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INTRODUCTION TO

and Research Medical Literature

for Health Professionals

J. Glenn Forister, MS, PA-C

Adjunct Associate Professor

Department of Physician Assistant Studies

School of Health Professions

UT Health Science Center San Antonio San Antonio, Texas

J. Dennis Blessing, PhD, PA

Distinguished Teaching Professor (Retired)

Department of Physician Assistant Studies

Associate Dean (Retired)

School of Health Professions

UT Health Science Center San Antonio

San Antonio, Texas

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Library of Congress Cataloging-in-Publication Data

Introduction to research and medical literature for health professionals / [edited by] J. Glenn Forister and J. Dennis Blessing. — 4th edition.

p.; cm.

Includes bibliographical references and index.

ISBN 978-1-284-03464-6

I. Forister, J. Glenn, editor. II. Blessing, J. Dennis, editor.

[DNLM: 1. Biomedical Research. 2. Health Personnel—education. 3. Research Design. W 20.5] R727

610.73'7069—dc23

6048

2014038444

J. Glenn Forister, MS, PA-C

J. Dennis Blessing, PhD, PA

Rhonda Oilepo, MS, CIP

Kimberly K. Summers, PharmD

Joseph O. Schmelz, PhD, RN, CIP, FAAN

Salah Ayachi, PhD, PA-C

J. Dennis Blessing, PhD, PA

Linda Levy, MSW, MLS, AHIP

J. Dennis Blessing, PhD, PA

Richard Dehn, MPA, PA-C

Margaret J. Foster, MS, MPH

Christopher E. Bork, PhD

Robert W. Jarski, PhD, PA-C

J. Glenn Forister, MS, PA-C

J. Dennis Blessing, PhD, PA

Chapter 8

Elsa M. González, PhD

J. Glenn Forister, MS, PA-C

Chapter 9 Community-Based Participatory Research

Scott D. Rhodes, PhD, MPH

Christina J. Sun, PhD, MS

Chapter 10 Clinical Investigations

J. Glenn Forister, MS, PA-C

Meredith A. Davison, PhD, MPH

Bruce R. Niebuhr, PhD

J. Glenn Forister, MS, PA-C

Chapter 12 Exploring Statistics Comparing Differences in Health Care

J. Glenn Forister, MS, PA-C

Chapter 13 The Results Section

Anthony A. Miller, MEd, PA-C

J. Dennis Blessing, PhD

Chapter 14 The Discussion Section

Richard R. Rahr, EdD, PA-C

J. Dennis Blessing, PhD, PA

Christine S. Gaspard, MSLS

Katherine A. Prentice, MSIS

Eric Willman, MSIS

Albert Simon, DHSc, MEd, PA-C

Chapter 16 Writing and Publishing in the Health Professions

James F. Cawley, MPH, PA-C, DHL (hon)

Chapter 17 Interpreting the Literature

J. Glenn Forister, MS, PA-C

J. Dennis Blessing, PhD, PA

Appendix Funding Research: Grants

J. Dennis Blessing, PhD

William D. Hendricson, MA, MS

Dedication

This book is dedicated to all the people who made it happen. The contributors to this book have put forth their effort to improve the research capabilities of all healthcare professionals, present and future. It is rare for authors from so many professions to collaborate on such an effort.

We further dedicate this book to our friends and colleagues at Jones & Bartlett Learning. They work behind the scenes to make us look good.

Ultimately, the contributors and publishers want this to be a successful book that helps every reader in their understanding of research and what it means to the people who benefit from our healthcare efforts.

Preface

The editors of and contributors to this book are dedicated teachers, researchers, administrators, and practitioners in healthcare professions. They have worked tirelessly to make this book readable, understandable, and useful for students and practitioners in healthcare professions. Our intent is to provide a tool that can be the first step in understanding research and, perhaps, the first step in a research career. We hope this book places that first step on a sound footing without intimidation.

Research articles, news flashes, and advertisements bombard us daily. To make sense of it all, we must be able to interpret and apply the information in our patients’ best interests. This skill is a critical requirement of clinical practice in today’s world, and it requires an understanding of the research process.

CONCEPTUAl APPROACh

We have tried to present our material in stepwise order, beginning with the protection of human subjects and the formation of a research question. Next, we consider different types of literature review and research methodologies. The analysis,

results, and discussion sections follow. We also consider the writing and publication process. Finally, a chapter on the interpretation of the literature covers the skills a health professional must develop to be a consumer of the literature.

Ultimately, understanding the research process and interpretation of the research literature are inextricable—this book addresses both at the basic level. Our contributors represent a wide range of healthcare and education professionals with expertise in different aspects of research; however, each contributor has written with the novice researcher or clinician in mind. Prior knowledge of research is not assumed.

ORGANIzATION AND FEATURES

Each chapter begins with a Chapter Overview designed to relate the essential information covered in the chapter. Basic Learning Objectives for the chapter are also provided. The important key terms for each chapter are highlighted in bold font, with definitions provided in the glossary. In most chapters, tables and figures are used to help summarize key information. The overall scheme allows

the reader to move naturally through the research process, ending with concepts needed to interpret the research of others.

NEW TO ThIS EDITION

The changes in this edition are based on the feedback from readers of the previous edition. A newly revised chapter on the regulatory protection of human subjects provides readers with a comprehensive look at the workings of the institutional review board. We have added new chapters covering systematic reviews, qualitative research, and statistics. Along with these new chapters, the editing and reorganization of the chapters from the previous edition provides the reader enhanced content without expanding the scope of the book beyond the beginner stage.

INSTRUCTOR RESOURCES

Qualified instructors can receive the full suite of Instructor Resources, including the following:

• Slides in PowerPoint format, featuring more than 350 slides

• Test Bank, containing more than 250 questions

• Instructor's Manual, including suggestions for classroom discussions and activities

• Sample Syllabus, providing guidance for structuring a course around this text

To gain access to these valuable teaching materials, contact your Health Professions Account Specialist at http://go.jblearning.com/findarep.

J. Glenn Forister

J. Dennis Blessing

Foreword

University of Arkansas for Medical Sciences

Little Rock, Arkansas

Over the past two decades, I have devoted thousands of hours, as a teacher, advisor, and thesis or dissertation committee member, to working with scores of students dealing with a research project of some type. These students in the allied health professions, nursing, dentistry, and biomedical sciences requested assistance with refining research questions, tying theories together, laying out research designs, planning for data collection and analyses, and relating their research findings to their research goals and specific aims. Other students required assistance in interpreting published research and applying the results to their anticipated practice. In the process, I often scoured my personal library of references on research methods and statistics to find just the right chapter or article that would enable the student to gain the insight they required to become more independent as a “consumer” of research literature or fledgling researcher. I often came up short because the book wasn’t exactly what the student needed. The examples were from a different discipline, making the information difficult to apply; the content was too basic and theoretical, making the information difficult to understand; or the information was outdated, not taking into account technological advances that make the conduct of research easier.

I wish now that I had had a book such as Introduction to Research and Medical Literature for Health Professionals, Fourth Edition, to lend. It would have made my task simpler and would have enlightened the student far better than what I was able to provide at the time. This book, edited by my colleagues J. Glenn Forister and J. Dennis Blessing, is the first research methods textbook written specifically for students in the allied health professions. Both gentlemen are respected physician assistant educators, researchers, and scholars. Dr. Blessing has received numerous national awards for his contributions to education and research, and Mr. Forister is recognized as an outstanding teacher and researcher.

Why a book on allied health research methods?

On the one hand, one may argue that research methods are research methods and data analysis techniques are data analysis techniques, regardless of the discipline, and that is true to some extent. On the other hand, there are many good reasons for a book specifically for allied health professions students.

First, the allied health professions are maturing at a rapid rate and are evolving into distinctive professions in their own right, with their own professional concerns, clinical techniques, roles within healthcare systems, and practice traditions. These factors often

lead to research questions that can and should be answered and, in turn, research findings must be understood and applied by students and practitioners.

Second, as the allied health professions evolve, greater demands are placed on practitioners for responsibility and accountability in health care. Increasingly, practitioners are expected to participate as full members of healthcare teams who contribute expertise on par with physicians, nurses, dentists, and other team members. Therefore, allied health professionals must stay current on the research in their disciplines and must understand how research finding A or technique X applies to the care of their patients or clients, because it is unlikely that other members of the team will be able to contribute that same expertise.

Third, allied health professionals must demonstrate the efficacy of their contributions to health and wellness. Evidence-based care, economic imperatives, and professional ethics require us to show concretely that research finding A or technique X actually does result in better outcomes or reduce costs. The days of justifying a procedure or clinical practice by invoking tradition are quickly fading away.

Finally, allied health research tends to be grounded in the real-life experiences of allied health clinicians, many of whom have extended therapeutic care relationships with patients, clients, and their families. Other allied health personnel such as laboratory scientists and health information professionals may have no or limited direct contact with patients or clients. Their vital contributions lead to other research opportunities that range from basic scientific mechanisms to investigations into human factors (person–program or person–machine interfaces) that result in more accurate laboratory tests or more efficient, productive, and useful information systems. The nature of these relationships and their role in treatment, healing, and wellness can and should shape the kinds of research questions that are posed, methods used for answering the questions, and even the theory that shapes practice.

Fulfilling as a research career may be, it is unlikely that a large proportion of students reading

Introduction to Research and Medical Literature for Health Professionals, Fourth Edition, will pursue a career in allied health research. Some will practice in clinical settings as clinician-researchers, research partners, or research participants. The majority, however, will be informed consumers of research as they apply new knowledge, new procedures, and new techniques to day-to-day clinical care. All will require competencies in reading and comprehending research reports, interpreting and applying results, judging the adequacy of research practices, and drawing justifiable conclusions.

The editors and authors of this book are expert educators, researchers, and academics who have “been there and done that.” They speak from experience in guiding students and conducting research. This book is a valuable introduction to the major considerations in planning and carrying out research projects, guidelines for judging the quality of investigations, cautions for interpreting and applying findings, and essential resources. The topics range from the process for identifying a “researchable” problem and focusing research questions to finding the appropriate journal for your manuscript. Research techniques are explained from positivist and postpositivist paradigms to qualitative methods. Ethical considerations of human research are described, and guidelines for writing a research report are provided. Community-based participatory research, an emerging expectation in biomedical research, is explained and guidelines are provided for planning and conducting such research. Chapters and sections that describe the full array of study types that fall under the term research are particularly valuable because they can stimulate creative thinking about options for answering research questions and, even, what kinds of questions are “legitimate.”

Regardless of the ultimate career aspirations of the allied health professions student reading this book, this is one that you will keep on your shelf and refer to often. I know that I will keep a copy (or two or three) handy for that student who knocks on my door asking for some advice about a perplexing research project.

Salah Ayachi, PhD, PA-C

Associate Professor (retired)

Department of Physician Assistant Studies

School of Health Professions

University of Texas Medical Branch Galveston, Texas

Christopher E. Bork, PhD Professor (retired)

Department of Public Health and Preventive Medicine College of Medicine

The University of Toledo Toledo, Ohio

James F. Cawley, MPH, PA-C, DHL (hon) Professor

Department of Prevention and Community Health School of Public Health and Health Services Professor

Department of Physician Assistant Studies School of Medicine and Health Sciences

The George Washington University Washington, D.C.

Contributors

Meredith A. Davison, PhD, MPH Associate Dean of Academic Services School of Community Medicine Associate Program Director Physician Assistant Program College of Medicine

The University of Oklahoma–Tulsa Tulsa, Oklahoma

Richard Dehn, MPA, PA-C Professor and Founding Chair Department of Physician Assistant Studies College of Health and Human Services Northern Arizona University Flagstaff, Arizona

Margaret J. Foster, MS, MPH Assistant Professor Systematic Reviews and Research Coordinator Medical Sciences Library

Texas A&M University College Station, Texas

Christine S. Gaspard, MSLS

Head of Access Services and Interlibrary Loan

Instructional Librarian, Briscoe Library

UT Health Science Center San Antonio San Antonio, Texas

Elsa M. González, PhD

Assistant Professor

Department of Educational Leadership, Higher Education Administration College of Education and Human Development

Texas A&M University–Corpus Christi Corpus Christi, Texas

Robert W. Jarski, PhD, PA-C Professor (retired) School of Health Sciences

The OU William Beaumont School of Medicine Director

Complementary Medicine and Wellness Program Oakland University Rochester, Michigan

Linda Levy, MSW, MLS, AHIP

Assistant Library Director (retired) Briscoe Library

UT Health Science Center San Antonio San Antonio, Texas

Anthony A. Miller, MEd, PA-C

Chief Policy Officer, Head of Research Physician Assistant Education Association Alexandria, Virginia

Bruce R. Niebuhr, PhD

Susan Brown Logan Distinguished Professor in Teaching Excellence

Distinguished Teaching Professor (retired) Department of Physician Assistant Studies School of Health Professions

University of Texas Medical Branch Galveston, Texas

Rhonda Oilepo, MS, CIP

Associate Director

Office of the Institutional Review Board

UT Health Science Center San Antonio San Antonio, Texas

Katherine A. Prentice, MSIS

Associate Director for User Experience and Assessment Schusterman Library

The University of Oklahoma–Tulsa Tulsa, Oklahoma

Richard R. Rahr, EdD, PA-C

Professor Emeritus Department of Physician Assistant Studies

School of Health Professions University of Texas Medical Branch Galveston, Texas

Scott D. Rhodes, PhD, MPH Professor

Division of Public Health Sciences School of Medicine

Wake Forest University Winston-Salem, North Carolina

Joseph O. Schmelz, PhD, RN, CIP, FAAN

Assistant Vice President for Research Operations

UT Health Science Center San Antonio San Antonio, Texas

Albert Simon, DHSc, MEd, PA-C Chair

Department of Physician Assistant Studies

Arizona School of Health Sciences Mesa, Arizona

Kimberly K. Summers, PharmD Director, Research Regulatory Programs

UT Health Science Center San Antonio San Antonio, Texas

Wake Forest University

Winston-Salem, North Carolina

UT Health Science Center San Antonio San Antonio, Texas

Reviewers

Allison Bernknopf, PharmD, BCPS

Associate Professor College of Pharmacy Ferris State University Big Rapids, Michigan

Vera C. Brancato, EdD, MSN, BSN, RN Professor of Nursing Alvernia University Reading, Pennsylvania

Pamela J. Bretschneider, PhD Faculty

Massachusetts College of Pharmacy and Health Sciences University Boston, Massachusetts

Kim Cavanagh, DHSc, MPAS, PA-C

Associate Professor Physician Assistant Program

Morosky College of Health Professions and Sciences Gannon University Erie, Pennsylvania

Sara M. Denning, MPA, PA-C

Academic Instructor, Clinical Science Instructor Physician Assistant Program The College of Health Professions The University of Findlay Findlay, Ohio

Michael L. Rowland, PhD Assistant Professor Department of Leadership, Foundations, and Human Resource Education School of Medicine University of Louisville Louisville, Kentucky

Michele L. Shade-McCay, MPH, DrPH Visiting Assistant Professor College of Science and Health DePaul University Chicago, Illinois

Daniel T. Vetrosky, PA-C, PhD, DFAAPA

Associate Professor and Director of Didactic Education Department of Physician Assistant Studies College of Allied Health Professions University of South Alabama Mobile, Alabama

Section I

GettinG Started

Chapter Overview

this chapter is designed to introduce health professionals and students to research. the chapter introduces readers to the basic definitions and sources of research. An outline is offered to aid in the development of a project or research agenda. each small piece of research that can add to the body of medical knowledge results in improvement in the healthcare professions and in the physical, mental, and social health of those for whom care is provided.

Learning Objectives

• Define research

• Describe types of research.

• Begin to develop a scientific approach to study and practice. c

J. Dennis Blessing, PhD, PA

• Describe and discuss the importance of research in the healthcare professions.

intrOduCtiOn

The bottom line is that research determines almost everything that is practiced now and in the future. The word research often evokes a panic reaction. Students may see research as a mysterious process that is difficult to understand and difficult to conduct. Often students cannot make the connection between a required research assignment and their future healthcare careers. Similarly, many clinicians may not connect research to their work. Research, however, provides an opportunity to explore, understand, and explain practice. By mastering research, healthcare professionals can enhance their clinical careers and improve patient outcomes.

Many clinical practices are becoming involved with clinical trials and studies. This involvement makes understanding the scientific process and research a practice requirement. Beyond the possibility of being directly involved in research, every healthcare

professional must understand research processes in order to interpret healthcare literature. The decision to incorporate a new treatment modality depends on the ability to assess and understand the research that led to that modality. Additionally, healthcare professionals must be able to evaluate the literature in terms of how it relates to patients and to evaluate the best treatment options.

researCh and students in heaLthCare prOfessiOns

The word research conjures up many images:

• Socially inept individuals hidden away in a lab doing something that seems to have little relationship to everyday life

• Dr. Frankenstein

• Boring work forced on students

• The pursuit of information that has little application in the real world

• Not something a health professional does in clinical practice

For many people, the research process is difficult to understand. Research requires manipulations of impossible-to-learn formulations that end up in a language that only other researchers comprehend. Research sometimes produces contradictory results that often leave healthcare professionals wondering what to do. Research frightens clinicians and keeps educators from taking tenuretrack positions. Research conjures up an image of boring, regimented work that may have little to do with the “real world.”

In reality, the very opposite is true. Research provides the basis for practice of the healthcare profession. Research is the key to the present and future, regardless of one’s profession, position, or function in health care. The practice of medicine, nursing, and health care is based in scientific research that is applied to every patient. The only way health care can advance is by research, that is, developing evidence of what works and applying the results. Practitioners who are not actively involved in research must possess a basic understanding of the processes and what research results mean to

practice. This understanding allows practitioners to interpret results, to differentiate between conflicting results, and to discern what is useful and best for patients. As evidence-based medicine becomes the basis for health care, understanding and conducting research also has become more important. More and more practicing healthcare professionals are finding that research or some aspect of research has become part of their day-to-day job.

researCh equaLs CuriOsity

Whether they realize it or not, everyone has done research in some manner. Seeking an answer to a question is a form of research. Even looking up a word in a dictionary can be considered a form of research. Curiosity and the need for information create the drive to find answers in health care and daily life. Finding those answers is research. Certainly, much “research” is informal and without the systematic constraints required in formal research, but it occurs every day. A parent’s admonition to “Look it up!” sends children off on a research effort whether they realize it or not. Practitioners do research every day as they investigate the literature for solutions to patients’ problems. Students do research as part of their education and preparation to enter their profession. The very act of study is an investigation in some ways, regardless of what it is called. Exam preparation is a form of research.

Research occurs in the laboratory, classroom, office, practice, and society at large. It may be directly applicable to a problem or only a small piece of larger solutions. Research can help practitioners prepare for what will happen and understand what has happened. Individual needs and desires direct how research is used and the part it plays in careers and lives. Research is a tool to be used. Learning to use this tool helps relieve anxieties and increases the ability to appreciate and enjoy the process. Application is likely to improve the lives of patients.

Research that involves interests or needs for discovery is most important. In some ways research may be more important to the practitioner than to

the student, but research skills are introduced during education. Similarly, what interests a healthcare practitioner or student may be mundane but necessary to the profession or livelihood. For example, an occupational therapist may have little interest in the differences in practice census flows by disability type, but that information may have a great impact on patient scheduling and clinical assignments. Research may provide answers that allow for the most efficient use of time and expertise in practice. Many questions about one’s practice can be answered by research. It may or may not require statistical analysis, but it requires the systematic gathering, analysis, and interpretation of information (data).

Another example of research application in practice is patient outcomes. What is the difference in practice outcomes if a disease is treated with regimen A versus regimen B? There may be a wealth of information in texts and the literature, but what about a particular practice? Personal research is needed to determine the answer, whether a formal or informal process is used. The values of informal versus formal research may be equal, but a formal investigation might lead to benefits beyond a single setting if the investigation yields significant information.

researCh and the students Of heaLthCare prOfessiOns

For a student, research is part of the task of discovery and learning. Research provides the information needed to build a fund of knowledge that guides what a student will do as a healthcare provider. Every student must become an informed consumer and learn to interpret the medical research and healthcare literature. At a minimum, learning how to interpret research findings is a necessary skill for a professional career. Effective interpretation skills allow healthcare practitioners to deliver an acceptable level of care. In many ways, the research process is comparable to clinical reasoning and critical thinking skills. Much of the discipline needed to develop and conduct

research is the same as the discipline needed to assess and manage disease processes. Education in the healthcare professions should be consistent with adult learning theory. All healthcare practitioners should be lifelong learners; the healthcare professional that stops building his or her knowledge base and abilities will soon be hopelessly behind. Experience is part of that knowledge base, but continuing to understand and interpret the literature is the foundation for maintaining, redefining, and increasing that base. Research can help meet future healthcare challenges. Research is one tool that helps practitioners to “learn how to learn.”

researCh and heaLthCare prOfessiOnaLs

The unknowns and seemingly complex methods of systematic research and its processes frighten many people. Analysis, statistics, and interpretation can be daunting, as well. Research as a discipline even has its own language. Research may be held in high regard by many and in low regard (almost thought of as a dirty word?) by others. Many healthcare professionals want to leave research to others. However, at a minimum, healthcare professionals must be able to interpret and apply research as steps in patient care. As some healthcare professionals become more involved and invested in their careers and practices, they may find roles and responsibilities in the research arena. Society expects healthcare professionals to understand healthcare research and apply it to the needs of the individual patient.

researCh takes Many fOrMs

Research takes many different forms (Table 1–1). Research can be categorized in various ways, including pure research, experimental research, clinical research, applied research, descriptive research, laboratory research, 1 and outcomes research. These forms depend on many factors.

table 1–1 types of research

type description

pure Abstract and general, concerned with generating new theory and gaining new knowledge for knowledge sake

experimental Manipulation of one variable to see its effect on another variable, while controlling for as many other variables as possible and randomly assigning subjects to groups

clinical performed in the clinical setting where control over variables is quite difficult

AppliedDesigned to answer a practical question, to help people do their jobs better

DescriptiveDescribing a group, a situation, or an individual to gain knowledge that may be applied to further groups or situations, as in case studies or trend analyses

Laboratory performed in laboratory surroundings that are tightly controlled

example(s)

theory development

Double-blind random assignment control groups, response to an intervention

Drug trials, therapeutic results

time use studies, evaluation of different types of interventions with the same purpose

Surveys, qualitative research, measurement of characteristics, response to phenomena

Basic science research

reproduced from: Bailey DM. Research for the Health Professional: A Practical Guide. 2nd ed. philadelphia, pA: FA Davis;1997:xxii.

The design of a research study is an important factor that confuses many beginning investigators. 2 Some research can be done without any special knowledge or skills, such as counting how many patients have a particular diagnosis. Some research requires specialized skills and must follow an exact methodology, such as clinical drug trials. Research has a language of its own that must be learned. The recording of experimental results and writing of research have unique requirements that must be learned, practiced, and perfected. For most, research is about phenomena (something that can be perceived) that affect what is done and what needs to be known. Research is about observation and interpretation of what is learned in order to answer the questions posed. Research can be challenging and difficult. It also can be enjoyable and rewarding. At every level and in every format and design, research should add to knowledge. It is unlikely that any single piece of research will make headlines. However, answering questions and making small contributions to the

larger body of medical knowledge are very satisfying. Health care at every level continually creates questions that need answers. Society has questions that need answers. When healthcare professionals accept the challenge of answering those questions, a basic understanding of research and how to apply it is necessary. Learning the research process offers the greatest likelihood of finding those answers. One does not have to be a genius to do research. One does not have to be mathematically gifted. One must only have an interest. Research and its results can be used in the classroom, laboratory, or clinic. It is a process to be learned and used to help healthcare practitioners, patients, students, and others.

deveLOping a researCh prOjeCt

If a research project is part of education and training, it may take many forms. Choosing a project and developing its design depend on a

number of factors. The first is to understand exactly what is expected. Schools or institutions may have specific guidelines. These parameters must be known before beginning any project. Many organizations prescribe a scientific writing format. Student investigators must know which style and style manual is required and should obtain a copy.

Schools or institutions may assign research topics and/or a specific design to follow. Development of a research project depends on many factors. Some introspection and consideration are required with regard to time, effort, cost, resources, and ability needed for any project. This introspection must include an assessment of personal attributes, interests, resources, and expectations of self (Jones PE, personal communication, 2004). Part of this assessment must consider strengths as a researcher and abilities to accomplish the project. One cannot do quantum physics without the education and skills necessary, no matter how interested one may be in quantum physics. Students and inexperienced investigators must be able to concentrate their research efforts to develop or use their expertise to the maximum benefit. It is better to be an expert in one small area than somewhat of an expert in several. Every beginning researcher needs mentors and collaborators. Students and beginning investigators should seek out people who have skills in their area of interest and ask for their help. They should explore the possibilities of collaborating with someone on their research as a learning activity. Another key element to a successful research effort is the allotment of adequate time for investigations. For students, time may be very limited by schedules, class obligations, planned graduation date, and the like. A timeline for a research project should be created and followed.

Research is a systematic, organized process that goes through a number of sequential (or near sequential steps (see Figure 1–1 ). The first step of developing a research project is brainstorming. This activity should be as expansive as possible by making a list (by hand or on the computer)

of everything of interest. Once these ideas are recorded, a short break of a few minutes or a few days should be taken (the key is not to think about the project for a short while). Then the list can be refined; new items can be added, and those that do not seem important can be eliminated. This process may be repeated more than once before a project is defined. A student, for example, may have an assigned topic, but there may be many ways to approach the assigned project. Once a list of possibilities has been developed, the defining process can be done in this way:

1. Make a list of everything of interest or questions that need to be answered.

2. Prioritize the list in the order of interests.

3. Make a second ordered list (from the first) of the things that are within the capabilities of the investigator.

4. Make a third ordered list (from the first) of the things that are important to the effort.

5. Make a fourth ordered list (from the first) of the things that are important to society, or health, or the particular profession.

6. Compare the lists. Items that appear at the top of all four lists should be prioritized and merged into a single list.

7. Make decisions about what can and cannot be accomplished. Mark off the things that cannot be done. This includes financing the study. Financial support is just as important to the project’s success as time and expertise.

8. The topic that survives or is central to the lists is the basis of the research project. This topic represents a process of summation that includes challenges that need to be researched; challenges to the capability of the researcher; and challenges that are important to the individual, the program, and the topic of interest. What could be better?

9. Develop a timeline for the study; set aside research time and plan the step-by-step process, and then . . .

Truth in the universe

Problem in practice, theory, application, humankind

Define the problem

Develop OR OR Hypothesis

Research question Nullhypothesis

Answer in the literature Solution discovered Literature review

Answer NOT in the literature

Data analysis Develop design and methodology

Data collection

Results

Interpretation

Conclusions

Dissemination

Poster PublicationPresentation

Figure 1–1 Outline of the scientific process.

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