By SN Ijeoma Amaoji – T2 2020

PICOT/Research question

In adult patients 65 years and older diagnosed with diabetes mellitus admitted to Inova Fairfax

Hospital medical units, how effective are the use of dietary supplements such as cinnamon

compared to medications such as insulin therapy/oral hypoglycemic in the prevention of diabetic

complications within one year period?

PICOT TABLE

P Adult patients 65 years and older with diabetes admitted to Inova Fairfax

Hospital medical units.

Age is one of the most important risk factors for type 2 diabetes with a high

prevalence in older age groups. Selvin and Parrinello (2013), pointed out that

in the USA adults aged 65 or older, had 20% or more than eight times higher

prevalence of being diagnosed diabetes in 2011 than the prevalence among

adults 18 to 44 years of age (2.4% prevalence).

I Dietary supplements like cinnamon.

It is believed that Dietary supplements like cinnamon help patients to control

blood glucose. As mentioned by Hasanzade et al., (2013), traditional herbs

and spices such as Ròu Guì and Cinnamomum cassia are commonly used for

control of glucose among has the greatest effect. They also added that adding

cinnamon to diet can help to lower the glucose level. Studies revealed that

spices such as cinnamon (Ròu Guì; Cinnamomum cassia), and carnation,

walnut, green tea, and mint have similar effects with insulin action in terms

By SN Ijeoma Amaoji – T2 2020

of reduction of sugar level and the most active of them is cinnamon

(Hasanzade et al., 2013).

C Insulin/Oral hypoglycemic medications.

Insulin alone or in addition to oral glycemic medications are universally used

to treat /manage diabetes due to their ability to bring down blood sugar

levels. Research has shown that insulin offers a unique ability to control

hyperglycemia, when used from the time of diagnosis in some circumstances

and when metabolic control is disturbed by medical illness, procedures, or

therapy, and also being used in the longer term ( Home et al., 2014).

O Prevention of diabetic complications. The ultimate goal of diabetes

management is prevention of long-term complications. Uncontrolled

diabetes can lead to a number of short and long-term health complications,

including hypoglycemia, heart disease, nerve damage and amputation, and

vision problems. According to Vinik & Vinik (2003), chronic complications

can be devastating to patients with diabetes mellitus. The major cause of

morbidity and mortality among these patients, are the complications like

Cardiovascular illness, macrovascular disease, with heart attacks, strokes,

and gangrene; and microvascular disease, with retinopathy, nephropathy, and

neuropathy (P. 571).

By SN Ijeoma Amaoji – T2 2020

T Within one year of being diagnosed.

In most cases, people are diabetic for quite a while without knowing before

receiving the actual diagnosis for it. Complications are said to begin to

develop after having diabetes for a number of years. I chose the time of one

year in consideration to the actual length of time they must have developed

diabetes without knowing. There are no set time frame for complications to

start occurring. It all depends on how uncontrolled the management has

been. The duration of diabetes and the degree of glycemic control achieved

are noted to be risk factors for complications (Nickerson & Dutta, 2012).

References

Selvin, E., & Parrinello, C. M. (2013). Age-related differences in glycemic control in diabetes.

Diabetologia, 56(12), 2549–2551. https://doi.org/10.1007/s00125-013-3078-7

Hasanzade, F., Toliat, M., Emami, S. A., & Emamimoghaadam, Z. (2013). The Effect of

Cinnamon on Glucose of Type II Diabetes Patients. Journal of traditional and complementary

medicine, 3(3), 171–174. https://doi.org/10.4103/2225-4110.114900

Home, P., Riddle, M., Cefalu, W. T., Bailey, C. J., Bretzel, R. G., Del Prato, S., Leroith, D.,

Schernthaner, G., van Gaal, L., & Raz, I. (2014). Insulin therapy in people with type 2 diabetes:

opportunities and challenges? Diabetes care, 37(6), 1499–1508. https://doi.org/10.2337/dc13-

2743

Vinik, A. I., & Vinik, E. (2003). Prevention of the complications of diabetes. The American

journal of managed care, 9(3 Suppl), S63–S84. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/12653455/

Nickerson, H. D., & Dutta, S. (2012). Diabetic complications: current challenges and

opportunities. Journal of cardiovascular translational research, 5(4), 375–379.

https://doi.org/10.1007/s12265-012-9388-1

1

EDITORIAL

Articulating Your Philosophy of Nursing

As the profession of nursing is dealing with rapid
changes in knowledge and practice, the specialty of
school nursing is attempting to articulate its value in
the educational setting. Both the profession and spe-
cialty are maturing, and along with this natural pro-
cess, nurses are clarifying their roles and scope of prac-
tice. As nurses examine their practice, they also are
questioning what is fundamentally important to them
as nurses and as individuals-their values and beliefs.
This has become particularly critical as more and more
nurses in all settings are finding that changing de-
mands and expectations of the role are greater than
the resources or number of hours in the day to accom-
plish what nurses would define as quality nursing
care. Such demands are pushing nurses to examine
their values and what drew them to the profession of
nursing in search of balance and meaning in the work
setting.
One strategy nurses can use to affirm that their

practice is in harmony with their value system is to
write a personal philosophy statement. This might be
general in nature, such as a philosophy that relates to
life values; it could be a philosophy statement related
to beliefs about the profession of nursing; or it might
be a philosophy specific to school nursing. In each
case, this activity will encourage nurses to clarify their
values and then examine how their philosophy fits
with their professional practice. Articulating a philos-
ophy statement is an intellectual activity that requires
careful thought, because values need to be identified,
clarified, and prioritized. Once these values are iden-
tified, putting them together into a short, cohesive
statement is a challenging process (Chitty, 2001).

The first part of the process is identifying general
values-values related to the nature of humankind
and society. These are the core values held by an in-
dividual, which are few in number but may evolve as
individuals mature and society changes. Examples of
these core values may relate to the dignity of man, the
sanctity of life, or values that give direction to our
journey of life. Personal values are influenced by fam-
ily, culture, religious orientation, education, and the
choice of one’s life work. All of these factors contrib-
ute to who we are, what we believe, and more impor-
tantly, how we act.

Next, values that relate to the profession of nursing
are delineated. Ideas may come from the American
Nurses’ Association’s code for nurses (American Nurs-
es’ Association, 1985) or the Standards o f Professional
School Nursing Practice (National Association of School
Nurses, 1998) and may include such themes as caring,
confidentiality, integrity, accountability, competence,
and improving the quality of care. Other important
values of the nursing profession are altruism, ethics,
and professionalism. In addition, the roles nurses per-
form are often integrated into philosophy statements.
Examples are caregiver, advocate, collaborator, case
manager, health educator, counselor, leader, and re-
searcher. Themes specific to school nursing relate to
the population served-children, families, and staff-
and the settings where care is delivered-the school
and the community. Specific goals of school nursing
may be articulated and include the prevention of dis-
ease, the promotion and maintenance of health, and
creation of an optimal environment for learning. Oth-
er important ideas are issues in today’s society related
to the allocation of resources and the delegation of
care.

Finally, the philosophy statement should end with
a few sentences of how personal values articulate with
values about nursing. Concluding statements could re-
late to striving for balance and profession growth
through continued learning. Caring for oneself as well
as others is a critical issue for busy nurses, as is being
a good role model for health in our homes, schools,
and communities. The final statement often relates to
how you hope to make a difference-in yourself or in
your home, school, community, or the world.
My first experience in articulating a philosophy of

nursing was when I was completing a master’s degree
in nursing of children. A class assignment forced me
to synthesize my personal beliefs with what I had
learned about caring for children and families. Al-
though the requirements were for a short statement,
the time taken to list these values and then organize
them into a cohesive whole was daunting. What re-
sulted was a meaningful statement that I still share
with students today, 30 years later. This experience has
inspired me to challenge others to take the same step
and create their own personal philosophy of nursing.

by guest on August 11, 2016jsn.sagepub.comDownloaded from

2

Through the years I have assigned graduate stu-
dents in my nursing education and child health nurs-
ing classes to write their own philosophy of nursing
education or child health nursing. Most find this as-
signment a meaningful part of their professional
growth and an appropriate capstone experience at the
end of their master’s degree program. More recently, I
have been teaching a course on the Art and Science of
Nursing to beginning nursing students and have re-
quired them to write a philosophy of nursing. Their
enthusiasm and ability to capture the essence of nurs-
ing and the many roles nurses perform in today’s
health care system have been amazing, considering
the point where they are in their career. As they com-
plete their baccalaureate program, students will have
an opportunity to update or rewrite their philosophy
as they enter the profession of nursing.

The box below has a short philosophy of life I re-
cently created to provide students an example on how
to capture some personal beliefs on paper. It pulls to-
gether some of the priorities that influence both my
personal and professional life. Writing these down has
helped me refocus my energies on what is really im-
portant to me, especially at a time when competing
demands often overshadow important values and how
my time is used.

Readers, I encourage each of you to take some time
as we enter a new year to create your personal philos-
ophy of nursing. Consider the ideas presented in this
editorial as a starting point in identifying what is im-
portant to you. Next, pull these ideas together in a
short statement that reflects your personal and pro-
fessional values. Each philosophy statement will be
uniquely you. It may not be perfect or all inclusive,
but it is an effort to clarify what you believe. As you

review your philosophy, seriously consider how this
statement will guide your practice as a school nurse.
When you complete your philosophy, I encourage you
to send me a copy. If I have a good response, I will
share some of your ideas in a future editorial.

Like life, a statement of philosophy is a work in
progress. It is ever changing as we change and as the
world around us changes. Saving earlier versions pro-
vides evidence of our personal and professional
growth over the years. Making the effort to articulate
your values in a one-page statement is a valuable

learning strategy for nurses today as we strive to pro-
vide the best quality care to children and families. Fre-
quently it gives us an opportunity to really examine
what we believe and how this fits with our personal
and professional lives. When there is not congruence
between one’s philosophy and one’s personal or pro-
fessional life, it provides the motivation to reconcile
these differences. The development of a personal phi-
losophy is an opportunity to explore what we believe.
It is an inspiring, growth-producing experience. A phi-
losophy statement expresses our unique values and
goals that ultimately guide our practice as professional
nurses.

Janice Denehy, RN, PhD, Executive Editor

REFERENCES

American Nurses’ Association. (1985). Code for nurses with inter-
pretive statements. Washington, DC: Author.

Chitty, K. K. (2001). Professional nursing: Concepts and challenges
(3rd ed.). Philadelphia: WB Saunders.

National Association of School Nurses. (1998). Standards of profes-
sional school nursing practice. Scarborough, ME: Author.

by guest on August 11, 2016jsn.sagepub.comDownloaded from

28 American Nurse Journal Volume 15, Number 6 MyAmericanNurse.com

ALL NURSES are expected to understand and
apply evidence to their professional practice.
Some of the evidence should be in the form
of research, which fills gaps in knowledge,
developing and expanding on current under-
standing. Both quantitative and qualitative re-
search methods inform nursing practice, but
quantitative research tends to be more empha-
sized. In addition, many nurses don’t feel
comfortable conducting or evaluating qualita-
tive research. But once you understand quali-
tative research, you can more easily apply it to
your nursing practice.

What is qualitative research?
Defining qualitative research can be challeng-
ing. In fact, some authors suggest that provid-
ing a simple definition is contrary to the
method’s philosophy. Qualitative research ap-
proaches a phenomenon, such as a clinical
problem, from a place of unknowing and at-
tempts to understand its many facets. This
makes qualitative research particularly useful
when little is known about a phenomenon
because the research helps identify key con-

Introduction to
qualitative

nursing
research

This type of research
can reveal important

information that
quantitative

research can’t.

By Jennifer Chicca, MS, RN, CNE, CNE-cl

STRICTLY CLINICAL RESEARCH 101

MyAmericanNurse.com June 2020 American Nurse Journal 29

cepts and constructs. Qualitative research sets
the foundation for future quantitative or qualita-
tive research. Qualitative research also can stand
alone without quantitative research.

Although qualitative research is diverse,
certain characteristics—holism, subjectivity,
intersubjectivity, and situated contexts—guide
its methodology. This type of research stresses
the importance of studying each individual as
a holistic system (holism) influenced by sur-
roundings (situated contexts); each person de-
velops his or her own subjective world (sub-
jectivity) that’s influenced by interactions with
others (intersubjectivity) and surroundings (sit-
uated contexts). Think of it this way: Each
person experiences and interprets the world
differently based on many factors, including
his or her history and interactions. The truth is
a composite of realities.

Qualitative research designs
Because qualitative research explores diverse
topics and examines phenomena where little
is known, designs and methodologies vary.
Despite this variation, most qualitative re-
search designs are emergent and holistic. In
addition, they require merging data collection
strategies and an intensely involved re-
searcher. (See Research design characteristics.)

Although qualitative research designs are
emergent, advanced planning and careful
consideration should include identifying a
phenomenon of interest, selecting a re-
search design, indicating broad data collec-
tion strategies and opportunities to enhance
study quality, and considering and/or setting
aside (bracketing) personal biases, views,
and assumptions.

Many qualitative research designs are used
in nursing. Most originated in other disci-
plines, while some claim no link to a particu-
lar disciplinary tradition. Designs that aren’t
linked to a discipline, such as descriptive de-
signs, may borrow techniques from other
methodologies; some authors don’t consider
them to be rigorous (high-quality and trust-
worthy). (See Common qualitative research
designs.)

Sampling approaches
Sampling approaches depend on the quali-
tative research design selected. However, in
general, qualitative samples are small, nonran-
dom, emergently selected, and intensely stud-

ied. Qualitative research sampling is con-
cerned with accurately representing and dis-
covering meaning in experience, rather than
generalizability. For this reason, researchers tend
to look for participants or informants who are
considered “information rich” because they
maximize understanding by representing
varying demographics and/or ranges of expe-
riences. As a study progresses, researchers
look for participants who confirm, challenge,
modify, or enrich understanding of the phe-
nomenon of interest. Many authors argue that
the concepts and constructs discovered in
qualitative research transcend a particular
study, however, and find applicability to oth-
ers. For example, consider a qualitative study
about the lived experience of minority nursing
faculty and the incivility they endure. The
concepts learned in this study may transcend
nursing or minority faculty members and also
apply to other populations, such as foreign-
born students, nurses, or faculty.

A sample size is estimated before a quali-
tative study begins, but the final sample size
depends on the study scope, data quality,
sensitivity of the research topic or phenome-
non of interest, and researchers’ skills. For ex-
ample, a study with a narrow scope, skilled

Most qualitative research designs share the following characteristics.

Characteristic Description Example

Emergent

Holistic

Intensely

involved

researcher

Merging data

collection

strategies

Research design characteristics

• Flexible
• Adaptable
• Changes to
reflect realities
and viewpoints,
which may not
be known at the
outset

• Considers the
whole

• Detailed study

• Many strategies
are used to
capture holism

A researcher completing a ground-
ed theory study changes the inter-
view questionnaire, based on pre-
liminary findings, to include more
focused questions to help saturate
theoretical categories

A researcher completing a histori-
cal research study analyzes arti-
facts, journals, interviews, docu-
ments, photographs, and records
to understand a past event

A researcher completing an ethno-
graphic inquiry spends time
(sometimes years) interviewing,
observing, and perhaps even par-
ticipating in the studied culture

A researcher completing a case
study analyzes interviews, observa-
tions, documents, and records to
understand the identified case

30 American Nurse Journal Volume 15, Number 6 MyAmericanNurse.com

researchers, and a nonsensitive topic likely
will require a smaller sample. Data saturation
frequently is a key consideration in final sam-
ple size. When no new insights or informa-
tion are obtained, data saturation is attained
and sampling stops, although researchers may
analyze one or two more cases to be certain.
(See Sampling types.)

Some controversy exists around the con-
cept of saturation in qualitative nursing re-
search. Thorne argues that saturation is a con-
cept appropriate for grounded theory studies
and not other study types. She suggests that
“information power” is perhaps more appro-
priate terminology for qualitative nursing re-
search sampling and sample size.

Data collection and analysis
Researchers are guided by their study design
when choosing data collection and analysis
methods. Common types of data collection in-
clude interviews (unstructured, semistructured,

focus groups); observations of people, envi-
ronments, or contexts; documents; records; ar-
tifacts; photographs; or journals. When collect-
ing data, researchers must be mindful of
gaining participant trust while also guarding
against too much emotional involvement, en-
suring comprehensive data collection and
analysis, conducting appropriate data manage-
ment, and engaging in reflexivity.

Reflexivity involves systematically analyz-
ing each step of the research process. Unlike
quantitative researchers, who use validated in-
struments, qualitative researchers themselves
are the instruments. They must strive to attain
and manage high-quality data. Journaling can
help researchers identify and manage how
their behaviors and thoughts influence their
study findings. When researchers bracket their
preconceived notions when collecting and an-
alyzing data, they help increase study rigor.

Data usually are recorded in detailed notes,
memos, and audio or visual recordings, which

Qualitative nursing research can take many forms. The design you choose will depend on the question you’re trying to answer.

Design Originating discipline Description Sample nursing research question

Action research Education Conducted by and for What happens to the quality of nursing practice
those taking action to when we implement a peer-mentoring system?
improve or refine actions

Case study Many In-depth analysis of an entity How is patient autonomy promoted by a unit?
or group of entities (case)

Descriptive N/A Content analysis of data What is the nursing role in end-of-life decisions?

Discourse analysis Many In-depth analysis of written, What discourses are used in nursing practice and
vocal, or sign language how do they shape practice?

Ethnography Anthropology In-depth analysis of a How does Filipino culture influence childbirth
culture experiences?

Ethology Psychology Biology of human behavior What are the immediate underlying psycho-
and events logical and environmental causes of incivility
in nursing?

Grounded theory Sociology Social processes within a How does the basic social process of role
social setting transition happen within the context of
advanced practice nursing transitions?

Historical research History Past behaviors, events, When did nurses become researchers?
conditions

Narrative inquiry Many Story as the object of How does one live with a diagnosis of
inquiry scleroderma?

Phenomenology Philosophy Lived experience What is the lived experience of nurses who were
Psychology admitted as patients on their home practice unit?

Common qualitative research designs

MyAmericanNurse.com June 2020 American Nurse Journal 31

frequently are transcribed verbatim and ana-
lyzed manually or using software programs,
such as ATLAS.ti, HyperRESEARCH, MAXQDA,
or NVivo. Analyzing qualitative data is com-
plex work. Researchers act as reductionists,
distilling enormous amounts of data into con-
cise yet rich and valuable knowledge. They
code or identify themes, translating abstract
ideas into meaningful information. The good
news is that qualitative research typically is
easy to understand because it’s reported in
stories told in everyday language.

Evaluating a qualitative study
Evaluating qualitative research studies can
be challenging. Many terms—rigor, validity,
integrity, and trustworthiness—can describe
study quality, but in the end you want to know
whether the study’s findings accurately and
comprehensively represent the phenomenon
of interest. Many researchers identify a quality
framework when discussing quality-enhance-
ment strategies. Example frameworks include:
• Trustworthiness criteria framework, which

enhances credibility, dependability, con-
firmability, transferability, and authenticity

• Validity in qualitative research framework,
which enhances credibility, authenticity, criti-
cality, integrity, explicitness, vividness, creativ-
ity, thoroughness, congruence, and sensitivity.
With all frameworks, many strategies can

be used to help meet identified criteria and
enhance quality. (See Research quality en-
hancement). And considering the study as a
whole is important to evaluating its quality
and rigor. For example, when looking for ev-
idence of rigor, look for a clear and concise
report title that describes the research topic
and design and an abstract that summarizes
key points (background, purpose, methods, re-
sults, conclusions). (Visit myamericannurse.com/
?p=66448 to learn what other questions to ask
when evaluating a qualitative study.)

Application to nursing practice
Qualitative research not only generates evi-
dence but also can help nurses determine pa-
tient preferences. Without qualitative research,
we can’t truly understand others, including their
interpretations, meanings, needs, and wants.
Qualitative research isn’t generalizable in the
traditional sense, but it helps nurses open their
minds to others’ experiences. For example,
nurses can protect patient autonomy by under-

standing them and not reducing them to univer-
sal protocols or plans. As Munhall states, “Each
person we encounter help[s] us discover what is
best for [him or her]. The other person, not us,
is truly the expert knower of [him- or herself].”
Qualitative nursing research helps us under-
stand the complexity and many facets of a
problem and gives us insights as we encourage
others’ voices and searches for meaning.

When paired with clinical judgment and
other evidence, qualitative research helps us
implement evidence-based practice success-
fully. For example, a phenomenological in-
quiry into the lived experience of disaster

Several sampling types guide qualitative research, and because designs
are emergent, sampling may change as a study progresses. In grounded
theory, for instance, sampling moves into more focused theoretical sam-
pling as a study progresses. The researcher may return to a participant
and question him or her more specifically about a theoretical construct,
such as the concept of “making it work” in a study about having a child
with a disability. This sampling approach helps ensure theoretical cate-
gories become saturated.

Sampling type Comments

Convenience or volunteer • Participants readily available
• Easy, efficient
• Might not be “information rich”

Purposive • Participants selected because they
benefit the study (for example,
selecting for varying demographics or
ranges of experience)

Shadow • Participants speak of others’
experiences in addition to their own

Snowball or chain • Early participants refer others
• Easy, efficient
• Might not be “information rich”

Theoretical • Participants selected based on