do not have the research degree and are not primarily engaged in research do not have role models who might lead them to research careers. Finally, as this Committee noted in 1981, the rapid growth of doctoral training programs (which the data suggest has outstripped the growth in supply of doctorally prepared faculty) has resulted in programs of less than optimal quality (NRC, 1981). 5 In short, nursing research still lacks the solid core of research trained and oriented teachers that are vital to any area of research .

Funds for Nursing Research

The Division of Nursing, HRSA, provided about $5 million annually in funds targeted to nursing research. In 1982 this dropped to close to $3.5 million. The Institute of Medicine in its 1983 study said that this “is not a level of visibility and scientific prestige to encourage scientifically oriented RNs to pursue careers devoted to research…(IOM, 1983, p. 19).” The same report notes that “A substantial share of the health care dollar is expended on direct nursing care…” and that “Despite the fact that nurses represent the largest single group of professionals in the providing of health services to the people of this country, there is a remarkable dearth of research in nursing practice” (IOM, 1983, pp. 216–217). In a stronger statement the study says that “Research in nursing has been handicapped by inadequate levels of support” and contrasts the $5 million annually for nursing research with $1.7 billion for biomedical research between 1976 and 1981, and with dental research which receives five times as much as nursing research (IOM, 1983, p. 137). The study committee suggests that “an increase on the order of $5 million per year for research could have a substantial impact in stimulating growth of capacity for research on nursing-related matters” (IOM, 1983, p. 22).

Other federal money is available for nursing research through the National Institutes of Health, the National Institute of Mental Health, the National Center for Health Services Research, the National Science Foundation, and other agencies. How much these agencies spend for nursing research is not clear. The National Institutes of Health in 1982 made awards worth roughly $2.8 million for projects that were defined as having nursing as a primary component. However, many of these were for training or curriculum development rather than research into nursing practice, and in many cases the abstracts of projects indicated only tangential nursing interest (National Institutes of Health, 1983).

Other sources of funds include the American Nurses' Foundation, which makes small (up to $2,100) awards. The number depends on available funds—23 in 1983, 12 in 1982.

Training Grants and Fellowships

If an adequate supply of qualified individuals to educate researchers and conduct research is an essential component of the infrastructure for research, training grants are a mechanism that can help the development of that infrastructure.

The Division of Nursing, HRSA, currently administers two programs that support graduate nurse training. The largest is for Advanced Training of Professional Nurses. This program awards grants to graduate schools of nursing and schools of public health which allocate the funds to full-time graduate students. Funding for this program totaled $7 million in 1965, and increased to $13 million in 1974. Until 1977 awards were made to undergraduate as well as graduate students. Since 1977 eligibility has been confined to graduate students. In 1983 funding dropped to $9.5 million. Those funds supported approximately 3,500 students in 137 schools, with each student receiving an average of $2,715 (Buchanan, 1983).

The second program—the National Research Service Awards (NRSA)— offers pre- and postdoctoral fellowships to students in nursing and relevant disciplines and institutional grants to schools to support full-time training in research. This program has been funded at about $1 million annually for the past 5 years (see Appendix Table D2 ). A few additional training awards in nursing research are made by the NIH. The Division of Nursing expects to make 38–45 new awards in FY 1983 (Wood, 1983). Only three institutional awards have been made since 1977 and all were phased out in 1981.

Since 1977 this Committee has developed recommendations concerning the number of students to be supported under the NRSA authority in the area of nursing research, the distribution between pre- and postdoctoral students, and the distribution between schools of nursing and other schools and basic science and non-science departments. The general view has been that federal support for nursing research training should emphasize the improvement of programs of demonstrated capability rather than the further proliferation of nursing doctoral programs. The Committee has also recommended that the emphasis of the fellowship programs should be on predoctoral support to increase the pool of research personnel, and provide research faculty to staff the proliferating doctoral nursing programs. In 1977 the Committee recommended that 29 percent of fellowships be awarded to students in graduate schools of nursing in 1979 and should rise to 57 percent by 1981. It was anticipated that schools of nursing would substantially increase their ability to provide research training. In the same report the Committee recommended that the proportion of fellowships in non-science departments fall from 29 percent to zero between 1979 and 1981.

Although the data are not available to show whether the recommendations concerning the training sites of students have been implemented, Table 6.2 shows the Committee's recommendations compared to actual awards where the data are available. Two points are clear from the table. First, funding has not allowed the NRSA fellowship program to reach the recommended levels of support. Second, the proportion of postdoctoral awards has remained well within the limits recommended by the Committee.

Actual and Recommended NRSA Training Awards in Nursing Research, FY 1979–81.

Table 6.2 shows the Committee's recommendations compared to actual awards and demonstrates that for each year funding has failed to allow the programs to reach the recommended levels of support—by substantial shortfalls. For example, in 1979 total awards were only 56 percent of the recommendations. In the following two years that proportion fell to 49 percent. In each year the shortfall in traineeships was greater than in fellowships, with traineeships reaching only 26 percent of the recommended number in 1979, compared to 65 percent for fellowships. In 1981 the gap was even wider with trainees attaining only 17 percent of the recommended level and fellowships achieving 66 percent.

The Institute of Medicine in its study of nursing education reviewed the programs of federal support and recommended an expansion of support of fellowships, loans, and programs at the graduate level “to assist in increasing the rate of growth in the numbers of nurses with masters and doctoral degrees in nursing and relevant disciplines” (IOM, 1983, p. 9). (It should be noted that two members of the committee made a statement of exception to the words “and relevant disciplines.” They argued that nurses should have advanced education in their own discipline—nursing—for a number of reasons including preparation for leadership in nursing and to develop competencies unique to nursing.)

In view of the continued high demand for doctorally prepared nurses and the relative immaturity of the emerging field of nursing research, we agree with the general conclusions of the IOM study. There is a need to continue to promote expertise in nursing research, and financial support for graduate students is a proven mechanism for doing so. As stated in Chapter 1 , the Committee reiterates its past recommendations for research training programs in nursing research under the NRSA Act and extends them through 1987.

Statements of the American Nurses' Association, 1981, as quoted in IOM, 1983.

An informal review of principal investigators awarded research grants by the Division of Nursing in HRSA revealed that through the 1960s nurses with masters degrees were awarded grants. Since the early 1970s most principal investigators of funded projects have doctorates.

It should be noted that a significant number of nurses advance through the educational system. Thirty-five percent of nurses with baccalaureates and half of the nurses with graduate degrees initially prepared for RN licensure in associate degree or diploma programs.

Health Resources and Services Administration estimated the number of nurses with doctorates to be 4,100 in 1980 (U.S. Department of Health and Human Services, 1982, Table 3). Although this is substantially higher than the ANA estimates it still represents only 0.25 percent of licensed RNs.

Under the Nurse Training Act (P.L. 94–63) some special funding is available to institutions with graduate nursing programs. About 90 programs receive support each year, 10 percent of them being doctoral programs. Appropriations for this Advanced Nursing Training program were at the $12 million level for 3 years, falling to $9.6 million in FY 1982.

• Cite this Page Institute of Medicine (US) Committee on a Study of National Needs for Biomedical and Behavioral Research Personnel. Personnel Needs and Training for Biomedical and Behavioral Research: The 1983 Report. Washington (DC): National Academies Press (US); 1983. 6., Nursing Research.

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• Research article
• Open access
• Published: 09 November 2005

A qualitative study of nursing student experiences of clinical practice

• Farkhondeh Sharif 1 &
• Sara Masoumi 2  

BMC Nursing volume  4 , Article number:  6 ( 2005 ) Cite this article

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Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice.

Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly from two hundred students and were arranged in 9 groups of ten students. To analyze the data the method used to code and categories focus group data were adapted from approaches to qualitative data analysis.

Four themes emerged from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap"," clinical supervision", professional role", were considered as important factors in clinical experience.

The result of this study showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting.

Peer Review reports

Clinical experience has been always an integral part of nursing education. It prepares student nurses to be able of "doing" as well as "knowing" the clinical principles in practice. The clinical practice stimulates students to use their critical thinking skills for problem solving [ 1 ]

Awareness of the existence of stress in nursing students by nurse educators and responding to it will help to diminish student nurses experience of stress. [ 2 ]

Clinical experience is one of the most anxiety producing components of the nursing program which has been identified by nursing students. In a descriptive correlational study by Beck and Srivastava 94 second, third and fourth year nursing students reported that clinical experience was the most stressful part of the nursing program[ 3 ]. Lack of clinical experience, unfamiliar areas, difficult patients, fear of making mistakes and being evaluated by faculty members were expressed by the students as anxiety-producing situations in their initial clinical experience. In study done by Hart and Rotem stressful events for nursing students during clinical practice have been studied. They found that the initial clinical experience was the most anxiety producing part of their clinical experience [ 4 ]. The sources of stress during clinical practice have been studied by many researchers [ 5 – 10 ] and [ 11 ].

The researcher came to realize that nursing students have a great deal of anxiety when they begin their clinical practice in the second year. It is hoped that an investigation of the student's view on their clinical experience can help to develop an effective clinical teaching strategy in nursing education.

A focus group design was used to investigate the nursing student's view about the clinical practice. Focus group involves organized discussion with a selected group of individuals to gain information about their views and experiences of a topic and is particularly suited for obtaining several perspectives about the same topic. Focus groups are widely used as a data collection technique. The purpose of using focus group is to obtain information of a qualitative nature from a predetermined and limited number of people [ 12 , 13 ].

Using focus group in qualitative research concentrates on words and observations to express reality and attempts to describe people in natural situations [ 14 ].

The group interview is essentially a qualitative data gathering technique [ 13 ]. It can be used at any point in a research program and one of the common uses of it is to obtain general background information about a topic of interest [ 14 ].

Focus groups interviews are essential in the evaluation process as part of a need assessment, during a program, at the end of the program or months after the completion of a program to gather perceptions on the outcome of that program [ 15 , 16 ]. Kruegger (1988) stated focus group data can be used before, during and after programs in order to provide valuable data for decision making [ 12 ].

The participants from which the sample was drawn consisted of 90 baccalaureate nursing students from two hundred nursing students (30 students from the second year and 30 from the third and 30 from the fourth year) at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery). The second year nursing students already started their clinical experience. They were arranged in nine groups of ten students. Initially, the topics developed included 9 open-ended questions that were related to their nursing clinical experience. The topics were used to stimulate discussion.

The following topics were used to stimulate discussion regarding clinical experience in the focus groups.

How do you feel about being a student in nursing education?

How do you feel about nursing in general?

Is there any thing about the clinical field that might cause you to feel anxious about it?

Would you like to talk about those clinical experiences which you found most anxiety producing?

Which clinical experiences did you find enjoyable?

What are the best and worst things do you think can happen during the clinical experience?

What do nursing students worry about regarding clinical experiences?

How do you think clinical experiences can be improved?

What is your expectation of clinical experiences?

The first two questions were general questions which were used as ice breakers to stimulate discussion and put participants at ease encouraging them to interact in a normal manner with the facilitator.

Data analysis

The following steps were undertaken in the focus group data analysis.

Immediate debriefing after each focus group with the observer and debriefing notes were made. Debriefing notes included comments about the focus group process and the significance of data

Listening to the tape and transcribing the content of the tape

Checking the content of the tape with the observer noting and considering any non-verbal behavior. The benefit of transcription and checking the contents with the observer was in picking up the following:

Parts of words

Non-verbal communication, gestures and behavior...

The researcher facilitated the groups. The observer was a public health graduate who attended all focus groups and helped the researcher by taking notes and observing students' on non-verbal behavior during the focus group sessions. Observer was not known to students and researcher

The methods used to code and categorise focus group data were adapted from approaches to qualitative content analysis discussed by Graneheim and Lundman [ 17 ] and focus group data analysis by Stewart and Shamdasani [ 14 ] For coding the transcript it was necessary to go through the transcripts line by line and paragraph by paragraph, looking for significant statements and codes according to the topics addressed. The researcher compared the various codes based on differences and similarities and sorted into categories and finally the categories was formulated into a 4 themes.

The researcher was guided to use and three levels of coding [ 17 , 18 ]. Three levels of coding selected as appropriate for coding the data.

Level 1 coding examined the data line by line and making codes which were taken from the language of the subjects who attended the focus groups.

Level 2 coding which is a comparing of coded data with other data and the creation of categories. Categories are simply coded data that seem to cluster together and may result from condensing of level 1 code [ 17 , 19 ].

Level 3 coding which describes the Basic Social Psychological Process which is the title given to the central themes that emerge from the categories.

Table 1 shows the three level codes for one of the theme

The documents were submitted to two assessors for validation. This action provides an opportunity to determine the reliability of the coding [ 14 , 15 ]. Following a review of the codes and categories there was agreement on the classification.

Ethical considerations

The study was conducted after approval has been obtained from Shiraz university vice-chancellor for research and in addition permission to conduct the study was obtained from Dean of the Faculty of Nursing and Midwifery. All participants were informed of the objective and design of the study and a written consent received from the participants for interviews and they were free to leave focus group if they wish.

Most of the students were females (%94) and single (% 86) with age between 18–25.

The qualitative analysis led to the emergence of the four themes from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap", clinical supervision"," professional role", was considered as important factors in clinical experience.

Initial clinical anxiety

This theme emerged from all focus group discussion where students described the difficulties experienced at the beginning of placement. Almost all of the students had identified feeling anxious in their initial clinical placement. Worrying about giving the wrong information to the patient was one of the issues brought up by students.

One of the students said:

On the first day I was so anxious about giving the wrong information to the patient. I remember one of the patients asked me what my diagnosis is. ' I said 'I do not know', she said 'you do not know? How can you look after me if you do not know what my diagnosis is?'

From all the focus group sessions, the students stated that the first month of their training in clinical placement was anxiety producing for them.

One of the students expressed:

The most stressful situation is when we make the next step. I mean ... clinical placement and we don't have enough clinical experience to accomplish the task, and do our nursing duties .

Almost all of the fourth year students in the focus group sessions felt that their stress reduced as their training and experience progressed.

Another cause of student's anxiety in initial clinical experience was the students' concern about the possibility of harming a patient through their lack of knowledge in the second year.

One of the students reported:

In the first day of clinical placement two patients were assigned to me. One of them had IV fluid. When I introduced myself to her, I noticed her IV was running out. I was really scared and I did not know what to do and I called my instructor .

Fear of failure and making mistakes concerning nursing procedures was expressed by another student. She said:

I was so anxious when I had to change the colostomy dressing of my 24 years old patient. It took me 45 minutes to change the dressing. I went ten times to the clinic to bring the stuff. My heart rate was increasing and my hand was shaking. I was very embarrassed in front of my patient and instructor. I will never forget that day .

Sellek researched anxiety-creating incidents for nursing students. He suggested that the ward is the best place to learn but very few of the learner's needs are met in this setting. Incidents such as evaluation by others on initial clinical experience and total patient care, as well as interpersonal relations with staff, quality of care and procedures are anxiety producing [ 11 ].

Theory-practice gap

The category theory-practice gap emerged from all focus discussion where almost every student in the focus group sessions described in some way the lack of integration of theory into clinical practice.

I have learnt so many things in the class, but there is not much more chance to do them in actual settings .

Another student mentioned:

When I just learned theory for example about a disease such as diabetic mellitus and then I go on the ward and see the real patient with diabetic mellitus, I relate it back to what I learned in class and that way it will remain in my mind. It is not happen sometimes .

The literature suggests that there is a gap between theory and practice. It has been identified by Allmark and Tolly [ 20 , 21 ]. The development of practice theory, theory which is developed from practice, for practice, is one way of reducing the theory-practice gap [ 21 ]. Rolfe suggests that by reconsidering the relationship between theory and practise the gap can be closed. He suggests facilitating reflection on the realities of clinical life by nursing theorists will reduce the theory-practice gap. The theory- practice gap is felt most acutely by student nurses. They find themselves torn between the demands of their tutor and practising nurses in real clinical situations. They were faced with different real clinical situations and are unable to generalise from what they learnt in theory [ 22 ].

Clinical supervision

Clinical supervision is recognised as a developmental opportunity to develop clinical leadership. Working with the practitioners through the milieu of clinical supervision is a powerful way of enabling them to realize desirable practice [ 23 ]. Clinical nursing supervision is an ongoing systematic process that encourages and supports improved professional practice. According to Berggren and Severinsson the clinical nurse supervisors' ethical value system is involved in her/his process of decision making. [ 24 , 25 ]

Clinical Supervision by Head Nurse (Nursing Unit Manager) and Staff Nurses was another issue discussed by the students in the focus group sessions. One of the students said:

Sometimes we are taught mostly by the Head Nurse or other Nursing staff. The ward staff are not concerned about what students learn, they are busy with their duties and they are unable to have both an educational and a service role

Another student added:

Some of the nursing staff have good interaction with nursing students and they are interested in helping students in the clinical placement but they are not aware of the skills and strategies which are necessary in clinical education and are not prepared for their role to act as an instructor in the clinical placement

The students mostly mentioned their instructor's role as an evaluative person. The majority of students had the perception that their instructors have a more evaluative role than a teaching role.

The literature suggests that the clinical nurse supervisors should expressed their existence as a role model for the supervisees [ 24 ]

Professional role

One view that was frequently expressed by student nurses in the focus group sessions was that students often thought that their work was 'not really professional nursing' they were confused by what they had learned in the faculty and what in reality was expected of them in practice.

We just do basic nursing care, very basic . ... You know ... giving bed baths, keeping patients clean and making their beds. Anyone can do it. We spend four years studying nursing but we do not feel we are doing a professional job .

The role of the professional nurse and nursing auxiliaries was another issue discussed by one of the students:

The role of auxiliaries such as registered practical nurse and Nurses Aids are the same as the role of the professional nurse. We spend four years and we have learned that nursing is a professional job and it requires training and skills and knowledge, but when we see that Nurses Aids are doing the same things, it can not be considered a professional job .

The result of student's views toward clinical experience showed that they were not satisfied with the clinical component of their education. Four themes of concern for students were 'initial clinical anxiety', 'theory-practice gap', 'clinical supervision', and 'professional role'.

The nursing students clearly identified that the initial clinical experience is very stressful for them. Students in the second year experienced more anxiety compared with third and fourth year students. This was similar to the finding of Bell and Ruth who found that nursing students have a higher level of anxiety in second year [ 26 , 27 ]. Neary identified three main categories of concern for students which are the fear of doing harm to patients, the sense of not belonging to the nursing team and of not being fully competent on registration [ 28 ] which are similar to what our students mentioned in the focus group discussions. Jinks and Patmon also found that students felt they had an insufficiency in clinical skills upon completion of pre-registration program [ 29 ].

Initial clinical experience was the most anxiety producing part of student clinical experience. In this study fear of making mistake (fear of failure) and being evaluated by faculty members were expressed by the students as anxiety-producing situations in their initial clinical experience. This finding is supported by Hart and Rotem [ 4 ] and Stephens [ 30 ]. Developing confidence is an important component of clinical nursing practice [ 31 ]. Development of confidence should be facilitated by the process of nursing education; as a result students become competent and confident. Differences between actual and expected behaviour in the clinical placement creates conflicts in nursing students. Nursing students receive instructions which are different to what they have been taught in the classroom. Students feel anxious and this anxiety has effect on their performance [ 32 ]. The existence of theory-practice gap in nursing has been an issue of concern for many years as it has been shown to delay student learning. All the students in this study clearly demonstrated that there is a gap between theory and practice. This finding is supported by other studies such as Ferguson and Jinks [ 33 ] and Hewison and Wildman [ 34 ] and Bjork [ 35 ]. Discrepancy between theory and practice has long been a source of concern to teachers, practitioners and learners. It deeply rooted in the history of nurse education. Theory-practice gap has been recognised for over 50 years in nursing. This issue is said to have caused the movement of nurse education into higher education sector [ 34 ].

Clinical supervision was one of the main themes in this study. According to participant, instructor role in assisting student nurses to reach professional excellence is very important. In this study, the majority of students had the perception that their instructors have a more evaluative role than a teaching role. About half of the students mentioned that some of the head Nurse (Nursing Unit Manager) and Staff Nurses are very good in supervising us in the clinical area. The clinical instructor or mentors can play an important role in student nurses' self-confidence, promote role socialization, and encourage independence which leads to clinical competency [ 36 ]. A supportive and socialising role was identified by the students as the mentor's function. This finding is similar to the finding of Earnshaw [ 37 ]. According to Begat and Severinsson supporting nurses by clinical nurse specialist reported that they may have a positive effect on their perceptions of well-being and less anxiety and physical symptoms [ 25 ].

The students identified factors that influence their professional socialisation. Professional role and hierarchy of occupation were factors which were frequently expressed by the students. Self-evaluation of professional knowledge, values and skills contribute to the professional's self-concept [ 38 ]. The professional role encompasses skills, knowledge and behaviour learned through professional socialisation [ 39 ]. The acquisition of career attitudes, values and motives which are held by society are important stages in the socialisation process [ 40 ]. According to Corwin autonomy, independence, decision-making and innovation are achieved through professional self-concept 41 . Lengacher (1994) discussed the importance of faculty staff in the socialisation process of students and in preparing them for reality in practice. Maintenance and/or nurturance of the student's self-esteem play an important role for facilitation of socialisation process 42 .

One view that was expressed by second and third year student nurses in the focus group sessions was that students often thought that their work was 'not really professional nursing' they were confused by what they had learned in the faculty and what in reality was expected of them in practice.

The finding of this study and the literature support the need to rethink about the clinical skills training in nursing education. It is clear that all themes mentioned by the students play an important role in student learning and nursing education in general. There were some similarities between the results of this study with other reported studies and confirmed that some of the factors are universal in nursing education. Nursing students expressed their views and mentioned their worry about the initial clinical anxiety, theory-practice gap, professional role and clinical supervision. They mentioned that integration of both theory and practice with good clinical supervision enabling them to feel that they are enough competent to take care of the patients. The result of this study would help us as educators to design strategies for more effective clinical teaching. The results of this study should be considered by nursing education and nursing practice professionals. Faculties of nursing need to be concerned about solving student problems in education and clinical practice. The findings support the need for Faculty of Nursing to plan nursing curriculum in a way that nursing students be involved actively in their education.

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The author would like to thank the student nurses who participated in this study for their valuable contribution

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Psychiatric Nursing Department, Fatemeh (P.B.U.H) College of Nursing and Midwifery Shiraz University of Medical Sciences, Zand BlvD, Shiraz, Iran

Farkhondeh Sharif

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FSH: Initiation and design of the research, focus groups conduction, data collection, analysis and writing the paper, SM: Editorial revision of paper

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Sharif, F., Masoumi, S. A qualitative study of nursing student experiences of clinical practice. BMC Nurs 4 , 6 (2005). https://doi.org/10.1186/1472-6955-4-6

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Received : 10 June 2005

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