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GRIDLINE SET IN 1ST-PP TO INDICATE SAFE AREA; TO BE REMOVED AFTER 1ST-PP Foundations of Nursing Research Sixth Edition Rose Marie Nieswiadomy, PhD, RN Professor Emerita Texas Woman’s University College of Nursing Pearson Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo Editor-in-Chief: Julie Alexander Designer Interior: Ilze Lemesis Acquisitions Editor: Pamela Fuller Senior Art Director Cover: Jayne Conte Editorial Assistant: Lisa Pierce/Cynthia Gates Cover Designer: Suzanne Behnke Director of Marketing: David Gesell Cover Art: Shutterstock Senior Marketing Manager: Phoenix Harvey Full-Service Project Management: Marketing Specialist: Michael Sirinides Kailash Jadli, Aptara®, Inc. Senior Managing Editor: Patrick Walsh Composition: Aptara®, Inc. Production Editor: Yagnesh Jani Text Printer/Bindery: R.R. Donnelley/Willard Project Manager: Susan Hannahs Cover Printer: Lehigh-Phoenix Color Art Director Interior: Maria Guglielmo-Walsh Text Font: 10/12 Palatino Credits and acknowledgments borrowed from other sources and reproduced, with permission, in this textbook appear on the appropriate page within the text. Copyright © 2012, 2008 by Pearson Education, Inc., One Lake Street, Upper Saddle River, NJ 07458. Publishing as Pearson. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. To obtain permission(s) to use material from this work, please submit a written request to Pearson Education, Inc., Permissions Department, One Lake Street, Upper Saddle River, NJ 07457. Many of the designations by manufacturers and seller to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps. Library of Congress Cataloging-in-Publication Data Nieswiadomy, Rose Marie. Foundations of nursing research/Rose Marie Nieswiadomy. —6th ed. p. cm. Includes bibliographical references and index. ISBN-13: 978-0-13-211857-6 (alk. paper) ISBN-10: 0-13-211857-2 (alk. paper) 1. Nursing—Research—Methodology. I. Title. [DNLM: 1. Nursing Research—methods. 2. Data Collection. 3. Research Design. WY 20.5] RT81.5.N54 2012 610.73072—dc22 2011000025 10987654321 ISBN 10: 0-13-211857-2 ISBN 13: 978-0-13-211857-6 To Ben Thank you for “lighting up my life” all of these years Contributor We extend a sincere thanks to our contributor. His time, effort, and expertise were so willingly given for the development and writing of resources that promote understanding of nursing research in the pursuit of nursing excellence. Michael L. Nieswiadomy, PhD, BA Professor of Economics and Director of the Center for Environmental Economic Studies and Research University of North Texas Denton, Texas vi Reviewers Thank You Our heartfelt thanks go out to our colleagues from schools of nursing across the country who have given their time generously to help us create this exciting new edition of our book. We have reaped the benefit of your collective experience as nurses and teachers, and have made many improvements due to your efforts. Among those who gave us their encouragement and comments are: Elizabeth N. Austin, PhD, MA, RN Victoria Menzies, PhD, RN, PMHCNS-BC Assistant Professor Assistant Professor Towson University Virginia Commonwealth University Towson, Maryland Richmond, Virginia Deborah Behan, PhD, RN-BC Donna Mitchell, PhD, RN Clinical Assistant Professor Director of School of Nursing The University of Texas–Arlington University of Rio Grande Arlington, Texas Rio Grande, Ohio Mary T. Boylston, RN, MSN, EdD Sue E. Odom, RN, DSN Professor Professor Eastern University Clayton State University St. Davids, Pennsylvania Morrow, Georgia Joy Longo, DNS, RN-NIC Sandra Millon Underwood, RN, PhD, FAAN Assistant Professor Professor Florida Atlantic University University of Wisconsin–Milwaukee Boca Raton, Florida Milwaukee, Wisconsin Deborah Mandel, PhD, MSN, RNC-OB Margaret G. Williams, PhD, RN Assistant Professor Professor Kutztown University Blessing-Rieman College of Nursing Kutztown, Pennsylvania Quincy, Illinois Kathy Mayle, RN, BSN, MNEd, MBA Kathleen Z. Wisser, PhD-c, MS, RN Director, Center for Health Care Diversity Assistant Professor Duquesne University Alvernia University Pittsburgh, Pennsylvania Reading, Pennsylvania vii Preface My main purpose for writing the sixth edition of this book continues to be the promotion of interest in nursing research. I firmly believe that research is essential to evidence-based nursing practice and the growth of the nursing profession. Results of nursing research studies improve patient care and demonstrate that nurses are not only caring, but cost-effective providers of health care. Research can be interesting and exciting, and I have tried, through the years, to present the ma- terial in this textbook in an inspirational manner. Nursing students and practicing nurses tell me that I have accomplished my goal. Many say they have actually read the entire book, which is not the case for most of their textbooks or other books that they read. After reading this introductory research book, you will not be expected to have the skills to conduct research independently or to critique re- search reports with a great deal of confidence. However, my goals will have been achieved if you: ¼ recognize the importance of research to evidence-based nursing practice ¼ are willing to use research findings in your practice ¼ have gained knowledge about the research process ¼ possess beginning skills necessary to evaluate research findings ¼ discuss research study results with your colleagues, family, and friends ¼ begin to think about conducting your own research study in the future For those of you just beginning your careers in nursing, the future of the profession depends on you. This book is intended primarily for individuals with little research experience, particularly under- graduate nursing students. However, many students in graduate programs have used this text to supplement their other research textbooks in order to gain a better understanding of nursing re- search. They have commented that this text explains the research simply and clearly. It is my hope that practicing