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Research Problem and Purpose

Chapter 5 Research Problem and Purpose   http://evolve.elsevier.com/Grove/practice/ We are constantly asking questions to better understand ourselves and the world around us. This human ability to wonder and ask creative questions about behaviors, experiences, and situations in the world provides a basis for identifying research topics and problems. Identifying a problem is the initial step, and one of the most significant, in conducting quantitative, qualitative, outcomes, and intervention research. The research purpose evolves from the problem and directs the subsequent steps of the research process. Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. Research topics contain numerous potential research problems, and each problem provides the basis for developing many purposes. Thus, the identification of a relevant research topic and a challenging, significant problem can facilitate the development of numerous study purposes to direct a lifetime program of research. However, the abundance of research topics and potential problems frequently is not apparent to nurses struggling to identify their first study problem. This chapter differentiates a research problem from a purpose, identifies sources for research problems, and provides a background for formulating a problem and purpose for study. The criteria for determining the feasibility of a proposed study problem and purpose are described. The chapter concludes with examples of research topics, problems, and purposes from current quantitative, qualitative, outcomes, and intervention studies. What Is a Research Problem and Purpose? A research problem is an area of concern where there is a gap in the knowledge base needed for nursing practice. Research is conducted to generate knowledge that addresses the practice concern, with the ultimate goal of providing evidence-based health care. A research problem can be identified by asking questions such as the following: What is wrong or is of concern in this clinical situation? What knowledge is needed to improve this situation? Will a particular intervention work in this clinical situation? What is known about this intervention’s effectiveness? Would another intervention be more effective in producing the desired outcomes? By questioning and reviewing the literature, researchers begin to recognize a specific area of concern and the knowledge gap that surrounds it. The knowledge gap, or what is not known about this clinical problem, determines the complexity and number of studies needed to generate essential knowledge for nursing practice ( Craig & Smyth, 2012 ; Creswell, 2009 ). In addition to the area of concern, the research problem identifies a population and sometimes a setting for the study. A research problem includes significance, background, and a problem statement. The significance of a problem indicates the importance of the problem to patients and families, nursing, healthcare system, and society. The background for a research problem briefly identifies what we know about the problem area. The problem statement identifies the specific gap in the knowledge needed for practice. A research problem from the study by Grady, Entin, Entin, and Brunye (2011) is presented as an example. This study was conducted to examine the effectiveness of educational messages or information on the knowledge, attitudes, and behaviors of people with diabetes. “Diabetes prevalence has reached epidemic proportions in this country. The health and economic consequences for Americans with this disease are overwhelming and expected to grow as our population continues to age. Approximately 23.6 million people in the United States have diabetes and, despite the disease being underreported as a cause of death, diabetes was listed as the seventh leading cause of death in the United States in 2006 ( Centers for Disease Control and Prevention, 2008a ). The direct medical costs of diabetes care and complications of $116 billion, together with indirect costs of $58 billion related to disability and reduced productivity, resulted in an estimated economic cost of diabetes totaling $174 billion in 2007 ( American Diabetes Association, 2009 ).… Complications contribute to a risk of death among individuals with diabetes that is about 2 times higher than that of individuals without diabetes ( Centers for Disease Control and Prevention, 2008a ). Amputations and foot ulcerations are the most common consequences of diabetic neuropathy and the major causes of morbidity and disability in people with diabetes. Approximately 2% to 3% of individuals with diabetes develop one or more foot ulcers each year, and an estimated 15% will develop a foot ulcer during their lifetime ( Singh, Armstrong, & Lipsky, 2005 ) [ problem significance ].… As the cornerstone of diabetes treatment and an integral part of a self-management regime, education of patients with diabetes takes place in both inpatient and outpatient venues.… Patient education takes time in the continuum of care that an already overworked staff is challenged to provide.… The research cited in the reviews of Boren et al. (2006) and Jackson et al. (2006) provides evidence that delivery of healthcare information can be accomplished effectively without involving diabetes educators or nurses and offers support for the use of information-technology-based education as an alternative way to provide information and guidance to persons with diabetes [ problem background ]. However, regardless of whether the information is presented in person or via technology, a relevant and still-open question is how to present the information so as to foster positive attitudinal and behavioral change and maximize the long-term effectiveness of health management education [ problem statement ].” ( Grady et al., 2011 , pp. 22-23) In this example, the research problem identifies an area of concern (incidence, costs, and complications of diabetes) for a particular population (persons with diabetes) in selected settings (inpatient and outpatient venues). Grady and colleagues (2011) clearly identified the significance of the problem, which is extensive and relevant to patients, families, nursing, healthcare system, and society. The problem background focuses on key research conducted to examine the effectiveness of health education on the management of diabetes. The last sentence in this example is the problem statement, which identifies the gap in the knowledge needed for practice. In this study, there is limited research on how to present diabetic education to maximize its effectiveness on attitudinal and behavioral change in people with this chronic illness. The research problem in this example includes concepts or research topics such as diabetes prevalence, economic consequences, complications of diabetes, consequences of diabetic neuropathy, health management education, self-management, and attitudinal and behavioral changes. Health management education is an abstract concept, and a variety of nursing actions or interventions could be implemented to determine their effectiveness in promoting long-term attitudinal and behavioral changes in persons with diabetes. Thus, each problem may generate many research purposes. The knowledge gap regarding how to present information to foster positive attitudinal and behavioral changes in persons with diabetes provides clear direction for formulating the research purpose. The research purpose is a clear, concise statement of the specific focus or aim of the study that is generated on the basis of the research problem. The purpose usually indicates the type of study (quantitative, qualitative, outcomes, or intervention) to be conducted and often includes the variables, population, and setting for the study. The goals of quantitative research include identifying and describing variables, examining relationships among variables, and determining the effectiveness of interventions in managing clinical problems ( Creswell, 2009 ; Shadish, Cook, & Campbell, 2002 ). The goals of qualitative research include exploring a phenomenon, such as depression as it is experienced by pregnant women; developing theories to describe and manage clinical situations; examining the health practices of certain cultures; describing health-related issues, events, and situations; and determining the historical evolution of the profession ( Marshall & Rossman, 2011 ; Munhall, 2012 ). The focus of outcomes research is to identify, describe, and improve the outcomes or end results of patient care ( Doran, 2011 ). Intervention research focuses on investigating the effectiveness of nursing interventions in achieving the desired outcomes in natural settings ( Forbes, 2009 ). Regardless of the type of research, every study needs a clearly expressed purpose statement to guide it. Grady et al. (2011) clearly identified their study purpose following their research problem statement of the gap in the knowledge base. Thus, the purpose of their study was to “examine the impact of information framing in an educational program about proper foot care and its importance for preventing diabetic complications on long-term changes in foot care knowledge, attitudes, and behavior” ( Grady et al., 2011 , p. 23). This research purpose indicates that these investigators conducted a quantitative quasi-experimental study to determine the effectiveness of an independent variable or intervention (information framing educational program about diabetic foot care and prevention of complications) on the dependent or outcome variables (foot care knowledge, attitudes, and behaviors). The researchers also identified two hypotheses to direct their study, which included the four variables identified (see Chapter 8 for a discussion of hypotheses). The study findings indicated that the gain-framed messages focused on the benefits of taking action were significantly more effective in promoting positive behavioral changes in people with diabetes than the loss-framed messages focused on the costs of not taking action. A gain-framed message might be stated as follows: “Achieving normal blood sugar increases your feelings of health and well being and promotes control of your illness.” A loss-framed message might be worded as follows: “Poorly controlled blood sugars can lead to complications of neuropathy, foot lesions, and amputation.” Grady et al. (2011) also found that changes in knowledge affected changes in attitudes and that attitudes were direct predictors of long-term behavior management of diabetes. The findings from this study and other research provide evidence of the effectiveness of information messages in sustaining health promoting behavior by people with diabetes. Sources of Research Problems Research problems are developed from many sources, but you need to be curious, astute, and imaginative to identify problems from the sources. The sources for research problems included in this text are (1) clinical practice, (2) researcher and peer interactions, (3) literature review, (4) theories, and (5) research priorities identified by funding agencies and specialty groups. Researchers often use more than one source to identify and refine their research problem. Clinical Practice The practice of nursing must be based on knowledge or evidence generated through research. Thus, clinical practice is an extremely important source for research problems. Problems can evolve from clinical observations. For example, while watching the behavior of a patient and family in crisis, you may wonder how you as a nurse might intervene to improve the family’s coping skills. A review of patient records, treatment plans, and procedure manuals might reveal concerns or raise questions about practice that could be the basis for research problems. For example, you may wonder: What nursing intervention will open the lines of communication with a patient who has had a stroke? What is the impact of home visits on the level of function, readjustment to the home environment, and rehospitalization pattern of a child with a severe chronic illness? What is the most effective treatment for acute and chronic pain? What is the best pharmacological agent or agents for treating hypertension in elderly, diabetic patients—angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), diuretic, beta blocker, calcium channel blocker, or alpha antagonist, or a combination of these drugs? What are the most effective pharmacological and nonpharmacological treatments for a patient with a serious and persistent mental illness? What are the needs of stroke survivors from their perspective? What are the cultural factors that promote better birth outcomes in Hispanic women? These clinical questions could direct you in identifying a significant research problem and purpose. Extensive patient data, such as diagnoses, treatments, and outcomes, are now computerized. Analyzing this information might generate research problems that are significant to a clinic, community, or national healthcare system. For example, you may ask: Why has adolescent obesity increased so rapidly in the past 10 years, and what treatments will be effective in managing this problem? What pharmacological and nonpharmacological treatments have been most effective in treating common acute illnesses such as otitis media, sinusitis, and bronchitis in your practice or nationwide? What are the outcomes (patient health status and costs) for treating such chronic illnesses as type 2 diabetes, hypertension, and dyslipidemia in your practice? Review of agency patient data often reveals patterns and trends in a clinical setting and helps nurses and students to identify patient care problems. Because health care is constantly changing in response to consumer needs and trends in society, the focus of current research varies according to these needs and trends. For example, research evidence is needed to improve practice outcomes for infants and new mothers, the elderly and residents in nursing homes, and persons from vulnerable and culturally diverse populations. Healthcare agencies would benefit from studies of varied healthcare delivery models. Society would benefit from interventions recognized to promote health and prevent illness. In summary, clinically focused research is essential if nurses are to develop the knowledge needed for evidence-based practice (EBP) ( Brown, 2009 ; Melnyk & Fineout-Overholt, 2011 ). Researcher and Peer Interactions Interactions with researchers and peers offer valuable opportunities for generating research problems. Experienced researchers serve as mentors and help novice researchers to identify research topics and formulate problems. Nursing educators assist students in selecting research problems for theses and dissertations. When possible, students conduct studies in the same area of research as the faculty. Faculty members can share their expertise regarding their research program, and the combined work of the faculty and students can build a knowledge base for a specific area of practice. This type of relationship could also be developed between an expert researcher and a nurse clinician. Because nursing research is critical for designation as a Magnet facility by the American Nurses Credentialing Center © (ANCC, 2012) , hospitals and healthcare systems employ nurse researchers for the purpose of guiding studies conducted by staff nurses. Building an EBP for nursing requires collaboration between nurse researchers and clinicians as well as with researchers from other health-related disciplines. Interdisciplinary research teams have the expertise to increase the quality and quantity of studies conducted. Being a part of a research team is an excellent way to expand your understanding of the research process. Beveridge (1950) identified several reasons for discussing research ideas with others. Ideas are clarified and new ideas are generated when two or more people pool their thoughts. Interactions with others enable researchers to uncover errors in reasoning or information. These interactions are also a source of support in discouraging or difficult times. In addition, another person can provide a refreshing or unique viewpoint, which helps avoid conditioned thinking, or following an established habit of thought. A workplace that encourages interaction can stimulate nurses to identify research problems. Nursing conferences and professional meetings also provide excellent opportunities for nurses to discuss their ideas and brainstorm to identify potential research problems. The Internet has greatly extended the ability of researchers and clinicians around the world to share ideas and propose potential problems for research. Most colleges or schools of nursing have websites that identify faculty research interests and provide mechanisms for contacting individuals who are conducting research in your area of interest. Thus, interactions with others are essential to broaden your perspective and knowledge base and to support you in identifying significant research problems and purposes. Literature Review Reviewing research journals, such as Advances in Nursing Science, Applied Nursing Research, Clinical Nursing Research, Evidence-Based Nursing, International Journal of Psychiatric Nursing Research, Journal of Nursing Scholarship, Journal of Advanced Nursing, Journal of Research in Nursing, Nursing Research, Nursing Science Quarterly, Research in Nursing & Health, Scholarly Inquiry for Nursing Practice: An International Journal, Southern Online Journal of Nursing Research, and Western Journal of Nursing Research , as well as theses and dissertations will acquaint novice researchers with studies conducted in an area of interest. The nursing specialty journals, such as American Journal of Maternal Child Nursing, Archives of Psychiatric Nursing, Dimensions of Critical Care, Heart & Lung, Infant Behavior and Development, Journal of Pediatric Nursing , and Oncology Nursing Forum, also place a high priority on publishing research findings. Reviewing research articles enables you to identify an area of interest and determine what is known and not known in this area. The gaps in the knowledge base provide direction for future research. (See Chapter 6 for the process of reviewing the literature.) At the completion of a research project, an investigator often makes recommendations for further study. These recommendations provide opportunities for others to build on a researcher’s work and strengthen the knowledge in a selected area. For example, the Grady et al. (2011 , p. 27) study, introduced earlier in this chapter, provided recommendations for further research to examine “the longer term eventualities of gain- and loss-framed messages on preventative behaviors.” They also recommended examining how long the gain-framed message might last and when it would be “necessary to provide another message presentation to bolster effective self-care behavior” (p. 27). These researchers also encouraged others to validate their findings through replication studies that varied the content and delivery format of educational messages provided persons with diabetes. Replication of Studies Reviewing the literature is a way to identify a study to replicate. Replication involves reproducing or repeating a study to determine whether similar findings will be obtained ( Fahs, Morgan, & Kalman, 2003 ). Replication is essential for knowledge development because it (1) establishes the credibility of the findings, (2) extends the generalizability of the findings over a range of instances and contexts, (3) reduces the number of type I and type II errors, (4) corrects the limitations in studies’ methodologies, (5) supports theory development, and (6) lessens the acceptance of erroneous results. Some researchers replicate studies because they agree with the findings and wonder whether the findings will hold up in different settings with different subjects over time. Others want to challenge the findings or interpretations of prior investigators. Some researchers develop research programs focused on expanding the knowledge needed for practice in an area. This program of research often includes replication studies that strengthen the evidence for practice. Four different types of replications are important in generating sound scientific knowledge for nursing: (1) exact, (2) approximate, (3) concurrent, and (4) systematic extension ( Haller & Reynolds, 1986 ). An exact (or identical) replication involves duplicating the initial researcher’s study to confirm the original findings. All conditions of the original study must be maintained; thus, “there must be the same observer, the same subjects, the same procedure, the same measures, the same locale, and the same time” ( Haller & Reynolds, 1986 , p. 250). Exact replications might be thought of as ideal to confirm original study findings, but these are frequently not attainable. In addition, one would not want to replicate the errors in an original study, such as small sample size, weak design, or poor-quality measurement methods. When conducting an approximate (or operational) replication , the subsequent researcher repeats the original study under similar conditions, following the methods as closely as possible. The intent is to determine whether the findings from the original study hold up despite minor changes in the research conditions. If the findings generated through replication are consistent with the findings of the original study, then the knowledge is considered more credible and has a greater probability of accurately reflecting the real world. If the replication fails to support the original findings, the designs and methods of both studies should be examined for limitations and weaknesses, and further research must be conducted. Conflicting findings might also generate additional theoretical insights and provide new directions for research. For a concurrent (or internal) replication , the researcher collects data for the original study and the replication study simultaneously thereby checking the reliability of the original study findings. The confirmation, through replication of the original study findings, is part of the original study’s design. For example, your research team might collect data simultaneously at two different hospitals to compare and contrast the findings. Consistency in the findings increases the credibility of the study and the likelihood that others will be able to generalize the findings. Some expert researchers obtain funding to conduct multiple concurrent replications, in which a number of individuals conduct repetitions of a single study, but with different samples in different settings. Clinical trials that examine the effectiveness of the pharmacological management of chronic illnesses, such as diabetes, hypertension, and dyslipidemia, are examples of concurrent replication studies. As each study is completed, the findings are compiled in a report that specifies the series of replications that were conducted to generate these findings. Some outcome studies involve concurrent replication to determine whether the outcomes vary for different healthcare providers and healthcare settings across the United States ( Brink & Wood, 1979 ; Brown, 2009 ; Doran, 2011 ). A systematic (or constructive) replication is done under distinctly new conditions. The researchers conducting the replication do not follow the design or methods of the original researchers; rather, the second investigative team identifies a similar problem but formulates new methods to verify the first researchers’ findings ( Haller & Reynolds, 1986 ). The aim of this type of replication is to extend the findings of the original study and test the limits of the generalizability of such findings. Intervention research might use this type of replication to examine the effectiveness of various interventions devised to address a practice problem. Nurse researchers need to actively replicate studies to develop strong research evidence for practice. However, the number of nursing studies replicated continues to be limited. The replications of studies might be limited because (1) some view replication as less scholarly or less important than original research, (2) the discipline of nursing lacks adequate resources and funding for conducting replication studies, and (3) editors of journals publish fewer replication studies than original studies ( Fahs et al., 2003 ). However, the lack of replication studies severely limits the generation of sound research findings needed for EBP in nursing. Thus, replicating a study should be respected as a legitimate scholarly activity for both expert and novice researchers. Funding from both private and federal sources is needed to support the conduct of replication studies, with a commitment from journal editors to publish these studies. Replication provides an excellent learning opportunity for the novice researcher to conduct a significant study, validate findings from previous research, and generate new research evidence about different populations and settings. Students studying for a master’s of science in nursing degree could be encouraged to replicate studies for their theses, possibly to replicate faculty studies. Expert researchers, with programs of research, implement replication studies to generate sound evidence for use in practice. When publishing a replication study, researchers need to designate the type of replication conducted and the contribution the study made to the existing body of knowledge. Theory Theories are an important source for generating research problems because they set forth ideas about events and situations in the real world that require testing ( Chinn & Kramer, 2008 ). In examining a theory, you may note that it includes a number of propositions and that each proposition is a statement of the relationship of two or more concepts. A research problem and purpose could be formulated to explore or describe a concept or to test a proposition from a theory. Middle range theories are the ones most commonly used as frameworks for quantitative studies and are tested as part of the research process ( Smith & Liehr, 2008 ). In qualitative research, the purpose of the study might be to generate a theory or framework to describe a unique event or situation ( Marshall & Rossman, 2011 ; Munhall, 2012 ). Some researchers combine ideas from different theories to develop maps or models for testing through research. The map serves as the framework for the study and includes key concepts and relationships from the theories that the researchers want to study. Frenn, Malin, and Bansal (2003 , p. 38) conducted a quasi-experimental study to examine the effectiveness of a “4-session Health Promotion/Transtheoretical Model-guided intervention in reducing percentage of fat in the diet and increasing physical activity among low- to middle-income culturally diverse middle school students.” The intervention was based on the “components of two behaviorally based research models that have been well tested among adults—Health Promotion Model ( Pender, 1996 ) and Transtheoretical Model ( Prochaska, Norcross, Fowler, Follick, & Abrams, 1992 )—but have not been tested regarding low-fat diet with middle school-aged children” ( Frenn et al., 2003 , p. 36). They developed a model of the study framework (see Figure 5-1 ) and described the concepts and propositions from the model that guided the development of different aspects of their study. Figure 5-1 The health promotion stage of change model: A synthesis of health promotion and transtheoretical models guiding low-fat diet intervention for students in an urban middle school. “A combined Health Promotion/Transtheoretical Model guided the intervention designed for this study [see Figure 5-1 ]. The first individual characteristic examined in this study was temptation (low self-efficacy), defined as the inability to overcome barriers in sustaining a low-fat diet … and an intervention helping adolescents develop behavioral control may enhance self-efficacy and improve health habits. The second characteristic common to both the Health Promotion and Transtheoretical Models was benefits/barriers. In a study of fifth- through seventh- grade children, Baranowski and Simons-Morton (1990) found the most common barriers to reducing saturated fat in the diet were (a) giving up preferred foods, (b) meals outside the home that contained fat, (c) not knowing what foods were low in fat, and (d) not wanting to take the time to read labels. The last individual characteristic used in this study was access to low-fat foods. This concept from the Health Promotion Model is important in a middle school-aged population, as they are, to some extent, dependent on others for the types of food available.” ( Frenn et al., 2003 , pp. 37-38) Frenn et al. (2003) used the Pender (1996) Health Promotion Model and the Transtheoretical Model ( Prochaska et al., 1992 ), which are middle range theories, to develop the following research questions to guide their study: “(a) Do demographic variables, access to low-fat foods, perceived self-efficacy, benefits/barriers, and stages of change predict percentage of fat reported in the diet by middle school-aged children? (b) Does the application of a Health Promotion/Transtheoretical Model intervention in 4 classroom sessions significantly improve adoption of a diet lower in fat and duration of physical activity as compared with a control group of students not engaged with the program?” ( Frenn et al., 2003 , p. 39) The findings from a study either support or do not support the relationships identified in the model. The study by Frenn et al. (2003) added support to the Health Promotion/Transtheoretical Model with their findings that the classroom intervention decreased dietary fat and increased physical activity for middle school–age adolescents. Further research is needed to determine whether classroom interventions over time reduce body mass index, body weight, and the percentage of body fat of overweight and obese adolescents. As a graduate student, you could use this model as a framework and test some of the relationships in your clinical setting. Research Priorities Since 1975, expert researchers, specialty groups, professional organizations, and funding agencies have identified nursing research priorities. The research priorities for clinical practice were initially identified in a study by Lindeman (1975) . Those original research priorities included nursing interventions related to stress, care of the aged, pain management, and patient education. Developing evidence-based nursing interventions in these areas continues to be a priority. Many professional nursing organizations use websites to communicate their current research priorities. For example, the American Association of Critical-Care Nurses (AACN) determined initial research priorities for this specialty in the early 1980s ( Lewandowski & Kositsky, 1983 ) and revised these priorities on the basis of patients’ needs and the changes in health care. The current AACN (2011) research priorities are identified on this organization’s website as (1) effective and appropriate use of technology to achieve optimal patient assessment, management, or outcomes, (2) creation of a healing, humane environment, (3) processes and systems that foster the optimal contribution of critical care nurses, (4) effective approaches to symptom management, and (5) prevention and management of complications. AACN (2011) has also identified future research needs under the following topics: medication management, hemodynamic monitoring, creating healing environments, palliative care and end-of-life issues, mechanical ventilation, monitoring of neuroscience patients, and noninvasive monitoring. If your specialty is critical care, this list of research needs might help you identify a priority problem and purpose for study. The American Organization of Nurse Executives (AONE, 2012) provides a discussion of their education and research priorities online at http://www.aone.org/education/index.shtml/ . For 2011-2012, AONE identified more than 25 research priorities in four strategic areas: (1) design of future patient care delivery systems, (2) healthful practice environments, (3) leadership, and (4) the positioning of nurse leaders as valued healthcare executives and managers. To promote the design of future patient care delivery systems, AONE encourages research focused on new technology, patient safety, and the work environment that allows strategies for improvement crucial to the success of the delivery system. In the area of healthful practice environments, AONE encourages research focused on practice environments that attract and retain nurses and that promote professional growth and continuous learning, including mentoring of staff nurses and nursing leaders. In the area of leadership, AONE encourages research focused on evidence-based leadership capacity, measurement of patient care quality outcomes, and technology to complement patient care. To promote the positioning of nurse leaders as valued healthcare executives and managers, AONE encourages research focused on patient safety and quality, disaster preparedness, and workforce shortages. AONE recognizes the importance of supporting education and research initiatives to create a healthy work environment, a quality healthcare system, and strong nurse executives. You can search online for the research priorities of other nursing organizations to help you identify priority problems for study. A significant funding agency for nursing research is the National Institute of Nursing Research (NINR). A major initiative of the NINR is the development of a national nursing research agenda that involves identifying nursing research priorities, outlining a plan for implementing priority studies, and obtaining resources to support these priority projects. The NINR has an annual budget of more than $90 million, with approximately 74% of the budget used for extramural research project grants, 7% for predoctoral and postdoctoral training, 6% for research management and support, 5% for the centers program in specialized areas, 5% for other research including career development, 2% for the intramural program, and 1% for contracts and other expenses (see NINR at http://www.ninr.nih.gov/ ). The NINR (2011) developed four strategies for building the science of nursing: “(1) integrating biological and behavior science for better health; (2) adopting, adapting, and generating new technologies for better health care; (3) improving methods for future scientific discoveries; and (4) developing scientists for today and tomorrow.” The areas of research emphasis include: (1) promoting health and preventing disease, (2) improving quality of life, (3) eliminating health disparities, and (4) setting directions for end-of-life research ( NINR, 2011 ). Specific research priorities were identified for each of these four areas of research emphasis and were included in the NINR Strategic Plan. These research priorities provide important information for nurses seeking funding from the NINR. Details about the NINR mission, strategic plan, and areas of funding are available on its website at http://www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan/ . Another federal agency that is funding healthcare research is the Agency for Healthcare Research and Quality (AHRQ). The purpose of the AHRQ is to enhance the quality, appropriateness, and effectiveness of healthcare services, and access to such services, by establishing a broad base of scientific research and promoting improvements in clinical practice and in the organization, financing, and delivery of healthcare services. Some of the current AHRQ funding priorities are research focused on prevention; health information technology; patient safety; long-term care; pharmaceutical outcomes; system capacity and emergency preparedness; and the cost, organization, and socioeconomics of health care. For a complete list of funding opportunities and grant announcements, see the AHRQ website at http://www.ahrq.gov/ . The World Health Organization (WHO) is encouraging the identification of priorities for a common nursing research agenda among countries. A quality healthcare delivery system and improved patient and family health have become global goals. By 2020, the world’s population is expected to increase by 94%, with the elderly population growing by almost 240%. Seven of every 10 deaths are expected to be caused by noncommunicable diseases, such as chronic conditions (heart disease, cancer, and depression) and injuries (unintentional and intentional). The priority areas for research identified by WHO are to (1) improve the health of the world’s most marginalized populations, (2) study new diseases that threaten public health around the world, (3) conduct comparative analyses of supply and demand of the health workforce of different countries, (4) analyze the feasibility, effectiveness, and quality of education and practice of nurses, (5) conduct research on healthcare delivery modes, and (6) examine the outcomes for healthcare agencies, providers, and patients around the world ( WHO, 2012 ). A discussion of WHO’s mission, objectives, and research policies can be found online at http://www.who.int/rpc/en . The Healthy People 2020 website identifies and prioritizes health topics and objectives for all age groups over the next decade ( U.S. Department of Health and Human Services, 2012 ). These health topics and objectives direct future research in the areas of health promotion, illness prevention, illness management, and rehabilitation and can be accessed online at http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx/ . In summary, funding organizations, professional organizations, and governmental healthcare organizations, both national and international, are sources for identifying priority research problems and offer opportunities for obtaining funding for future research.

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• Helen Noble 1 ,
• Allison Shorten 2
• 1 School of Nursing and Midwifery, Queens University Belfast , Belfast , UK
• 2 Department of Family, Community and Health Sciences , University of Alabama at Birmingham School of Nursing , Birmingham , Alabama , USA
• Correspondence to Dr Helen Noble, School of Nursing and Midwifery, Queens University Belfast, Belfast BT9 7BL, UK; helen.noble{at}qub.ac.uk

https://doi.org/10.1136/eb-2017-102850

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EBN perspectives bring together key issues from the commentaries in one of our nursing topic themes.

Introduction

This article is part of Evidence Based Nursing ( EBN ) Perspective series. In this series, published commentaries related to a specific nursing theme are collated and highlights are discussed. The topic for this edition is ‘nursing issues’, covering 21 commentaries published from October 2016 over a 12-month period. A summary of works is organised into key themes, research methods are identified and important implications for practice and future research are explored.

Evidence-Based Nursing commentaries on nursing issues (October 2016–October 2017)

Theme 1: professional issues—nursing workforce/workplace.

Staffing and nurse-perceived quality of care ( http://ebn.bmj.com/content/20/1/19 ).

Greater nurse autonomy associated with lower mortality and failure to rescue rates ( http://ebn.bmj.com/content/20/2/56 ).

Health, psychosocial and workplace characteristics may identify nurses and midwives at risk of high absenteeism ( http://ebn.bmj.com/content/20/3/83 ).

Good peer relationships can attenuate the negative effect of horizontal violence on job satisfaction  ( http://ebn.bmj.com/content/19/3/91 ).

Simple variations to traditional models of care can dramatically improve emergency department performance ( http://ebn.bmj.com/content/20/3/87 ).

Emergency department nurses report high workload and management pressure to meet 4-hour treatment targets ( http://ebn.bmj.com/content/19/3/90 ).

Information gaps in medication communication during clinical handover calls for a different approach ( http://ebn.bmj.com/content/19/4/125 ).

Nurses require confidence, knowledge and communication skills for referrals to doctors ( http://ebn.bmj.com/content/20/3/84 ).

Reporting of professional misconduct is influenced by nurses’ level of education and managerial experience ( http://ebn.bmj.com/content/20/3/89 ).

Mindfulness training can reduce depression and anxiety among nurses ( http://ebn.bmj.com/content/20/2/57 ).

Theme 2: Evidence-based nursing care—patient care/therapies

Earplugs could be an effective sleep hygiene strategy to reduce delirium in the intensive care unit ( http://ebn.bmj.com/content/20/1/20 ).

Intravenous paracetamol or intravenous propacetamol can provide effective postoperative analgesia for some patients ( http://ebn.bmj.com/content/20/3/88 ).

Acceptance and commitment therapy: an appropriate treatment option for older adults with chronic pain ( http://ebn.bmj.com/content/19/4/123 ).

It is unclear if combined motivational interviewing and cognitive behavioural therapy improve medication adherence ( http://ebn.bmj.com/content/20/3/86 ).

The effectiveness of protected mealtimes in hospital remains unclear ( http://ebn.bmj.com/content/20/3/86 ).

Subclavian site should be preferred for central venous access ( http://ebn.bmj.com/content/19/4/126 ).

Low pressure, knee-length compression stockings provide most comfort with no effect on thrombosis risk ( http://ebn.bmj.com/content/19/3/89 ).

Theme 3: Patient and family perspectives—giving rise to the patient and family voice

Family-centred advanced care planning with adolescents living with HIV is perceived as important, helpful and meaningful ( http://ebn.bmj.com/content/20/3/85 ).

Patients’ perspectives on the impact of fasting while in hospital  ( http://ebn.bmj.com/content/19/3/92 ).

Costs incurred by family caregivers of patients with palliative care needs ( http://ebn.bmj.com/content/19/3/93 ).

Home death versus hospital death: are they comparable at all? ( http://ebn.bmj.com/content/19/3/94).

Implications for practice and future research

A variety of methodologies have been used including cross-sectional studies (n=6), reviews of the literature (n=5), randomised controlled trials (n=5), qualitative studies (n=4) and other quantitative studies (n=3). Areas explored include issues directly related to nursing staff including autonomy, staffing, absenteeism, quality of care, peer relationships, depression and anxiety, meditation, communication and professional misconduct. Other areas relate directly to patients and cover reduction of delirium, pain relief, medication adherence, protected mealtimes, central venous access, management of thrombosis, impact of fasting and palliative care. Finally, some studies focus on models of care to improve advance care planning (ACP), emergency department performance and pain management.

There is a strong emphasis on the value of nursing care/therapies in promoting optimal health and the impact of nursing workforce issues on care quality and patient outcomes. Commentaries are generally directed to identifying best nursing practices, but they also highlight significant challenges faced by nurses, patients and families. Some of the workforce challenges included staffing, autonomy, relationships and how models of care can help to address these challenges.

Nursing researchers have long identified the important relationship between nurse staffing levels and patient care quality. A recent international study explored the relationship between nurse staffing levels and overtime and nurse perceptions of patient safety and quality of care ( http://ebn.bmj.com/content/20/1/19 ). Cho et al used a cross-sectional survey, which highlighted concerns of South Korean nurses about patient safety when staffing levels were low and when they were working overtime. 1 Results were compared with those from other countries, noting the international significance of this issue. Commentator Dr Pamela de Cordova pointed to the role of nurse administrators in identifying patient safety issues associated with work hours and overtime, recommending that future nursing research should examine the potential impact of workplace policy and legislation on patient safety in a global context.

Throughout the workforce/workplace theme, there was a strong focus on promoting health and wellness within the nursing profession, linking nursing wellness to quality and safety. Specific interventions were directed towards keeping nurses safe, thereby ensuring appropriate staffing levels and potentially improving patient outcomes. A commentary by Hunter ( http://ebn.bmj.com/content/20/2/57 ) discussed the value of mindfulness training in reducing depression and anxiety among nurses ( http://ebn.bmj.com/content/20/2/57 ), thereby reducing work-related stress, with the potential to improve patient care. Recent work by Lamont et al provides evidence regarding the identification of nurses and midwives at risk of high absenteeism. 2 This evidence from Australia highlights that the health and well-being of the nursing workforce goes ‘hand in hand’ with levels of absenteeism ( http://ebn.bmj.com/content/20/3/83 ) and can be linked to healthcare quality and safety. Recommendations for nursing leaders and policymakers included creating working environments with adequate support systems for nurses. In addition, there was a clear recommendation for organisations to conduct future benchmarking against programmes that effectively promote nurse’s well-being. It was clear that relationship building and effective communication are critical in promoting positive workplaces for nurses and their patients. For example, interventions that build positive peer relationships and mediate against horizontal violence in the workplace can improve job satisfaction ( http://ebn.bmj.com/content/19/3/91 ). This is another area where future research is needed to identify strategies to improve relationships and ultimately emotional well-being of nurses in the workplace, thereby strengthening our nursing workforce to provide high-quality patient care.

The evidence-based nursing car e theme presents a variety of studies examining strategies to deliver ‘best care’ to patients and addresses questions about effectiveness of patient therapies. It is evident that nurses have played a significant role in the development and testing of patient and family-centred interventions in a wide range of healthcare settings to improve patient experiences and outcomes. Commentaries include studies of interventions focused on improving patient outcomes by addressing problems that develop directly from the experience of being hospitalised. One example is the challenge nurses face in providing healthy sleep environments for patients in critical care settings to reduce the risk of delirium related to sleep deprivation. Commentator Laura Hill presented work by Litton et al 3 examining the benefits of using patient earplugs in intensive care unit settings. Evidence was clear that this relatively simple intervention, used on its own or with other interventions, could reduce the risk of delirium by increasing opportunity for patients to sleep ( http://ebn.bmj.com/content/20/1/20 ). Of course, this includes the caveat that high-quality research is needed to identify optimal strategies and co-interventions for reducing delirium risks.

Another essential component to patient health often compromised through hospitalisation is nutrition, with malnutrition affecting as many as one in three hospitalised patients ( http://ebn.bmj.com/content/20/3/86 ). A recent stepped-wedge cluster randomised controlled trial by Porter  et al 4 investigated whether a multifaceted ward-based ‘protected mealtime’ policy could improve patient energy and protein intake. Researchers concluded that the impact of system-wide ‘protected mealtime’ policies remains uncertain and a more focused approach of ‘assisted mealtimes’ may be more beneficial. This is interesting as sometimes the patient-centred solution can be more effective than system-centric policies, even when both approaches aim to improve patient outcomes. Providing fundamental nursing care to patients who need assistance during mealtimes using mealtime volunteers may have a significant impact on outcomes, without requiring larger-scale systems change necessary for implementing ‘protected mealtime’ policies within complex healthcare organisations. 4 Dr Adrienne Young recommends that future research in this area should involve patients and carers in study design. This would ensure implementation factors and measured outcomes are centred on what matter most to patients ( http://ebn.bmj.com/content/20/3/86 ).

As nurses place patients at the centre of care, patients and family perspectives were reviewed, addressing topics such as promoting family centredness in ACP ( http://ebn.bmj.com/content/20/3/85 ); perspectives on fasting in hospital ( http://ebn.bmj.com/content/19/3/92 ) and examining costs incurred by carers when patients are receiving palliative care ( http://ebn.bmj.com/content/19/3/94 ). One study focused on communication via ACP in advanced disease. Dalas et al 5 carried out a two-arm longitudinal multisite randomised controlled trial with adolescents aged 14–21 years and their healthcare surrogates. Adolescent/family dyads were randomised to receive either an ACP intervention or a time-matched control. The intervention included a survey of values and life experiences of illness and end of life care, an ACP interview to identify care goals and treatment preferences and the completion of an advance directive. Those who received the intervention reported it as significantly more useful and worthwhile than the control group. Importantly, although the participants reported feelings of sadness during difficult discussions concerning the approach of end of life, they found them helpful rather than harmful. Commentators Dr Wiener and Dr Rosenberg suggest that ACP discussions should be offered in a timely fashion without waiting until a teen is in crisis. This will ensure adolescents are allowed to partake in meaningful conversations related to their deteriorating health ( http://ebn.bmj.com/content/20/3/85 ).

Another study explored the important concept of home deaths versus hospital deaths and asked if they were comparable. 6 A mortality follow-back design of patients with cancer in the UK who died in hospital (n=177) or at home (n=175) analysed associations between a number of items including place of death, pain, feeling at peace and grief intensity. The aim was to compare hospital deaths with home deaths and identify which was better for patients and carers. Commentator Dr Neergaard found this question impossible to answer and highlighted how inherently different these two groups of patients are. Patients who die in hospital often have an indication for hospital admission, leading to confounding, making comparisons very difficult.

The commentaries of recent research summarise the plethora of evidence which can be used to explore further, the challenges faced by nurses implementing evidence-based care. Ongoing nursing research deepens our professional understanding of workforce challenges while gaining perspectives of patients and their carers to ensure the delivery of effective evidence-based nursing care. As the world of healthcare is constantly changing, it is imperative that nursing continues to contribute to growing knowledge about the effects of nursing interventions on outcomes and care quality. Nurses are charged with the undertaking to seek answers to increasingly complex practice questions and to identify and address the issues that matter most to patients and families.

• Kim EY , et al
• Brunero S ,
• Perry L , et al
• Carnegie V ,
• Elliott R , et al
• Haines TP ,
• Dallas RH ,
• Wilkins ML , et al
• Calanzani N ,
• Koffman J , et al

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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Current Trends in Critical Care Nursing Research

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Cindy L. Munro , Aluko A. Hope; Current Trends in Critical Care Nursing Research. Am J Crit Care 1 May 2023; 32 (3): 150–152. doi: https://doi.org/10.4037/ajcc2023943

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Critical care has faced unprecedented challenges in the recent past, including the COVID-19 pandemic and deterioration of the health care work environment. Research is crucial in discovering innovative solutions to these challenges, but the pandemic made critical care nursing research more difficult. Increased demands of caring for patients with high acuity and high mortality resulted in less time and energy for nurses at the bedside to participate in research. Nurse researchers had reduced access to critically ill patients, and medical studies of COVID-19 treatments often were prioritized over studies focused on nursing care or the work environment.

Despite these complicated constraints, researchers have persisted. And, as the research journal for the American Association of Critical-Care Nurses (AACN), the American Journal of Critical Care ( AJCC ) has continued to publish research of relevance to critical care nursing and interdisciplinary teamwork. Our primary goal is to provide our readers with reports of high-quality, timely clinical research that can inform and improve the care of critically ill patients and their families. In this editorial, we reflect on recent themes in research published in AJCC and provide examples from 2023 papers. We also alert readers to research events that will be offered at this month’s National Teaching Institute (NTI 2023) meeting in Philadelphia, Pennsylvania, May 22-24, 2023.

Between January 2022 (Volume 31, Issue 1) and the current May 2023 journal issue (Volume 32, Issue 3), AJCC published 71 reports of original research. These recent papers addressed a wide range of research topics, including bedside patient care, palliative and end-of-life care, intensive care unit (ICU) survivorship, measurement and prediction of patient problems, family concerns, communication, moral distress, and healthy work environment. The needs of patients across the lifespan were represented.

From a topical review of these recently published research papers, 3 overarching focal areas of high interest to bedside care emerged as themes. The first theme, improving patient care, was the predominate focus of many papers. The second theme, family well-being, remained an important concern. The third theme, understanding and improving the critical care work environment, was also well represented among recent papers. Appropriately, each of these themes is well aligned with the AACN vision, which states “AACN is dedicated to creating a healthcare system driven by the needs of patients and families where acute and critical care nurses make their optimal contribution.” 1  

Research to improve patient care at the bedside is foundational to nursing research. This focus has always been a primary emphasis for AJCC , and recent papers reflect the journal’s commitment to publishing rigorous clinical research that is applicable to bedside care. As an example, a paper in the March 2023 issue of AJCC reports the results of a randomized controlled trial of a live music intervention in the ICU. 2   The trial demonstrated that a 30-minute live music intervention provided by a board-certified music therapist significantly reduced agitation, pain, and heart rate in a group of adults receiving mechanical ventilation, compared with a usual care group who did not receive the live music intervention. Notably, this nurse-led research was conducted in a Beacon unit of a Magnet-designated community hospital, and the collaboration between nursing and music therapy highlighted the power of interdisciplinary care in improving patient outcomes. Because providing evidence of the effectiveness of nonpharmacologic interventions in reducing agitation and pain is crucial to informing practice, this article was selected as a continuing education offering.

“Recent papers reflect the journal’s commitment to publishing rigorous clinical research that is applicable to bedside care.”

The work of the critical care team encompasses meeting the needs of patients’ families, and effective teams understand that the well-being of the family is intricately linked to the patient’s outcomes. The experiences and concerns of families, and measures to alleviate their ICU-related stress and suffering, are important areas of research that are well represented in AJCC . In a qualitative study reported in the January 2023 issue of AJCC , Blok and colleagues described the multiple factors that contribute to distress of family caregivers; the concerns were wide ranging and included factors related to the ICU environment as well as stressors external to the ICU. 3   In order to disseminate these findings more broadly, this article was featured as a continuing education offering, and an interview with the nurse researcher who led the study was featured as a video on the AJCC website. 4  

AACN has been a leader in building and disseminating evidence about healthy work environments, including advocating for nurse well-being as a prerequisite for safe, high-quality patient care. AACN has published data about nurses’ well-being and about the positive effects of healthy work environments. 5 , 6   AACN was the convener for the Partners for Safe Staffing, a multiorganizational effort to address health care team staffing solutions that led to the initiation of both a Nurse Staffing Think Tank and a Nurse Staffing Task Force. 7   The importance of nurse well-being was explicitly noted in The Future of Nursing 2020-2030 ; recommendation 3 of that report states,

By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity. 8(p13)  

Building the evidence to support the health and well-being of critical care nurses and ICU team members is an important priority for AJCC and is reflected in the research we publish in this focal area. This issue of AJCC includes exciting results from long-term longitudinal follow-up of participants in the Mindful Ethical Practice and Resilience Academy (MEPRA). 9 , 10   MEPRA is an experiential educational program designed to improve nurses’ skills in mindfulness, resilience, and competence to confront ethical challenges. In an earlier AJCC publication, the researchers reported that MEPRA was effective in the period immediately following the intervention. 9   New results demonstrate that the positive benefits of MEPRA continued to persist at the longest follow-up measurement— 6 months after the intervention. 10   This research is important; it provides evidence and direction for health care systems to improve nurse well-being in alignment with AACN healthy work environment standards and the recommendation from The Future of Nursing 2020-2030 . It is also featured as a continuing education offering.

The needs of COVID-19 patients have appropriately garnered much attention during the pandemic. Between January 2022 and May 2023, 16 AJCC papers (23%) specifically focused on COVID-19. Interestingly, although focused on COVID-19, these papers aligned well with the 3 general themes previously described. COVID-19 patient problems and care were examined in 5 papers, 5 concerned the needs of family members of COVID-19 patients, and 6 studied work environment issues (4 describing nurses’ and staff experiences related to the pandemic, and 2 describing risks of transmission of COVID-19 infection to health care workers). These papers most likely have relevance beyond COVID-19. Conversely, research studies that were not specific to COVID-19 patients might have broad applicability to their care as well. Elements of care that are unique to COVID-19, and how care of these patients is similar to or different from care of other critically ill patients, are topics that require further delineation.

“Overarching themes of AJCC articles published since January 2022 are improving patient care, family well-being, and healthy work environment.”

There is more to come at NTI 2023. The research that will be presented there promises to be engaging, motivating, and useful for practice. On Monday afternoon, May 22, 2023, Dr Cynthia Rushton will highlight her long and successful research trajectory as she presents the 2023 AACN Distinguished Research Lecture, “Transforming Moral Suffering by Cultivating Moral Resilience and Ethical Practice.” NTI attendees can find her lecture on the conference schedule as activity #C75M412. As is customary for AACN Distinguished Research Lectures, the abstract for the presentation is published in this issue of AJCC and available before her lecture. 11   The complete Distinguished Research Lecture paper will be published in the July issue of AJCC .

It is also customary that the May issue of AJCC includes an online article containing all of the research abstracts to be presented at that year’s NTI; the research abstracts can be accessed on the AJCC website ( ajcconline.org ) via the May issue’s table of contents. We encourage NTI attendees to review the research abstracts in advance of the meeting as they plan their NTI schedules. At NTI 2023, 4 award-winning research abstracts will be featured in 2 oral presentation sessions (Tuesday, May 23, activity #C60M406 and Wednesday, May 24, activity #C60M407). An additional 20 research abstracts will be presented as posters in the Research Poster session on Monday, May 22 (activity #POS115). As might be expected, the research abstracts to be presented at NTI 2023 also fit nicely into the overarching themes of improving patient care, family well-being, and healthy work environment.

Every year, NTI offers a celebration of nursing practice and research. If you are able to join the exceptional community of nurses who attend NTI 2023, we hope that you will choose to experience the Distinguished Research Lecture and other research presentations. Nonetheless, you can always find research that underpins the practice of acute and critical care nurses and the interdisciplinary team in the pages of AJCC .

The statements and opinions contained in this editorial are solely those of the coeditors in chief.

FINANCIAL DISCLOSURES

None reported.

To purchase electronic or print reprints, contact American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, [email protected] .

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Nursing's research problem: A call to action

Affiliations.

• 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
• 2 School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
• PMID: 31407374
• DOI: 10.1111/jan.14169

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List of 350 Brilliant Nursing Research Topics to Investigate in 2024

Nursing education is challenging. Writing hundreds of tedious nursing research pieces is the most frustrating part. But we know how to help you! Discover 350 exciting nursing research topics and learn how to choose the best one.

• Primary Care Topics
• Public Health Topics
• Emergency Nursing Topics
• Midwifery Topics
• Neonatal Nursing Topics
• Pediatric Research Topics
• Nutrition Topics
• Mental Health Topics
• Healthcare Management Topics
• Medical Ethics Topics
• Nursing Leadership Topics
• Qualitative and Quantitative Research
• How to Choose a Nursing Topic

Process of Nursing Research

350 interesting nursing research topics.

Nursing research topics for college students can cover various areas of this field. Below you will find a list of 350 exciting ideas, which we have divided into different areas of activity. No matter what nursing research is in your sphere of interest. We’ve got you covered! You can also check research essay samples on the same topic for more inspiration.

Primary Care Research Topics

Primary care is the leading clinical service that sustains the health of an entire nation. The study of this topic is mandatory for the stable development of the healthcare system. Here are primary nursing research titles examples:

• What healthcare problems can be in primary care?
• The role of private health care providers in primary care.
• Peculiarities of vaccination in rural areas.
• Basic methods for assessing the quality of primary care .
• The role of modern technology in primary care .
• Basic techniques of evaluating the patient’s health .
• Private sector activities in primary care .
• The necessity to provide childcare services.
• Primary care and chronic pain problem .
• Vaccination programs : pros and cons.
• The role of social workers in primary care.
• Responsibility of the pharmacist for public health.
• Effective methods of asthma prevention.
• Advantages and disadvantages of home nursing care.
• How can primary care system help fight depression?
• Vaccination of the elderly: challenges and potential benefits.
• Principles of preventive medicine: primary care for the elderly.
• Migraine diagnosis and treatment methods.
• Innovative methods in cardiology .
• Major causes of anxiety disorders in adults.
• The problem of obesity treatment in primary care .
• Effective ways of taking anamnesis.
• Methods for diagnosing stroke in the elderly.
• Basic precautions for Parkinson’s disease .
• Basic requirements for intensive care .
• Connection of primary care and information technology training .
• Sleep disorders in women.
• Standard protocol for the treatment of headache in adults.
• Basic guidelines for primary care for disaster victims.
• The role of government agencies in primary care.

Based on previous papers, you can try to come up with your nursing research topics, for example, on infection control.

Research Topics in Public Health

The public health area has a strong connection with government issues. However, it is doctors who study the basis of all problems. So, let’s check out these special nursing research paper topics!

• The role of governmental organizations in the public health system .
• Effectiveness of government programs to prevent drug addiction .
• What role do parents play in promoting children’s health?
• Features of the school nurses’ work.
• The importance of proper nutrition and exercise .
• Telemedicine : advantages and disadvantages.
• The role of government in providing nursing education .
• The importance of long-term care facilities to the healthcare system .
• Discovering public health’s primary functions .
• Promoting healthy lifestyle in old age.
• Sedentary change programs for adolescents.
• Educational strategies for healthcare organizations in social media.
• Ways to educate young people about a positive body image .
• Formation of public behavior in the problem of cancer prevention.
• Occupational health and safety for workers in hazardous professions.
• Connection of modern technologies and public health system .
• Government AIDS awareness programs.
• State programs to increase awareness of heart disease .
• Government programs aimed at maintaining a healthy work environment .
• Health promotion methods.
• Companies against alcohol: examples from history.
• Public health policies: sugary drink tax .
• Raising awareness of the importance of vaccines .
• How is lung cancer related to air condition?
• Promotion of activity among children with disabilities .
• Disease eradication as a leading public health policy target .
• Government mental health awareness programs.
• Improving individual health as a way to counter epidemics .
• Ways of transmission of infectious diseases .
• Educating children about the importance of sports .

Public health is an excellent topic choice for a nursing dissertation. Try it!

Emergency Nursing Research Topics

New studies are essential for new practical approaches for nurses in emergencies. Try to discover new methods with these critical care nursing research topics!

• What role can stress play in emergency nursing?
• How to deal with anaphylactic shock?
• Effective methods of providing emergency care .
• Features of decision-making by a nurse in critical situations.
• Analysis of the effectiveness of emergency assistance in case of accidents.
• Analysis of the extreme degrees of pain in a patient.
• Diagnosing problems in ER.
• Emergency training methods.
• How to increase chances to save a drowning person?
• Models for reducing violence in emergency departments .
• The problem of rural residents’ access to ambulance services.
• Can family stay close to the patient during resuscitation?
• What effect do tasers have on the development of heart disease ?
• Diagnosing sepsis in emergencies.
• Effective methods of dealing with the effects of using pepper sprays.
• Screening for alcohol and drug addiction in adolescents.
• The role of ambulance crews in the fight against human trafficking .
• Identification and assistance to victims of violence.
• How to deal with unwanted patient behavior?
• Pediatric trauma and shock.
• Psychiatric screening in first aid cars.
• Ways to develop tolerance in first-aid workers.
• Effective ER worker behavior models.
• The role of private clinics in providing emergency services.
• The role of nurses in the ambulance crew.
• Common causes of death in ER patients.
• Correct gender policy towards ER staff.
• How to organize a working emergency care system?
• How to help relatives survive the death of a patient?
• Techniques for teaching nurses to diagnose and respond to life threats quickly.

These nursing research topics for critical care would be an excellent choice for your papers!

Midwifery Research Topics

Midwifery is one of the more challenging medical areas. We picked 30 of the best nursing research topics on pregnancy and prenatal care to help you improve your knowledge! Take a look:

• How can midwifery recognize domestic violence?
• Excess weight problems during pregnancy .
• How to analyze the effectiveness of childbirth ?
• Disease prevention during pregnancy.
• Effective methods of newborn resuscitation.
• Features of adolescent education in gynecology.
• Prenatal nursing care.
• Precautions for preterm labor.
• Rules of conduct for staff in the delivery room.
• Basic rules for saving mother and child.
• Preparing staff and the patient for a caesarean section.
• Preventing depression during pregnancy .
• Features and importance of family planning .
• Childbirth in water: advantages and disadvantages.
• Features of caring for pregnant women with breast cancer .
• The influence of the autonomic nervous system on the course of pregnancy.
• Methods for predicting preeclampsia.
• Diseases of the cervix associated with human papillomavirus .
• Frequency and possible complications of pregnancy and cervical disease.
• Treatment tactics of pregnancy complications in women with disorders of the upper urinary tract.
• Identifying asymptomatic pregnancy complications.
• The use of modern technologies in the treatment of fetal diseases.
• Features of the reproductive system after termination of pregnancy.
• Reasons for using iodine supplementation during pregnancy.
• Prevention of complications after operations on the pelvic organs .
• Impact of epilepsy on reproductive health .
• Features of reproductive behavior in students and ways to correct it.
• The effect of oral contraceptives on the contents of immune complexes in the blood.
• Operative delivery and influence on the child.
• Psychological assistance to patients with infertility .

Remember some of these nursing research topics on midwifery. Profs love them!

Neonatal Nursing Research Topics

Neonatal studies are one of the most innovative medical spheres. Check out this brilliant list of research topics for nursing students in the neonatal area. They will help you better understand the neonatal care importance.

• The importance of hand hygiene in neonatal units .
• Features of neonatal practice in rural areas.
• The leading causes of child mortality .
• How neonatal care has evolved in recent decades.
• Hygiene of newborns and skincare for babies.
• Postpartum infant care basics.
• Principles of breastfeeding infants.
• Predicting feeding problems and treatments.
• The leading causes of seizures in newborns and methods of treatment.
• Eating disorder in infants.
• Methods for predicting diseases in newborn children.
• Effective medical practices for babies.
• Nursing ethics for newborn care.
• Features of modern neonatal practices.
• Features of the development of the pulmonary tract of newborns.
• Studies of the lungs of a newborn: functions and structural features.
• Influence of inflammatory processes on the infant’s brain.
• The role of biomarkers in the diagnosis of traumatic brain injury in infants.
• The importance of neonatal health services.
• Basic strategies for modeling neonatal education.
• Monitoring the quality of neonatal services.
• Influence of neonatal care on the further treatment of a newborn.
• Impact of maternal obesity on infant development.
• Causes of abnormal neurological development in children.
• Use of hormones to regulate fetal lung development.
• Diagnosis of diaphragmatic hernia in infants.
• Potential lung disease in premature babies.
• Using nitric oxide to treat premature babies.
• Parental drug use and effects on fetal neurological development.
• Use of biomarkers for neonatal sepsis.

A nursing dissertation on neonatal issues is always a wise choice!

Pediatric Nursing Research Topics

Studies in pediatrics are aimed to help students discover children’s health issues to solve. Innovative approaches are mandatory to fight modern challenges. Check out these research topics for nursing students; they’ll help you become more informed:

• The importance of self-care nursing in pediatrics.
• Features of the treatment of children with autism .
• Childhood obesity problem.
• Features of vaccination of minors.
• Therapy for speech disorders .
• Causes of diabetes in young people.
• Music therapy and phlebotomy.
• Suboptimal diabetes: causes and methods of intervention.
• Causes of increased fatigue in adolescents.
• HIV prevention in adolescence.

• Preventing unwanted teenage pregnancies .
• Features of the use of painkillers in children.
• Methods for analyzing adolescent behavior.
• Features of the work of the pediatric department in schools.
• The importance of health promotion in pediatrics .
• Ways to connect with your child.
• Pediatric care basics.
• How can a healthcare professional deal with adolescent aggression ?
• Reducing the risk in children receiving oxygen therapy .
• The role of molecular markers in the diagnosis of childhood leukemia .
• Psychological help for children with cancer .
• Assessment of language models in children with autism .
• The use of stem cells in the treatment of childhood diseases.
• How do environmental problems affect the development of a child’s body?
• Implications of passive smoker syndrome for children.
• Possible complications of measles in children .
• Methods for diagnosing asthma in children .
• Common causes of Tourette’s syndrome in children.
• How does anorexia affect cognitive function in children?
• Diagnosis of ear infections in childhood.

We guess this ultimate list of research topics in pediatric nursing will be helpful for you!

Nutrition Research Topics for College Students

The eating habits of modern people can be harmful to the body. Therefore, doctors are seriously studying the current problems in this area. Here you can find tons of excellent nursing research topics on nutrition and its possible issues.

• What are referral reasons for the dietary assessment?
• Nutrition assistance for the elderly.
• Effects of stress on childhood metabolism .
• Prevention of obesity in adolescents.
• Linking diet to behavioral changes.
• How social media influences teen food choices .
• Patient nutrition problem in healthcare policy .
• Predicting and assessing diabetes .
• The problem of dietary intervention in the elderly.
• Promoting healthy eating as a way to fight obesity.
• Nursing promotion of healthy homemade food.
• Effects of good nutrition on fetal development .
• How does nutrition affect a child’s development ?
• Root causes of weight gain : a clinical study.
• Common diseases caused by poor nutrition .
• Nutrition screening for the elderly.
• The nutritional problem of children with autism .
• The importance of proper nutrition during pregnancy .
• Baby food: preventing eating disorders.
• Diet as a cause of dementia development in adults.
• Osteoporosis : the role of diet in disease prevention.
• The role of diet in healthy aging.
• What is the relationship between cancer and diet ?
• Nursing role in the safety of nutrition.
• The main benefits of a healthy diet : advice to patients.
• The role of parents in maintaining healthy eating habits in children.
• The relationship between healthy eating and cognitive development .
• Modern trends in youth nutrition.
• The nurse’s role in maintaining quality nutrition for pregnant women .
• Innovative nursing nutritional care.

Now let’s move to the next section – research topics in mental health!

Mental Health Nursing Research Topics

Mental health problems are more relevant now than ever. According to the National Alliance on Mental Illness , nearly 20% of the US adult population suffers from mental health problems. That’s why psychiatry research topics capture the interest of college students.

• The importance of nursing in mental health safety .
• Features of mental disorder in alcohol dependence .
• How does police work affect mental health?
• The connection between video games and the development of teenage aggression.
• How is schizophrenia diagnosed?

• Main theories in mental health studies .
• Features of bipolar mental disorder .
• Causes and prevention of drug addiction .
• Mental health problems of athletes after physical injuries .
• Conditions for the use of psychotherapy .
• Reasons and methods for tackling health imbalances.
• The influence of phone usage on mental health .
• Brain stimulation techniques.
• Diversity of sexual orientation psychology features.
• Methods for dealing with physical violence.
• The effectiveness of traditional methods of treating mental illness .
• Features of mental support for the patient’s relatives.
• The role of nurses in the management of geriatric patients with mental disorders.
• Combating burnout in the practice of healthcare professionals.
• The problem of war veterans’ mental health .
• The phenomenon of occupational deformation as a type of mental disorder.
• Chest pain as a symptom of mental health problems in adults.
• The relationship between increased risk of cancer and depression.
• Basic treatments for dementia .
• Nursing refugee mental health help .
• The practice of mirror therapy in rehabilitation.
• Methods to help victims of violence.
• Helping patients after a stroke .
• The use of antipsychotics : benefits and harms.
• How belly massage helps fight residual stomach volume.

We believe you’re going to find one of the best psychiatric nursing research topics!

Healthcare Management Research Topics

The effective functioning of the health care system is impossible without competent leadership. Therefore, nursing research study topics on healthcare management are as important as the others!

• The importance of financial management for the healthcare industry .
• Assessment of the economic component of primary health care .
• How does bias affect healthcare funding?
• How to properly organize health care at home?
• The Importance of a Unified Nursing Code.
• How risk management affects healthcare projects?
• Gender policy in health management .
• Features of the initial stages of private medical practice.
• The importance of the apology law.
• Features of selling medical marijuana .
• Features of healthcare contracts.
• The problem of human resources in the healthcare industry .
• The problem of the shortage of men in healthcare.
• Medicare : how to get benefits.
• How to improve the minimum level of nursing training ?
• Modern trends in the healthcare management area .
• Staff uniform rules.
• Legal risks of medical personnel .
• Gender bias in nursing.
• Features of the organization of the first aid service in private sector.
• Risk management in healthcare.
• The connection of healthcare and conflict management .
• Ways to solve staffing problems in healthcare.
• Ensuring the personnel safety from infectious diseases .
• Strategies to improve the emotional health of employees.
• What is the danger of not having enough nursing staff for patients?
• Personnel policy in public medical institutions.
• International nursing training.
• Basic principles of management in healthcare facilities.
• Possible ways to get a nursing promotion.

These nursing research titles on healthcare management will impress your professors!

Medical Ethics Research Paper Topics

Controversial issues in the field of medical ethics are felt more and more acutely every year. That is why they need to be solved, and research topics related to nursing ethics present a good opportunity for highlighting them:

• The role of ethical values in the nursing decision-making process .
• Particular ethics of data collection in primary care.
• The ethical dilemma of abortion.
• Moral choice in opioid addiction .
• Features of ethics in helping the homeless .
• Ethics of care for patients with mental disorders .
• Phantom pain phenomenon.
• Features of cultural perception in the work of nurses.
• How can religious beliefs affect medical ethics?
• The role of relatives in the treatment of geriatric patients .
• Ethics of the need to increase sales in medicine.
• The problem of sexualizing the image of a nurse.
• The importance of solving moral dilemmas in nursing .
• Assisting female patients by male nurses .
• What are the main medical ethics principles?
• Ethics of care for geriatric patients.
• The problem of compulsory vaccination : solutions.
• The dilemma of artificial feeding of patients.
• Ethics of nursing in preventive medicine.
• The importance of a hospital work ethic.
• The U.S. standard of ethics for nursing .
• The dilemma of medical ethics .
• The difference in medical ethics in Asian countries and European countries.
• How can medical ethics conflict with religious beliefs?
• Assisting suicide as a dilemma in medical ethics.
• The ethical problem of marijuana usage for medical purposes .
• The impact of cultural patterns on medical ethics .
• Child maltreatment : a medical ethics dilemma.
• Implementation of international medical ethics standards for healthcare development.
• Methods for monitoring compliance with medical ethics.

Nursing ethics research questions have a tendency to be the most interesting ones!

Nursing Leadership Paper Topics

The principle of developing leadership among nurses is vital for improving the performance of any clinic. This list consists of 30 nursing research topics about leadership in healthcare field:

• What role does leadership play in nursing?
• Which skills are necessary for effective nursing leadership performance?
• The nurse’s role in providing quality health care .
• Why is it important for nurses to attend medical conferences?
• Features of the classification of nurses.
• What is a retention strategy for experienced nurses?
• How does nursing leadership development affect patient outcomes?
• The problem of obtaining a diploma for a nurse.
• Nursing leadership : key challenges and opportunities.
• Ethical issues in nursing leadership .
• Protecting staff interests in nursing management .
• Analyzing college students’ nursing leadership experience .
• Effective nursing leadership styles .
• Ways to develop nursing leadership in private healthcare facilities.
• Nursing manual: Betty Newman theory.
• The importance of intuitiveness in the workplace.
• The importance of conflict resolution in the nursing leadership sphere .
• Patient advocacy opportunities for the lead nurse.
• Nursing manual: theory of intellectual capital.
• Effective models of professional practice in nursing.
• Professional opportunities for nursing graduates in nursing leadership .
• What are modern approaches in nursing leadership?
• Transformational leadership model for nursing.
• Fundamental theories for effective nursing leadership .
• Methods for applying leadership theories to nursing .
• What is the need for effective nursing leadership ?
• Methods for monitoring the effectiveness of nursing leadership .
• Principles of delegation of authority in nursing leadership practice.
• The importance of nursing leadership in strategic hospital planning.
• Nursing leadership as a method to retain experienced staff.

Evidence-based nursing topics on leadership can become a great start to your career!

Easy Topics for Nursing Qualitative and Quantitative Research

The division into qualitative and quantitative research can be confusing. But don’t worry, we’ll help you figure it out! Each type of nursing research topic and other materials may depend on dry numbers or subjective opinions. Keep reading for more detailed information and examples of quantitative and qualitative research topics in nursing!

Qualitative vs. Quantitative Nursing Research

Empirical research methods can be divided into two broad categories: quantitative and qualitative. As their name suggests, each view relies on specific types of data. Therefore, your nursing paper topics can also reveal either qualitative or quantitative aspects of the problem. Let’s take a quick look at the main differences between these two methods.

The quantitative method relies entirely on numbers and statistics. Your task is to find patterns and come to a conclusion by analyzing a large amount of data. This type of nursing research is as structured and objective as possible. These are the quantitative method characteristics:

• Sources of information are polls, reviews, records, documents.
• The deductive methodology involved.
• As objective as possible.
• The main content is numbers and data.
• Validity depends on the selected analysis tools.

The qualitative method , on the contrary, is a reflection of the author’s thoughts and conclusions. It depends entirely on the depth of understanding of the problem and the existing materials on the nursing thesis topics. The task of the researcher is to analyze previous works and create their theory through reflection. Check the qualitative method characteristics:

• Sources of information: focus groups, document reviews, interviews.
• The inductive process is involved.
• The subjective opinion of the author is allowed.
• The main content is text and reflections.
• Validity depends on the skill of the author.

You can check lists of topics for nursing research ideas in these spheres below!

Qualitative Nursing Research Topics

Qualitative analysis is a complex but critical aspect of medical practice. Nursing qualitative research topics are designed for students to develop skills of analyzing challenging issues and make proper conclusions:

• The role of technology in improving the quality of nursing care .
• Empowering nurses to prescribe: advantages and disadvantages.
• The problem of equality between doctors and nurses .
• Nursing stereotypes.
• Issues of accreditation of medical schools.
• The problem of systemic racism in the healthcare system.
• How nursing has changed in the 20th and 21st centuries.
• The importance of nursing staff in primary care .
• Priority of cancer in adults.
• Advantages and disadvantages of qualitative research in nursing .

These qualitative nursing research topics can help you improve your analytical skills significantly!

Quantitative Nursing Research Topics

Quantitative type of scientific work is all about statistics, percentages, and numbers. Prepare yourself to analyze tons of information with these nursing quantitative research topics:

• Evaluation of the effectiveness of primary patient care.
• The leading causes of heart disease .
• Analysis of the efficacy of telemedicine .
• The problem of an overabundance of information noise in the modern world.
• Evaluation of methods of assistance in suicide attempts.
• Statistical analysis of the benefits of diets .
• Causes of mental illness in women.
• Using unconventional methods to treat diabetes .
• Benefits of probiotics for treating diarrhea .
• Methods for assessing pain in critically ill patients.

For a successful paper, it’s importnt to pick a good research topics for nursing students based on quantitative evidence.

How to choose a Nursing Research Topic?

Choosing a quality nursing research topic idea can be a daunting task. This is mainly because the variety of possible options is simply too large. But don’t worry, here are some simple tips to help you choose the theme that’s right for you!

📜 Remove large-scale topics . You should not waste your energy on massive topics. Instead, choose narrow evidence-based ideas that allow you to focus on one issue. 📜 Use personal experience . One cannot be informed in all aspects of medicine. So when you write about a topic you have no experience with, you risk getting bogged down in hours of tedious research. Try to remember what problems you faced yourself. This way, you will already have a basic knowledge of the topic. 📜 Review literature . A large amount of ready-made research a topic will be an excellent help in writing about it. Try to do a systematic nursing topics review to find more examples. This does not mean that you should copy the work of another medic. On the contrary, it will be a good opportunity for you to highlight additional information. Therefore, before choosing from easy nursing research topics, look at how much information is already in the public domain.

What is the process of nursing research? Oh, that’s a tricky question. Let’s look at the main stages you need to go through!

✨ Define the research problem . To solve a problem, you first need to find it. That is why the first thing you should do is choose a nursing research question. If you have any experience with the topic, that will be a big plus! ✨ Develop hypothesis . Now, you need to think and create your theory. It can be of any form. The main thing is to make a connection between the data pieces and find a pattern. Of course, the hypothesis must be consistent with the current nursing research topics. ✨ Literature review . Before you start writing, it’s important to tighten your knowledge of the central thesis of the topic you’ve selected. Try reading other people’s research, finding the statistics you want, and just surfing the internet. ✨ Prepare an outline . It is essential to formulate a plan for your work before you start working on it. The more detailed you describe each paragraph of your article, the less time you will need to write it. Quality work begins with a quality plan! ✨ Conduct research . Now you start the longest and most important part of the whole nursing project. You should delve deeper into the problem and find the information you need. Everything that you write should help you prove your hypothesis in one way or another. ✨ Make a conclusion and develop further recommendations . After you have processed all the material, it is time to write a conclusion. Here, you must indicate whether you have succeeded in proving the hypothesis and recommend the application for your scientific work.

Congratulations, you did it! Writing a good paper is not that difficult. It all depends on a well-chosen research topic in the nursing field; luckily, you have a list of 350 topics to look through in this article! You can find more nursing research ideas on our website!

❓ What Is Translational Research in Nursing?

Translational research is a kind of scientific work, and its task is to transform theory into new practical approaches. In other words, discoveries made in laboratories become the basis for creating a new actionable framework in nursing.

❓ What Is an Example of a Clinical Question?

The clinical question is an integral part of your scientific work. It can relate to categories such as the cause of the problem, the manifestation of the disease in the patient, possible solutions, and potential results. A well-formulated clinical question helps you write a quality article.

❓ How to Determine Level of Evidence in Nursing Research?

Several criteria determine the level of evidence in nursing research. These include quality of design, validity, and applicability of results to patient care. Therefore, you should constantly monitor the reliability of your sources and the correctness of your conclusions.

❓ What Are Some Controversial Issues in Nursing?

In modern nursing, there are some controversial issues, mainly of an ethical nature. Such problems include the issue of vaccination of people who are against it, artificial nutrition, opioid addiction, and others. There is a lively discussion about how to act correctly in some instances and what factors the decision may depend on.

📎 References:

• Evidence-Based Practice: PICO. Duke University .
• Asking the clinical question. Penn State University
• Evidence-Based Practice Toolkit. Darrell W. Krueger Library
• Top 5 Ethical Issues in Nursing. American Mobile
• Differences Between Qualitative and Quantitative Research Methods.
• Qualitative vs. Quantitative Research – What Is the difference? Imotions
• The Seven Steps of the Research Process. Teacherph
• Research Paper Writing Guide. Grammarly
• Choosing a research topic. Florida Gulf Coast University
• Nursing Process. NCBI
• Sample Research Topics. CFAES
• Selecting a Research Topic: Overview. MIT Libraries
• Three Important Nursing Subjects Students Should Know. Distant learning systems
• Evidence-Based Practice Tutorial: Asking Clinical Questions. University of Maryland
• Top 5 Ethical Issues in Nursing. Avant Healthcare
• Ethical Issues in Nursing: Explanations & Solutions. Duquesne University
• Clinical & Translational Research. UNC
• Writing a Thesis for Nursing School | Nursejournal.org
• A practical approach to the process of writing a dissertation. Nursing Times
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Memorable human trafficking essay: topics & outline [2024], credible sources 101: how to evaluate them + 60 reliable websites for students, 265 powerful research proposal topics to consider [+ writing tips].

• Open access
• Published: 25 March 2024

Outcomes of professional misconduct by nurses: a qualitative study

• Shokoh Varaei   ORCID: orcid.org/0000-0001-7126-2014 1 ,
• Nahid Dehghan Nayeri   ORCID: orcid.org/0000-0003-1594-6790 2 ,
• Leila Sayadi   ORCID: orcid.org/0000-0001-7613-3051 3 ,
• Mehraban Shahmari   ORCID: orcid.org/0000-0002-2501-8667 4 &
• Akram Ghobadi   ORCID: orcid.org/0000-0002-7673-7362 5  

BMC Nursing volume  23 , Article number:  200 ( 2024 ) Cite this article

213 Accesses

Metrics details

Professional misconduct by nurses is a critical challenge in providing safe quality care, which can lead to devastating and extensive outcomes. Explaining the experiences of clinical nurses and nursing managers in this regard using an in-depth qualitative method can be beneficial. This study was conducted with the aim of explaining the experiences of nurses regarding the outcomes of professional misconduct.

The present study used a qualitative descriptive with a conventional content analysis approach. A total of 22 clinical nurses and nursing managers were selected through purposive sampling until data saturation was reached. Data were collected using semi-structured in-depth interviews and analyzed using Graneheim and Lundman’s approach.

Analyzed data were categorized into four main themes and 11 subthemes: (1) Physical outcomes: critical threat and weakening patients’ safety; (2) Psychological outcomes: psycho-emotional responses of patients and their families, moral distress, and cautionary tale of nurses; (3) Financial outcomes: imposing costs on the patient and financial loss of the nurse; (4) Organizational outcomes: the normalization of misconduct, chaos in the organization, waste of the organization’s resources, and reputational damage to the organization.

Professional misconduct by nurses can have adverse outcomes for patients in physical, mental, and financial dimensions, their families, nurses, and healthcare organizations. Therefore, it is indispensable to adopt management strategies to reduce the rate of professional misconduct.

Peer Review reports

Nurses play a vital role in ensuring patients’ well-being and recovery. They are patients’ trustworthy caregivers, advocates, and instructors [ 1 ]. According to the code of ethics for nurses, they have the responsibility for protecting the patient, society, and the profession against possible harm [ 2 ]. Maintaining nurses’ ethical standards and professional conduct is imperative in ensuring patient safety, trust, and integrity of the nursing profession [ 1 , 3 , 4 ]. In the nursing profession as a caring and humane profession, there is the possibility of another reality termed professional misconduct [ 5 , 6 , 7 ]. Professional misconduct refers to any practice or action by nurses that deviates from the established ethical and professional standards and guidelines [ 8 , 9 ].

Professional misconduct in nursing is a multifaceted issue with wide-ranging outcomes in patient safety (physical and mental harm or even death), trust in the healthcare system, and healthcare workers’ well-being. Professional misconduct can damage the profession’s reputation and weaken nurses’ vital role in society [ 10 , 11 ].

Considering that professional misconduct weakens the integrity of nursing practice, perceiving consequences is of particular importance for nurses, healthcare managers, and policymakers since it emphasizes the prominence of maintaining the highest professional standards [ 12 ]. As part of a broader research initiative, this study extensively examines the multifaceted repercussions of such misconduct, extending beyond immediate effects, to deepen understanding across various dimensions. Given healthcare organizations’ mandate to deliver high-standard care with minimal harm, comprehending these implications becomes paramount. The research enhances related knowledge by categorizing the consequences of misconduct, highlighting potential dangers and irreparable harm. Also, it emphasizes the imperative of responsibility and ethical conduct to enhance patient quality and safety. Through this endeavor, the study addresses gaps in understanding within the field.

Study design, setting, and participants

This qualitative descriptive study was conducted through the generic qualitative design and content analysis approach to data analysis. The study setting was different wards of general and referral hospitals in the capital of one of the western provinces of Iran. The participants included in the study were selected using purposive sampling. The inclusion criteria included at least a bachelor’s degree in nursing, an experience of observing professional misconduct by colleagues, and the willingness to discuss experiences. Before conducting the interview, the researcher coordinated the interview time and location while establishing communication with the eligible participants and explaining the study objectives. In order to achieve maximum diversity and richness of data, participants with diverse personal and professional characteristics were selected. Sampling continued until saturation, resulting in the inclusion of 22 nurses and nursing managers aged between 25 and 48 years (Table  1 ).

Data collection

After preparing the interview guide using the expert opinions of the research team, the data were collected through a semi-structured individual interview. Each interview lasted between 45 and 90 min. Data collection was performed by the first author under the supervision and cooperation of the research team. Participants were asked: “Describe your experience on the outcomes of professional misconduct.” “Who is affected by the outcomes of professional misconduct? Explain it.” At the end of the interview, open questions were asked. The interviews were recorded using a mobile phone with the participants’ permission. Data collection and analysis were performed simultaneously from February 2021 to August 2021.

Data analysis

The conventional content analysis method was employed by following five steps proposed by Graneheim and Lundman [ 13 ]: (1) Implementing the entire interview immediately after each interview, (2) Reading the entire text several times to get an overall understanding of its content, (3) Determining semantic units and basic codes, (4) Classifying primary codes in more comprehensive categories, and (5) Determining the main theme of categories.

Interviews were recorded and transcribed using Word software, followed by iterative readings for content understanding. Semantic units were identified based on study objectives, and primary codes were derived. The initial codes were categorized, and the main and sub-themes were determined. Data management was facilitated by MAXQDA10 software.

It is noteworthy that the researcher, aimed to maintain objectivity during the coding process by closely aligning the codes with the data, and setting aside personal biases and preconceptions.

Trustworthiness

The following strategies were used to establish the trustworthiness of Study [ 14 ] Credibility was achieved through trust-based communication and prolonged engagement with the participants and the data and by providing a lot of time for data collection. Dependability was ensured by checking the consistency between quotes and codes/subthemes by the research team and two external observers familiar with qualitative research. In addition, confirmability was established by presenting the quotes extracted from each interview and returning the text of several interviews to a number of participants and applying their opinions, Transferability was enhanced by selection of participants with maximum diversity in terms of age, gender, work experience, educational level and position and detailed description of the research process, participant characteristics, and study context. In addition, quotes were expressed directly by providing each participant’s quote (P).

Ethical considerations

The Joint Ethics Committee of the Faculty of Nursing, Midwifery, and Rehabilitation of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. The study objectives were explained to the participants at the beginning of the interviews. Due to the disapproving nature of professional misconduct and the sensitivity of the issue, the possibility of voluntary participation, confidentiality, and anonymity of individuals and their organizations were guaranteed. Written informed consent was obtained from all participants. Transcripts were securely stored in an encrypted file on a personal computer and destroyed following data analysis to further protect the confidentiality of participants.

The outcomes of professional misconduct by nurses were categorized into four main themes and 11 sub-themes (Table  2 ).

Physical outcomes

Data analysis indicated that patients were the primary individuals affected by professional misconduct by nurses and experienced more harm than other parties. One of the most critical outcomes of misconduct is the physical impact on patients. This theme is subdivided into two aspects: critical threat and undermining of patient safety.

Critical threat to patients

The participants’ experience showed that professional misconduct by nurses exposes patients to critical and adverse events such as death, disability such as leg amputation, and critical injuries such as pneumothorax, finger gangrene, tissue necrosis, burns, bleeding, and falls.

“ The patient was critically ill and we announced the CPR code ten minutes after the shift was handed over. We checked and noticed that they hadn’t inserted an IV line for him. It was impossible to do it with a blood pressure of 65. We finally inserted the intravenous) IV (, but it was in vain…” (Participant 9).

Weakening patients’ safety

According to the participants’ experiences, in addition to critical injuries, less life-threatening injuries such as mouth sores and infections could occur following professional misconduct by nurses. There was also the possibility of unwanted side effects. Yet most of these complications may not appear right away and be noticed after discharge from the hospital.

“ One of the colleagues, as she said, made a potion, combined several antibiotics into the Microset, and injected it into the patient .” (Participant 14).

This theme shows that considering the physical aspect, professional misconduct by nurses ultimately leads to a decrease in the quality of care and safety and delays the treatment process.

Psychological outcomes

Based on data analysis, professional misconduct by nurses affects psychological aspects in addition to physical dimensions. This outcome may involve not only patients but also their families and nurses. This theme includes the psycho-emotional responses of patients and their families, moral distress, and edification of nurses.

Psycho-emotional responses of patients and their families

Nurses’ experiences showed that professional misconduct sometimes caused psycho-emotional reactions in the patient or their companions. These side effects were reported as crying, feeling abandoned, distrust, dissatisfaction, cursing, aggression, objection, reporting to the authorities, and complaints.

“ At the beginning of the outbreak, a patient suspected of being infected with coronavirus was hospitalized in the ward and was left in the room; the door was closed. She was ordered not to get out of the room because she could spread the coronavirus to other patients; she was crying all the time.” (Participant 11).

Moral distress of nurses

Sometimes, the repercussions of professional misconduct by a nurse affect both the perpetrator and the cooperating and witnessing nurse. The participants stated that, at times, they experienced various emotional reactions, including discomfort, remorse, guilt, and even psychological complications and quitting work after committing misconduct. In addition, the colleagues of a nurse who is the perpetrator of the misconduct may express regret, discomfort, and anger upon witnessing this situation.

“ I know that catheterization is a sterile procedure, and I’m fully aware of it, but at that moment, there may not be a betadine or a sterile set or gloves. I may not do it correctly and scientifically as I should, which is really sad. Most of the time, we feel guilty.” (Participant 10).

Cautionary tale

According to some participants’ experiences, the effect of a nurse’s encounter with a colleague’s misconduct depended on the morale and personality of the witnessing nurse. By witnessing misconduct and its negative outcomes for the patient and the nurse committing it, the nurse may learn never to commit such misconduct. According to the famous quote, “A man profits more by the sight of an idiot than by the orations of the learned,” it should also be instructive and improve patient care quality.

“ Misconduct by a colleague can influence the nurse seeing it and make them improve, that is, not perform that wrong deed. Due to a written warning to a few colleagues because of the rapid infusion of antibiotics, the others learned and are now very careful .” (Participant 10).

This theme showed that professional misconduct by nurses might harm patients not only physically but also mentally and occasionally cause psychological problems for the nurses. It should be noted that, besides all the negative outcomes, professional misconduct by nurses has a positive consequence, which is a cautionary tale of other nurses and, subsequently, efforts to improve care.

Financial outcomes

Data analysis showed that another outcome of professional misconduct by nurses was the financial outcomes that could affect the patient or nurse. This theme includes two subthemes: ‘imposing costs on the patient’ and ‘financial loss of the nurse.’

Imposing costs on the patient

According to the obtained data, additional costs are imposed on the patient due to adverse events and unwanted complications caused by the reduced care quality resulting from professional misconduct by nurses. These costs may be related to increased length of hospital stay and the need for additional procedures or medication.

“ Unfortunately, some colleagues don’t observe the principles of sterile technique when dressing, which can cause the patient to return with an infection at the surgery site and need to take intravenous antibiotics such as Ciprofloxacin and Clindamycin and be hospitalized for a few days, all of which impose an additional cost to the patient.” (Participant 11).

The financial loss of the nurse

Several participants’ experiences showed that the nurse might experience legal issues such as warnings, reprimands, and referrals to the administrative violations department following committing misconduct, which, especially if repeated, could negatively affect the process of recruiting the training nurses or changing their employment status, in-service promotion process when being appointed to a position until retirement. Based on the participants’ experiences, addressing misconduct might have financial outcomes for the nurse who committed it. These financial damages included a deduction of salary and wages, no further promotion after warning, reprimand and its negative impact on salary, and incurring damages.

“Our nurse colleague hadn’t paid attention to the warmer’s temperature. The mask on the baby’s nose was almost burnt and caused nasal necrosis. The baby’s family pursued it. The nurse was fined to pay the damages. ” (Participant 8).

This theme generally indicated the financial damages resulting from professional misconduct by nurses, which might affect patients and nurses.

Organizational outcomes

Professional misconduct by nurses has negative outcomes not only for individuals but also for the organization. This theme includes the subthemes of normalization of misconduct, chaos in the organization, waste of the organization’s resources, and reputational damage to the organization.

The normalization of misconduct

Participants stated that one of the organizational outcomes of misconduct was its normalization for the perpetrator, modeling, and contagion of misconduct to other colleagues, leading to the normalization of erroneous conduct in the organization.

“M isconduct possibly affects others as well, as it is considered a routine, as they think somebody did it, and there was no problem. Now, in ward X, it has become routine that vital signs aren’t monitored and are only recorded .’ (Participant 10).

Chaos in the organization

The data analysis showed that due to professional misconduct by nurses, colleagues might be forced to compensate for their colleague’s misconduct by carrying out the medical orders for the maltreated patient. As a result, nurses usually avoided working shifts together with that nurse. There might also be turmoil, chaos, arguments, protests, complaints, and even physical encounters between patients and their companions with the medical staff or colleagues.

“ My colleague’s work burden falls on my shoulders, so I should also manage her duty. For example, in my shift, I followed up on a medicine that had to be prepared in the previous shift and made a prescription for the patient; the patient prepared it but growled at me because the medicine was expensive. The doctor talked to me as if I was the one who hadn’t done it while it hadn’t been followed up in the previous shift .” (Participant 19). “ Colleagues who impatiently do the patient’s tasks get angry at the patient. The patient or the companion asks one question or two; upon the third question, they conflict with the patient’s companion. We have a code called code 44 for a security guard, which is often announced during their shifts.” (Participant 19).

Waste of the organization’s resources

After analyzing the data, it was revealed that due to the professional misconduct by nurses, the patient might need a transfer to the intensive care unit or more specialized centers, additional procedures, such as debridement, intubation, dialysis, surgery, re-surgery, or cancellation of surgery, increased hospital stay, and re-hospitalization. By jeopardizing the quality and safety of patient care, these cases lead to complications, and managing them can impose additional costs on the hospital. Some participants believed that failure to provide optimal care caused the patient’s condition to aggravate and the nurse’s workload to increase.

“ The patient, who was just discharged from the operating room, was bleeding badly. The nurse hadn’t followed up or informed the doctor. The patient was transferred to the ICU due to severe bleeding and was treated for approximately 15–16 days. He was operated on twice .” (Participant 14).

In addition, nurses’ professional misconduct directly leads to the waste of resources and equipment.

“ For example, in the COVID-19 situation, when the equipment and supplies were scarce from the beginning, they rationed it for the wards. A male colleague poured Septicidine. Well, it was wasted. It could be used in the COVID-19 ward .” (Participant 7).

Reputational damage to the organization

According to the data analysis, professional misconduct could lead to damage to the reputation and credibility of the nursing profession and loss of public trust in nurses and healthcare organizations in general.

“ Sometimes we refer the patient to a certain hospital, but they say they wouldn’t go there even if they die. They believe whoever is referred to that hospital won’t stay alive .” (Participant 13).

This theme revealed outcomes of misconduct that threatened and affected the healthcare organization.

In the present study, nurses’ experiences regarding the outcomes of professional misconduct were investigated. The results showed that this phenomenon had widespread outcomes in different dimensions and levels, including patients, nurses, and healthcare organizations. In line with the present study, researchers concluded in a systematic review that unprofessional conduct included multidimensional issues and serious outcomes concerning patient safety, nurses, colleagues, managers, and healthcare organizations [ 6 ].

One of the significant outcomes of professional misconduct is physical outcomes, which can critically threaten patients’ health and life or jeopardize their safety. In a review, the threat to patients’ safety has been identified as the main reason for adopting disciplinary measures against nurses [ 15 ]. In addition, in a qualitative study, various unsafe practices leading to physical harm to patients have been identified and classified [ 16 ]. In line with the present study, Rooddehghan et al. (2018) reported that missed nursing care could lead to the elimination or postponement of scheduled therapies, which causes serious life threats, complications, and, as a result, patient dissatisfaction [ 17 ]. Professional misconduct in health care can jeopardize patients’ safety, health, and well-being [ 5 , 18 , 19 ]. Since the main goal of health care is to provide quality and safe care to patients, the physical outcomes of professional misconduct by nurses are considered the most important outcomes, and their prevention is absolutely vital.

Another consequence of professional misconduct by nurses is its psychological effects on patients and nurses. Healthcare workers’ misconduct can cause psychological harm to patients, including anxiety, feeling insulted, and fear [ 18 ]. Moreover, misconduct demonstrates the violation of patients’ human rights and dignity [ 7 ]. Since the quality of services provided to patients is an important component of their satisfaction [ 20 ], professional misconduct can reduce patient satisfaction by negatively affecting the quality of care. Nurses charged with professional misconduct face a variety of outcomes, including psychological, physical, and mental suffering [ 21 ]. Furthermore, observing misconduct can lead to moral and emotional distress, sympathy for patients, and increased negative emotions such as distress, sorrow, guilt, bias, and negative stigma in fellow nurses [ 18 , 22 ]. These nurses may to leave their positions and may experience anxiety, sleep disturbances, and uncertainty in dealing with their colleagues [ 16 ]. In general, professional misconduct can cause psychological problems not only for patients but also for nurses, which supports the need for prevention and corrective action.

Unprofessional conduct is a complex phenomenon that impacts nurses’ practice [ 6 ]. In the present study, it was found that professional misconduct could serve as edification for other nurses. In other words, misconduct by colleagues can serve as a cautionary tale to assist nurses in improving their performance. In this regard, studies have shown that unsafe practices by colleagues and related complaints can provide an opportunity for nurses to strengthen their abilities by focusing more on themselves and being more attentive, and contribute to professional development and increased patient safety [ 16 , 23 ]. Therefore, it seems that, when encountering colleague misconduct, nurses can use negative experiences in the organization and enhance their skills and precision in order to improve professional conduct and patient safety.

Other outcomes of professional misconduct by nurses obtained in the present study were financial outcomes that could affect patients and nurses. In line with this finding, a study shows that unsafe practices can impose additional costs on patients [ 24 ]. The financial losses of nurses caused by professional misconduct can be related to legal outcomes such as restrictions, suspension, revocation of professional license, or finement [ 15 , 25 , 26 ]. It can be concluded that, regarding economic issues, professional misconduct by nurses can harm the patients and even the nurses.

Professional misconduct by nurses has outcomes not only for patients and nurses but also for the healthcare organization. These outcomes include issues such as the normalization of misconduct, chaos in the organization, waste of the organization’s resources, and reputational damage to the organization. These issues can reduce the organization’s efficiency and cause concerns about the safety and quality of services provided by nurses. Professional misconduct is often initiated by one individual; however, it can spread quickly, change the organization’s dominant values, norms, and behaviors, and become established [ 27 ]. These disciplinary processes affect the nursing profession, and these impacts become more significant in retaining nurses, particularly in global staffing shortage conditions [ 25 ]. In addition, professional misconduct in health care can jeopardize the quality of nurses’ teamwork [ 5 ], increase colleagues’ workload [ 22 ], and threaten the organization’s long-term credibility and ultimate sustainability by deviating the organization from achieving its main goals [ 10 ]. Misconduct in health care can cause patients and the general public to mistrust medical affairs and damage the reputation of the nursing profession and the organization [ 24 , 28 , 29 ]. Jeopardizing satisfactory standards of practice is a clear violation of nursing ethics, norms, and laws, particularly public trust in nurses and the nursing profession as a whole [ 30 ]. To prevent these challenges, the organization can create a safety culture, develop protocols to report misconduct, and encourage and support nurses. These measures can prevent misconduct, help increase public trust in the nursing profession, and improve the working conditions of nurses.

The present study had several limitations. At first, some participants had doubts about the confidentiality of their names and institutional information in the study. This concern was resolved by assuring them about the anonymity and confidentiality of the information. This research was conducted qualitatively, and therefore, the generalizability of the findings is limited.

According to the results of this study, it is revealed that the outcomes of professional misconduct in the nursing field affect not only patients and nurses but also the healthcare organization. The outcomes of professional misconduct have diverse and widespread dimensions. Physically, professional misconduct can lead to a critical threat to patients or jeopardize their safety. Psychologically, it can create psychological responses in patients and nurses or become an edification for other nurses. Financially, it might impose costs on patients and financial losses for nurses. Organizational effects include the normalization of misconduct, chaos in the organization, waste of resources, and damage to the dignity and credibility of the organization. To prevent these complications, there is a need for programs and management measures to deal with professional misconduct and ensure the provision of safe, quality, and compassionate care to patients. To reduce serious outcomes, further studies in diverse nursing communities are required.

Data availability

Availability of data and materials: Data are available by contacting the corresponding author.

Abbreviations

Cardiopulmonary resuscitation

Intravenous

Intensive care unit

Coronavirus disease 2019

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Varaei, S., Nayeri, N.D., Sayadi, L. et al. Outcomes of professional misconduct by nurses: a qualitative study. BMC Nurs 23 , 200 (2024). https://doi.org/10.1186/s12912-024-01859-3

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The influencing factors of clinical nurses’ problem solving dilemma: a qualitative study

a Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China

b Tongji University School of Medicine, Shanghai, China

c Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Problem solving has been defined as “a goal-directed sequence of cognitive and affective operations as well as behavioural responses to adapting to internal or external demands or challenges. Studies have shown that some nurses lack rational thinking and decision-making ability to identify patients’ health problems and make clinical judgements, and have poor cognition and response to some clinical problems, easy to fall into problem-solving dilemma. This study aimed to understand the influencing factors of clinical nurses’ problem solving dilemma, to provide a basis for developing training strategies and improving the ability of clinical nurses in problem solving.

A qualitative research was conducted using in-depth interviews from August 2020 to December 2020. A total of 14 participants from a tertiary hospital in Shanghai, China were recruited through purposive sampling combined with a maximum variation strategy. Data were analysed with the conventional content analysis method.

Three themes and seven subthemes were extracted: nurse’s own factors (differences in knowledge structure and thinking, differences in professional values, poor strain capacity); improper nursing management (low sense of organizational support, contradiction between large workload and insufficient manpower allocation); patient factors (the concept of emphasizing medicine and neglecting to nurse, individual differences of patients).

The influencing factors of clinical nurses’ problem-solving dilemma are diverse. Hospital managers and nursing educators should pay attention to the problem-solving of clinical nurses, carry out a series of training and counselling of nurses by using the method of situational simulation, optimize the nursing management mode, learn to use new media technology to improve the credibility of nurses to provide guarantee for effective problem-solving of clinical nurses.

Introduction

Nursing education in China can be divided into two main levels: vocational education and higher education. Vocational education includes technical secondary schools and junior colleges, while higher education includes undergraduate, master’s and doctoral education. Vocational education aims at training students to master basic nursing service skills and to be able to take the post to engage in daily nursing work (Sun & Zong, 2017 ). Higher nursing education started late, and undergraduate education has always followed the “three-stage” education model of clinical medicine (basic medical courses, specialized courses and clinical practice). Most courses are centred on subject knowledge, and all clinical practice takes the form of centralized practice (Li, 2012 ). The training goal of nursing postgraduates is gradually expanding from academic master to professional master. The curriculum mainly includes classroom teaching and clinical practice. The classroom teaching contents include public courses (political theory, foreign languages, etc.), professional basic courses (advanced health assessment, pharmacotherapy, pathophysiology, evidence-based nursing, medical statistics or clinical epidemiology), specialized courses (advanced nursing practice theory) and Academic activities . The goal of nursing doctoral training is to cultivate high-level nursing research talents, focusing on the cultivation of scientific research ability rather than clinical practice ability. The curriculum includes ideology and politics, basic theory, research methods, specialized courses, development frontier, scientific writing, etc (Luo et al., 2018 ). There are some problems in the training mode and curriculum, such as theory and practice are out of touch, traditional lecture-based classroom teaching makes students passively accept knowledge, students attach importance to theory over practice, knowledge input to ability output, professional study to humanities knowledge. Nursing students receive no theoretical and/or practical training in problem solving before entering the clinical setting, so there is not a starting point for these nurses to clinical dilemmas in their professional life.

With the development of medicine, people pay more attention to health and have higher requirements for nursing service ability (Yang, Ning, et al., 2018). The National Nursing Development Plan (National Development and Reform Commission, 2017 ) points out that it is necessary to strengthen the construction of nurse teams, establish nurse training mechanisms and improve the professional quality and service ability of nurses. However, in the face of increasingly complex and changeable clinical environment, nurses are still lacking in problem-solving thinking and ability, and often fall into the dilemma of problem solving (Li et al., 2020 ).

Typical decision theory approaches to the identification of problem solving in nursing have viewed the process as a series of decision formulations that include: decisions about what observations should be made in the patient situation; decisions about deriving meaning from the data observed (clinical inferences); and decisions regarding the selection of action to be taken that will be of optimal benefit to the patient (McGuire, 1985 ). Information processing theory describes problem solving as an interaction between the information processing system (the problem-solver) and a task environment, which can be analysed as two simultaneously occurring sub-processes of “understanding” and “search” (VanLehn, 1989 ). Individuals collect the stimulus that poses the problem in the understanding process, forming the internal representation of the problem, transforming the problem stimulus into the initial information needed in the search process, and then producing mental information structures for the understanding of the problem, which making individuals distinguish the nature of the problem and clarify the goal of the problem. The mental information structures drive the search process that enables the individual to find or calculate the solution to the problem. This process starts with the nurse identifying the clinical problem and continues until the decision is made to resolve the problem (Taylor, 2000 ). Clinical problem solving requires nurses to have a variety of cognitive strategies, which involves nurses’ knowledge, experience, and memory process. Nurses must recognize the current problem and use all available knowledge and experience to transform the problem into their internal problem representation, and then set goals and search for strategies that can achieve the goal (Mayer & Wittrock, 1992 ). In today’s complex clinical environment, nurses need to be able to solve problems accurately, thoroughly, and quickly. Nurses who can solve problems efficiently have fewer medical errors (Babaei et al., 2018 ), and the level of nursing skills and empathy are higher (Ay et al., 2020 ; Bayindir Çevik & Olgun, 2015 ). To cultivate nurses’ problem solving thinking and ability, it is necessary to better understand the influencing factors of problem solving dilemma. However, these cannot be obtained by observing nurses’ behaviour in their work, and cannot be obtained through quantitative research either. Exploring the thinking process involved in nurses’ work through qualitative interviews is an effective way to understand the influencing factors of nurses’ problem solving. Given this, this study used qualitative research methods to deeply analyse the influencing factors of clinical front-line nurses’ problem solving dilemma, to provide a basis for making relevant strategies to cultivate nurses’ thinking and ability of problem solving.

Study design

A qualitative study based on in-depth interviews was conducted to obtain influencing factors of nurses’ problem-solving dilemma.

Settings and participants

Purposive sampling combined with a maximum variation strategy was used to identify and select information-rich participants related to the research phenomenon. Maximum variation was achieved in terms of participants’ gender, education level, professional title, marital status, seniority, and administrative office, respectively. The study was conducted between August 2020 to December 2020 in a tertiary hospital in Shanghai, China. The inclusion criteria were a nurse practicing certificate of the People’s Republic of China and within the valid registration period; having been engaged in clinical nursing work for at least 1 year and still engaged in clinical nursing work; clear language expression, able to clearly describe the solution and feelings of clinical problem solving; informed consent to this study and voluntary participation. The exclusion criterion were on leave during the study period (personal leave, maternity leave, sick leave, etc.); out for further study or came to the hospital for further study; confirmed or suspected mental illness and psychotropic medicine users. Purposive sampling continued until thematic saturation was reached during data analysis.

Data collection

Face-to-face, a semi-structured interview was used to collect information. All interviews were conducted in the lounge to ensure quiet and undisturbed by a female postgraduate nursing student with the guidance of her master tutor. Initially, an interview guide was developed based on literature review and expert consultation including about five predetermined questions: What thorny problems have you encountered in clinical work or have a great impact on you? How did you solve it? Why take such a solution? What is the biggest difficulty encountered in the process of problem solving? How does it affect you? How do you feel in the process of problem solving? Before the interview, the consent of the interviewee was obtained and then the researcher fully explains to the interviewees and starts with a friendly chat to allay the interviewees’ worries. During the interview, the researcher listened carefully and responded in time, always maintaining a neutral attitude, without any inducement or hint, if necessary, giving encouragement and praise to support the expression of the interviewees, and to record the interviewees’ facial expressions, physical movements and emotional responses in time. At the same time, a recording pen was used to ensure that the interview content was recorded accurately and without omission. The interview time for each person was 30 to 40 minutes.

Data analysis

After each interview, the researcher wrote an interview diary in time to reflect on the interview process and transcribed the interview content into words within 24 hours, then the researcher made a return visit by phone the next day to confirm that the information is correct. The seven-step method of Colaizzi’s phenomenological analysis method ( Table I ) was adopted to analyse the collected data(Colaizzi, 1978 ). Two researchers collated the original data, independently coded, summarized this information as themes, and organized a research group meeting once a week to discuss and reach a consensus.

7 steps of Colaizzi’s phenomenological analysis method.

Ethical considerations

This study was approved by the Ethics Committee of the Shanghai Pulmonary Hospital, Affiliated to Tongji University, project number: K16-252. Before the interview, the researcher explained the purpose and significance of the study to each interviewee in detail and obtained the informed consent of them on a voluntary basis and all of the interviewees signed informed consent forms. To protect the privacy of each interviewee, their names are replaced by numbers (e.g., N1, N2), and the original materials and transcribed text materials involved are kept by the first author himself, and all materials are destroyed after the completion of the study.

There was no new point of view when the 13th nurse was interviewed, and there was still no new point of view when one more nurse was interviewed, the interview was over, 14 nurses were interviewed. Three themes and seven subthemes were extracted. The characteristics of the participants ( N = 14) are provided in Table II .

Participant characteristics (N = 14).

Nurses’ own factors

Differences in knowledge structure and thinking.

Differences in the structure of prior knowledge and way of thinking will affect nurses’ processing of clinical data, thus affecting their clinical decision-making. The nurses made a wrong judgement of the condition because of the solidified thinking that postoperative nausea and vomiting symptoms were side effects of narcotic drugs and the lack of overall control and understanding of the patient’s condition.

There was a patient who came back after surgery with nausea and vomiting, the first thing that went through my mind, is the drug side effects, so I didn’t pay much attention, as is often the case, the most common cause of postoperative nausea and vomiting is anesthetic drug side effects, but later found to be cerebral infarction, this kind of situation I find it hard to recognize.

Differences in professional values

Professional values of nurses are accepted codes of conduct internalized by nursing professionals through training and learning (Pan, 2016 ). Negative professional values are easy to lead to problem solving dilemma. Some nurses think nursing is just a service.

The work is difficult to do, everything is the nurse’s fault, the nurse must apologize and put up with the patient’s scolding, nursing is a service industry, sometimes I am really wronged.” There are also nurses who believe that nursing work can reflect their personal value, and solving problems successfully will bring them a sense of achievement.

Although the nursing work is very intense, I live a full life every day. I feel a sense of accomplishment and pride that I can solve the problems of patients and discharge them smoothly through my work.

Poor strain capacity

Nursing work is patient-centred holistic nursing, the current clinical situation is complex and changeable, requiring nurses must have good strain capacity, and can “be anxious about what the patient needs, think what the patient thinks, and solve the patient’s difficulties.”

All patients are self-centered, and they don’t care whether you (the nurse) are busy or not. For example, once I gave oral medicine to a patient, a patient in the same ward was in a hurry and asked me to help him call his son. I was busy handing out the medicine and did not help. As a result, the patient was very dissatisfied and complained to the head nurse.

The 20-bed patient went through the discharge formalities but was still lying in the hospital bed. when the new patient arrived and she didn’t leave, I went to urge her to leave the hospital, she suddenly got angry and scolded me, I don’t know what to do.

Improper nursing management

Low sense of organizational support.

Organizational support is an important resource for clinical nurses in the process of problem solving (Poghosyan et al., 2020 ). Low sense of organizational support will hinder nurses’ problem solving.

The style of leadership and the atmosphere of the department are very important. in a department I rotated before, the leader was too strict to listen to your explanation, and the atmosphere of the department was not good. I couldn’t find help when I encountered problems. When I have a conflict with a patient, the leader will only criticize me, which makes me feel helpless.

Sometimes there will be a conflict with patients due to the bed turnover problem, and the patient will not listen to your explanation and turn around to complain, the nurse will be responsible for such things. In severe cases, even violent incidents will be encountered and the personal safety can not be guaranteed.

Insufficient allocation of manpower

Although the total number of nurses has increased substantially, there is still a shortage of human resources under the rapidly increasing workload (Guo et al., 2021 ).

When I was on the night shift and I encountered the critical moment of rescuing patients, I had to call an anesthesiologist, a doctor on duty, a nurse on duty simultaneously, an observation of the patient’s condition to prevent accidents was needed, I also have to race against time to give the patient ECG monitoring and oxygen inhalation. When the doctor came, he also criticized me that the first-aid equipment was not in place (crying).

According to the normal nurse-patient ratio, each nurse takes care of eight patients, and now there are not only eight patients, but also with extra beds and a fast turnover, and sometimes a nurse is responsible for more than 12 patients

Patient factors

The concept of emphasizing medicine and neglecting to nurse.

There is a deviation in society’s cognition of the profession of nurses, which believes that nurses are the “legs” of doctors, and nurses’ work is to help doctors run errands, give injections and give fluids. This concept not only leads to nurses’ lack of due respect, but also hinders nurses’ professional identity, and has a great negative impact on nurses’ problem-solving (Gao et al., 2015 ).

The patient did not dare to tell the doctor something he was not satisfied with, but complained directly to the nurse. For example, if the patient did not want to do some tests, he would scold the nurse. The nurse explained to him that he would not listen. But when the doctor came, he smiled and refused to admit that he cursed nurses, and he would frame the nurse. 90% of the patients would be willing to listen to the doctor.

Sometimes the patient says he was not feeling well, and I know the patient’s condition. I will give her some reasonable explanations, but the patient does not accept it. She is satisfied only when the doctor come to see her. In the final analysis, the patient just don’t believe us. No matter how much I explain to her, it is not as effective as the doctor’s glance at her.

Individual differences of patients

There are differences in patients’ personality characteristics, cultural background, views on nurses and state of an illness, these individual differences are also the reasons for nurses’ problem-solving dilemma (Chan et al., 2018 ).

Some cancer patients are in a period of anger, and it is very difficult to communicate with him. When I see him angry and lose his temper, I will not talk to him and just leave.”

Patients have different cultural levels and different social backgrounds. Sometimes I can’t talk too deeply. If patients are a little more educated, it will be easier for us to communicate with them, and some patients can’t understand anything we say.”

Multiple factors affecting clinical nurses’ problem-solving dilemma

The reasons for nurses’ failure in problem solving are mainly in the process of understanding the problem, the search process driven by the psychological information structure, and the problem or loss of balance in the process of implementing the plan. In the process, the three factors of nurses, management and patients all played an important role. Nurses’ knowledge structure and thinking loopholes led to the deviation of nurses’ internal representation of the problem (Jonassen, 2005 ). Poor professional values and low sense of organizational support can lead to nurses’ negative orientation and attitude towards problems (Poghosyan et al., 2020 ; X. Wang et al., 2018 ). The manpower allocation of nurses, patients’ emphasis on medical treatment over nursing care, and individual differences mainly increase the complexity and difficulty of nurses’ problem-solving task environment as external factors. The three factors work together on the problem-solving of clinical nurses, which leads to the dilemma of problem-solving.

Implementing situational simulation training to improve the comprehensive quality of nurses

At present, the overall quality and ability of nurses cannot meet the requirements of systematic, effective and rapid problem-solving. It is necessary to strengthen the construction of nurses to improve nurses’ problem-solving ability. Some studies have shown that situational simulation class can improve students’ knowledge, experience, psychological quality and other abilities (Mohammad, 2020 ). It is suggested that nursing educators should explore targeted situational simulation teaching and strengthen the relationship between classroom teaching and clinical practice through situational simulation, and to build a novel, perfect and clinical knowledge network for nurses. Secondly, emergency situational simulation teaching should be carried out to enable nurses to experience emergency situations from different angles, so as to improve their thinking, skills and timeliness in dealing with emergencies (Zhang et al., 2019 ). The content of professional values training should also be added to the situational simulation class in order to cultivate nurses’ positive, accessible and stable professional values and promote their positive orientation and attitude when facing problems (Skeriene, 2019 ).

Optimize nursing management and improve nurses’ working experience

Through interviews, it is found that nursing management factors have caused nurses’ problem-solving dilemma to a certain extent, which needs to be optimized according to the specific problems existing in nursing management to help nurses deal with the problems and solve the dilemma effectively. The total number of registered nurses in China exceeded 4.7 million in 2021, an increase of 1.46 million from 3.24 million in 2015, an increase of 45% (Deng et al., 2019 ]. However, there is still a large workload and underallocation of manpower, which may be due to the unreasonable distribution of human resources between time periods and departments. Hospitals and nursing managers can use the hospital information system to evaluate the nursing workload, and allocate nursing human resources reasonably according to the evaluation results (H. Yang et al., 2019 ), so as to avoid nurses falling into the dilemma of problem solving due to long-term overloaded work. In addition, it is necessary to create a harmonious departmental atmosphere for nurses, create a supportive departmental environment (Aghaei et al., 2020 ), and strictly ensure the safety of nurses’ practice and put an end to the occurrence of violence. Timely and strong organizational support can reduce the painful feelings of nurses caused by adverse events (Stone, 2020 ). and help them to solve problems actively.

Using new media to improve the image and credibility of nurses

There is a bias in social cognition of the profession of nurses, and some negative media reports mislead patients, resulting in social stereotypes of nurses (L. Q. Wang et al., 2021 ). It is necessary to make full use of new media to objectively introduce the nursing profession to the public, publicize outstanding nursing figures and typical deeds, make the public realize the important role of nurses in health care, and create an atmosphere of understanding and supporting nurses in the whole society to enhance the image and credibility of nurses and help nurses deal with problems and solve difficulties effectively (Falkenstrom, 2017 ).

Limitations and strengths of the study

The limitation is that the transferability of this study’s results may be limited as a result of including a small number of participants and the participants all worked in the same hospital in Shanghai. More participants in different cities and hospitals could have increased the variety of the descriptions and experiences. The strength is that the use of purposive sampling facilitated inclusion of participants from a range of demographic groups. The use of maximum variation strategy facilitated that the participants covered different gender, education level, professional title, marital status, seniority and department, which helped to increase the representativeness of sample.

Implications for practice

This study provides an in-depth exploration of the problem solving dilemmas of clinical nurses in China and provides valuable insights into the continuing education of nurses. These insights shine a light on areas that warrant further investigation and need to be improved in continuing education of nurses. It is of great significance to improve nurses’ problem-solving ability, improve nurses’ professional quality, effectively solve patients’ medical treatment and health problems, and improve patients’ experience of seeking medical treatment.

Through the semi-structured interview, it is found that the problem-solving dilemma of clinical nurses is affected by many factors. Nurses themselves should be confident, self-improvement, constantly learning and enterprising to improve their own ability, and be good at using new media to improve nurses’ image and credibility. Hospitals, nursing administrators and nursing educators should take corresponding measures to improve the knowledge structure of nurses, cultivate nurses’ positive professional values and adaptability, and give full organizational support to nurses. optimize the allocation of nursing human resources to provide a strong guarantee for nurses to deal with problems solving dilemma.

Biographies

Yu Mei Li : associate chief nurse, master degree, master supervisor, engaged in nursing of tumor patients.

Yifan Luo : nurse, master degree, engaged in clinical nursing.

Funding Statement

This work was supported by the Graduate Education Research and Reform Education Management program of Tongji University [2021YXGL09].

Disclosure statement

No potential conflict of interest was reported by the author(s).

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• Home Safety

This Device Saved My House From an Electrical Fire. And You Might Be Able to Get It for Free.

I was in my car, miles from home, when a panicky phone alert shook me out of my NPR haze: An electrical fire hazard had been detected at my house. Immediately I called my wife, who told me the house wasn’t burning. Then I called the number in the alert to determine what it was all about.

The alert came from Ting , an electricity-monitoring service whose device I’d plugged into an outlet a few weeks earlier and almost forgotten about. The Ting agent who answered my call calmed me down a little but also assured me that the device had detected a serious fire hazard. He even told me where the hazard was located and said I should call my utility company right away.

The next morning I had a visit from my electric company. The electrician gave me a skeptical harrumph when I showed him the information on the Ting smartphone app, but he inspected the issue anyway. About 20 minutes later he came back to me, quite surprised, and confirmed that the Ting Sensor had indeed found a big problem. A team returned that day to put a temporary fix on it, and over the next several weeks, contractors dug up my front yard to replace the main power line, at no expense to me.

Ting by Whisker Labs

Electrical fire protection.

This easy-to-use (and frequently free) device monitors your home for electrical fire hazards and gives you more peace of mind.

Buying Options

What is ting, and what does it do.

The Ting Sensor is a device about the size of a smart plug or baby monitor. Once you plug it into a wall outlet, connect it to Wi-Fi, and set it up with the accompanying app, it goes into a learning mode for about a week, where it monitors your home to establish a baseline of electrical activity.

After that it starts looking for fire hazards in the form of electrical arcs, which happen when electricity jumps from one place to another when it isn’t supposed to. Arcs are a leading cause of home electrical fires and can develop in overloaded outlets, in damaged or old wiring, in lamps or light switches, or even (as in my case) in the main connection to your house. Just like other things in your home, components of your electrical system can age and wear out over time from normal use.

After the electric company resolved my incident, I talked to Bob Marshall, CEO of Whisker Labs, the maker of the Ting Sensor. He said that each electrical problem has a unique signature, which the Ting Sensor is designed to detect. For instance, an arc caused by a malfunctioning electric blanket looks different to the Ting Sensor than an arc caused by a faulty neutral connection.

The Ting Sensor takes 30 million measurements a second, looking for anomalies. When it identifies a problem it recognizes, the owner receives an alert through the Ting app that provides advice on what to do. Depending on the issue, a live member of the company’s Fire Safety Team may contact you to walk you through whatever remediation steps might be required.

In addition, if Ting finds a problem, the company will coordinate service by a licensed electrician and cover costs to remedy the problem up to $1,000. In my case, since the problem was the electrical connection to my home, the power company did the work at its own cost.

The simple Ting app features a main view showing your home’s electrical health in the form of a real-time voltage meter—sort of like taking your blood pressure. It tells you whether your home’s voltage is within normal range (the target is 120 volts, but between 108 V and 132 V is considered normal). Voltages outside that range, particularly for long periods, can damage appliances and may be an indication of a fire hazard. The app also shows any notifications from Ting and a history of readings and notifications. That’s about it. For most people, if your electrical system is working properly, you never have to look at the app.

In my case, I started getting readings outside the normal voltage range right away, and almost every day I received a notification, but it took a few weeks for Ting to analyze the pattern and discern what the problem was. Small dips and surges aren’t totally unusual, and I had noticed flickering lights in my house for a while (and ignored them).

What Ting doesn’t do

The Ting Sensor isn’t a smoke alarm or a replacement for one. If you knock over a candle or start a cooking fire, it won’t sound an alarm or send an alert to the fire department. Its purpose is to notify you about problems that have the potential start a fire, not to let you know about fires currently in progress. You still need multiple smoke detectors around your home, and we highly recommend a smart smoke detector .

If you live in an apartment, you can use Ting only if your unit has its own utility meter. If you’re not sure, consult with your building’s management.

Ting doesn’t integrate with other smart-home platforms such as Alexa or HomeKit; if you have a lot of smart-home devices and like to group them in one app, keep in mind that you still need the Ting app too. Because you interact with Ting only when the sensor detects a problem, there really isn’t much reason to integrate it with other systems anyway. The Ting Sensor doesn’t have a built-in alarm and can’t integrate with one, so the only way to get notifications is via your smartphone.

Although the device does monitor your electrical system, it doesn’t monitor energy usage, so it can’t tell you, say, that your aging fridge is using too much electricity or that other members of your household never turn the lights off . It also can’t turn your power off if it senses an immediate problem.

Another thing that isn’t a dealbreaker but is something to consider if you don’t have a lot of outlets in your home: The Ting Sensor is large enough to cover both receptacles in an outlet, so you can’t plug a lamp or something else in the same place.

How you can get one

I received my Ting Sensor the way most people do: for free from my homeowner’s insurance provider. My insurer sent me a few emails offering the device plus the monitoring service at no cost. Ting partners with insurers including Liberty Mutual, Nationwide, Pure, and State Farm to offer the devices to customers.

Insurance companies aren’t doing this out of the kindness of their hearts. Prevention is cheaper than rebuilding; the up-front costs are much less than paying out an insurance claim. This business model is similar to how most insurance companies are willing to pay toward the cost of a home security system.

Customers of Pure and State Farm can go to this page on the Ting site to get the device and enroll in the monitoring service. Liberty Mutual and Nationwide customers should contact their agent.

If your insurance company doesn’t offer Ting, you can buy the Ting Sensor directly from the manufacturer for $100, which includes one year of monitoring. After that, monitoring requires a $50 annual fee.

Privacy and security snapshot

• Whisker Labs requires a unique username and password but does not support two-factor authentication except during initial product registration.
• Whisker Labs may collect personal information, such as your name, address, email address, and phone number, which it requires to contact you in the event of a fire hazard.
• The company says that data is stored in a secure cloud environment and fully encrypted, and that access is monitored and limited to key personnel.
• Customer data is not shared with or sold to third parties.
• For more, view Whisker Labs’s privacy policy .

This article was edited by Jon Chase.

Meet your guide

Grant Clauser

Senior Editor

Grant Clauser is the senior editor for the smart-home and audio/video categories. He has been reporting on technology since 1999 and has been an invited speaker at events including CES and CEDIA. He has completed certification classes from THX, ISF, and Control4. He also teaches poetry classes. Really.

Further reading

The Best Smart Home Devices to Help Aging in Place

by Rachel Cericola

Smart-home devices can make it easier for you to help an older loved one age safely and securely in their own home.

The Best Smart Thermostat

by Roy Furchgott

Smart thermostats like our pick, the Ecobee Premium , can make your home’s HVAC more energy efficient without sacrificing your comfort.

The Best Smart Water-Leak Detector

A smart water-leak detector can alert you to small plumbing leaks before they turn into big, expensive nightmares.

The Best Emergency Preparedness Supplies

by Ellen Airhart

After hundreds of hours of research, we narrowed down the items that could prove indispensable in a natural disaster—and most are helpful in everyday life, too.