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With the increasing number of cross-cultural nursing studies, many scholars have suggested methods for conducting cross-cultural research. However, rigor in cross-cultural research has rarely been addressed. In this paper, five evaluation criteria for rigor in cross-cultural nursing research are proposed based on a review of the literature related to cross-cultural research published from 1965 to 2003. The proposed evaluation criteria include: (a) cultural relevance; (b) contextuality; (c) appropriateness; (d) mutual respect; and (e) flexibility. We advocate that these evaluation criteria be used to ensure rigor of cross-cultural nursing research, whether quantitative or qualitative work.

Aim: This paper discusses the literature on establishing rigour in research studies. It describes the methodological trinity of reliability, validity and generalization and explores some of the issues relating to establishing rigour in naturalistic inquiry., Background: Those working within the naturalistic paradigm have questioned the issue of using validity, reliability and generalizability to demonstrate robustness of qualitative research. Triangulation has been used to demonstrate confirmability and completeness and has been one means of ensuring acceptability across paradigms. Emerging criteria such as goodness and trustworthiness can be used to evaluate the robustness of naturalistic inquiry., Discussion: It is argued that the transference of terms across paradigms is inappropriate; however, if we reject the concepts of validity and reliability, we reject the concept of rigour. Rejection of rigour undermines acceptance of qualitative research as a systematic process that can contribute to the advancement of knowledge. Emerging criteria for demonstrating robustness in qualitative inquiry, such as authenticity, trustworthiness and goodness, need to be considered. Goodness, when not seen as a separate construct but as an integral and embedded component of the research process, should be useful in assuring quality of the entire study. Triangulation is a tried and tested means of offering completeness, particularly in mixed-method research. When multiple types of triangulation are used appropriately as the 'triangulation state of mind', they approach the concept of crystallization, which allows for infinite variety of angles of approach., Conclusion: Qualitative researchers need to be explicit about how and why they choose specific legitimizing criteria in ensuring the robustness of their inquiries. A shift from a position of fundamentalism to a more pluralistic approach as a means of legitimizing naturalistic inquiry is advocated.

Background: The most vulnerable older adults are often referred to as the frail elderly. There is a high prevalence of urinary incontinence (UI) in this population, yet there is little research to guide nurses in providing effective continence care to this vulnerable group of elders., Objectives: To summarize current knowledge on UI in frail older adults and suggest future areas for research in this population., Methods: Existing literature about UI in the frail elderly was analyzed to generate a plan for future research., Results: Gaps exist in the knowledge base needed to guide the nursing care of incontinent frail elders in the following areas: effectiveness of interventions, caregiver characteristics and management models, prevalence, risk factors, and reliability and validity of outcome measures. There are barriers to conducting research in long-term care settings., Conclusions: Despite the challenges inherent in doing research with incontinent frail elders, there is an urgent need for research to guide the nursing care of this population in all healthcare settings.

Background: As knowledge of the prevalence and impact of fecal incontinence increases, additional research is needed to improve patient outcomes and support the practice of nurses in this area., Objectives: To outline needs for future nursing research on fecal incontinence in aging adults., Methods: Existing literature about fecal incontinence was analyzed to generate a plan for future research., Results: Recommendations for investigation were proposed in the following areas: mechanisms underlying fecal incontinence and common to fecal incontinence and urinary incontinence; assessment of fecal incontinence; management strategies; and tracking a patient's response to fecal incontinence therapies across the healthcare system. Other areas of study identified as priorities included lessening the psychological burden of fecal incontinence, preventing perineal skin problems with appropriate skin care protocols and products, and developing efficacious nursing home routines and environments., Conclusions: Increasing the capacity of nursing research focused on fecal incontinence through funding support and recruitment incentives for new investigators is essential to achieve the proposed agenda.

Evidence-based nursing practice is now the expected standard of care intensifying the need to conduct clinical research studies to investigate the efficacy of nursing interventions. To ensure that the urgency to document such efficacy does not compromise human participant safety, government research funding agencies are advocating special procedures to protect individuals who voluntarily participate in research studies. The National Institutes of Health application for clinical trial funding requires a data and safety monitoring plan (DSMP) to enhance human participant safety and clinical research integrity. This article describes an approach to developing a DSMP that includes a study risk assessment and a monitoring design based on that assessment.

This article aims to discuss the problem of caring, researching and teaching in hospital nursing: general characteristics of Modern Nursing -- teaching and practice paradigm; characteristics of the Nightingale System. The research methodology was based on the analysis of fundamental care, research and teaching concepts in nursing practice, involving technical and gnoseological implications for pedagogical and research practice, which are illustrated through examples of hospital research. These entail repercussions for an epistemology of nursing. We highlight professional attitudes for the state of the art. The author evokes the need for disclosure, for efficient research methods and result reliability in (oncology?) nursing care, research and teaching activities. The conclusion points towards the relevance of nursing as a social practice and the problem of nursing activities in any area of care pragmatics -- whether in or outside the hospital context.

Does anyone working in home care have the time to do one more thing? We would think most clinicians, administrators, educators, and quality improvement coordinators would answer "NO." This article provides a current example of what happened when three Medicare-certified home health agencies answered "YES" to a research partnership dedicated to addressing the unique challenges of enhancing late-life depression treatment and outcomes in the home care setting. The development of an ongoing home care agency-university partnership is described to stimulate other agencies to consider this type of research collaboration.

Repeated measures designs are often used to evaluate the effectiveness of interventions. In these designs, the outcomes are measured on several occasions before and after implementation of the intervention. Two statistical methods, the repeated measures analysis of variance (RM-ANOVA) and hierarchical linear models (HLM), can be used to analyze the data. The authors provide an overview of the statistical models underlying RM-ANOVA and HLM and discuss the strengths and limitations of each. They propose that the 2 methods are complementary in determining the effectiveness of interventions.

The objective of this descriptive study was to evaluate the methodological accuracy of the studies presented by the Nursing Faculty in the 5h Congress on Scientific Initiation in a university in the city of São Paulo, based on a summary published in the event annals and on the posters presented there. Considering the 42 works, the objectives were adequately constructed in 45.2%, while 31% were not clear and not able to be evaluated. More than one methodological inadequacy was observed for the same work, totaling 56 occurrences. The results showed to be adequate in 24 works. 33.3% of the works had adequate conclusions, followed by 31.5% which did not meet the objectives of the study. Ethic questions in research were not mentioned in 64.3% of the works. When comparing works of the same subject performed by other Brazilian researchers, results indicate that the research activity in this Nursing Faculty needs more investment regarding qualification of the professors-orientators to fulfill the need of strengthening the activity.

This paper describes a mini review which enabled the identification of a suitable methodology to undertake a study about quality in the public health nursing in the Republic of Ireland. Reviews of literature increasingly adopt the methods of systematic review. In general, these methods have been developed to answer clearly focussed clinical questions. In this paper, we adopt the key elements of systematic review, comprehensive identification of relevant material and selection based on objectively defined validity, to a different type of question, that of an appropriate methodology to examine quality in the public health nursing service. In doing so, we demonstrate that questions of clinical effectiveness are but one application for systematic review.

This document initially presents an introduction to the global scenario in which nursing research is set today. Next, the main nursing research priorities are described in accordance with the agendas of international health and nursing organizations on different continents, as well as the characteristics of nursing research in Latin America until the end of the XXth century, based on studies and publications in which the main thematic tendencies are identified. Finally, the author reflects on the priority definition process in nursing knowledge production, with a view to attending the need for foundations of the subject area as well as public health needs.

Undergraduate nursing students have long been excluded from performing original theory-based nursing research due to severe time and work constraints. However, without actual research opportunities, students also lack research-writing experiences. This author describes successful strategies for teaching an undergraduate class how to write and submit a manuscript that describes an original research project.

Purpose/objectives: To identify the significant dimensions of the clinical trials nursing role and to construct a reliable and valid survey instrument to reflect these dimensions., Design: Methodologic survey., Setting/sample: The judge panel consisted of six national nurse experts. The focus group sample was comprised of 24 clinical research nurses from the West, Northeast, and Great Lakes regions of the United States and five research nurses from Canada. The sample for instrument testing consisted of 40 oncology clinical research nurses from the Southeast., Methods: Several strategies were used to develop the Clinical Trials Nursing Questionnaire (CTNQ): literature review, conceptualization of the subscales, development of items for each subscale, development of the tool, expert judge panel evaluation, focus group testing, administration of the tool, and psychometric analysis of the results., Main Research Variables: Frequency and importance of clinical trials nursing activities., Findings: Content validity was established at 0.95. The alpha reliability coefficient was 0.92 for the frequency scale and 0.95 for the importance scale. A two-week test-retest reliability of 0.88 was obtained for the frequency scale and 0.92 for the importance scale. The final CTNQ contained 12 sections with 154 items., Conclusions: The CTNQ has acceptable content validity, internal consistency, and stability reliability. This instrument is promising for the assessment of the research nurse role, and its use in further research is appropriate., Implications for Nursing: A valid and reliable measure can be used to delineate the subspecialty of clinical trials nursing, thus providing a better understanding of how nursing professionals contribute to the cancer research enterprise.

Background: Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care., Aim: The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing., Method: The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing., Conclusion: The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses' thinking and practice by increasing awareness of the social, political and cultural dimensions of disability.

Observations about patients made by nurses and other healthcare professionals are important and may lead to new knowledge about patient outcomes and the development of interventions to improve outcomes. However, observations need careful study and validation before any conclusions can be drawn. The importance of the research process and building solid evidence is discussed, using an article from this issue of the Journal of Cardiovascular Nursing as an example.

The drive towards evidence-based practice is part of a modern reflective and caring service. However there is a paradox at the heart of the notion of evidence-based care. In order to perform any systemized examination of treatment there has to be a conscious acknowledgement of uncertainty about that treatment. This is uncomfortable and when research does find evidence in favour of a treatment, there is a relief and a return to conviction about what is the best. The paradox is that it seems the most valued research practices are predicated on generalizations about patient treatments and categories. However, nursing care is based on the notion of the uniqueness of the patient and the nurse-patient relationship. Sometimes it is necessary to address the particular and not to rush to generalizations and certainty. The psychoanalytic framework promotes a capacity to tolerate uncertainty and provides a model for understanding conflicting feelings, which can occur within the nurse-patient relationship. The author proposes the psychoanalytic observational method as an adjunct to other research methods. This method places certain kinds of evidence within the rubric of evidence-based nursing practice. The evidence collected in this method is the evidence of the conscious and unconscious experience within the nurse-patient relationship. The author will describe and argue for the place of this research method within the canon of other more widely practised methods within mental health practice. She will propose that for safe practice it is necessary to value and examine the veracity of the feelings and tacit understanding of the nurse. She contends that the current climate of excessive bureaucracy and persecutory risk management is having a damaging effect on both the research process and effective nursing care.

Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.

In nursing research, once one has a solid design, one has still to think about-.a sampling strategy and implementation. Too often, the paraphernalia of inferential statistical reasoning is inappropriately deployed when the achieved sample can in no way be claimed to represent the drawn sample. Given the traditionally low rates of response in most nursing research (usually well under 90 per cent, and often unknown), there is a danger that perfectionist counsels would lead to an end to serious research. In this paper, Laurence Moseley and Donna Mead argue that such a nihilistic position is not necessary and that, instead, researchers should tailor their inferential analyses to the demands of any particular study. They argue that for many purposes, simple computations of both maximum and minimum population estimates are both defensible and useful.

Purpose: To examine the concepts of external validity and generalizability, and explore strategies to strengthen generalizability of research findings, because of increasing demands for knowledge utilization in an evidence-based practice environment., Framework: The concepts of external validity and generalizability are examined, considering theoretical aspects of external validity and conflicting demands for internal validity in research designs. Methodological approaches for controlling threats to external validity and strategies to enhance external validity and generalizability of findings are discussed., Conclusions: Generalizability of findings is not assured even if internal validity of a research study is addressed effectively through design. Strict controls to ensure internal validity can compromise generalizability. Researchers can and should use a variety of strategies to address issues of external validity and enhance generalizability of findings. Enhanced external validity and assessment of generalizability of findings can facilitate more appropriate use of research findings.

Background: The randomized controlled trial is viewed by many researchers as the 'gold standard' research design. It is used increasingly to evaluate the effectiveness of socially complex activities such as nursing interventions. This use is seen by many commentators as problematic, while others are concerned about the quality of many published trial reports. One area of concern is that of intervention bias: the impact that a sentient intervention, such as a nursing one, may have consciously or unconsciously on study outcomes. This paper reports on an analysis of intervention definitions and possible intervention bias in 47 reports of randomized controlled trials of nursing interventions published in 2000 or 2001., Aims: This study evaluates four characteristics of the included reports: intervention sample size, intervention definition, involvement of intervention nurses in other aspects of the trial, and the claimed generalizability of results., Methods: Reports of randomized controlled trials published in 2000 or 2001 were identified. Full-text versions of 47 papers were obtained and information about the four characteristics was extracted and analysed., Results: Problems relating to possible intervention bias were identified in each of the papers. Inadequate intervention definition was the commonest problem, leading to difficulties in calculating the 'intervention dose' and in replicating or generalizing from the studies., Discussion: None of the included studies met the requirements of the Consolidated Standards of Reporting Trials. Four types of intervention bias were identified, and their possible implications for the reporting of trials of nursing interventions are discussed. This was a small-scale study, limited by time and resources. Its results are suggestive of a major problem of intervention bias but larger-scale investigations are necessary to quantify its extent., Conclusions: Intervention bias is potentially a problem in randomized controlled trials. Lack of detail about interventions in published papers could be corrected by stricter adherence to guidelines such as the Consolidated Standards of Reporting Trials, but this will not correct the underlying problem of inadequate study design that appears to be widespread in randomized controlled trials of nursing interventions.

In February 2001, President Clinton's Information Technology Advisory Commission reported that information technology has the potential to advance biomedical research. As nursing research via the Internet expands, important ethical and legal issues need to be addressed. The purpose of this article is to report one researcher's journey in attempting to conduct ethical and legal nursing research via the Internet. The ethical and legal issues needing attention are discussed. Potential guidelines are provided for researchers wanting to use Internet technology.

As the case study approach gains popularity in nursing research, questions arise with regard to what it exactly is, and where it appears to fit paradigmatically. Is it a method, a design, are such distinctions important? Colin Jones and Christina Lyons review some of the key issues, with specific emphasis on the use of case study within an interpretevist philosophy.

Evidence-based practice is an approach involving the definition of a problem, the search for and critical evaluation of available evidence, the implementation of evidence in practice and the evaluation of the results obtained. In order to implement this approach in nursing, nurses must know how to obtain, interpret and integrate evidence stemming from research in the care rendered to patients and their relatives. Based on the literature, this article presents theoretical considerations concerning the hierarchy of evidence and where to search for the best evidence.

Professional practice is built on sound knowledge specific to each discipline. This knowledge is developed and validated through a process of scientific investigation or research. However, lack of knowledge about the research process acts as a barrier to applying evidence-based practice within the school setting. Understanding the components that make up a research study facilitates critical analysis and application in school nursing practice. This article describes a straightforward method for analyzing research studies, enabling school nurses to understand and apply current research in their daily practice.

The focus of this article is quality assurance in nursing research. Due to well established problems regarding the education of nursing research and increasing pressure to take responsibility for the quality of all educational activities, departments of nursing are obliged to initiate actions to assure quality in nursing research. A nursing department functions within a well-defined external context. The external context comprises of various aspects such as role player expectations and current educational and professional legislation. Standards are the basic components of any quality assurance system (Booyens, 1996:305). Standards give direction to the practitioner and must be compiled within the context of the country's cultural, philosophical and ethical value systems, as well as its social economic and political development. The premise of the study was that if the education of nursing research, indeed the total management of nursing research within the department, is subjected to quality assurance, the outcome of the in terms of nursing research will be positive. The research objective addressed in the study was to formulate and validate standards against which quality in nursing research in a nursing department can be judged. Muller's phases of standard formulation were used as the methodological basis for the study. Optimal, specific standards were formulated using a deductive process and validated by implementing the standards in a department of nursing.

This fourth article of a series of six focuses on some of the key aspects of quantitative research methods. Starting with a review of what quantitative research is, the distinguishing characteristics of experimental and non-experimental research strategies, the different approaches for collecting data including self-completion questionnaires, interviews and scales, together with their respective strength and weaknesses are discussed. The differences between probability and non-probability sampling and the different methods for selecting a sample are described. Aspects of quantitative data analysis are briefly reviewed and the concepts of reliability and validity are described in the context of ensuring rigour in the research design. Finally, some guidance on the reporting the findings from quantitative research is provided.

Aim: This paper discusses measurement of the quality of judgement and decision-making in nursing research. It examines theoretical and research issues surrounding how to measure judgement accuracy as a component of evaluating decision-making in nursing practice., Discussion: Judgement accuracy is discussed with reference to different methods of measurement, including comparing judgements with independent criteria and inter-judge approaches. Existing research on how judgement accuracy has been measured in nursing practice is examined. Evaluation of decisions is then discussed, including consideration of the process of decision-making and evaluating decision outcomes. Finally, existing research on decision-making in nursing is assessed and the strengths and limitations of different types of measurement discussed., Conclusion: We suggests that researchers examining the quality of judgement and decision-making in nursing need to be aware of both the strengths and limitations of existing methods of measurement. We also suggest that researchers need to use a number of different methods, including normative approaches such as Bayes' Theorem and Subjective Expected Utility Theory.