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2019v1.0
Fifth Edition
LoBiondo-Wood and Haber’s
NURSING RESEARCH
IN CANADA
Methods, Critical Appraisal, and Utilization
MINA D. SINGH, RN, RP, BSc, BScN, LORRAINE M. THIRSK, RN, PhD
MEd, PhD, I-FCNEI Assistant Professor
Professor Faculty of Health Disciplines
School of Nursing Athabasca University
Faculty of Health, York University Athabasca, Alberta
Toronto, Ontario
Canada
Associate Editors
SARAH STAHLKE, BScN, MHSA, PhD RAMESH VENKATESA PERUMAL, RN,
Adjunct Professor/Associate Lecturer MSc(N), CCNE, CNCC®, PhD(c)
Department of Sociology Professor
University of Alberta; Edmonton, Alberta School of Community and Health Studies
Sessional Instructor Centennial College;
Faculty of Health Disciplines Assistant Professor
Athabasca University School of Nursing
Athabasca, Alberta Faculty of Health
York University
Toronto, Ontario
US Authors
GERI LOBIONDO-WOOD, PhD, RN, FAAN JUDITH HABER, PhD, RN, FAAN
Professor, Director of PhD Nursing Program The Ursula Springer Leadership Professor in Nursing
University of Texas Health Sciences Center Rory Meyers College of Nursing
School of Nursing, Nursing Systems and Technology New York University
Houston, Texas New York, New York
Elsevier
LOBIONDO-WOOD AND HABER’S NURSING RESEARCH IN CANADA:

METHODS, CRITICAL APPRAISAL, AND UTILIZATION, FIFTH EDITION ISBN: 978-0-323-77898-5
Copyright © 2022 Elsevier Inc. All Rights Reserved.
Previous editions copyrighted 2018, 2013, 2009, and 2005 by Elsevier Canada, a division of Reed Elsevier
Canada, Ltd.
Adapted from Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice, 10th edition, by
Geri LoBiondo-Wood and Judith Haber. Copyright © 2022 Elsevier Inc. All Rights reserved. Previous editions
copyrighted 2018, 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986.
ISBN: 978-0-323-76291-5 (softcover).
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Reproducing passages from this book without such written
permission is an infringement of copyright law.
Requests for permission to make copies of any part of the work should be mailed to: College Licensing Officer,
access ©, 1 Yonge Street, Suite 1900, Toronto, ON, M5E 1E5. Fax: (416) 868-1621. All other inquiries should
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances in
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Library of Congress Control Number: 2021946978

Managing Director, Global ERC: Kevonne Holloway
Senior Content Strategist (Acquisitions, Canada): Roberta A. Spinosa-Millman
Content Development Specialist: Theresa Fitzgerald
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Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contents
PART ONE PART TWO
Research Overview, 1 Indigenous Peoples: Research,
RESEARCH VIGNETTE: Nursing research to improve Knowledges, and Ways of
immunization in Canada, 2
Shannon MacDonald
Knowing, 133
RESEARCH VIGNETTE: An Interview with
1 The Role of Research in Nursing, 5 Dr. Evelyn Voyageur, 134
Lorraine Thirsk Caroline Foster-Boucher & Evelyn Voyageur
2 Theoretical Frameworks, 20 7 Indigenous Peoples: Research,

Sarah Stahlke Knowledges, and Ways of Knowing, 138
Caroline Foster-Boucher & Lorraine Thirsk
3 Critical Appraisal Strategies: Reading
Research, 37
Lorraine Thirsk PART THREE
4 Developing Research Questions, Qualitative Research, 165
Hypotheses, and Clinical Questions, 57 RESEARCH VIGNETTE: Public Health Nursing and the
Mina D. Singh & Ramesh Venkatesa Perumal
Social Construction of Mothering, 166
Megan Aston
5 Finding and Appraising the Literature, 82
Lorraine Thirsk
8 Introduction to Qualitative Research, 168
Sarah Stahlke & Lorraine Thirsk
6 Legal and Ethical Issues, 104
9 Qualitative Approaches to Research, 186
Lorraine Thirsk & Sarah Stahlke
iii

iv CONTENTS
PART FOUR 17 Quantitative Data Analysis, 367

Mina D. Singh
Quantitative Research, 209
RESEARCH VIGNETTE: Why I Focus on Violence Against
18 Presenting the Findings, 400
Mina D. Singh
Women and Girls (VAWG), 210
Ruth Rodney
10 Introduction to Quantitative Research, 212 PART SIX

Ramesh Venkatesa Perumal & Mina D. Singh Critiquing Research, 413
11 Experimental and Quasiexperimental RESEARCH VIGNETTE: Rural and Remote Nursing
Designs, 230 Research, 414
Ramesh Venkatesa Perumal & Mina D. Singh Martha MacLeod
12 Nonexperimental Designs, 249 19 Critiquing Qualitative Research, 416

Lorraine Thirsk
20 Critiquing Quantitative Research, 462

Ramesh Venkatesa Perumal & Mina D. Singh
PART FIVE
Processes Related to PART SEVEN
Research, 275 Application of Research:
RESEARCH VIGNETTE: Nursing Workforce, 276
Evidence-Informed Practice, 495
Mélanie Lavoie-Tremblay
RESEARCH VIGNETTE: The Influence of NP Program
13 Sampling, 278 Students in My Current Research Portfolio:
Mina D. Singh & Ramesh Venkatesa Perumal Exploring Medical Cannabis and Applying It to
Clinical Practice, 496
14 Data-Collection Methods, 308 Luisa Barton
21 Developing an Evidence-Informed
15 Rigour in Research, 328 Practice, 498
Mina D. Singh & Lorraine Thirsk Lorraine Thirsk
RESEARCH VIGNETTE: Cancer Survivorship Program:
16 Qualitative Data Analysis, 350 Cancer, Work, Fear of Cancer Recurrence, 526
Lorraine Thirsk & Sarah Stahlke Christine Maheu
CONTENTS v
Appendices D How Does Simulation Impact Building

Competency and Confidence in
Recognition and Response to the
A The Rocks and Hard Places of MAiD: Adult and Paediatric Deteriorating
A Qualitative Study of Nursing Practice Patient Among Undergraduate Nursing
in the Context of Legislated Assisted Students?, 575
Death, 533 Sandra Goldsworthy, J. David Patterson, Martie Dobbs,
Barbara Pesut, Sally Thorne, Catharine J. Schiller, Arfan Afzal & Shelley Deboer
Madeleine Greig & Josette Roussel
E Prenatal Maternal Anxiety as a Risk
B Lanolin for the Treatment of Nipple Pain Factor for Preterm Birth and the Effects
in Breastfeeding Women: A Randomized of Heterogeneity on This Relationship: A
Controlled Trial, 552 Systematic Review and Meta-Analysis, 585
Kimberley T. Jackson & Cindy-Lee Dennis M. Sarah Rose, Gianella Pana & Shahirose Premji
C Mâmawoh Kamâtowin, “Coming GLOSSARY, 611

Together to Help Each Other in
Wellness”: Honouring Indigenous Nursing ANSWERS AND RATIONALES TO THE
Knowledge, 563 CRITICAL JUDGEMENT QUESTIONS, 623
R. Lisa Bourque Bearskin, Brenda L. Cameron, Malcolm
King, Cora Weber-Pillwax, Madeleine Dion Stout, Evelyn
Voyageur, Alice Reid, Lea Bill & Rose Martial INDEX, 630
Author Biographies
Mina D. Singh, RN, RP, BSc, BScN, MEd, in acute care, mainly in the operating room and
PhD, I-FCNEI, is a Professor at the School of intensive care. After moving into leadership and
Nursing, York University. She has a long career administrative roles, she worked in program de-
in nursing, having worked in acute care, mental velopment, hospital management, and professional
health, psychotherapy, and public health. Her regulation. She is currently an adjunct professor and
expertise is as a research methodologist, statisti- lecturer in sociology at the University of Alberta
cian, and program evaluator. In addition, she is and an instructor in the nursing/health studies mas-
a psychotherapist. She won the 2012 National ter’s degree program at Athabasca University. Her
Nursing Research Scholar award and the 2014 research and teaching interests relate to nursing
Accreditation Reviewer Excellence award, both roles, nursing practice environments, employee
granted by the Canadian Association of Schools engagement, organizational studies, professional
of Nursing (CASN). She was an Accreditation regulation, and interprofessional relationships.
Reviewer for CASN for over 18 years and has Sarah is an internationally recognized qualitative
travelled internationally and nationally reviewing methodologist and has taught numerous courses
nursing education programs. and workshops on qualitative research methods.
Lorraine M. Thirsk, RN, PhD, is an Assistant Ramesh Venkatesa Perumal, RN, MSc(N),
Professor in the Faculty of Health Disciplines, CCNE, CNCC®, PhD(c), is a Professor at
Athabasca University. Over the last 20 years, Centennial College and an Assistant Professor at
she has worked in rural and tertiary hospitals, York University. In addition to being a Critical
home care, and palliative care. In advanced Care Nurse, Ramesh has more than 20 years of
practice, she worked as a community therapist, experience in teaching, research, and community
nurse consultant, and a clinical nurse specialist. service. He has served on the editorial boards of
Her research program focuses on family nursing nursing journals and has been a peer reviewer
interventions in adult populations facing seri- of nursing journals. He won a prestigious award
ous illness. As an educator, she is interested in for the best teacher (Award for Excellence in
supporting undergraduate nursing students to Teaching) in 2009 at a public university in
develop competencies in working with families Muscat, Sultanate of Oman. His research and
and supporting graduate students from across teaching interests relate to mentorship in nurs-
the health disciplines in the research process. In ing, Internationally Educated Nurses (IEN), and
addition, she is passionate about supporting and Relational Care in intensive care units.
advancing evidence-informed nursing practice.
Methodologically, she is interested in mixed Geri LoBiondo-Wood, PhD, RN, FAAN, is
methods and using qualitative research to under- Professor and Director of the PhD in Nursing
stand complex interventions. Program at the University of Texas Health Science
Center at Houston, School of Nursing (UTHSC-
Sarah Stahlke, BScN, MHSA, PhD, is a sociolo- Houston) and former Director of Research
gist and a nurse. As a clinician, her experience is and Evidence-Based Practice Planning and
vi
AUTHOR BIOGRAPHIES vii
Development at the MD Anderson Cancer Center, Rory Meyers College of Nursing, at New York
Houston, Texas. She received her Diploma in University. She received her undergraduate
Nursing at St. Mary’s Hospital School of Nursing nursing education at Adelphi University in New
in Rochester, New York; Bachelor’s and Master’s York, and she holds a Master’s degree in Adult
degrees from the University of Rochester; and a Psychiatric–Mental Health Nursing and a PhD
PhD in Nursing Theory and Research from New in Nursing Theory and Research from New York
York University. Dr. LoBiondo-Wood teaches re- University. Dr. Haber is internationally recog-
search and evidence-based practice principles to nized as a clinician and educator in psychiatric–
undergraduate, graduate, and doctoral students. At mental health nursing. She has extensive clinical
MD Anderson Cancer Center, she developed and experience in psychiatric nursing, having been
implemented the Evidence-Based Resource Unit an advanced practice psychiatric nurse in private
Nurse (EB-RUN) Program, a hospital-wide pro- practice for over 30 years, specializing in treat-
gram that involves all levels of nurses in the ap- ment of families coping with the psychosocial se-
plication of research evidence to practice. She has quelae of acute and chronic catastrophic illness.
extensive national and international experience Her NIH-funded program of research addressed
guiding nurses and other health care profession- physical and psychosocial adjustment to illness,
als in the development and utilization of research. focusing specifically on women with breast can-
Dr. LoBiondo-Wood is an editorial board mem- cer and their partners and, more recently, breast
ber of Progress in Transplantation and a reviewer cancer survivorship. Dr. Haber is also committed
for Nursing Research, Oncology Nursing Forum, to an interprofessional program of clinical schol-
Oncology Nursing, and Nephrology Nursing arship related to improving oral-systemic health
Journal. Her research and publications focus on outcomes and leads the Oral Health Nursing
chronic illness and oncology nursing. Education and Practice (OHNEP) program
Dr. LoBiondo-Wood has been active locally funded by the DentaQuest Foundation, as well
and nationally in many professional organiza- as the HRSA-funded Teaching Oral Systemic
tions, including the Oncology Nursing Society, Health (TOSH) program.
Southern Nursing Research Society, the Midwest Dr. Haber has been active locally and nation-
Nursing Research Society, and the North American ally in many professional organizations, including
Transplant Coordinators Organization. She has re- the American Nurses Association, the American
ceived local and national awards for teaching and Psychiatric Nurses Association, and the American
contributions to nursing. In 1997, she received Academy of Nursing. She has received numerous
the Distinguished Alumnus Award from New local, state, and national awards for public policy,
York University, Division of Nursing Alumni clinical practice, and research, including the APNA
Association. In 2001, she was inducted as a Fellow Psychiatric Nurse of the Year Award in 1998 and
of the American Academy of Nursing and in 2007 2005 and the APNA Outstanding Research Award
as a Fellow of the University of Texas Academy in 2005. She received the 2007 NYU College of
of Health Science Education. In 2012, she was ap- Nursing Distinguished Alumnus Award, the 2011
pointed as a Distinguished Teaching Professor of NYU Distinguished Teaching Award, and the 2013
the University of Texas System. NYU Alumni Meritorious Service Award. In 1993,
she was inducted as a Fellow of the American
Judith Haber, PhD, RN, FAAN, is the Ursula Academy of Nursing and in 2012 as a Fellow in
Springer Leadership Professor in Nursing at the the New York Academy of Medicine.
Contributors
Megan Aston, RN, PhD Martha MacLeod, RN, PhD
Professor Professor
School of Nursing School of Nursing & School of Health Sciences
Dalhousie University University of Northern British Columbia
Halifax, Nova Scotia Prince George, British Columbia
Luisa Barton, NP-PHC, BScN, MN, DNP Christine Maheu, PN, PhD
Assistant Professor Associate Professor
Faculty of Health Disciplines Ingram School of Nursing
Athabasca University McGill University
Athabasca, Alberta Montreal, Quebec
Caroline Foster-Boucher, RN, MN Ruth Rodney, RN, PhD

Assistant Professor Assistant Professor
Department of Nursing Science School of Nursing
MacEwan University York University
Edmonton, Alberta Toronto, Ontario
Mélanie Lavoie-Tremblay, BScN, MScN, PhD Evelyn Voyageur, RN, PhD (psychology)
Associate Professor Elder in Residence, Aboriginal Education
Ingram School of Nursing North Island College, Comox Valley Campus
McGill University Courtney, British Columbia
Montréal, Quebec
Shannon MacDonald, RN, PhD

Assistant Professor
Faculty of Nursing
University of Alberta
Edmonton, Alberta
viii
Reviewers
Miranda Bevilacqua, RN, BScN, MN, PhD(c) Catherine (Cathy) Doreen MacDonald, BScN, RN,
Professor MN, PhD
School of Health, Negahneewin, & Community Services Associate Dean Academic Affairs, Arts & Science
Confederation College Arts & Science & Nursing
Thunder Bay, Ontario Rankin School of Nursing
Saint Francis Xavier University
Ellen Buck-McFadyen, RN, MScN, PhD Antigonish, Nova Scotia
Assistant Professor
Trent/Fleming School of Nursing Elise J. Matthews, BScN, BA, RN, PhD
Trent University Assistant Professor
Peterborough, Ontario Faculty of Nursing
University of Regina
Tracy M. Christianson, RN, BSN, MN, DHEd, CCNE Regina, Saskatchewan
Assistant Professor
School of Nursing Christie Pettipas, BSW, MPA, EdD
Thompson Rivers University Instructor
Kamloops, British Columbia School of Community Studies
Bow Valley College
Calgary, Alberta
Angela J. Gillis, RN, PhD
Professor Emeritus
Cheryl Pollard, RPN, RN, PhD
School of Nursing
Dean
Saint Francis Xavier University
Faculty of Nursing
Antigonish, Nova Scotia
University of Regina
Regina, Saskatchewan
Tracy Hoot RN, BScN, MSN, DHEd
Associate Dean Nancy A. Sears, RN, BNSc, MPA, CHE, PhD
School of Nursing Professor
Thompson Rivers University School of Baccalaureate Nursing
Kamloops, British Columbia St. Lawrence College (Laurentian University
collaborative BScN program)
Laura Anne Killam, BScN, RN, MScN Kingston, Ontario
Professor
Health Sciences, Nursing & Emergency Services Candice Waddell, RPN, BScPN, MPN, PhD(c)
Cambrian College Assistant Professor
Sudbury, Ontario Department of Psychiatric Nursing
Faculty of Health Studies
Tsorng-Yeh Lee, RN, PhD Brandon University
Associate Professor Brandon, Manitoba
School of Nursing
York University Karla L. Wolsky, RN, PhD
Toronto, Ontario Nursing Instructor
Nursing Centre for Health and Wellness
Lethbridge College
Lethbridge, Alberta
ix

Acknowledgements
THIS MAJOR UNDERTAKING WAS ACCOMPLISHED WITH writing during the pandemic would mean ex-
the help of many people, some of whom made tending deadlines
direct contributions to this new edition and some • Our vignette contributors, whose willingness
of whom contributed indirectly. We acknowledge to share their wisdom and evidence of their in-
with deep appreciation and our warmest thanks novative research made a unique contribution
the following people who made this fifth Cana- to this edition
dian edition possible: • All of the reviewers, who provided thoughtful
• The Inuit, First Nations, and Métis people who feedback not only on the previous four edi-
first lived on these lands and whose ancestors tions but also on the fifth Canadian edition
shared their knowledge with the settlers manuscript
• Nursing educators across Canada who provided • Our families, who supported us and picked up
valuable and insightful comments that helped the “loose ends” while we wrote and revised.
to direct the revisions featured in this edition
and contributed to improving the content To my husband Neranjan, my daughter Sandhya,
• Our students, particularly past and present and my parents Ram and Betty Laljie, for their
nursing students at York University, University support and encouragement.
of Alberta, and Athabasca University, who in- Mina D. Singh
spired us with their feedback and ideas
• Roberta A. Spinosa-Millman, Senior Content To my husband Reidar Hagtvedt, my sons
Strategist, who got us started with encourage- Benjamin and Alexander, and my parents Theo
ment, a sense of humour, and great insight and Margot Thirsk. Completing this fifth edition,
• Theresa Fitzgerald, Content Development Spe- during the pandemic, would not have been pos-
cialist, who encouraged us with positive feed- sible without your support.
back, made sense of the process, and understood Lorraine M. Thirsk
x
Preface
THE FOUNDATION OF THE FIFTH CANADIAN edition of
evident not only in the undergraduate nursing
LoBiondo-Wood and Haber’s Nursing Research
research course but also throughout the curric-
in Canada: Methods, Critical Appraisal, and
ulum. The research role of nurses calls for ev-
Utilization continues to be the belief that nursing
idence-informed practice competencies; central
research is integral to all levels of nursing edu-
to this are critical appraisal skills—that is, nurses
cation and practice. Since the first edition of this
should be competent in using research.
textbook, we have seen the depth and breadth of
Preparing students for this role involves de-
nursing research grow. More nurses are conduct-
veloping their critical thinking and reading
ing research and using research evidence to shape
skills, thereby enhancing their understanding of
clinical practice, education, administration, and
the research process and their ability to appraise
health policy.
research critically. An undergraduate course in
The Canadian Nurses Association promotes
nursing research should develop this basic level
the notion that nurses must provide care that is
of competence, which is an essential requirement
based on the best available scientific evidence.
if students are to engage in evidence-informed
This is an exciting challenge to meet. Nurses are
clinical decision-making and practice. This con-
using the best available evidence, combined with
trasts with a graduate-level research course, in
their clinical judgement and patient preferences,
which the emphasis is on conducting research, as
to influence the nature and direction of health care
well as understanding and appraising it.
delivery and to document outcomes related to the
The primary audience for this textbook remains
quality and cost-effectiveness of patient care. As
undergraduate students who are learning the steps
nurses continue to develop a unique body of nurs-
of the research process, as well as how to develop
ing knowledge through research, decisions about
clinical questions, critically appraise published
clinical nursing practice will be increasingly evi-
research literature, and use research findings to
dence informed.
inform evidence-informed clinical practice. This
As editors, we believe that all nurses not only
book is also a valuable resource for students at the
need to understand the research process but also
Master’s and doctoral levels who want a concise
need to know how to critically read, evaluate,
review of the basic steps of the research process,
and apply research findings in practice. We real-
the critical appraisal process, and the principles
ize that understanding research, as a component
and tools for evidence-informed practice.
of evidence-informed practice, is a challenge for
This text is also a key resource for health
every student, but we believe that the challenge
care leaders who are preparing to be experts at
can be accomplished in a stimulating, lively, and
evidence-informed initiatives in clinical settings.
learner-friendly manner.
Furthermore, it is an important resource for
Consistent with this perspective is a com-
practising nurses who strive to use research evi-
mitment to advancing implementation of the
dence as the basis for clinical decision-making
evidence-informed practice paradigm. Under-
and development of evidence-informed poli-
standing and applying nursing research must
cies, protocols, and standards, rather than rely
be an integral dimension of nursing education,
on tradition, authority, or trial and error. It is an
xi
xii PREFACE
important resource for nurses who collaborate producers, they must become knowledgeable
with nurse-scientists in the conduct of clinical research consumers.
research and evidence-informed practice. • Emphasizing the role of evidence-informed
Building on the success of the fourth edition, practice as the basis for informing clinical de-
we maintain our commitment to introduce evi- cision-making and nursing interventions that
dence-informed practice and research principles support nursing practice, demonstrating qual-
to baccalaureate students, thereby providing a ity and cost-effective outcomes of nursing care
cutting-edge research consumer foundation for delivery.
their clinical practice. • Presenting numerous examples of recently
Knowledge and language concerning sex, gen- published research studies that illustrate and
der, and identity are fluid and continually evolv- highlight each research concept in a manner
ing. The language and terminology presented in that brings abstract ideas to life for students
this text endeavours to be inclusive of all people new to the research and critical appraisal pro-
and reflects what is to the best of our knowledge cess.
current at the time of publication. • These examples are a critical link for reinforce-
LoBiondo-Wood and Haber’s Nursing Research ment of evidence-informed concepts and the
in Canada: Methods, Critical Appraisal, and related research and critiquing process.
Utilization prepares nursing students and practis- • Showcasing, in Research Vignettes, the work
ing nurses to become knowledgeable nursing re- of renowned nurse researchers whose careers
search consumers in the following ways: exemplify the links among research, education,
• Addressing the evidence-informed practice and practice.
role of the nurse, thereby embedding evidence- • Providing numerous pedagogical chapter fea-
informed competence in the clinical practice of tures, including Learning Outcomes, Key
every baccalaureate graduate. Terms, Key Points, new Critical Think-
• Demystifying research, which is sometimes ing Challenges, Research Hints, Evidence-
viewed as a complex process. Informed Practice Tips, new Practical Appli-
• Using an evidence-informed approach to teach- cations, revised Critical Thinking Decision
ing the fundamentals of the research process. Paths, and Critical Judgement Questions, as
• Teaching the critical appraisal process in a well as numerous tables, boxes, and figures. At
user-friendly but logical and systematic pro- the end of each chapter that presents a step of
gression. the research process, we feature a section titled
• Promoting a lively spirit of inquiry that devel- Appraising the Evidence, which reviews how
ops critical thinking and critical reading skills, each step of the research process should be
facilitating mastery of the critical appraisal evaluated from a consumer’s perspective. This
process. section is accompanied by an updated Critiqu-
• Developing information literacy, searching, ing Criteria box.
and evidence-informed practice competencies • Providing a Study Guide that promotes active
that prepare students and nurses to effectively learning and assimilation of nursing research
locate and evaluate the best available research content.
evidence. • Offering an Evolve site presenting free Evolve
• Elevating the critical appraisal process and Resources for Instructors that includes a Test
research appreciation to a position of im- Bank, TEACH, PowerPoint slides, critiqu-
portance comparable to that of producing ing exercises, an Image Collection, and criti-
research. Before students become research cal appraisal activities. There are also Evolve
PREFACE xiii
resources for both the student and faculty that students and nurses with the tools necessary to ef-
include an audio glossary. fectively search, retrieve, manage, and evaluate
The fifth Canadian edition of LoBiondo-Wood research studies and their findings. This chapter
and Haber’s Nursing Research in Canada: also develops research consumer competencies
Methods, Critical Appraisal, and Utilization is that prepare students and nurses to critically read,
organized into seven parts. Each part is preceded understand, and appraise a study’s literature re-
by an introductory section and opens with an ex- view and framework. The final chapter in this
citing “Research Vignette” by a renowned nurse section, Chapter 6, “Legal and Ethical Issues,”
researcher. provides an overview of the increased emphasis
Part One, Research Overview, contains six on the legal and ethical issues facing researchers
chapters. Chapter 1, “The Role of Research in in Canada.
Nursing,” provides an excellent overview of re- Part Two, Indigenous Peoples: Research,
search and evidence-informed practice processes Knowledges, and Ways of Knowing, is an ex-
that shape clinical practice. This chapter introduces citing, brand-new section in this fifth edition. We
the role that research plays in practice and educa- were honoured to be able to include an interview
tion, the roles of nurses in research activities, a his- with Elder Evelyn Voyageur, and to work with
torical perspective, and future directions in nursing Caroline Foster-Boucher, to develop Chapter 7,
research. The style and content of this chapter are “Indigenous Peoples: Research, Knowledges, and
designed to make subsequent chapters more user- Ways of Knowing.” This section will introduce
friendly. Chapter 2, “Theoretical Framework,” fo- students to the history and significance of colo-
cuses specifically on how theoretical frameworks nization as it relates to how Indigenous peoples
guide and inform knowledge generation through have been affected by, and are affecting, nursing
the research process. Chapter 3, “Critical Appraisal and health research. The chapter highlights the
Strategies: Reading Research,” addresses students relevant recommendations from the Truth and
directly and highlights critical thinking and critical Reconciliation Commission and offers a begin-
reading concepts and strategies, thereby facilitat- ning exploration of Indigenous Methodologies.
ing students’ understanding of the research process Part Three, Qualitative Research, contains
and its relationship to the critical appraisal process. two interrelated qualitative research chapters.
This chapter introduces a model evidence hierar- Chapter 8, “Introduction to Qualitative Research,”
chy that is used throughout the text. provides a framework for understanding qualita-
The next two chapters address foundational tive research designs and literature, as well as
components of the research process. Chapter 4, the significant contribution of qualitative re-
“Developing Research Questions, Hypotheses, search to evidence-informed practice. Chapter 9,
and Clinical Questions,” focuses on how research “Qualitative Approaches to Research,” presents,
questions, hypotheses, and evidence-informed illustrates, and, in examples from the literature,
practice questions are derived, operationalized, showcases major qualitative methods. This chap-
and critically appraised. Numerous clinical ex- ter highlights the questions most appropriately
amples illustrating different types of research answered using qualitative methods.
questions and hypotheses maximize student un- Part Four, Quantitative Research, con-
derstanding. Students are also taught how to de- tains Chapter 10 (“Introduction to Quantitative
velop clinical questions that are used to guide Research”), 11 (“Experimental and Quasiex-
evidence-informed inquiry. Chapter 5, “Finding perimental Designs”), and 12 (“Nonexperimental
and Appraising the Literature,” showcases cut- Designs”). These chapters delineate the essential
ting-edge information literacy content, providing steps of the quantitative research process, with
xiv PREFACE
published, current clinical research studies used to frameworks for implementing and evaluating the
illustrate each step. Links between the steps and outcomes of evidence-informed health care.
their relationship to the total research process are The Evolve website that accompanies the fifth
examined. Canadian edition provides interactive learning activ-
Part Five, Processes Related to Research, de- ities that promote the development of critical think-
scribes the specific steps of the research process for ing, critical reading, and information literacy skills
qualitative and quantitative studies. The chapters designed to develop the competencies necessary to
make the case for linking an evidence-informed produce informed consumers of nursing research.
approach with essential steps of the research pro- Instructor resources are available at a passcode-
cess by teaching students how to critically ap- protected website that gives faculty access to all in-
praise the strengths and weaknesses of each step structor materials online, including the TEACH for
of the research process. Students learn how to se- Nurses Lesson Plans, Image Collection, PowerPoint
lect participants (Chapter 13, “Sampling”), gather Slides, a Test Bank that allows faculty to create ex-
data (Chapter 14, “Data-Collection Methods”), aminations through the use of the ExamView test
analyze the results (Chapter 16, “Qualitative Data generator program, and more.
Analysis,” and Chapter 17, “Quantitative Data The development and refinement of an evi-
Analysis”), and present their results (Chapter 18, dence-informed foundation for nursing practice is
“Presenting the Findings”). Chapter 15, “Rigour an essential priority for the future of professional
in Research,” gives students the tools for assess- nursing practice. The fifth Canadian edition of
ing the quality and trustworthiness of a study. LoBiondo-Wood and Haber’s Nursing Research
Part Six, Critiquing Research, makes the case in Canada: Methods, Critical Appraisal, and
for linking an evidence-informed approach with Utilization will help students develop a basic
essential steps of the research process by teaching level of competence in understanding the steps of
students how to critically appraise the strengths and the research process that will enable them to criti-
weaknesses of each step of the research process. cally analyze research studies, evaluate their mer-
Each chapter critiques two examples of actual pub- it, and judiciously apply evidence in practice. To
lished research. Chapter 19, “Critiquing Qualitative the extent that this goal is accomplished, the next
Research Articles,” focuses on qualitative research, generation of nursing professionals will include a
whereas Chapter 20, “Critiquing Quantitative cadre of clinicians who inform their practice by
Research,” is based on the quantitative research using theory and research evidence, combined
process. with their clinical judgement, and specific to the
Part Seven, Application of Research: health care needs of patients and their families in
Evidence-Informed Practice, contains the final health and illness.
chapter in the book. Chapter 21, “Developing Mina D. Singh
an Evidence-Informed Practice,” provides a dy- [email protected]
namic review of evidence-informed models. Lorraine M. Thirsk
These models can be applied—step by step, at [email protected]
the organizational or individual patient level—as
To the Student
EVIDENCE-INFORMED PRACTICE is integral to meet- Remember that evidence-informed practice
ing the challenge of providing quality health care skills are used in every clinical setting and can
in partnership with patients and their families be applied to every patient population or nursing
and significant others, as well as with the com- practice issue. Whether your practice involves
munities in which they live. As you read this primary care or specialty care and provides inpa-
fifth Canadian edition of LoBiondo-Wood and tient or outpatient treatment in a hospital, clinic,
Haber’s Nursing Research in Canada: Methods, or home, you will be challenged to use research
Critical Appraisal, and Utilization, we hope you as the foundation for your evidence-informed
develop an appreciation of the importance of practice. The fifth Canadian edition of LoBiondo-
nursing research to practice. Whether you are a Wood and Haber’s Nursing Research in Canada:
student or a practising nurse whose goal is to use Methods Critical Appraisal, and Utilization will
research evidence as the foundation of your prac- guide you as you discover your ability to play
tice, you will discover that nursing research and a a vital role in contributing to the building of an
commitment to evidence-informed practice posi- evidence-informed professional nursing practice.
tions our profession at the forefront of change. As Mina D. Singh
you learn about nursing research and evidence- [email protected]
informed practice, you will develop a foundation Lorraine M. Thirsk
of knowledge and skills that will equip you for [email protected]
clinical practice today and into the future.
The fifth Canadian edition of LoBiondo-Wood
and Haber’s Nursing Research in Canada: Meth- A NOTE ABOUT THE
ods, Critical Appraisal, and Utilization reflects NEXT-GENERATION NCLEX
cutting-edge trends for developing evidence- The National Council for the State Boards of
informed nursing practice. The seven-part or- Nursing (NCSBN) is a not-for-profit organiza-
ganization and special features in this text are tion whose members include nursing regulatory
designed to help you develop your critical think- bodies. In empowering and supporting nursing
ing, critical reading, information literacy, and regulators in their mandate to protect the pub-
evidence-informed clinical decision-making while lic, the NCSBN is involved in the development
providing a user-friendly approach to learning of nursing licensure examinations, such as the
that expands your competence to deal with these NCLEX-RN®. In Canada, the NCLEX-RN® was
new and challenging experiences. The compan- introduced in 2015 and is, as of the writing of this
ion Study Guide, with its chapter-by-chapter ac- text, the recognized licensure exam required for
tivities, will serve as a self-paced learning tool to practising RNs in Canada.
reinforce the content of the text. The accompa- The NCLEX-RN® will, as of 2023, be changing
nying Evolve website offers “summative” review in order to ensure that its item types adequately
material to help you reinforce the concepts dis- measure clinical judgement, critical thinking, and
cussed throughout the book. problem-solving skills on a consistent basis. The
xv

xvi TO THE STUDENT
NCSBN will also be incorporating into the ex- • All new item types are accompanied by mini
amination what they call the Clinical Judgement case studies with comprehensive patient infor-
Measurement Model (CJMM), which is a frame- mation—some of it relevant to the question,
work that the NCSBN has created to measure a and some of it not.
novice nurse’s ability to apply clinical judgement • Case information may present a single, un-
in practice. changing moment in time (a “single-episode”
These changes to the examination come as a re- case study) or multiple moments in time as a
sult of research findings that indicated that novice patient’s condition changes (an “unfolding”
nurses have a much higher than desirable error rate case study).
with patients (i.e., errors that cause patient harm) • Single-episode case studies may be accompa-
and, upon NCSBN’s investigation, the discovery nied by one to six questions; unfolding case
that the overwhelming majority of these errors studies are accompanied by six questions.
were caused by failures of clinical judgement. For more information (and detail) regarding the
Clinical judgement has been a foundation un- NCLEX-RN® and changes coming to the exam,
derlying nursing education for decades, based on visit the NCSBNs website: https://www.ncsbn
the work of a number of nursing theorists. The .org/11447.htm and https://ncsbn.org/Building_a_
theory of clinical judgement that most closely Method_for_Writing_Clinical_Judgment_It.pdf.
aligns to what NCSBN is basing their CJMM is For further NCLEX-RN® examination prepara
the work by Christine A. Tanner. tion resources, see Silvestri’s Canadian Compre-
The new version of the NCLEX-RN® is loosely hensive Review for the NCLEX-RN® Examination,
being identified as the “Next-Generation NCLEX” Second Edition, ISBN 9780323709385.
or “NGN” and will feature the following: Prior to preparing for any nursing licensure
• Six key skills in the CJMM: recognizing cues, examination, please refer to your provincial
analyzing cues, prioritizing hypotheses, gener- or territorial nursing regulatory body to deter-
ating solutions, taking actions, and evaluating mine which licensure examination is required
outcomes. in order for you to practise in your chosen
• Approved item types as of June 2020: multiple jurisdiction.
response, extended drag and drop, cloze (drop- Next-Generation NCLEX™ (NGN)-Style Case
down), enhanced hotspot (highlighting), and Studies can be found on this text’s accompanying
matrix/grid. More question types may be added. Evolve site.
PA RT ON E
Research Overview
1 The Role of Research in
Nursing
2 Theoretical Frameworks
3 Critical Appraisal Strategies:
Reading Research
4 Developing Research
Questions, Hypotheses,
and Clinical Questions
5 Finding and Appraising the
Literature
6 Legal and Ethical Issues
focus my research on identifying
RESEARCH VIGNETTE and improving system-level fac-
tors that influence convenience,
Nursing Research to Improve such as immunization access,
Immunization in Canada accurate immunization records,
and reminder systems. Through
our research, my team has found
Shannon MacDonald, PhD, RN decided not to give them the vac- that these system-level barriers
Assistant Professor cine. Later in my nursing career, I disproportionately impact vulner-
Faculty of Nursing
travelled to less developed regions able populations, including chil-
University of Alberta
Edmonton, Alberta of the world, where it wasn’t un- dren receiving child intervention
common for mothers to report los- services (Hermann et al., 2019),
ing multiple children to vaccine- First Nations children (MacDon-
We have all seen social media posts preventable diseases. In those ald et al., 2016), and children in
that try to scare people about vac- cases, it wasn’t due to a choice single-parent, low-income fami-
cines. There are claims that vaccines not to vaccinate, but instead due lies that have unstable housing
are unnecessary, ineffective, or to limited access to health ser- (Bell et al., 2015). Identifying
unsafe. Unfortunately, the average vices. The cumulative effect of these at-risk populations allows
Canadian doesn’t see the other side those clinical experiences led to us as nurses to develop strategies
of the story, namely the people who my lifelong passion and program to reach them, and to advocate for
have come to harm because they of research focused on improving public health policies to provide
weren’t protected from vaccine- immunization practices, policies, system-level supports for these
preventable diseases. As nurses, we and parent decision-making. populations. I will share with you
see both sides because we are the The World Health Organization two examples of my research that
ones caring for people infected with (WHO, 2014) has a conceptual seeks to achieve these goals.
these diseases. We also have the sci- framework to explain the influ- Under-immunization of chil-
entific literacy to critically read and ences on vaccine hesitancy and dren receiving child intervention
evaluate the evidence on this topic. uptake. They identify ‘the 3 Cs’: services: Children who receive
Thus, nurses are in the ideal posi- Complacency (vaccines are not intervention from the child wel-
tion to promote vaccine uptake; to perceived as necessary), Con- fare system (sometimes referred
advocate for equitable vaccine ac- fidence (lack of trust in the vac- to as “children in care”) typically
cess; and to ask important research cines/providers/policy-makers), do so to ensure their safety and
questions that ensure that safe and and Convenience (physical avail- security (Canadian Child Welfare
effective vaccine programs contin- ability, affordability, geographical Research Portal, 2020). However,
ue to be provided to Canadians. accessibility, ability to understand, the circumstances in their home,
My own interest in the immuni- and appeal/ease of immunization the processes of removal from
zation field started when I worked services). Any one, or a combina- their home, and their subsequent
as a nurse in the Pediatric Inten- tion, of these factors can act as an placement in one or more other
sive Care Unit. I cared for children impediment to someone accepting care settings (e.g., foster care
who were on ventilators as a result vaccines for themselves or their homes) may result in interrup-
of a whooping cough infection children. tions in provision of their immu-
contracted because they were too When considering the WHO nizations (Hermann et al., 2019).
young to be vaccinated; teenagers ‘3 Cs’ framework, I have al- In our study (Hermann et al.,
who lost hands or legs to menin- ways found it striking that ‘con- 2019), we wanted to assess vac-
gococcemia because the vaccine venience’ can prevent someone cine coverage (i.e., the proportion
wasn’t yet available to them; and from vaccinating, even if com- of the eligible population who
children who had measles enceph- placency or confidence are not a have received a vaccine) of chil-
alopathy because their parents had concern. Thus, I have chosen to dren who had spent time in care of
2
the child welfare system. What we coverage for rotavirus vaccine, the largest groups of health care
discovered was that children in in order to identify areas for im- providers, and the most trusted
care have consistently lower vac- proved service delivery. What by the public (Milton, 2018), we
cine coverage than children who we found was that pre-term in- are in a prime position to provide
had never been in care. For infants were less likely to be vac- clear, evidence-informed guid-
stance, at age 2, vaccination cov- cinated, despite being at higher ance to families who are strug-
erage for children in care ranged risk of becoming seriously ill gling with the immunization de-
from 54.3% to 81.4%, depend- from a rotavirus infection. Other cision. In many provinces and
ing on vaccine, while coverage studies from the USA (Fathima territories of Canada, nurses are
for those not in care ranged from et al., 2019; Dahl et al., 2018), also the main provider of immu-
74.2% to 87.4%. So, our study re- found similarly that infants that nizations. Thus, the role we can
vealed that vaccine coverage for were pre-term and/or low birth play is significant. Nurses are also
this already vulnerable popula- weight had low rotavirus vaccine ideally positioned to lead research
tion was significantly below the coverage, and that these infants in the field of immunization. We
rest of the population and vastly were more likely to have spent have the clinical perspective, the
below the target level for vaccine their first days/weeks/months in experience of interacting with
coverage (target levels for most a Neonatal Intensive Care Unit families, and the education to en-
vaccines are >95%). As a result (NICU). Our study raised a red gage in critical inquiry. Currently,
of our study, we have advocated flag in Alberta regarding whether there are only a handful of nurses
for improvements in tracking im- infants in the NICU were receiv- in Canada who are working in this
munizations for children in care, ing their recommended vaccines field. My dream is for nurses and
as well as increased collaboration while hospitalized. It led us to emerging nurse researchers to ac-
between health and children’s collaborate with public health and cept the challenge to improve the
services ministries to ensure hospital-based clinicians to assess care provided to families in Cana-
these vulnerable children are bet- and remedy the situation. da and beyond through improved
ter served. We also identified the These are just two examples evidence-informed immunization
need to conduct more research on of the type of research that I and services. ■
this topic, specifically, qualitative my research team have engaged
REFERENCES
studies to identify the specific bar- in to improve immunization ser-
Bell, C. A., Simmonds, K. A., & MacDon-
riers that are preventing equitable vice delivery, and to improve the
ald, S. E. (2015). Exploring the het-
access to immunizations for this convenience for parents seeking erogeneity among partially vaccinated
population. immunizations for their children. children in a population-based cohort.
Rotavirus immunization for The fact that I am a nurse leads Vaccine, 33(36), 4572–4578.
pre-term infants: Rotavirus vac- me to approach this research Canadian Child Welfare Research Portal
(2020). Frequently Asked Questions
cine is provided to infants, start- through a nursing lens. I also
(FAQs). http://cwrp.ca/faqs.
ing when they are 2 months old, approach research from a very Dahl, R. M., Curns, A. T., Tate, J. E.,
with additional booster doses applied, rather than theoretical, & Parashar, U. D. (2018). Effect of
provided before the child turns 8 perspective. I am always eager rotavirus vaccination on acute diarrheal
months old. Unlike some other to move beyond acquisition of hospitalizations among low and very
low birth weight us infants, 2001-
vaccines, there is an upper age knowledge, to identify ways that
2015. The Pediatric Infectious Disease
limit to when children can receive this new knowledge can improve Journal, 37(8), 817–822. https://doi.
the vaccine, due to safety con- clinical care and health policies org/10.1097/INF.0000000000001930.
cerns for older children (Parashar in the real world. Fathima, P., Gidding, H. F., Snelling,
et al., 2018). Our team conducted Nurses, and nurse researchers, T. L., McIntyre, P. B., Blyth, C. C.,
Sheridan, S., & Moore, H. C. (2019).
a study (Rafferty et al., 2019) to have the potential to play impor-
Timeliness and factors associated with
determine whether there were tant roles in supporting immuni- rotavirus vaccine uptake among Aus-
some sub-populations of children zation best practices, policies, and tralian Aboriginal and non-Aboriginal
in Alberta that had lower vaccine parent decision-making. As one of children: A record linkage cohort study.
3

Vaccine, 37(39), 5835–5843. https://doi MacDonald, S. E., Bell, C. A., & Sim- Rafferty, E., Guo, X., McDonald, B.,
.org/10.1016/j.vaccine.2019.08.013. monds, K. A. (2016). Coverage and Svenson, L. W., & MacDonald, S. E.
Hermann, J. S., Featherstone, R. M., Rus- determinants of uptake for privately (2019). Measurement of coverage,
sell, M. L., & MacDonald, S. E. (2019). funded rotavirus vaccine in a Canadian compliance and determinants of
Immunization coverage of children birth cohort, 2008–2013. The Pediatric uptake in a publicly funded rotavirus
in care of the child welfare system in Infectious Disease Journal, 35(6), vaccination programme: A retrospec-
high-income countries: A systematic e177–e179. https://doi.org/10.1097 tive cohort study. BMJ Open, 9(11).
review. American Journal of Preventive /INF.0000000000001125. http://dx.doi.org/10.1136/bmjopen
Medicine, 56(2), e55–e63. https://doi Milton, C. L. (2018). Will nursing con- -2019-031718.
.org/10.1016/j.amepre.2018.07.026. tinue as the most trusted profession? World Health organization (WHO) (2014).
Hermann, J. S., Simmonds, K. A., Bell, C. A., An ethical overview. Nursing Science Report of the SAGE working group on
Rafferty, E., & MacDonald, S. E. (2019). Quarterly, 31(1), 15–16. https://doi.org vaccine hesitancy. http://www.who.int
Vaccine coverage of children in care of the /10.1177/2F0894318417741099. /immunization/sage/meetings/2014
child welfare system. Canadian Journal Parashar, U. D., Cortese, M. M., & Offit, /october/SAGE_working_group_revised
of Public Health, 110(1), 44–51. https://doi P. A. (2018). Rotavirus vaccines _report_vaccine_hesitancy.pdf?ua=1.
.org/10.17269/s41997-018-0135-5. (7th ed.). Philadelphia: Elsevier. Accessed May 14, 2020.
4
C H APT ER 1
The Role of Research in Nursing

Lorraine Thirsk
LEARNING OUTCOMES
After reading this chapter, you will be able to do the following:
• State the significance of research to the practice of nursing.
• Recognize that theory, research, and practice are related.
• Describe the history of nursing research.
• Identify the roles of the research user and producer.
• Identify trends and priorities in health care research.
KEY TERMS
critical appraisal evidence-based practice quality improvement
data evidence-informed practice research
dissemination phenomena
STUDY RESOURCES
Go to Evolve at http://evolve.elsevier.com/Canada/LoBiondo/Research
for the Audio Glossary.
HOW DO YOU KNOW WHAT YOU know? Is it less own experiences, from our family, culture, tradi-
painful for a patient if you remove a burn dress- tions, and authorities. Historically, many nursing
ing slowly or quickly? What are the challenges that practices were based on received wisdom or tra-
pregnant women face in obtaining prenatal care, and dition. Some of the first documentation discuss-
how is this complicated if they lack transportation ing the importance of research evidence in nurs-
or housing? How do you assess pain in someone ing practice is from Florence Nightingale, who, in
with cognitive impairment like dementia? What is the 1850s, noted there was a connection between
the best way to talk with a family who is hesitant to poor sanitary conditions and death rates among
vaccinate their child? Does cannabis have a thera- wounded soldiers (Nightingale, 1863).
peutic effect for the treatment of anxiety? These are In Europe, in the early 20th century, a move-
all questions that can be answered with research and ment began to define criteria that would separate
are important to nurses. science from non-sciences such as pseudoscience,
Research is a systematic way to acquire knowl- metaphysics, ideology, and religion (Hansson,
edge. We also acquire knowledge through our 2017). The scientific method was developed as a
5

6 PART ONE Research Overview
systematic way to determine knowledge and un- skills in relation to the steps of the research pro-
derstand the world. While human beings have an cess. Research Hints, designed to reinforce your
incredible capacity for thinking and understand- understanding and critical thinking, appear at
ing the world around them, the mind does some- various points throughout the chapters. Evidence-
times make mistakes and is influenced by beliefs Informed Practice Tips will help you apply
and ideology that do not always reflect reality. evidence-informed practice strategies in your
Over the last century, psychological studies have clinical practice. Finally, Practical Application
revealed that people have biases in their thought boxes offer examples of translating principles and
processes that can be problematic and give us an methods of nursing research into real-life nursing
incorrect or a skewed view of the world around situations and interventions.
us (Buetow, 2019; Kahneman, 2011; Paley et al., Your critical thinking, critical reading, and
2007). Our hunches about patterns and probabili- clinical decision-making skills will expand as you
ties are insufficient to ensure good decision-mak- develop clinical questions, search the research lit-
ing. Health care resources are scarce, and thus it erature, evaluate the research evidence found in
is prudent for nurses and other health care profes- the literature, and make clinical decisions about
sionals to ensure that scarce resources are used applying the best available evidence. In this
wisely. In other words, we need to know that our book you will discover the “who, what, where,
decisions are based on the best evidence available when, why, and how” of research and develop
(Melnyk & Fineout-Overholt, 2011). a foundation of knowledge, evidence-informed
Research is integral to achieving the goal of practice, and competencies that will equip you
providing quality outcomes in partnership with for 21st-century nursing practice. To begin, this
patients, their families and significant others, chapter provides an overview of the importance
and the communities in which they live. As you of research to evidence-informed practice, the
progress through your educational program you role that research plays in practice, the roles of
will be taught how to ensure quality and safety nurses in research activities, and future directions
in practice by acquiring knowledge of various of health care research.
sciences and health care principles. Research is a
critical foundation of an evidence-informed ap-
proach to nursing practice, positioning nurses at SIGNIFICANCE OF RESEARCH AND
the cutting edge of change and improvement in EVIDENCE-INFORMED PRACTICE
patients’ outcomes. The health care environment is changing at an in-
The aim of this book is to prepare you to criti- creasingly rapid pace. The challenges associated
cally appraise research and incorporate research with these changes and with nursing’s rapid pace
into your practice. Throughout this text you will of growth can best be met by integrating evidence-
find special features that will help refine and de- informed knowledge into nursing practice. Nurs-
velop your competence in using research. Each ing research provides scientific knowledge that
chapter contains a Critical Thinking Decision enables nurses to keep up with these changes.
Path related to each step of the research process; In learning about research, it is important
these will sharpen your decision-making skills as to differentiate between the terms research,
you critique research articles. Internet resources evidence-based practice, and evidence-informed
in the chapters will also enhance your research practice. Research is systematic, rigorous, logi-
user skills. Critical Thinking Challenges, which cal investigation with the aim of answering ques-
appear at the end of each chapter, are designed tions about nursing phenomena. Phenomena can
to reinforce your critical thinking and judgment be defined as occurrences, situations, or facts that
CHAPTER 1 The Role of Research in Nursing 7
are perceptible by the senses. Although the ori- more inclusive and interactive process of decision-
gin of the term phenomena refers to events that making that pertains to all nurses—whether they
are observable and/or measurable, nurses are also are clinicians, educators, researchers, administra-
interested in experiences that are not easily ob- tors, or policy-makers (CNA, 2018). Building on the
served, such as the experiences of pain, loss, or foundation of evidence-based practice, evidence-
anxiety. informed practice also involves acknowledging
In the past 25 years, many health care dis- and considering the myriad factors that constitute
ciplines have adopted the tenets of evidence- decision-making, taking into account patient pref-
informed practice to provide better health care erence, culture, history, and local context.
for their patients. The roots of modern evi- When you first read about the research and the
dence-informed practice stem from Dr. Archie evidence-informed practice process, you will no-
Cochrane’s investigation of the efficacy of health tice that both processes may seem similar. Each
care interventions, particularly in medicine. begins with a question. The difference is that in
His work resulted in the establishment of the a research study, the question is tested with a de-
Cochrane Collaboration, which provides system- sign appropriate for the question and with specific
atic reviews of health care interventions. methods (sample, instruments, procedures, and
In 1996, Sackett and colleagues defined data analysis). In the evidence-informed practice
“evidence-based medicine” as the “conscientious, process, a question is used to search the literature
explicit, and judicious use of current best evidence for studies already completed and then you criti-
in making decisions about the care of individual cally appraise this literature in order to answer
patients” (p. 312). This was considered the be- your clinical question.
ginning of evidence-based practice, which most Broadly, there are two types of research: quanti-
health professions have now adopted. Research is tative and qualitative. Increasingly, many research-
completed, published in academic journals, and ers use mixed methods—in other words, they
then assessed to determine application to clinical utilize both types of research in one project, or in
practice—this results in practice that is evidence- examination of one phenomenon in a program of
based. The evidence-based practice movement research. You will be introduced to these types of
has not been without challenges and problems. research in more depth in Chapter 2. In addition,
The strict application of algorithms and guide- the Research Vignettes included throughout the
lines, along with selective trials that overlook text will introduce you to nurses who use a variety
multiple morbidities, means that individual pa- of research methods to study phenomenon impor-
tients are not always receiving the most appropri- tant to health care and nursing practice. The meth-
ate care (Greenhalgh et al., 2014). Evidence-based ods used by nurse researchers are the same meth-
practice can become rigid and not consider patient ods used in other disciplines; the difference is that
preferences, individuality, and contexts. nurses study questions relevant to nursing practice.
Evidence-informed practice extends beyond Nurse researchers also conduct research collab-
the early definitions of evidence-based practice. oratively with researchers from other disciplines.
With evidence-informed practice, the methods for Through the conducting of research, they produce
gathering evidence are the same as the processes knowledge that is reliable and useful for nursing
used for evidence-based practice; however, the practice. The methods and findings of studies pro-
evidence also incorporates expert opinion, clini- vide evidence that is evaluated, and their applica-
cal expertise, patient preference, and other re- bility to practice is used to inform decisions.
sources (CNA, 2018). It is important to remem- Throughout this text, the steps of the research
ber that evidence-informed practice focuses on a and evidence-informed practice processes are
described. Understanding the step-by-step pro-

cess that researchers use will help you develop Practical Application
the assessment skills necessary to judge the Dan Ariely was badly burned when he was
18 years old (Ariely, 2009)—70% of his body experi-
soundness of research studies and participate in
1234567890-=qwertyuiop[]\asdfghjkl;’zx-
enced 3rd degree burns. During daily dressing changes,
or lead research projects someday. Chapter 21
cvbnm,./
he noticed that most of the nurses would grab the
will further describe how you can implement evi- bandages and rip them off as quickly as possible. He
dence into practice to improve patient outcomes. recalls thinking the nurses had theorized that quick,
sharp bursts of pain were better for the patient than
slowly pulling off the bandages. In addition, he noticed
RESEARCH: THE ELEMENT THAT LINKS that there was no rationale as to whether the dressing
changes were started at the most painful part of his
THEORY, EDUCATION, AND PRACTICE body or the least painful part. As a patient, he had opin-
Research links theory, education, and practice. ions about which methods were better, but there did
not seem to be any evidence to help guide the nurses
Theoretical formulations supported by, or devel- on the best methods. When he later attended univer-
oped from, research findings may become the sity, Ariely began working as a research assistant and
foundations of theory-informed practice in nurs- eventually started to test some of his theories about
ing and inform further research studies. Your edu- pain and the removal of burn dressings. The research he
conducted showed that slowly removing burn dressings
cational setting, whether a nursing program or the would result in the least amount of pain for the patient.
health care organization where you are employed, He wondered how these kind and experienced nurses
provides an environment in which you, as a stu- could be so wrong. “I knew that their behaviour was
not due to maliciousness, stupidity, or neglect. Rather,
dent or an employee, can learn about the research they were most likely the victims of inherent biases in
process. In the setting of a nursing program or their perceptions of their patients’ pain—biases that ap-
a health care organization, you can also explore parently were not altered even by their vast experience”
(Ariely, 2009, p. xvi). Interestingly, when he reported his
different theories and practices and begin to evalu- results back to the nurses at the burn unit, one nurse
ate them based on research findings. The knowl- explained that perhaps removing the dressings quickly
edge you gain through your educational program, lessened the nurse’s psychological pain, which they ex-
whether theory or research based, will inform the perienced when they inflicted pain on patients.
decisions that you make in your practice. See the Source: Based on Ariely, D. (2009). Predictably Irrational: The Hidden
Forces That Shape Our Decisions. New York:. Harper Perennial.
Practical Application box for an example of how
theory and research influence health care practices.
The example in the Practical Application box through research, and then this new evidence needs
is an attempt to answer a question that you may to be incorporated into practice. Often in the ab-
have asked before taking this course: “How will the sence of evidence, theoretical knowledge will guide
theory and research content of this course relate to practice. Research can also be used to generate new
my nursing practice?” This example demonstrates theory. The relationships between theory, practice,
how theory informs practice, how knowledge based and research will be further explored in Chapter 2.
only on experience can be biased and limited, and
how approaching clinical problems with system- Evidence-Informed Practice Tip
atic, scientific research methods can improve pa- What is the current evidence on how to remove
tient outcomes. Dan Ariely was not a nurse, but this burn dressings? Given that the example provided was
anecdote demonstrates how nursing practice could over a decade old, has this research been incorporated
be drastically changed by research. In this example into practice? Has more recent research been done?
Health care leaders have an important role to play in
you can see how theory, research, and practice are implementing research in practice areas. Implementing
connected. Theory is used to explain causal rela- research in practice requires support from leaders who
tionships (e.g., if I remove the dressing quickly, are champions of evidence (see Chapter 21 for more
about implementing evidence-informed practice).
it will be less painful). Theory needs to be tested
Learning about research will provide you reviewed journals that summarize valid and clinically
with an appreciation and understanding of the useful published studies. (CNA, 2018, p. 1)
research process so that you can more easily Therefore, to use research for evidence-
become a participant in research activities and informed practice, you may not necessarily be
an intelligent consumer of research. A research conducting research, but you can understand
user actively uses and applies research. To be and appraise the steps of the research process in
a knowledgeable research user, you must have order to read the research literature critically and
knowledge about the relevant subject matter, use it to inform your clinical decisions. Even as
the ability to discriminate and to evaluate in- students you can participate by completing sur-
formation logically, and the ability to apply the veys, attending research conferences, and asking
knowledge gained. You need not actually con- questions.
duct research to be able to appreciate and use At a provincial level, each province in Canada
research findings in practice. Rather, you must has its own standards for entry into nursing prac-
understand the research process and develop tice, and many of these standards have specific
the critical evaluation skills needed to judge the related research competencies. For example, the
merit and relevance of evidence before applying College and Association of Registered Nurses of
it to practice. The success of evidence-informed Alberta (2019) outlined the following competen-
practice depends on your ability to understand cies for nurses in their role as scholars:
the research process and to evaluate the evidence. Registered nurses are scholars who demonstrate a
Nurses in practice, who understand research and lifelong commitment to excellence in practice through
its contribution to knowledge, are ideally suited critical inquiry, continuous learning, application of
to identify phenomena and issues to be studied evidence to practice, and support of research activities.
(p. 15)
by asking relevant research questions.
Nurses must be intelligent users of research;
ROLES OF THE NURSE IN THE RESEARCH that is, they must understand all steps of the re-
PROCESS search process and their interrelationships. Frisch
et al. (2013) have developed a useful description
Every nurse practising in the 21 century has a role
of a Health Services Researchers Pathway that ex-
to play in the research process.
plains the five levels of nurses’ roles in research
The Canadian Nurses Association (2017) de-
(Table 1.1). The nurse interprets, evaluates, and
clares that “nurses support, use and engage in
determines the credibility of research findings.
research and other activities that promote safe,
The nurse discriminates between interesting find-
competent, compassionate and ethical care, and
ings for which further investigation is required and
they use guidelines for ethical research that are
those that are sufficiently supported by evidence
in keeping with nursing values” (p. 9). What does
before applying findings to practice. The nurse
this mean for you? There is a consensus that ef-
should then use these competencies to advance
fective use of research calls for the skills of criti-
nursing or interdisciplinary evidence-informed
cal appraisal; that is, you can appraise research
practice projects (e.g., developing clinical stan-
evidence and use existing standards to determine
dards, tracking quality improvement data, or co-
the merit and readiness of research for use in clin-
ordinating implementation of a pilot project to test
ical practice:
the efficacy of a new wound care protocol) of the
Sources of evidence need to be critically appraised
before their findings are incorporated into decision- workplace committees to which he or she belongs.
making and practice. Sources that meet this standard Nurses are also responsible for generating clinical
include systematic reviews, research studies and peer- questions to identify nursing issues that necessitate
TABLE 1.1
HEALTH SERVICES RESEARCHER PATHWAY
RESEARCH PROCESS DATA ANALYSIS LITERACY KNOWLEDGE TRANSLATION
Level 1 Research User: • Defines and distinguishes • Understands and values • Identifies credible and
Learning about between research and statistics and quantitative reliable resources
research use in care quality improvement and qualitative research
delivery settings methods
• Follows agency policy • Reads research reports • Performs literature
and clinical practice searches, integrating
guidelines; collaborates evidence into EIP
on QI activities
• Curious and willing to • Interested in and
learn about research advocates for practice
improvement
Level 2 Research User: • Describes research and • Understands application • Identifies opportunities
Using research in care QI processes; explains QI of statistics and steps of for knowledge sharing,
delivery settings processes and models research process understands concept of
strength of evidence,
distinguishing between
single studies and
systematic reviews
• Interprets protocols for • Collects and uses accurate • Collaborates with team
relevancy, conducts litera- data, uses basic statistics to change practice and
ture reviews, participates and qualitative methods support KT
in policy development
and QI
• Appreciates relationship • Appreciates the process of • Aware of and appreciates
between research and conducting research research activities in the
practice, values active workplace and willing to
engagement of front-line lead KT activities
staff in QI and research
Level 3 Research User: • Describes emerging • Interprets qualitative and • Describes KT practices
Facilitating and knowledge, best practices quantitative data and can and facilitates KT projects,
leading research and priorities; facilitates conduct simple analysis translates projects
use in care delivery research
settings
Level 4 Research • Understands research • Understands advanced • Uses research findings
Producer: Beginning designs and theoretical analysis techniques, to support policy and
researcher frameworks, manages critically and accurately practice, carries out KT
research projects, analyzes research data plans
contributes to research
teams
Level 5 Research • Expertise in at least one • Expert in analysis • Builds and implements KT
Producer: Research method, understands methods in own research as part of own research
scientist leading a various research program, manages and program
program of research approaches supervises use of data,
values rigorous analysis
• Leads a program of
research
Source: Adapted from Frisch & Hamilton (2013). Health Services Researcher Pathway. Michael Smith Foundation for Health Research and the BC Nursing
Research Initiative.
investigation and for participating in the imple- master’s-level training also facilitate the investi-
mentation of scientific studies. Nurses often gen- gation of clinical problems by enabling a climate
erate research ideas or questions from hunches, that is open to nursing research and by engaging
gut-level feelings, intuition, or observations of pain evidence-informed practice projects. A clinical
tients or nursing care. These ideas often become nurse specialist prepared with a master’s or doc-
the seeds of research investigations. toral degree in nursing who has clinical expertise
Nurses may participate in research projects as in a specific practice area can be the primary re-
members of research teams in one or more phases searcher or act as a collaborator to “ensure their
of a project. For example, a staff nurse may work practice applies evidence-based care most effec-
on a clinical research unit in which a research tively while being a leader in every aspect of re-
project is underway to test a new type of nurs- search” (CNA, 2020, Roles section).
ing care (e.g., for pain management, prevention To achieve the greatest expertise in appraising,
of falls, or treatment of urinary incontinence). designing, and conducting research, nurses must
In situations such as these, the nurse administers complete PhDs. Nurses with doctoral degrees de-
care according to the format described in the re- velop theories for phenomena relevant to nursing,
search protocol. The nurse may also be involved develop methods of scientific inquiry, and use a
in collecting and recording data relevant to the variety of methods to modify or extend existing
administration of, and the patient’s response to, knowledge so that it is relevant to nursing (or to
nursing care. other areas of health care). In addition to their role
After new knowledge is generated, it is im- as researchers, nurses with doctoral-level training
portant to share findings widely. This is called act as role models and mentors to guide, stimu-
dissemination. Examples of dissemination in- late, and encourage other nurses who are devel-
clude publishing an article or presentation at a oping their research skills. Nurses with doctoral
conference. It may involve joining a health care degrees also collaborate and consult with social,
agency’s research committee or its quality assur- educational, and health care institutions or gov-
ance or quality improvement committee, in which ernmental agencies in their respective research
research articles, integrative reviews of the litera- endeavours. These nurses then disseminate their
ture, and clinical practice guidelines are evaluated research findings to the scientific community, cli-
for evidence-informed clinical decision-making. nicians, and—as appropriate—the general public
Nurses who have graduate degrees are fur- through scientific journal articles and presenta-
ther prepared to conduct research as co-investi- tions at research conferences.
gators or primary investigators. With a master’s An essential responsibility of all nurses is to
degree, nurses can focus on being more active pay special regard to the ethical principles of re-
members of research teams. Although master’s search, especially the protection of human par-
degrees may focus on advanced clinical practice, ticipants (see Chapter 6). For example, nurses car-
advanced practice nurses are still champions for ing for patients who are participating in research
research. They can assume the role of clinical ex- on antinausea chemotherapy must ensure that
pert, collaborating with an experienced research- patients have signed the informed consent form
er in proposal development, data collection, data and that all their questions are answered by the
analysis, and interpretation. Nurses with mas- research team before they begin participation.
ter’s degrees enhance the quality and relevance Furthermore, if patients have an adverse reaction
of nursing research by providing clinical exper- to the medication, nurses must not administer
tise and evidence-informed knowledge about the more doses until they have notified an appropri-
way clinical services are delivered. Nurses with ate member of the research team. Regardless of
their role, nurses need to view the research pro- 1991. Another was established at the University
cess as integral to the growing professionalism in of British Columbia School of Nursing later
nursing. that year, and programs at McGill University
As a professional, you must take time to read and the University of Toronto followed in 1993.
research studies and evaluate them, using the Now there are many doctoral nursing programs
current standards for scientific research. Also, in universities across Canada. In addition, there
you will need to use the critiquing process to has been growth of university-based Registered
identify the strengths and weaknesses of each Psychiatric Nursing programs, with the first mas-
study. Bearing in mind that each study has its ter’s degree established at Brandon University in
limitations, you should consider whether sound 2011.
and relevant evidence from one study can be Growing awareness of the importance of nurs-
used in other settings as well. Chapter 21 will ex- ing research gradually led to the availability of
pand on how to bring research into your nursing research funds. The year 1964 marked the first
practice. time that a federal granting agency funded nurs-
ing research in Canada (Good, 1969). In 1999,
HISTORICAL PERSPECTIVE1 the Canadian government established the Nursing
Research Fund, budgeting $25 million for nursing
During the Crimean War, Florence Nightingale’s
research ($2.5 million over each of the following
detailed and systematic observation of nursing
10 years). The research areas targeted for support
actions and outcomes resulted in major changes
included nursing policies, management, human
in nursing practice. Her work demonstrated the
resources, and nursing care. Although this fund-
importance of systematic observational research
ing is no longer available, nurse researchers have
to nursing practice.
been successful at obtaining Tri-Council fund-
In Canada, the establishment of univer-
ing nationally and international funding to sup-
sity nursing courses starting in 1918, followed
port their programs of research. Tri-Council is a
by master’s degree programs in the 1950s and
term referring to three federal research agencies:
1970s and by doctoral programs in the 1990s
Canadian Institutes of Health Research, National
and 2000s, was crucial to the development of
Science and Engineering Research Council of
nursing research. Since the 1970s and 1980s, the
Canada, and the Social Sciences and Humanities
two major factors in the development of nurs-
Research Council.
ing research have been the establishment of re-
search training through doctoral programs and
the establishment of funding to support nurs- CURRENT STATE AND FUTURE DIRECTIONS
ing research. Throughout the 1970s and 1980s, While the last 30 years has seen an increase
university faculties and schools of nursing built in the number of nurse researchers in Canada,
their research resources so that they could estab- there are still challenges. A global shortage of
lish doctoral programs. The first provincially ap- nursing faculty, particularly of nurses who hold
proved doctoral nursing program was established PhDs, impacts the education of the next genera-
at the University of Alberta Faculty of Nursing in tion of nurses as well as the capacity for nurs-
ing research (Vandyk et al., 2017). In Canada,
1
This section (i.e. Historical Perspectives p. 12) is adapted
there are numerous faculty vacancies and an in-
with permission from Duggleby, W., & Astle, B.J. (2019).
The development of nursing in Canada. In Potter, P., sufficient number of PhD graduates every year
Duggleby, W., Stockert, P. Astle, B., Perry A., & Hall, A. to fill these spaces; recruitment and retention
(Eds.), Canadian fundamental of nursing (6th ed., pp. 75–80). of faculty is a concern with an aging nursing
Elsevier. faculty workforce (Canadian Association of
Schools of Nursing, 2016). Nursing faculty are

needed to teach in undergraduate and gradu- Practical Application
ate programs and mentor the new generation of Dr. Kelli Stajduhar is a professor at the Institute
for Aging and Lifelong Health and the School of Nursing
nurse researchers. To further the body of 1234567890-=qwertyuiop[]\asdfghjkl;’zx-
nurs- at the University of Victoria. With a research career span-
ing knowledge, nurses will need to developcvbnm,./
pro- ning more than 20 years, Dr. Stajduhar leads a team of
grams of research, increase research on nursing researchers studying palliative and end-of-life care is-
interventions and outcomes, and be aware of sues. The work of this team of researchers spans from
palliative care in vulnerable populations (Stajduhar
national and international trends and issues in et al., 2019), supporting family caregivers (Sutherland
health and health care. et al., 2016), and understanding family’s experiences
(Stajduhar et al., 2017). Dr. Stajduhar collaborates with
researchers from around the world, as well as policy
Developing Programs of Research makers and health care providers. This work has influ-
To build robust research knowledge, nurses need enced and will continue to shape a palliative approach
to care in Canada.
to be recruited early in their careers to pursue
graduate education and develop programs of re-
search. Developing a program of research can the importance of research teams. A large cadre
take years. Researchers need time in their careers of nurse researchers, who begin their research
to establish their expertise and develop the neces- careers at a young age, is important for the
sary collaborations and funding streams to sup- development of research programs like Dr.
port their investigations. Stajduhar’s. The goal is to increase the longevity
Research programs that include a series of of research careers, enhance the discipline’s sci-
studies in a similar area, each of which builds entific development, promote mentoring oppor-
on a prior investigation, promote depth and tunities, prepare the next generation of research-
credibility in nursing science. An example of ers, and provide leadership in health care. The
a research program can be seen in the Practical Research Vignettes included in this book have fur-
Application box. To maximize use of resources ther examples of Canadian nurse researchers who
and to prevent duplication, researchers must have developed programs of research addressing
develop intradisciplinary, interdisciplinary, and a variety of current health care trends and issues.
international networks in similar areas of study.
Researchers from a variety of health profes-
sions (e.g., medicine, nursing, and respiratory Interventions and Outcomes
therapy) and other disciplines such as psychol- Globally, there is a need for more research on
ogy, law, and business can come together to de- nursing interventions (Richards, Hanssen, & Bor-
lineate common and unique aspects of patient glin, 2018) and fundamental nursing care (Kitson
care. Interdisciplinary health research may be et al., 2019). Quality research is still needed to
“a team of researchers who come together to re- address essential nursing care tasks including
search an important and challenging health is- managing elimination, hygiene, nutrition, and
sue” (Hall et al., 2006, p. 764). Interdisciplinary mobility with patients (Richards, Hilli, et al.,
research is increasingly becoming a mandate of 2018).
research funders, as it is recognized that exper- Strategies that enhance nurses’ focus on out-
tise is required from many disciplines to solve comes management through evidence-informed
complex health and social problems (Clarke quality improvement activities and the use of
et al., 2012). research findings for effective clinical deci-
Dr. Stajduhar’s work illustrates the value of sion making also are being refined and iden-
building a program of research and highlights tified as research priorities (see Chapter 21).
Evidence-informed practice guidelines, stan- logistical limitations of this method, the number
dards, protocols, decision tools, and critical path- of international collaborative research projects
ways are becoming benchmarks for cost-effec- has increased. Nurse researchers participating in
tive, high-quality clinical practice. For example, collaborative international research projects are
the Registered Nurses’ Association of Ontario well positioned to play a large role in improving
(RNAO) (2016) has developed 50 best practice health care globally (CNA, 2012; Grady, 2015).
guidelines to support nurses in their efforts to pro- An example of international collaboration can be
vide the best possible patient care. seen in Chapter 19 (Harvey et al., 2019).
International organizations committed to the
goal of health care for all help create natural
Evidence-Informed Practice Tip
research partnerships. For example, the World
The COVID-19 pandemic in 2020 created many
challenges and opportunities for nursing research. Health Organization (WHO, n.d.) has established
While delaying the conduct of some research projects a series of collaboration centres to advance health
and funding decisions, the pandemic also resulted in care for the global community. One such centre
a plethora of research on new topics. For example, re-
search is examining the impact of personal protective works toward maximizing the contribution of
equipment on nursing workflow in emergency depart- nursing and midwifery and provides relevant re-
ments (Government of Canada, 2020), standardized search and clinical training to nurses worldwide.
nursing care models for COVID-19 patients (Richards,
2020), and nursing leadership in acute and long term
care settings during the pandemic (Baxter, 2020). Research Priorities Reflecting Trends
and Issues
Funding agencies often determine research pri-
An International Perspective orities based on their needs and interests. These
The continuing development of a national and priorities are often reflective of trends and issues
international research environment is essential in health and health care. In 2018, the Canadian
to the nursing profession’s mission to “improve Association of Schools of Nursing identified seven
the health and well-being of all world citizens” priorities for nursing research:
(National Institute of Nursing Research, 2015, • Indigenous and other vulnerable and/or equity
n.p.). The CNA has been partnering with many seeking communities
international networks in more than 45 countries • Chronic disease management and care delivery
to strengthen the nursing profession’s contribu- across space and time
tion to global health through study, research, and • Home care and primary health care nursing
practice (CNA, 2012). Because of nursing’s em- • Care of older adults across diverse care contexts
phasis on the cultural aspects of care and the in- • Roles, scopes of practice, and value of RNS,
fluence of such factors on practice, international and/or NPs to health care
research is likely to increase. Access to multiple • Nursing care, quality improvement, and patient
populations as a function of globalization allows safety
the testing of nursing science from various per- • Nursing education outcomes
spectives. The Canadian Foundation for Healthcare Im
International research projects are often fo- provement (CFHI, 2020a) supports spreading
cused on comparative research in which a phe- health care innovations throughout Canada by
nomenon is studied in more than one country. bringing together patients, families, health and
Ideally, relationships are formed with researchers social services providers, governments, and other
from the international sites, resulting in collabor- organizations from across the country to solve
ative research projects. Despite the financial and persistent health care problems. Two priority
health challenges that have been identified are sustained life-threatening illnesses will live with
improving access to addiction and mental health the help of new life-sustaining technology that
services, and home and community care (CFHI, will in turn create new demands for self-care and
2020b). These two areas were identified by the family support. Cancer, heart disease, arthritis,
Government of Canada as shared health priorities asthma, chronic pulmonary disease, diabetes, and
between federal, provincial, and territorial gov- Alzheimer’s disease, prevalent during middle age
ernments (Health Canada, 2018). and later life, will be responsible for expendi-
The Canadian Institute for Health Research tures of large proportions of the available health
(CIHR) is one of the largest funders of health re- care resources. The impacts of the COVID-19
search, although the application process is highly pandemic on the health of individuals and com-
competitive, with as few as 13% of applicants be- munities will likely not be fully understood for
ing successful in procuring funding (Semeniuk, years. HIV/AIDS, a chronic illness that affects
2016). men, women, and children, will continue to have
In 2016, CIHR developed a strategy for a significant effect on health care delivery. Access
patient-oriented research to help engage patients to quality palliative care services and ground-
in research as more than just participants and to breaking research on medical assistance in dying
promote research that addressed patients’ con- will be prevalent.
cerns (CIHR, 2018). This resulted in research
Another vulnerable population, persons with
units being developed across the country to
mental health illness and addictions, will be
help researchers increase and improve patient-
served by a better understanding of mental disor-
oriented research. It has impacted how research-
ders, which will emerge because of advancements
ers get funding for research and offers support to
in psychobiological knowledge and research ini-
help facilitate research that is focused on patient
tiatives. Mental health illnesses will continue to
outcomes.
be a major public health issue; “depression is
Reducing health disparities in underserviced
a leading cause of disability and a major con-
communities and vulnerable populations is an-
tributor to the overall global burden of disease”
other major topic that will shape the focus of
future nursing- and interdisciplinary-related re- (WHO, 2020, Key Facts). Alcohol and drug abuse
search agendas, particularly among Indigenous will continue to be responsible for significant in-
peoples. The CIHR (2020) has an Institute dividual suffering and health care expenses as
of Indigenous Peoples’ Health and the health well as significant social and economic losses
of First Nations, Inuit and Metis Peoples is a (WHO, 2018).
priority for the other institutes of CIHR that Nurse researchers will have an increasingly
offer research funding. In 2019, CIHR created strong voice in shaping public policy relating to
six research awards for Indigenous Research health care. Disciplines such as nursing—because
Chairs in Nursing. These awards, totalling close of its focus on treatment of chronic illness, health
to $6 million, support Indigenous and non- promotion, independence in health, and care of
indigenous nurses to conduct research focused the acutely ill, all of which are heavily emphasized
on Indigenous health. values for the future—will be central to the shap-
Health research will continue to occur across ing of health care policy in the future. Research
the lifespan. For example, the health concerns of evidence that supports or refutes the merit of
mothers and infants will continue to spur research health care needs and programs focusing on these
that deals effectively with the maternal–neonatal issues will be timely and relevant. Thus, nurs-
mortality rate. Individuals of all ages who have ing and its scientific base is well placed to shape
health policy decisions (Turale & Kunaviktikul,

2019). CRITICAL THINKING CHALLENGES
Data analytics has incredible potential to im- ■ What research roles are you interested in?
prove health care. Nurse leaders will need com- ■ What effects will evidence-informed patient out-
petencies in analyzing, managing, and using data come studies have on the practice of nursing?
analysis tools. Using this unprecedented amount ■ Have you had any experiences, like Dan Ariely’s,
of information, nurses can improve patient care that make you question nursing practice?
and mitigate risk by informing decisions about ■ Why is it important to have interdisciplinary and
patient flow, interventions, workforce model- international research perspectives?
ling, cost drivers, and workplace safety (Solman,
■ What topics in nursing do you think require fur-
2017). Knowing how to ethically access and suc-
ther research?
cessfully analyze this data will be key if nurses—
regardless of their role—are to make the best use
out of this increase in technology and computing CRITICAL JUDGEMENT QUESTIONS
power.
1. What is the most appropriate source of informa-
Communication of nursing research has also tion for evidence-informed practice?
become increasingly important. Research find-
ings continue to be disseminated in professional A. Charge nurse
arenas (e.g., international, national, regional, and B. Attending physician
local electronic and print publications and con- C. Clinical practice guideline
ferences) as well as in consultations and staff D. Nightingale’s notes on nursing
development programs implemented on site 2. Why are interdisciplinary networks important in
through webinars and websites. Dissemination research?
of research findings in the public sector has also A. Collaboration can help solve complex prob-
gained importance. lems
Increasingly, nurse researchers are being asked B. Nurses do not do independent research
to testify at governmental hearings and to serve C. Research funding needs to be spread across
on commissions and task forces related to health disciplines
care. Nurses are quoted in the media when health D. There is overlap in the scopes of practice
care topics are addressed, and their visibility has 3. What drives the priorities for health care research?
expanded significantly. A. Political agenda
As opportunities are recognized and gaps in B. Changes in values in society
science are observed, nurses will conduct, cri- C. Trends and issues in health care
tique, and use nursing research in ways that pub- D. The United Nations
licly demonstrate how nursing care makes a dif-
ference in patients’ lives. Nurses have a research
heritage to be proud of. They also have a chal-
lenging and exciting future ahead of them. Both KEY POINTS
researchers and users of research need to engage
• Nursing research expands the body of scien-
in a united effort to gather and assess research tific knowledge that forms the foundation of
findings that make a difference in the care that evidence-informed nursing practice.
is provided and in the lives that are touched by • Nurses gain research literacy through educa-
their commitment to evidence-informed nursing tion and practical experience. As users of
practice.
Canadian Foundation for Healthcare Improvement

research, nurses must have a basic under- [CFHI]. (2020a). About us. Retrieved from https://
standing of the research process and must www.cfhi-fcass.ca/AboutUs.aspx.
demonstrate critical appraisal skills to evaluate Canadian Foundation for Healthcare Improvement
the strengths and weaknesses of research be- [CFHI]. (2020b). Priority health innovation
fore applying the research to clinical practice. challenge. Retrieved from https://www.cfhi-fcass.ca
• All nurses, whether they possess baccalaure- /WhatWeDo/challenges/priority-challenge.
Canadian Institutes of Health Research [CIHR]. (2018).
ate, master’s, or doctoral degrees, have a
About SPOR. Retrieved from https://cihr-irsc
responsibility to participate in the research
.gc.ca/e/51036.html.
process. Canadian Institutes of Health Research [CIHR]. (2020).
• Programs of research studies and replication of Indigenous health research at CIHR. Retrieved from
studies will become increasingly valuable. https://cihr-irsc.gc.ca/e/50339.html.
• Research studies will emphasize clinical issues, Canadian Nurses Association [CNA]. (2012). CNA global
problems, and outcomes. Priority will be health partnerships retrospective. Retrieved from https://
given to research studies that focus on health nurseone.ca/, http://media/cna/page-content/pdf-fr
promotion, care for the health needs of vulner- /global_health_partnership_program_2012_e.pdf?la=en.
able groups, and the development of cost- Canadian Nurses Association [CNA]. (2017). Code of
effective health care systems. ethics for registered nurses. Retrieved from https://
www.cna-aiic.ca/html/en/Code-of-Ethics-2017
• Both users of research and nurse researchers
-Edition/files/assets/basic-html/page-1.html.
will engage in a collaborative effort to further
Canadian Nurses Association [CNA]. (2018). Evidence-
the growth of nursing research and accomplish informed decision-making and nursing practice.
the profession’s research objectives. Retrieved from https://www.cna-aiic.ca/-/media/cna
/page-content/pdf-en/evidence-informed-decision
FOR FURTHER STUDY -making-and-nursing-practice-position-statement
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LoBiondo/Research for the Audio Glossary. nurse specialists,.Retrieved from https://www.cna
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/advanced-nursing-practice/clinical-nurse-specialists.
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CHAPTE R 2
Theoretical Frameworks
Sarah Stahlke
LEARNING OUTCOMES
After reading this chapter, you will be able to do the following:
• Define key concepts in the philosophy of science.
• Identify and differentiate between theoretical/empirical, aesthetic, personal, sociopolitical, and ethical
ways of knowing.
• Identify assumptions underlying the post-positivist, critical social, and interpretive/constructivist views
of research.
• Compare inductive and deductive reasoning.
• Describe how a framework guides research.
• Differentiate between conceptual and operational definitions.
• Describe the relationships among theory, research, practice, and leadership.
• Discuss levels of abstraction related to frameworks guiding research.
• Describe the points of critical appraisal used to evaluate the appropriateness, cohesiveness, and
consistency of a framework guiding research.
KEY TERMS
aim of inquiry epistemology post-positivism
concept hypothesis qualitative research
conceptual definition inductive reasoning quantitative research
conceptual framework methodology text
constructivism model theoretical framework
constructivist paradigm ontology theory
context operational definition values
critical social theory paradigm worldview
critical social thought philosophical beliefs
deductive reasoning positivism
STUDY RESOURCES
Go to Evolve at http://evolve.elsevier.com/Canada/LoBiondo/Research
for the Audio Glossary.
20
CHAPTER 2 Theoretical Frameworks 21
THE NATURE OF KNOWLEDGE becomes outdated. In this chapter, we focus spe-

AS YOU LEARNED IN CHAPTER 1, NURSES DEVISE clini-
cifically on theoretical frameworks and how they
cal questions, based on their daily practice experi- guide and inform knowledge generation.
ences, that, if answered, can improve the care they Nursing knowledge is created and interpreted
provide to individuals, families, and communities. at various levels of abstraction, ranging from the
Each question requires that clinicians and nurse most abstract to the most concrete thinking (Butts,
researchers engage in a knowledge development 2015). Fawcett has identified five components of
process (Fig. 2.1). The process begins with the nursing knowledge, which span a range of ab-
identification of knowledge gaps: the absence of straction levels. These include metaparadigm,
theoretical or scientific knowledge relevant to the philosophy, conceptual model, theory, and em-
phenomenon of interest. Knowledge generation pirical indicator (Butts, 2015). The metaparadigm
occurs next, with the conduct of research that pro- is the most abstract level of knowledge in nurs-
vides answers to well-thought-out research ques- ing. It is the worldview of the discipline, which
tions. This knowledge is then distributed through distinguishes its focus (Butts, 2015). Philosophy
journal articles, textbooks, and public presenta- addresses questions about existence, reality,
tions to nurses. Next, the knowledge is adopted, knowing, and ethics as they pertain to nursing
as nurses alter their practice based on published (Butts, 2015). Conceptual models are a set of con-
information or as health care organizations de- cepts that address broad, general ideas of interest
velop policies and protocols that are informed by to the discipline, while theories translate concepts
newly generated knowledge. Finally, knowledge into testable questions that can be explored using
is reviewed and revised as new health issues arise, empirical indicators such as instruments, experi-
advances in clinical practice occur, or knowledge ments, or procedures (Butts, 2015).
Knowledge Gap
• Nurses ask questions that require
answers from experts in the field.
• Absence of theoretical/empirical
knowledge.
Knowledge Review and Knowledge Generation

Revision
• Research questions are devised
• New health issues lead to the asking about a phenomenon.
of new questions. • Qualitative and quantitative
• Old knowledge is revised or excluded. methods are used to answer the
• New questions prompt the need for questions.
new research.
Knowledge Distribution
Knowledge Adoption
• Knowledge is shared with profession
• New knowledge is used to alter
through formal (presentation, journal
practice.
publications, reports) and informal
• New knowledge is used to
(media, Internet, social networks)
develop policies and protocols.
reporting methods.
FIG. 2.1 Knowledge development process.

Knowledge that comes from the inner

experiences and maturation of the nurse
Encompasses becoming a whole, aware,
genuine, and authentic self
Continual life process that occurs with
deep reflection
Scientific knowledge Allows for interpersonal relationships
Development and testing of
theories/theoretical models Theoretical/ Personal
Observation and measurement of Empirical Knowledge
case-specific issues and phenomena Knowledge
Quantitative and qualitative research
Knowledge that comes from
repeated exposure to
Contextual knowledge that situations that lead to the
moves beyond nurse– refining of earlier ideas and
patient relationship and the thoughts
profession Experiential Involves movement along a
Understanding of culture, Sociopolitical Culture Knowledge continuum of novice
society, and politics Knowledge competent expert
Awareness of how society practitioner
is organized and its Expert practitioner is fully
implications for health engaged and attuned to
each situation and responds
on the basis of past learning
The art of nursing
The expressive, intuitive, and Ethical
Aesthetic Moral component of nursing knowledge
creative aspect of nursing Knowledge
Knowledge Encompasses the moral principles, codes,
Practice that incorporates poetry, art,
music, and stories, allowing a deep and theories of ethical conduct
understanding of the human The moment-to-moment judgement of
experience what is “right” and “responsible”
Involves confrontation and resolution of
ethical conflicts
FIG. 2.2 Nursing knowledge.

(Adapted from Chapter 2 of the previous edition of this book, written by Cherylyn Cameron.)
Figure 2.2 outlines the various ways by which in nursing (Zander, 2007). Understanding the so-
nurses inform their practice. These include theo- ciopolitical context of practice is an overarching
retical/empirical, personal, experiential, ethical, way of knowing; nurses can situate their practice
aesthetic, and sociopolitical/cultural ways of and knowledge within a societal context (Zander,
knowing (Chinn & Kramer, 2015; Zander, 2007). 2007).
Empirical knowing is acquired through the sci- It is important to remember that the way we
entific process, which results in tested and justi- understand these aspects of knowledge is based
fiable knowledge for practice (Zander, 2007). In on our cultural perspectives, such as Western
contrast, aesthetics is the art of nursing in which ideologies or Indigenous ways of knowing.
the nurse interprets the patient’s behaviour and Indigenous perspectives are covered in depth in
needs and addresses the bigger picture of pa- Chapter 7, but a brief introduction is warranted
tient care (Zander, 2007). Ethical knowing is the here. Indigenous knowledge is “a learned way
moral component of nursing and is concerned of looking at the world that may have very dif-
with justifying and judging actions. This know- ferent forms of acquisitions, transmission, and
ing depends on an understanding of philosophi- manifestation for Indigenous peoples” (Battiste
cal concepts about what is good as well as rights & Henderson, 2000, p. 48). Indigenous knowl-
and obligations (Zander, 2007). Personal know- edge is transmitted through oral traditions, which
ing involves an existential awareness of self and provides a way of understanding Indigenous
others in relationship (Zander, 2007). Experience people’s experiences and promotes a continued
and intuition constitute other forms of knowing existence of their culture. Battiste (2000) rightly
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Money should never be carried; one’s servant should keep it, save
a few kerans.
In very cold weather it is as well to put on a big pair of coarse
country socks over one’s boots, and to twist a bit of sheepskin, with
the hair on, round the stirrup iron; these precautions keep the feet
warm.
A sun hat or topi is of the first necessity; also thick and strong
loose-fitting gloves (old ones are best) of buckskin.
A change of trousers or breeches, in case of a soaking, should be
kept with the head servant, who should always have matches.
Bryant and May’s are the best, and with three of their matches a
cigar or pipe can be lit in any wind: they sell a tin outer match-box
which is very useful, as one cannot crush the box; this, with one’s
knife, pipe and pocket-handkerchief, should be one’s only personal
load.
Oxford shirts, grey merino socks, and a cardigan of dark colour,
complete the equipment; the last is a sine quâ non.
A Norfolk jacket is best for outer garment. No tight-fitting thing is of
any use.
On arrival tea should be the first thing, the kettle being got under
way at once; then carpets spread, chairs and table brought,
mattresses filled and laid, beds made, and fire lit if cold. Make tea
yourself in your kettle, and make it strong; never let your servants
make it, as they either steal the tea or put it in before the water is
boiling, so that they may get a good cup, and you, of course, get
wash.
A Persian lantern should be taken of tin and linen (this shuts up)
for visiting the stable at night, and another for the cook to use.
Water should always be carried both to quench thirst, and for a
small supply lest at the next stage water be bad or salt.
Smoked goggles are a necessity.
A puggree of white muslin should be used for day marching.
A big brass cup can be taken in a leather case on the head
servant’s saddle-bow; it acts as cup or basin.
No English lamps should be used, as they always get out of order.
It is wise before starting to see that the cook’s copper utensils are
all tinned inside. A copper sponge-bath and wash-basin are needed.
Plates and dishes all of tinned copper.
A few nails are required to nail up curtains, stop holes, etc.
APPENDIX D.
RUSSIAN GOODS VERSUS ENGLISH.
The Karūn River Route—The best means of reaching the Commercial

Centres of Persia—Opinions of Experts—Wishes Of Merchants.
Colonel Bateman Champain, R.E., in a paper read before the

Royal Geographical Society, January 15, 1883, after estimating the
population of Persia at six millions, gives among the products of the
country, “grains of all kinds, cotton, tobacco, silk, opium, fruits, dates,
wool, hides, carpets, rugs, and an immense variety of the luxuries
and necessaries of life. There is, on the other hand, a large demand
for cloth, cotton fabrics, sugar, tea, coffee, and all the innumerable
comforts called for by a moderately civilised community.” He then
goes on to state, “that the great proportion of these articles are
imported from or through Russia” and that “it is but too evident that
Russian manufactures are steadily superseding British wares at
Ispahan, and even in the Persian markets south of that centre.”
Colonel Champain then proceeds to notice the various proposed
means for reaching the commercial centres of Persia; and after
pointing out their disadvantages, draws the attention of the Society
to the proposed route viâ the Karūn River.
General Sir F. Goldsmid, after corroborating the statements of
Colonel Champain as to the roads, spoke of railways in the future
through Persia, particularly a complete railway between England and
India; said that “failing the project of the great Indian railway, which
could not be carried out for many years, nothing could be better than
the proposed communication, partly by water and partly by road, viâ
Ahwaz to Ispahan and Teheran” (the Karūn River route).
Mr. G. S. Mackenzie, after some prefatory remarks, recounted how
he started from Mohammera (to which place goods may be taken by
ocean steamers), on the 27th July, 1878, in the steamer Karūn of
120 tons, built for Hadji Jabar Khan, Governor of Mohammera, at a
cost of 6000l.; in twenty-three hours Mr. Mackenzie arrived at
Ahwaz, without the steamer either bumping or grounding, and he
ascertained that at the lowest season the river is navigable. At
Ahwaz the river is blocked by rapids for about 1100 yards as the
crow flies, but (a canal or) a tramway of some 1600 yards would
reach the open portion of the river; thence Captain Selby, in the
Indian steamer Assyria, succeeded in ascending to within five miles
of Shuster (and also he steamed up the Diz River to within one mile
of Dizful). From Shuster to Ispahan is 266 miles, or twelve ordinary
mule stages.
The time taken by goods in reaching Ispahan from Mohammera by
river is,
Days. hrs.
By steamer to Ahwaz 0 23
By transshipment by (train or) mules 0 4
Thence to Shuster by river, say fifty miles 0 12
By caravan to Ispahan (allowing one day’s detention) 13 0
14 15
The present route is from Bushire to Ispahan (while from
a week’s to a fortnight’s delay at Shiraz is generally 23 0
experienced in getting fresh mules)
Certain difference 8 9
Or probably (on account of delay at Shiraz) 18 0
The land journey (the chief of the Bakhtiaris being favourable, of

which there is no doubt) resolves itself to a journey over an ordinary
Persian mule track, no worse than the old one from Bushire to
Shiraz, while as it passes through a good grazing country, hire would
be cheaper.
After some remarks in praise of Russia from Col. C. E. Stewart,
Mr. Russell Shaw, having a general experience of railways, and
having actually surveyed a proposed line from Baghdad to the
Persian frontier, disposed of the various costly and ideal schemes of
railways for Persia; and suggested the feasibility of reaching Persia
from India.
The President, after a few general remarks, in which he wished
well to large schemes of railway extension through Persia, in the far
distant future, “thought it had been clearly demonstrated that it
was possible, at a very small cost, to get a route into that
part of Persia where alone Englishmen could hope
successfully to compete with Russians.”
The President stated that, “It was clear that if she (Persia) would
offer no obstacles, the route up the Karūn would very soon be made
practicable; and he could not but think that if it were steadily pressed
upon the Persian Government, the desired result would be
obtained.”
He concluded with well-deserved compliments to Colonels
Champain and Smith, and Mr. Mackenzie.
It is a question whether the valuable commercial interests of this
country in Persia receive the attention they deserve. Why do we not
try to imitate Russia in opening the marts of Persia? She has done
so till the word “Russian” has come to mean “anything foreign”! Why
do not we insist on the Karūn River being thrown open to British
enterprise? Russia is a civilising influence, a rough one, perhaps, but
still a civilising influence: and she is civilising the Turkoman.
The export of opium alone in 1881 was 924,000 lbs., which at 16s.
a lb.—an ordinary price—is 739,200l.; and were Persia thrown open
to English enterprise, this sum would have been sent there, not in
specie, but in Manchester manufactured goods, etc.
I have good authority for stating that England is the only country
admitting the produce of Persia duty free; as opium, wool, cotton
(and good cotton), carpets, grain, dates, galls, gums.
Persia gives nothing in the way of facilities in return, for Russian
influence is too strong, and under that influence, or from her own
tortuous policy, she keeps the southern route, viâ the Karūn River,
closed to English enterprise.
But the principal difficulty that the English merchant has to contend
against, is the difficulty he has as an Englishman to recover debts,
and whether this be impotence or policy on the part of those in
authority, the fact remains, and has necessitated the withdrawal of
important English establishments from Ispahan and Shiraz. The tact
or energy of Her Majesty’s representatives at Teheran and Bushire is
not to be doubted; but Downing Street seems to order a “masterly
inactivity” or “an expectant attitude.” At Teheran we have a Minister
Plenipotentiary and a Vice Consul, with the usual staff of a Legation;
at Tabriz and Bushire, Consuls-General: but at Kermanshah,
Hamadan, Ispahan, Shiraz, Yezd, and Kerman, all great commercial
centres, we have only native agents; these men exercise no
influence, and are held in contempt by natives and Europeans alike,
as powerless. At times, however, the native (or British) agent has
real influence, mostly personal: as in the case of Mirza Hassan Ali
Khan, C.I.E., our late agent at Shiraz. We want English Consuls to
protect us and our trade, say the merchants, and then the opening of
the Karūn River: without these Persia as a mart is closed to English
enterprise, and becomes the monopoly of Russia.
GLOSSARY OF PERSIAN WORDS,
Having the transliteration of the Oriental scholar Johnson affixed in
parentheses to most words. Where no parentheses occur, the same
way of writing the word as that scholar is employed.
Abba, Abbah (abā).—A long, sleeveless, square-cut cloak,

generally of camel-hair—much worn by priests.
Ab-i-Rūkhni (ābi rukni).—The Spring of Rukhni (Rooknabad,
Moore).
Ab Khori (āb khūrī).—A watering bit.
Achōn (ākhūn).—A schoolmaster.
Agha, Aga (āghā).—A lord, a master.
Ahū (āhū).—An antelope.
Aid-i-no rūz (aidi naw roz).—New Year’s Day.
Alangū.—A bangle (of glass).
Aleph, Alef (alaf).—A grain, grass, or forage-seller.
Alhamdulillah (al hamdu li’llāh).—Thank God. Praise to
God.
Alkalūk, Alkalōok (alkhálik).—An inner quilted tunic.
Alū Balū (ālū bālū).—A cherry.
Alū Bokhara (ālū Bokhara).—A kind of small acid plum.
Amān, Amaun (amān).—Mercy!
Anderūn (andarūn).—The harem. Women’s quarters.
Asp-i-no-zin (aspi naw zīn).—A horse just fit for the saddle.
Badinjon (bādinjān).—The aubergine or brinjal.
Badragha (badraka).—A riding out with a departing guest.
Baggali (baghalī).—Native glass bottles.
Bakkal (bakkāl).—A general dealer.
Bamiah.—The ladies’-finger (a vegetable).
Bala khana (bālā khāna).—An upper room, hence balcony.
Bander (banda).—Literally, a slave. I (by courtesy used).
Bazaar (bāzār).—A collection of shops (the road between
which is usually covered).
Bazaar kabob (bāzār kabāb).—Minced and seasoned meat
toasted.
Bāzārcha buland.—The lofty bazaar.
Bazū-band (bāzū-band).—An armlet (generally containing a
talisman).
Bazzaz.—A shopkeeper.
Belli (balē).—Yes.
Bero (bi-ro).—Go! (Imperative).
Berūni (birūni).—The outer (or men’s) apartments.
Bezun (bi-zan).—Beat! (Imperative).
Bhuta (bota).—Camel-thorn, brushwood.
Bismillah (bismi’llāh).—In the name of God!
Borio (būrīy).—A kind of coarse matting.
Brilliān (biryān).—Minced and spiced meat sold cooked in
the bazaar.
Bulbul (pronounced Bull Bull).—A nightingale.
Būrak.—A small meat pie.
Butcha, Batcha (bacha).—Child! (Mode of addressing
servants, equivalent to the Anglo-Indian, boy!)
Cafsh-dooz. See Kafsh-dooz.
Cah (See Kah).—Cut straw.
Cajaweh. See Kajaweh.
Calaat. See Kalaat.
Calam-i-Rumi. See Kalam-i-Rumi.
Canaāt. See Kanaat.
Canjar. See Kanjar.
Caravanserai. See Karavanserai.
Chadūr (chādar).—An outer woman’s veil.
Chai (chā).—Tea (used throughout Russia and the East).
Chargāt (chargāt).—A square headkerchief.
Chehel sitoon (chihal-sitūn).—“The Forty Columns.”
Chekmeh-dooz (Chakmah dūz).—A boot-maker.
Chenar (chanār).—A plane-tree.
Cherragh (charāgh).—A lamp (in form and principle that of
the early classic one).
Chick (chīgh).—A fly blind.
Chillaw (chulāw).—Plain boiled rice.
Chocolah (chaghāla).—Green fruit when very small.
Chuppao (chāpū).—A raid on horseback.
Chupper (chār pā).—A mounted post (a quadruped), posting.
Chupperkhana (chār pā khāna).—A posting-house.
Colah. See Kolah.
Coorjin. See Koorjīn.
Coorshid. See Kūrshid.
Cossib. See Kossib.
Danah (dahanah).—A curb-ring bit.
Dar (dār).—A gallows, the execution pole.
Delak (dallāk).—A barber, a bath attendant.
Delleh.—A kind of weasel (? Mustela sarmatica).
Deyeereh (dayyīrah).—A tambourine.
Dilgoosha (dil-ku-shāy).—“Heartsease,” name of a garden at
Shiraz.
Dolma (dūlmah).—A kind of sweet or flavoured pudding of
rice or meat.
Doogh (dogh).—Buttermilk, curds and water.
Dozd (duzd).—A thief.
Dozd gah (duzd-gāh).—A place of thieves.
Dubbeh (dabbah).—A repented and repudiated bargain.
Dyah (dāya).—A wet nurse.
Fal (fāl).—A lot, an omen (sortes), pronounced fahl.
Farnoose (fānūs).—A cylindrical lantern.
Farrash, Ferash (farāsh).—A carpet-spreader.
Farrash (ferash)-Bashi.—Lit. chief carpet-spreader.
Farsakh.—A distance of from three and a half to four miles,
the hour’s march of a loaded mule, the parasang of
Xenophon.
Farsh.—A carpet of any kind.
Fellak, Fellek (fallak).—A pole having a noose attached to
hold the feet for the application of “the sticks” (or
bastinado).
Feramoosh-khana (farāmush khana).—The (lit.) house of
forgetfulness, a masonic lodge.
Fizinjan (fizinjān).—A dish flavoured with condensed
pomegranate juice and pounded walnuts.
Furder Insh’allah (fardā Insh’allāh).—“Please God to-
morrow.”
Gelas (gelās).—A white-heart cherry.
Gelim (gilīm).—A common kind of carpet.
Germak (garmak).—A small early melon.
Gezanjabine (gazangubīn).—Manna, or nougat.
Gheva (gewa).—A summer shoe described at p. 190.
Gholam (ghulām).—A mounted servant, lit. a slave, an
irregular cavalry-man.
Goja (gaujah).—A small green plum.
Gōmpezah (gōmbeza).—A dome.
Goor Khur (gor khar).—The wild ass.
Gūl (gul).—A flower.
Gūl Anar (guli nār).—Pomegranate flower.
Gūl-i-Soorkh (guli surkh).—The moss rose from which the
attār is made.
Gūmrūk (gumruk).—A custom-house.
Gūmrūkji (gumruk-chi).—A custom-house officer, or farmer
of customs.
Gunge (ganj).—A treasure.
Gungifeh (ganjīfa).—Playing cards.
Hakim (hakīm).—A physician.
Hakim-bashi (hakīm bashi).—The chief physician.
Hammal (hammāl).—A porter.
Hammam (hammām).—A bath similar to the Turkish bath.
Harrh (harr).—Rabid.
Hassin or Hasseen (hasīn).—A pan.
Hassir (hasīr).—A kind of fine matting.
Hauz (hawz).—A tank generally of stone and raised above
the ground-level.
Henna (hinnā).—A vegetable dye used on hair, hands, and
feet.
Hindiwana (hinduwānah).—A water-melon.
Hissam u Sultaneh (Husām us Sultana).—The Sharp Sword
of the State (a title that was given to the late uncle of the
Shah).
Hoojrah (hajrah).—An office, or bureau.
Huc (hak).—A share, the dervishes’ cry.
Hukhm (hukm).—An order.
Imād-u-Dowlet (Imad ud Dawla).—A title, viz. the Pillar of
the State.
Imam (imām).—A saint.
Iran (Īrān).—Persia.
Istikhbal (istikbāl).—A riding out to meet an arriving guest or
personage.
Istikhara (istiharat).—Omens (taking), chances.
Itizad-u-Sultaneh (Itizād us Saltanah).—A title, viz. the
Support of the State.
Jai-sheer (jayshīr).—Wild celery.
Jejim (jājim).—A thin kind of travelling carpet.
Jika (jīgha).—A jewel worn on the head by women. The royal
hat ornament of feathers and diamonds.
Jūl (jall).—A portion of horse-clothing.
Jūniver (jānwār).—A wild animal, an animal.
Kabab or Kabob (kabāb).—A roast or toasted meat.
Kaffir (kāfir).—An infidel (a term of reproach).
Kafsh.—A shoe.
Kafsh-dooz (kafsh-doz).—A shoe- or slipper-maker.
Kafteh-bazi (kaftār).—Pigeon-flying.
Kah (kāh).—Cut straw.
Kah gil (kāh gil).—Clay and straw mixed for plastering.
Kahtam (khātam).—Inlaid work like Tonbridge ware.
Kajaweh (kajāwa).—A covered horse pannier.
Kalaat (khalat).—A robe (or other token) of honour.
Kalam-dan (kalamdān).—A pen-case.
Kalam-i-Rumi (kallami-Rumi).—Lit. Turkish cabbage.
Kali (kālī).—A carpet having a pile.
Kalian, Kallian, Calian (kalyūn, kalyān).—A water-pipe or
hubble-bubble.
Kallehpuz (kallapaz).—Sheep’s head- and trotter-boiler.
Kanaat, Kanat, Canaāt (kanāt).—An underground channel
for irrigating.
Kanara (kanāra).—A side carpet.
Kanjar (khanjar).—A curved dagger.
Karavanserai (karavān-serai).—A public rest-house for
caravans; a khan.
Karbīza (kharbuza).—A melon.
Karkool (kakūl).—A long lock of hair by which Mahommed is
supposed to draw the believer up into paradise.
Kashang.—A beau, lit. beautiful.
Kawam.—A prefect.
Keeal (kayal).—A cucumber.
Keesa, Keeseh (kisa).—A hair glove used in the bath.
Keisi (kayzi ?).—Dried apricots.
Kemmerbund (kamar-band).—A belt, or sash.
Kendil (kindīl).—A votive offering of peculiar shape, generally
of copper or other metal.
Kenneh (? kannah).—A camel- or sheep-tick.
Ketkhoda (kat-khudā).—The head-man of a parish or village.
Khan (Khān).—A conferred title, which descends to all
children—now very common: in the second generation
equal to Esquire.
Khānum (khānam).—A lady.
Khok ber ser um (khāk bar sar-am).—Ashes on my head.
Kholar (? kolar).—A kind of wine of Shiraz.
Khyat (khayyāt).—A tailor.
Kohl.—Black antimony, eye paint.
Kolah (kulah).—A hat.
Kolajah (kulījah).—An outer coat for men or women.
Koompezeh, Kumbiza (kumbīza).—A species of cucumber.
Koorisht (khūrish).—A savoury dish, a ragout.
Koorjin, Coorjin (khwur-chīn).—Saddle-bags.
Kosh guzeran (khwush guzārān).—A free liver.
Kossib, Cossib (kasb).—A craftsman.
Kotol.—An effigy.
Kotul (kutal).—A mountain pass, lit. a ladder.
Kummer, Kammer (kammah).—A straight hiltless sword or
dirk, with a broad blade.
Kūmrah (khumra).—A wine (or other) jar.
Kūrbāghah.—A frog.
Kūrshid (khūrshīd).—The sun with rays of light.
Kūrsi (kūrsī).—A small platform used to cover a fire-pot, a
chair.
Kuttl-i-aum (katli ām).—A general massacre.
Lahaf (lihāf).—A quilted coverlid.
Lallah (lālā).—A male nurse.
Lanjin, Lanjeen.—An earthen pan.
Latifeh (latīfeh ?).—A courtezan, a Persian court card.
Lodah, Lodeh (lawda).—A pannier for grapes.
Lūti (lūtī).—A buffoon, a scamp, a thief.
Machrore (makrūh).—Lit. detestable, but yet not illicit; things
not to be eaten, but yet not unclean; i. e. not an unlawful
thing, but one which had better be avoided.
Maidān (maydān, mīdān).—The public square. A distance
about a furlong.
Makhmūn shud um (makhmūn shudam).—I am deceived.
Mallagh (?).—A tumbler pigeon, a summersault.
Mambar (mimbar).—A pulpit.
Mangal (munkul).—A brazier.
Mash’allah (Māshā’llah).—Lit. What God pleases! A phrase
used when praising, to avoid evil eye.
Mast (māst).—Curdled milk (Turkish, yaourt).
Maund (man).—A Persian weight of nearly seven, or nearly
fourteen pounds.
Meana (miyāna).—The middle. The middle tube of the water-
pipe.
Mehdresseh (medresseh; Arabic, madrasat).—A college.
Mejlis (majlas).—An assembly, a reception.
Mil, Meel (mayl).—A column, a watch-tower.
Mir-achor (mīr-ākhur).—Master of the horse, the.
Mir-shikar (mīr-shikār).—Chief huntsman, the.
Mirza (mīrzā).—One who can write, a clerk, a secretary, a
gentleman. As an affix equals “Prince.”
Moaalim (mwallīm).—A schoolmaster.
Modakel (mudākhil).—Illicit percentage, “cabbage.”
Mohulla (mahallah).—A street, a parish.
Monajem (munajjam).—An astrologer.
Mor (muhr).—A seal, a piece, as at draughts, etc.
Mūlla, Moollah (mūllā).—A priest.
Mūnshi, Moonshee (munshī).—A secretary, a clerk.
Murshed (murshid).—A chief of dervishes, or of a sect or
guild.
Mūschir (mushīr al mulk).[38]—The principal revenue officer
of Fars.
Mūshtahed (Mujtahid).—A teacher of law.
Must (mast).—Lit. drunk. The state of excitement of the
camel, etc.
Mutlub (matlab).—The pith, or meaning (of a letter).
Naib (naīb).—A deputy, a post-house keeper.
Naksh.—A kind of embroidery. See p. 131.
Nammad (namad).—A felt (of various kinds).
Nammak (namak).—Beauty of a brunette, high colour.
Narghil (nārjīl).—A cocoa-nut, a kind of water-pipe.
Nawalla (?).—Balls of flour given to horses and camels.
Nazir (nāzir).—A steward.
Neh (nay).—A reed, a spear, a flute.
Neh-peech (nay-pīch).—The flexible tube of a water-pipe.
Nejis (najīs).—Unclean.
Nober (nawba).—First-fruits.
Noker (nawkar).—A servant.
Nuffus (nafs).—Breath.
Ootoo (atw).—An iron.
Ootoo kesh (atw-kash).—An ironer.
Orūssēe (ūrūsī).—Lit. Russian, i. e. foreign. A Russian (-
shaped), i. e. foreign shoe, a raisable window, a room
having a raisable window, etc.
Paleng (palank).—A panther.
Pallikee (pālkī?).—A mule pannier to ride in.
Pane (pa-in).—Dried horse-dung.
Peilewan, Pehliwan (pahlevān).—A wrestler.
Peish-kesh (pīsh-kash).—An offering to obtain favour (a
nominal present).
Peish Khidmut (pīsh khidmat).—A head table-servant.
Peish-waz (pīsh-wāz).—Lit. a going out to meet.
Perhān, Perahān (pīrahan).—A shirt (for man, woman, or
horse).
Pider-sag (pidar sag).—Son of a dog! (Lit. O dog-fathered
one!)
Pillaw, Pilaw (palāw).—Rice boiled with butter.
Pūlad (pūlād).—Art steel-work. Damascened iron.
Rammal (rammāl).—A conjuring mountebank and finder of
treasure, a diviner. See p. 120.
Rangraz (rang-rez).—A dyer.
Rassianah (rāziyānah).—Anise plant, the.
Reich-i-Baba (rīsh-i-Baba).—A grape called “Old man’s
beard.”
Reis-i-Seem (rais).—Lit. master of the wire, i. e. Telegraph
superintendent.
Resht-i-Behesht (Risht-i-Bihisht ?).—Glory or brightness of
heaven.
Rivend (rīwand).—Rhubarb.
Roseh Khana (rosah-khānah).—A prayer-meeting, etc.
Rubanda (rū-band).—A (face) veil.
Rushwah (rishwat).—Lit. manure, i. e. a bribe.
Ryot (ra-īyat).—A subject, a tiller of the earth, a villager.
Sag.—A dog, a cur, a term of abuse.
Sahib (sāhib).—Lit. owner; Sir, Mr. (to an European).
Sāle ab (sayl ab).—Rise of the waters.
Sandalli (sandalī).—A chair.
Sang.—Lit. a stone, i. e. a weight.
Sangak.—A kind of bread. See p. 334.
Santoor, Santūr (santīr or santūr).—Harmonicon.
Sarhang.—A colonel.
Segah (sīgha).—A concubine.
Ser-andaz (sar-andāz).—That (carpet) laid over the head (of
the room).
Ser-Kashik-ji-bashi (sar-kashīkchi bāshī).—Chief of the
guard.
Seroff (sarrāf).—A banker, a money-changer.
Shah (Shāh).—The King.
Shahzadeh (Shāh-zāda).—Lit. born of a King, i. e. Prince (or
descendant of a Prince or King).
Shargird-chupper (shāgird-chāpār).—A posting guide.
Shatir (shātir).—A running footman.
Shatrunj (shatrang).—Chess.
Shatur.—A wrinkle.
Sheera (shīra).—Condensed grape sugar.
Shemr (Shimar).—The slayer of the martyr Houssein.
Sherbet (sharbat).—Syrup—generally fruit syrup—syrup and
water.
Sherbet-dar (sharbat-dār).—A servant who makes ices, etc.
Shikari (shikārī).—A huntsman.
Shireh-Khana (? shīra-khāna).—A wine-factory.
Shitūr (shatūr).—A wrinkle (of a carpet, etc.).
Shub-kolah (shab-kulah).—A night-hat (or cap).
Shukker para (shakar-pāra).—A kind of very sweet apricot
(lit. a lump of sugar).
Shul-berf (shal [?] bāf).—Loosely woven.
Shulwar (shalwār).—Trousers, breeches, petticoats.
Shuma (shumā).—You.
Soorki, Sorki (sākī).—(Classical) a cupbearer.
Sufrah.—A sheet of stuff or leather spread on ground to dine
off.
Sungak. See Sangak.
Syud, Seyd (sayyid).—A descendant of Mahommed.
Tager (tājir).—A merchant.
Takhja (tākchah).—A recess in the wall a yard from the
ground, a niche.
Takht.—A throne, a bedstead, a sofa, a platform.
Takht-i-Nadir (takhti-Nadir).—Backgammon. (Nādir Shah’s
favourite game.)
Takht-i-Pul.—A kind of backgammon.
Takht-rowan (takhti-ravanda).—Lit. a flowing or running bed,
i. e. a horse-litter.
Talár (tālār).—A lofty verandah, an arched room open at one
end.
Tamasha (tamāsha).—A show, a sight, a spectacle.
Tannoor, Tannūr, Tandoor (tannūr).—An oven.
Tarr (tār).—A guitar-like banjo.
Tatar (Turkish).—A gholam, a post rider, a courier.
Tazzia (Ta-ziyah).—The religious dramas or miracle plays.
Tazzie (tāzi).—A greyhound.
Teleet (? talīt).—A mixture of grass and cut straw for horse
feed.
Telism (tilism).—A talisman.
Teriak (tiryak).—Opium.
Teriakdan (tiryak-dan).—An opium pill-box.
Teriakmali (tiryak-māli).—Rubbing (i. e. preparation of)
opium.
Terkesh-dooz (tarkash-doz).—A quiver-maker, a saddler.
Toman, Tomaun (tomān).—Ten kerans (7s. 6d.), a gold coin.
Toolah (tūla).—A sporting dog.
Toorbesah, Toorbiza (turbuza).—A radish.
Tootoon (tūtan).—Tobacco for the chibouque.
Tūmbak (tumbak).—A kind of drum.

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