Quick Guide to Bivariate Statistical Tests
Acquisitions Editor: Christina Burns Product Development Editor: Katherine Burland Editorial Assistant:
Cassie Berube Marketing Manager: Dean Karampelas Production Project Manager: Cynthia Rudy Design
Coordinator: Joan Wendt Manufacturing Coordinator: Karin Duffield Prepress Vendor: Absolute Service,
Copyright © 2017 Wolters Kluwer.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2008, 2004, 1999
by Lippincott Williams & Wilkins. Copyright © 1995, 1991, 1987, 1983, 1978 by J. B. Lippincott
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies,
or utilized by any information storage and retrieval system without written permission from the copyright
owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this
book prepared by individuals as part of their official duties as U.S. government employees are not covered
by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two
Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at firstname.lastname@example.org, or
via our website at lww.com (products and services).
Printed in China
Library of Congress Cataloging-in-Publication Data Polit, Denise F., author.
Nursing research : generating and assessing evidence for nursing practice / Denise F. Polit, Cheryl
Tatano Beck. — Tenth edition.
p. ; cm.
Includes bibliographical references and index.
I. Beck, Cheryl Tatano, author. II. Title.
[DNLM: 1. Nursing Research—methods. WY 20.5]
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based on healthcare professionals’ examination
of each patient and consideration of, among other things, age, weight, gender, current or prior medical
conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does
not provide medical advice or guidance, and this work is merely a reference tool. Healthcare professionals,
and not the publisher, are solely responsible for the use of this work including all medical judgments and
for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and
treatment options should be made and healthcare professionals should consult a variety of sources. When
prescribing medication, healthcare professionals are advised to consult the product information sheet (the
manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use,
warnings, and side effects and identify any changes in dosage schedule or contraindications, particularly if
the medication to be administered is new, infrequently used, or has a narrow therapeutic range. To the
maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any
injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise,
or from any reference to or use by any person of this work.
Our Beloved Family: Our Husbands, Our Children (Spouses/Fiancés), and Our
Husbands: Alan Janosy and Chuck Beck
Children: Alex (Maryanna), Alaine (Jeff), Lauren (Vadim), and Norah (Chris); and
Curt and Lisa
Grandchildren: Cormac, Julia, Maren, and Ronan
This 10th edition, like the previous nine editions, depended on the contribution of
dozens of people. Many faculty and students who used the text have made
invaluable suggestions for its improvement, and to all of you we are very grateful.
In addition to all those who assisted us during the past 35 years with the earlier
editions, the following individuals deserve special mention.
We would like to acknowledge the comments of reviewers of the previous
edition of this book, anonymous to us initially, whose feedback influenced our
revisions. Faculty at Griffith University in Australia made useful suggestions and
also inspired the inclusion of some new content. Valori Banfi, reference librarian at
the University of Connecticut, provided ongoing assistance. Dr. Deborah Dillon
McDonald was extraordinarily generous in giving us access to her NINR grant
application and related material for the Resource Manual.
We also extend our thanks to those who helped to turn the manuscript into a
finished product. The staff at Wolters Kluwer has been of great assistance to us
over the years. We are indebted to Christina Burns, Kate Burland, Cynthia Rudy,
and all the others behind the scenes for their fine contributions.
Finally, we thank our family and friends. Our husbands Alan and Chuck have
become accustomed to our demanding schedules, but we recognize that their
support involves a lot of patience and many sacrifices.
Ellise D. Adams, PhD, CNM
The University of Alabama in Huntsville Huntsville, Alabama
Jennifer Bellot, PhD, RN, MHSA
Associate Professor and Director, DNP Program Thomas Jefferson University
Philadelphia, Pennsylvania Kathleen D. Black, PhD, RNC
Assistant Professor, Jefferson College of Nursing Thomas Jefferson University
Philadelphia, Pennsylvania Dee Campbell, PhD, APRN, NE-BC, CNL
Professor, Graduate Department Felician College, School of Nursing Lodi, New
Patricia Cannistraci, DNS, RN, CNE
Albany, New York
Julie L. Daniels, DNP, CNM
Frontier Nursing University Hyden, Kentucky
Rebecca Fountain, PhD, RN
University of Texas at Tyler Tyler, Texas
Teresa S. Johnson, PhD, RN
Associate Professor, College of Nursing University of Wisconsin—Milwaukee
Jacqueline Jones, PhD, RN, FAAN
Associate Professor, College of Nursing University of Colorado, Anschutz Medical
Campus Aurora, Colorado
Mary Lopez, PhD, RN
Associate Dean, Research
Western University of Health Sciences Pomona, California
Audra Malone, DNP, FNP-BC
Frontier Nursing University Hyden, Kentucky
Sharon R. Rainer, PhD, CRNP
Assistant Professor, Jefferson College of Nursing Thomas Jefferson University
Philadelphia, Pennsylvania Maria A. Revell, PhD, RN
Professor of Nursing
Middle Tennessee State University Murfreesboro, Tennessee
Stephanie Vaughn, PhD, RN, CRRN
Interim Director, School of Nursing California State University, Fullerton
Research methodology is not a static enterprise. Even after writing nine editions of
this book, we continue to draw inspiration and new material from groundbreaking
advances in research methods and in nurse researchers’ use of those methods. It is
exciting and uplifting to share many of those advances in this new edition. We
expect that many of the new methodologic and technologic advances will be
translated into powerful evidence for nursing practice. Five years ago, we
considered the ninth edition as a watershed edition of a classic textbook. We are
persuaded, however, that this 10th edition is even better. We have retained many
features that made this book a classic textbook and resource, including its focus on
research as a support for evidence-based nursing, but have introduced important
innovations that will help to shape the future of nursing research.
N E W TO T H I S E D I T I O N
New Chapters We have added two new chapters on “cutting-edge”
topics that are not well covered in any major research methods
textbook, regardless of discipline. The first is a chapter on an issue of
critical importance to health professionals and yet inadequately
addressed in the nursing literature: the clinical significance of
research findings. In Chapter 20, we discuss various
conceptualizations of clinical significance and present methods of
operationalizing those conceptualizations so that clinical significance
can be assessed at both the individual and group level. We believe that
this is a “must-read” chapter for nurses whose research is designed to
inform clinical practice. The second new chapter in this edition
concerns the design and conduct of pilot studies. In recent years,
experts have written at length about the poor quality of many pilot
studies. Chapter 28 provides guidance on how to develop pilot study
objectives and draw conclusions about the appropriate next step—that
is, whether to proceed to a full-scale study, make major revisions, or
abandon the project. This chapter is included in Part 5 of this book,
which is devoted to mixed methods research, because pilots can
benefit from both qualitative and quantitative evidence.
New Content Throughout the book, we have included material on
methodologic innovations that have arisen in nursing, medicine, and
the social sciences during the past 4 to 5 years. The many additions
and changes are too numerous to describe here, but a few deserve
special mention. In particular, we have totally revised the chapters on
measurement (Chapter 14) and scale development (Chapter 15) to
reflect emerging ideas about key measurement properties and the
assessment of newly developed instruments.
The inclusion of two new chapters made it challenging to keep the textbook to a
manageable length. Our solution was to move some content in the ninth edition to
supplements that are available online. In fact, every chapter has an online
supplement, which gave us the opportunity to add a considerable amount of new
content. For example, one supplement is devoted to evidence-based methods to
recruit and retain study participants. Other supplements include a description of
various randomization methods, an overview of item response theory, guidance on
wording proposals to conduct pilot studies, and a discussion of quality
improvement studies. Following is a complete list of the supplements for the 31
chapters of this textbook: 1. The History of Nursing Research 2. Evaluating
Clinical Practice Guidelines—AGREE II 3. Deductive and Inductive Reasoning 4.
Complex Relationships and Hypotheses 5. Literature Review Matrices 6.
Prominent Conceptual Models of Nursing Used by Nurse Researchers, and a Guide
to Middle-Range Theories 7. Historical Background on Unethical Research
Conduct 8. Research Control 9. Randomization Strategies 10. The RE-AIM
Framework 11. Other Specific Types of Research 12. Sample Recruitment and
Retention 13. Other Types of Structured Self-Reports 14. Cross-Cultural Validity
and the Adaptation/Translation of Measures 15. Overview of Item Response
Theory 16. SPSS Analysis of Descriptive Statistics 17. SPSS Analysis of
Inferential Statistics 18. SPSS Analysis and Multivariate Statistics 19. Some
Preliminary Steps in Quantitative Analysis Using SPSS
20. Clinical Significance Assessment with the Jacobson-Truax Approach 21.
Historical Nursing Research 22. Generalizability and Qualitative Research 23.
Additional Types of Unstructured Self-Reports 24. Transcribing Qualitative
Data 25. Whittemore and Colleagues’ Framework of Quality Criteria in
Qualitative Research 26. Converting Quantitative and Qualitative Data 27.
Complex Intervention Development: Exploratory Questions 28. Examples of
Various Pilot Study Objectives 29. Publication Bias in Meta-Analyses 30. Tips
for Publishing Reports on Pilot Intervention Studies 31. Proposals for Pilot
Intervention Studies Another new feature of this edition concerns our interest in
readers’ access to references we cited. To the extent possible, the studies we
have chosen as examples of particular research methods are published as openaccess articles. These studies are identified with an asterisk in the reference list
at the end of each chapter, and a link to the article is included in the Toolkit
section of the Resource Manual. We hope that these revisions will help users of
this book to maximize their learning experience.
O R G A N I Z AT I O N O F T H E T E X T
The content of this edition is organized into six main parts.
• Part I—Foundations of Nursing Research and Evidence-Based Practice
introduces fundamental concepts in nursing research. Chapter 1 briefly
summarizes the history and future of nursing research, discusses the
philosophical underpinnings of qualitative research versus quantitative research,
and describes major purposes of nursing research. Chapter 2 offers guidance on
utilizing research to build an evidence-based practice. Chapter 3 introduces
readers to key research terms and presents an overview of steps in the research
process for both qualitative and quantitative studies.
• Part II—Conceptualizing and Planning a Study to Generate Evidence further
sets the stage for learning about the research process by discussing issues
relating to a study’s conceptualization: the formulation of research questions
and hypotheses (Chapter 4), the review of relevant research (Chapter 5), the
development of theoretical and conceptual contexts (Chapter 6), and the
fostering of ethically sound approaches in doing research (Chapter 7). Chapter 8
provides an overview of important issues that researchers must attend to during
the planning of any type of study.
• Part III—Designing and Conducting Quantitative Studies to Generate
Evidence presents material on undertaking quantitative nursing studies. Chapter
9 describes fundamental principles and applications of quantitative research
design, and Chapter 10 focuses on methods to enhance the rigor of a
quantitative study, including mechanisms of research control. Chapter 11
examines research with different and distinct purposes, including surveys,
outcomes research, and evaluations. Chapter 12 presents strategies for sampling
study participants in quantitative research. Chapter 13 describes using structured
data collection methods that yield quantitative information. Chapter 14
discusses the concept of measurement and then focuses on methods of assessing
the quality of formal measuring instruments. In this edition, we describe
methods to assess the properties of point-in-time measurements (reliability and
validity) and longitudinal measurements—change scores (reliability of change
scores and responsiveness). Chapter 15 presents material on how to develop
high-quality self-report instruments. Chapters 16, 17, and 18 present an
overview of univariate, bivariate, and multivariate statistical analyses,
respectively. Chapter 19 describes the development of an overall analytic
strategy for quantitative studies, including material on handling missing data.
Chapter 20, a new chapter, discusses the issue of interpreting results and making
inferences about clinical significance.
• Part IV—Designing and Conducting Qualitative Studies to Generate
Evidence presents material on undertaking qualitative nursing studies. Chapter
21 is devoted to research designs and approaches for qualitative studies,
including material on critical theory, feminist, and participatory action research.
Chapter 22 discusses strategies for sampling study participants in qualitative
inquiries. Chapter 23 describes methods of gathering unstructured self-report
and observational data for qualitative studies. Chapter 24 discusses methods of
analyzing qualitative data, with specific information on grounded theory,
phenomenologic, and ethnographic analyses. Chapter 25 elaborates on methods
qualitative researchers can use to enhance (and assess) integrity and quality
throughout their inquiries.
• Part V—Designing and Conducting Mixed Methods Studies to Generate
Evidence presents material on mixed methods nursing studies. Chapter 26
discusses a broad range of issues, including asking mixed methods questions,
designing a study to address the questions, sampling participants in mixed
methods research, and analyzing and integrating qualitative and quantitative
data. Chapter 27 presents innovative information about using mixed methods
approaches in the development of nursing interventions. In Chapter 28, a new
chapter, we provide guidance for designing and conducting a pilot study and
using data from the pilot to draw conclusions about how best to proceed.
• Part VI—Building an Evidence Base for Nursing Practice provides additional
guidance on linking research and clinical practice. Chapter 29 offers an
overview of methods of conducting systematic reviews that support EBP, with
an emphasis on meta-analyses, metasyntheses, and mixed studies reviews.
Chapter 30 discusses dissemination of evidence—how to prepare a research
report (including theses and dissertations) and how to publish research findings.
The concluding chapter (Chapter 31) offers suggestions and guidelines on
developing research proposals and getting financial support and includes
information about applying for NIH grants and interpreting scores from NIH’s
new scoring system.
K E Y FE AT U R E S
This textbook was designed to be helpful to those who are learning how to do
research as well as to those who are learning to appraise research reports critically
and to use research findings in practice. Many of the features successfully used in
previous editions have been retained in this 10th edition. Among the basic
principles that helped to shape this and earlier editions of this book are (1) an
unswerving conviction that the development of research skills is critical to the
nursing profession, (2) a fundamental belief that research is intellectually and
professionally rewarding, and (3) a steadfast opinion that learning about research
methods need be neither intimidating nor dull. Consistent with these principles, we
have tried to present the fundamentals of research methods in a way that both
facilitates understanding and arouses curiosity and interest. Key features of our
approach include the following: • Research Examples. Each chapter concludes
with one or two actual research examples designed to highlight critical points made
in the chapter and to sharpen the reader’s critical thinking skills. In addition, many
research examples are used to illustrate key points in the text and to stimulate ideas
for a study. Many of the examples used in this edition are open-access articles that
can be used for further learning and classroom discussions.
• Critiquing Guidelines. Most chapters include guidelines for conducting a
critique of each aspect of a research report. These guidelines provide a list of
questions that draw attention to specific aspects of a report that are amenable to
• Clear, “user-friendly” style. Our writing style is designed to be easily digestible
and nonintimidating. Concepts are introduced carefully and systematically,
difficult ideas are presented clearly, and readers are assumed to have no prior
exposure to technical terms.
• Specific practical tips on doing research. This textbook is filled with practical
guidance on how to translate the abstract notions of research methods into
realistic strategies for conducting research. Every chapter includes several tips
for applying the chapter’s lessons to real-life situations. These suggestions are
in recognition of the fact that there is often a large gap between what gets taught
in research methods textbooks and what a researcher needs to know to conduct a
• Aids to student learning. Several features are used to enhance and reinforce
learning and to help focus the student’s attention on specific areas of text
content, including the following: succ ...
Purchase answer to see full