solution: Unit 5 Discussion 1 – Change Agent 1000w 4-3-22 According to Porter O’Grady and Malloch (2015), “In

Unit 5 Discussion 1 – Change Agent 1000w 4-3-22

According to Porter O’Grady and Malloch (2015), “In the twentieth century the focus of work was on performing the right processes. In the twenty-first-century the focus is on obtaining the right outcomes”. The purpose of using evidence to guide practice is to promote positive outcomes.

As it pertains to healthcare and improving patients overall health consider the following questions in your discussion post:

1. How do you see yourself as a change agent guiding others to move from a process focus to outcomes focus on healthcare and the nursing profession? Provide example of actions you would take.

2. Discuss your role as a change agent in relation to your area of concentration – practice and/or education (area of concentration is Psychiatric Mental Health Nurse). Speak on the stigma and limited access to care for individuals suffering from mental health issues.

3. Elaborate the rationale behind the change from process to outcomes, what steps are involved?

4. In nursing history speak on a particular individual that is a change agent within the nursing profession.

5. What is the role of nurse as a change agent? Why do nurses need to be leaders and agents of change?

Burns and Grove’s the Practice of Nursing Research

Appraisal, Synthesis, and Generation of Evidence


Jennifer R. Gray, PhD, RN, FAAN
Associate Dean
College of Natural and Health Sciences
Oklahoma Christian University
Edmond, Oklahoma;
Professor Emeritus
College of Nursing and Health Innovation
The University of Texas at Arlington
Arlington, Texas

Susan K. Grove, PhD, RN, ANP-BC, GNP-BC
Professor Emeritus
College of Nursing and Health Innovation
The University of Texas at Arlington
Arlington, Texas;
Adult Nurse Practitioner
Family Practice
Grand Prairie, Texas

Suzanne Sutherland, PhD, RN
Professor Emeritus and Part-Time Lecturer
California State University, Sacramento
Sacramento, California

Table of Contents

Cover image

Title Page

Inside Front Cover






New Content

Student Ancillaries

Instructor Ancillaries


Unit One Introduction to Nursing Research

1 Discovering the World of Nursing Research

Definition of Nursing Research

Framework Linking Nursing Research to the World of Nursing

Significance of Research in Building an Evidence-Based Practice for Nursing

Key Points


2 Evolution of Research in Building Evidence-Based Nursing Practice

Historical Development of Research in Nursing

Methodologies for Developing Research Evidence in Nursing

Classification of Research Methodologies Presented in This Text

Introduction to Best Research Evidence for Practice

Key Points


3 Introduction to Quantitative Research

The Scientific Method

Types of Quantitative Research

Applied Versus Basic Research

Rigor in Quantitative Research

Control in Quantitative Research

Control Groups Versus Comparison Groups

Steps of the Quantitative Research Process

Selecting a Research Design

Key Points


4 Introduction to Qualitative Research

Perspective of the Qualitative Researcher

Approaches to Qualitative Research

Key Points


Unit Two The Research Process

5 Research Problem and Purpose

The Research Problem

The Research Purpose

Sources of Research Problems

To Summarize: How to Decide on a Problem Area and Formulate a Purpose Statement

Examples of Research Topics, Problems, and Purposes for Different Types of Research

Key Points


6 Objectives, Questions, Variables, and Hypotheses

Levels of Abstraction

Purposes, Objectives, and Aims

How to Construct Research Questions

Variables in Quantitative Versus Qualitative Research

Defining Concepts and Operationalizing Variables in Quantitative Studies


Key Points


7 Review of Relevant Literature

Getting Started: Frequently Asked Questions

Developing a Qualitative Research Proposal

Developing a Quantitative Research Proposal

Practical Considerations for Performing a Literature Review

Stages of a Literature Review

Processing the Literature

Writing the Review of Literature

Key Points


8 Frameworks

Introduction of Terms

Understanding Concepts

Examining Statements

Grand Theories

Middle-Range Theories

Appraising Theories and Research Frameworks

Developing a Research Framework for Study

Key Points


9 Ethics in Research

Historical Events Affecting the Development of Ethical Codes and Regulations

Early U.S. Government Research Regulations

Standards for Privacy for Research Data

Protection of Human Rights

Balancing Benefits and Risks for a Study

Human Subject Protection in Genomics Research

Obtaining Informed Consent

Institutional Review

Research Misconduct

Animals as Research Subjects

Key Points


10 Quantitative Methodology

Concepts Relevant to Quantitative Research Designs

Design Validity for Noninterventional Research

Descriptive Research and Its Designs

Correlational Designs

Key Points


11 Quantitative Methodology

Concepts Relevant to Interventional Research Design

Validity for Interventional Research

Categorizing and Naming Research Designs

Experimental Designs

Quasi-Experimental Designs

Maintaining Consistency in Interventional Research

Algorithms of Research Design

Key Points


12 Qualitative Research Methods

Clinical Context and Research Problems

Literature Review for Qualitative Studies

Theoretical Frameworks

Research Objectives or Questions

Obtaining Research Participants

Data Collection Methods

Electronically Mediated Data

Transcribing Recorded Data

Data Management

Data Analysis

Methods Specific to Qualitative Approaches

Key Points


13 Outcomes Research

Current Status of Outcomes Research

Theoretical Basis of Outcomes Research

Structure and Process Versus Outcome in Today’s Healthcare and Outcomes Research

Critical Paths or Pathways

Federal Government Involvement in Outcomes Research

Nongovernmental Involvement in Outcomes Research

Outcomes Research and Evidence-Based Practice

Methodological Considerations for Outcomes Studies

The Specific Designs of Outcomes Research

Key Points


14 Mixed Methods Research

Philosophical Foundations

Overview of Mixed Methods Designs

Challenges of Mixed Methods Designs

Critically Appraising Mixed Methods Designs

Key Points


15 Sampling

Sampling Theory

Probability (Random) Sampling Methods

Nonprobability (Nonrandom) Sampling Methods Commonly Applied in Quantitative and
Outcomes Research

Nonprobability Sampling Methods Commonly Applied in Qualitative and Mixed Methods

Sample Size in Quantitative Research

Sample Size in Qualitative Research

Research Settings

Recruiting and Retaining Research Participants

Key Points


16 Measurement Concepts

Directness of Measurement

Measurement Error

Levels of Measurement

Reference Testing Measurement



Accuracy, Precision, and Error of Physiological Measures

Sensitivity, Specificity, and Likelihood Ratios

Key Points


17 Measurement Methods Used in Developing Evidence-Based Practice

Physiological Measurement

Observational Measurement




Q-Sort Methodology

Delphi Technique


Measurement Using Existing Databases

Selection of an Existing Instrument

Constructing Scales

Translating a Scale to Another Language

Key Points


Unit Three Putting It All Together for Evidence-Based Health Care

18 Critical Appraisal of Nursing Studies

Evolution of Critical Appraisal of Research in Nursing

When Are Critical Appraisals of Research Implemented in Nursing?

Nurses’ Expertise in Critical Appraisal of Research

Critical Appraisal Process for Quantitative Research

Critical Appraisal Process for Qualitative Studies

Key Points


19 Evidence Synthesis and Strategies for Implementing Evidence-Based Practice

Benefits and Barriers Related to Evidence-Based Nursing Practice

Guidelines for Synthesizing Research Evidence

Models to Promote Evidence-Based Practice in Nursing

Implementing Evidence-Based Guidelines in Practice

Evidence-Based Practice Centers

Introduction to Translational Research

Key Points


Unit Four Collecting and Analyzing Data, Determining Outcomes, and
Disseminating Research

20 Collecting and Managing Data

Study Protocol

Factors Influencing Data Collection

Preparation for Data Collection

Pilot Study

Role of the Researcher During the Study

Research/Researcher Support


Key Points


21 Introduction to Statistical Analysis

Concepts of Statistical Theory

Types of Statistics

Practical Aspects of Statistical Analysis

Choosing Appropriate Statistical Procedures for a Study

Key Points


22 Using Statistics to Describe Variables

Using Statistics to Summarize Data

Using Statistics to Explore Deviations in the Data

Key Points


23 Using Statistics to Examine Relationships

Scatter Diagrams

Bivariate Correlational Analysis

Bland and Altman Plots

Factor Analysis

Key Points


24 Using Statistics to Predict

Simple Linear Regression

Multiple Regression

Odds Ratio

Logistic Regression

Cox Proportional Hazards Regression

Key Points


25 Using Statistics to Determine Differences

Choosing Parametric Versus Nonparametric Statistics to Determine Differences


One-Way Analysis of Variance

Pearson Chi-Square Test

Key Points


26 Interpreting Research Outcomes

Example Study

Identification of Study Findings

Identification of Limitations Through Examination of Design Validity

Generalizing the Findings

Considering Implications for Practice, Theory, and Knowledge

Suggesting Further Research

Forming Final Conclusions

Key Points


27 Disseminating Research Findings

Components of a Research Report

Types of Research Reports

Audiences for Communication of Research Findings

Strategies for Presentation and Publication of Research Findings

Key Points


Unit Five Proposing and Seeking Funding for Research

28 Writing Research Proposals

Writing a Research Proposal

Types of Research Proposals

Contents of Student Proposals

Seeking Approval for a Study

Example Quantitative Research Proposal

Key Points


29 Seeking Funding for Research

Building a Program of Research

Building Capital

Identifying Funding Sources

Submitting a Proposal for a Federal Grant

Grant Management

Planning Your Next Grant

Key Points


Appendix A z Values Table

Appendix B Critical Values for Student’s t Distribution

Appendix C Critical Values of r for Pearson Product Moment Correlation

Appendix D Critical Values of F for a = 0.05 and a = 0.01

Appendix E Critical Values of the ?2 Distribution




Inside Front Cover

Designs for Quantitative Nursing Research in This Text: Quick-Access Chart
Descriptive Designs
(Simple) descriptive design, 200
Comparative descriptive design, 201
Descriptive longitudinal design, 204
Descriptive longitudinal design with partitioning, 205
Trend analysis, 206
Descriptive cross-sectional design, 207
Repeated measures descriptive cross-sectional design, 201 (Figure 10-2)
Correlational Designs
(Simple) correlational design, 209
Comparative correlational design, 209 (Figure 10-6)
Cross-sectional correlational design, 209 (Figure 10-6)
Longitudinal correlational design, 209 (Figure 10-6)
Predictive correlational design, 212
Model-testing designs, 213
Path analysis, 213
Structural equation modeling, 213
Experimental Designs
Pretest-posttest control group design (true experimental design), 232
Posttest-only control group design, 234
Solomon four-group design, 235
Factorial design, 235
Crossover design, 236
Variations in method of random assignment
Randomized blocking (randomized block design), 233
Nesting (nested design), 233
Quasi-Experimental Designs
No researcher manipulation of the independent variable, 241
No traditional type of control group (subjects act as their own controls),
One-group pretest-posttest design (single-group pretest-posttest), 240
Time series design, 242
Time series design with nonrandom control group, 242
Time series design with repeated reversal (single subject research), 243
No random assignment to group
Posttest-only design with comparison group, 245
Pretest-posttest design with nonrandom control group, 244
No control group of any kind
Pretest-posttest design with comparison with norms, 239 (Figure 11-7)
Posttest-only design with comparison with norms, 245


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Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods,
professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
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With respect to any drug or pharmaceutical products identified, readers are advised
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Previous editions copyrighted 2013, 2009, 2005, 2001, 1997, 1993, and 1987.

Library of Congress Cataloging-in-Publication Data

Names: Gray, Jennifer, 1955- author. | Grove, Susan K., author. | Sutherland,
Suzanne, author.
Title: Burns and Grove’s the practice of nursing research: appraisal, synthesis, and
generation of evidence / Jennifer Gray, Susan K. Grove, Suzanne Sutherland.
Other titles: Practice of nursing research
Description: Eighth edition. | St. Louis, Missouri: Elsevier, [2017] | Preceded by:
The practice of nursing research / Susan K. Grove, Nancy Burns, Jennifer Gray. 7th
ed. c2013. | Includes bibliographical references and index.
Identifiers: LCCN 2016030245 | ISBN 9780323377584 (pbk.)
Subjects: | MESH: Nursing Research–methods | Evidence-Based Nursing
Classification: LCC RT81.5 | NLM WY 20.5 | DDC 610.73072–dc23 LC record
available at

International Standard Book Number: 978-0-323-37758-4

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Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1


To our readers and researchers, nationally and internationally, who will
provide the science to develop an evidence-based practice for nursing.

To our family members for their constant input, support, and love, and
especially to our husbands

Randy Gray,

Jay Suggs,


Jerry Sutherland

Jennifer, Susan, and Suzanne


Daisha J. Cipher PhD
Clinical Associate Professor
College of Nursing and Health Innovation
University of Texas at Arlington
Arlington, Texas

Kathryn M. Daniel PhD, RN, ANP-BC, GNP-BC, AGSF
Associate Professor
Associate Chair for Nurse Practitioner Programs, Graduate Program
Director, Adult-Gerontology Primary Care Nurse Practitioner Program
Interim Director, Family Nurse Practitioner Program
College of Nursing and Health Innovation
University of Texas at Arlington
Arlington, Texas


Sara L. Clutter PhD, RN
Associate Professor of Nursing
Department of Nursing
Waynesburg University
Waynesburg, Pennsylvania

Betsy Frank RN, PhD, ANEF
Professor Emerita
Department of Baccalaureate Nursing Completion
Indiana State University
Terre Haute, Indiana

Sharon Kitchie RN, PhD
Adjunct Instructor
Department of Nursing
Keuka College
Keuka Park, New York

Teresa M. O’Neill PhD, APRN, RNC
Professor Emerita
Our Lady of Holy Cross College
New Orleans, Louisiana

Jeanne Tucker RN, MSN, HSAD, PhD, CHES, PCEP
Assistant Professor of Nursing
Patty Hanks Shelton School of Nursing
A Consortium of Hardin Simmons University and McMurry University
Abilene, Texas

Angela F. Wood RN, PhD, NNP
Professor of Nursing, Chair
Department of Nursing
Carson-Newman University
Jefferson City, Tennessee


Research is a major force in the nursing profession that is used to change practice,
education, and health policy. Our aim in developing the eighth edition of The
Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence is to
increase excitement about research and to facilitate the development of evidence-
based practice for nursing. It is critically important that all nurses, especially those
in advanced-practice roles (nurse practitioners, clinical nurse specialists, nurse
anesthetists, and nurse midwives) and those assuming roles as administrators and
educators, have a strong understanding of the research methods conducted to
generate evidence-based knowledge for nursing practice. Graduate and
undergraduate nursing students and practicing nurses must be actively involved in
critically appraising and synthesizing research evidence for the delivery of quality,
cost-effective care. This text provides detailed content and guidelines for
implementing critical appraisal and synthesis processes. The text also contains
extensive coverage of the research methodologies—quantitative, qualitative, mixed
methods, and outcomes—commonly employed in nursing. Doctoral students might
use this text to facilitate their conduct of quality studies essential for generating
nursing knowledge.

The depth and breadth of content presented in this edition reflect the increase in
research activities and the growth in research knowledge since the previous edition.
Nursing research is introduced at the baccalaureate level and becomes an integral
part of graduate education (master’s and doctoral) and clinical practice. We hope
that this new edition might increase the number of nurses at all levels involved in
research activities, so as to improve outcomes for nursing practice.

This eighth edition is written and organized to facilitate ease in reading,
understanding, and implementing the research process. The major strengths of this
text are as follows:

• State-of-the-art coverage of evidence-based practice (EBP)—a topic of vital and
growing importance in a healthcare arena focused on quality, cost-effective patient

• Addition of a chapter on mixed methods research, a methodology that is
employed today with increasing frequency, reflecting the modern proliferation of
multifaceted problems.

• A clear, concise writing style for facilitation of student learning that is consistent
throughout all chapters.

• Comprehensive coverage of quantitative, qualitative, mixed methods, and
outcomes research strategies, with examples provided from published studies.

• A balanced coverage of qualitative and quantitative research methodologies.
• An introduction to ethical issues related to genomics research.
• Electronic references and websites that direct the student to an extensive array of

information that is important for conducting studies and using research findings
in practice.

• Rich and frequent illustration of major points and concepts from the most current
nursing research literature, emphasizing a variety of clinical practice areas.

• A strong conceptual framework that links nurs?ing research with EBP, theory,
knowledge, and philosophy.

Our text provides a comprehensive introduction to nursing research for graduate
and practicing nurses. Of particular usefulness at the master’s and doctoral level,
the text provides not only substantive content related to research but also practical
applications based on the authors’ experiences in conducting various types of
nursing research, familiarity with the research literature, and experience in
teaching nursing research at various educational levels.

The eighth edition of this text is organized into 5 units and 29 chapters. Unit One
provides an introduction to the general concepts of nursing research. The content
and presentation of this unit have been designed to introduce EBP, quantitative
research, and qualitative research.

Unit Two provides an in-depth presentation of the research process for
quantitative, qualitative, mixed methods, and outcomes research, including two
detailed chapters on measurement. As with previous editions, this text provides
extensive coverage of study designs and statistical analyses.

Unit Three addresses the implications of research for the discipline and
profession of nursing. Content is provided to direct the student in conducting
critical appraisals of both quantitative and qualitative research. A detailed
discussion of types of research synthesis and strategies for promoting EBP is

Unit Four provides students and practicing nurses the content they require for
implementation of actual research studies. This unit includes chapters focused on
data collection and management, statistical analysis, interpretation of research
outcomes, and dissemination of research findings.

Unit Five addresses proposal development and seeking support for research.
Readers are given direction for developing successful research proposals and
seeking funding for their proposed research.

The changes in the eighth edition of this text reflect advances in nursing research
and also incorporate comments from outside reviewers, colleagues, and students.
Our desire to promote the continuing development of the profession of nursing
was the incentive for investing the time and energy required to develop this new

New Content
The eighth edition provides current comprehensive coverage of nursing research
and is focused on the learning needs and styles of today’s nursing students and
practicing nurses. Several exciting new areas of content based on the changes and
expansion in the field of nursing research are included in this edition. Some of the
major changes from the previous edition are as follows:

• Chapter 1, “Discovering the World of Nursing Research,” provides a stronger
introduction to EBP and includes an example of the most current evidence-based
guidelines for the management of hypertension.

• Chapter 2, “Evolution of Research in Building Evidence-Based Nursing Practice,”
has a new figure for demonstrating the levels of research knowledge. In addition,
this chapter introduces the most current processes for synthesizing research
knowledge, which are systematic reviews, meta-analyses, meta-syntheses, and
mixed-method systematic reviews.

• Chapter 3, “Introduction to Quantitative Research,” was rewritten to provide a
clearer overview of the quantitative research process and the role of iteration in
the design process, for the beginning researcher. It also includes the concept of
theoretical substruction and the application of this strategy.

• Chapter 5, “Research Problem and Purpose,” was rewritten to reflect practical
considerations of how to identify a problem area and define the purpose of a

• Chapters 6, 7, and 8 have been reordered, reflecting a more logical sequencing.
• Chapter 6, “Objectives, Questions, Variables, and Hypotheses,” has been

rewritten to guide the student in how to word research questions for various
quantitative and qualitative designs, identify types of variables, write conceptual
and operational definitions, and construct various types of hypotheses.

• Chapter 7, “Review of Relevant Literature,” provides practical steps in searching
the literature, synthesizing the information, and writing the review.

• Chapter 9, “Ethics in Research,” features new coverage of genomics research,
recent ethical violations, and government regulations. This chapter also details the
escalating problem of scientific misconduct in all healthcare disciplines and the
actions that have been taken to manage this problem.

• Chapters 10 and 11 have been rewritten and re-organized, presenting
noninterventional designs in one chapter and interventional designs in the other.

• Chapter 10 “Quantitative Methodology: Noninterventional Designs and Methods”
presents concepts pertinent to noninterventional research, including specifics of
design validity. It also describes and provides examples and new illustrations for
various descriptive and correlational designs used frequently in nursing research,
or potentially useful for healthcare research. Its algorithms for differentiating
among the four major quantitative design types, and for selecting specific designs
from among both descriptive and correlational methods, have been revised.

• Chapter 11 “Quantitative Methodology: Interventional Designs and Methods”
presents concepts pertinent to interventional research, including descriptions of
specific threats to validity for interventional studies. It also describes and provides
new examples and illustrations for various experimental and quasi-experimental
designs used frequently in nursing research, or potentially useful for healthcare
research. Its algorithms for selecting specific interventional designs from among
both experimental and quasi-experimental methods, have been revised.

• Chapter 12, “Qualitative Research Methods,” describes each step of the research
process from writing the problem statement to interpreting the findings for
qualitative studies. In addition to the data collection methods of observing,
interviewing, and conducting focus groups, content was added about web-based

research and other electronic means of collecting qualitative data.
• Chapter 13, “Outcomes Research,” a unique feature of our text, was rewritten to

extend the revisions begun by Dr. Diane Doran, a leading authority in the conduct
of outcomes research, for edition 7, and to update content so that it reflects
current trends in outcomes research. More detail in content is included for the
foundational concepts described by Donabedian, including his theoretical bases
for outcomes research and his own history. The interplay between outcomes
research and EBP, from standpoints of quantitative and qualitative research, has
been clarified and is displayed in a new diagrammatic model.

• Chapter 14, “Mixed Methods Research,” is a new chapter and proposes three
broad categories of mixed methods research: exploratory sequential design,
explanatory sequential design, and convergent concurrent designs. The often-
missing steps of integrating the findings across methods is newly described.

• Chapter 15, “Sampling,” was revised to reflect the most current coverage of
sampling methods and the processes for determining sample size for quantitative
and qualitative studies in nursing. Discussion of sampling methods and settings
are supported with examples from current, relevant studies.

• Chapter 16, “Measurement Concepts,” features detailed, current information for
examining the reliability and validity of measurement methods and the precision
and accuracy of physiological measures used in nursing studies. The discussions
of sensitivity, specificity, and likelihood ratios are expanded and supported with
examples from current studies.

• Chapter 17, “Measurement Methods Used in Developing Evidence-Based
Practice,” provides more current detail on the use of physiological measurement
methods in research. A new diagram is added to promote the use of Q-sort
methodology in studies.

• Chapter 18, “Critical Appraisal of Nursing Studies,” now includes consistent
steps for the critical appraisal of quantitative and qualitative studies: (

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