Characteristics Of Tragedy In The Merchant Of Venice

The Merchant of Venice by William Shakespeare is often called a problem play because it does not neatly fit the characteristics of either a comedy or a tragedy. A tragedy is a drama or literary work in which one of the main characters is brought to ruin or suffer extreme sorrow, especially as a tragic flaw or moral weakness. The Merchant of Venice has a character that is brought to ruin. It also has many other characteristics of a tragedy. Most of the events being serious is one of the characteristics of a tragedy. A comedy is any discourse or work that is intended to be humorous or to amuse by inducing laughter or it could simply be a story with a happy ending. The Merchant of Venice is not funny. The Merchant of Venice is more of a†¦show more content†¦Shylock must do these things because he attempted to murder a citizen of Venice. Shylock is not a citizen because he is a Jew so this means he gets more punishments. This is a tragedy for Shylock because he hates Christians and he wanted to get revenge on them. The tragic flaw was that he wanted to get revenge on Antonio but it backfired on him. This part of the play is tragic also because Antonio was supposed to lose one pound of his flesh. Antonio could have been the character that was brought to ruin. If this was a comedy play then there wouldn’t be any of these tragic scenes in the play. The third reason why The Merchant of Venice is a tragedy is that the events in the play were serious and tragic. They weren’t happy or comical. There were many tragic events in the story. When Antonio finds out his ships crashed it was tragic. This what Tubal says when he talks about Antonio’s ships: â€Å"Hath an argosy cast away, coming from Tripolis† (Shakespeare 3.1.95). This means his ship crashed in Tripolis. This is tragic for Antonio because he needs money from the ships to pay Shylock. Another tragic scene is in the courtroom when Shylock is forced to become a Christian. This is tragic for Shylock because he dislikes the Christians. The play is serious. Shylock’s desireShow MoreRelatedXenophobia in Othello and the Merchant of Venice1541 Words   |  7 Pagesand Tragedies From 1589 to 1613 William Shakespeare produced some of the most original, thought-provoking and emotionally compelling plays, sonnets, and poetry. Two of his finest pieces of work, Othello and The Merchant of Venice feature dynamic characters, and insights into the chivalry and the xenophobic disposition of the English people at the time. Throughout these two stories, three primary female characters emerge, Desdemona from Othello, and Portia and Jessica from The Merchant of VeniceRead MoreCommon Features of a Shakespeare Comedy1745 Words   |  7 PagesCommon Features of a Shakespeare Comedy What makes a Shakespeare comedy identifiable if the genre is not distinct from the Shakespeare tragedies and histories? This is an ongoing area of debate, but many believe that the comedies share certain characteristics, as described below: * Comedy through language: Shakespeare communicated his comedy through language and his comedy plays are peppered with clever word play, metaphors and insults. 1. Love: The theme of love is prevalent in everyRead MoreWilliam Shakespeare s A Merchant Of Venice Essay971 Words   |  4 Pagesconsideration when analyzing play or drama lies within the classification of the piece of work in terms of comedy or tragedy. As with poems and other forms of literature, the classification may be clearly known or it can be a topic of question, requiring additional analysis and justification in order to pinpoint the author’s direction and or intentions. William Shakespeare’s â€Å"A Merchant in Venice† includes a myriad of characters, dialogue, situations, and moods that make classifying this piece of literatureRead MoreBackground and Influence: Merchant of Venice1447 Words   |  6 Pages The battles existed between Catholics, Jews, and Protestants although, for the majority of the time, the Protestants pitted the Jews and Catholics on the same side, against themselves. In The Merchant of Venice, a play that was later dubbed a co medy, tragedy was just as evident. I believe that the tragedy of the play was the reality of the situation the play encompassed. It cannot be a coincidence that there is such a parallel of situations that Shakespeare wrote about. The concept of a JewRead MoreThe Merchant of Venice by William Shakespeare Essay example2165 Words   |  9 PagesJohn Fletcher. Jacobean poetry also included the graceful verse of Ben Jonson. When one look upon the themes of the both the Elizabethan and Jacobean Era, one see that the both the eras had quite most of the themes in common. The subject of the tragedies of Shakespeare in Elizabethan era was that the meaning of human life, exploration of power and what makes a good ruler. There is a depiction of the good and the bad and the ugly side of the rulers. Then there was portrayal of love, family, relationshipsRead MoreWilliam Shakespeare: Greatest Playwright of All1554 Words   |  7 Pagesto the people of Elizabethan England, but also provide a reference for life in his time for us to view the contemporary society. Shakespeare was born in Stratford-upon Avon in Warwickshire and was baptized on April 26, 1564. His father was a wool merchant and his mother was the daughter of a landowner. The next documented event was his marriage when he was 18 years old to Anne Hathaway who was 26 years old at that time, and they had three children. There was another gap where some scholars referredRead MoreWilliam Shakespeare: Greatest Playwright of All1568 Words   |  7 Pagesto the people of Elizabethan England, but also provide a reference for life in his time for us to view the contemporary society. Shakespeare was born in Stratford-upon Avon in Warwickshire and was baptized on April 26, 1564. His father was a wool merchant and his mother was the daughter of a landowner. The next documented event was his marriage when he was 18 years old to Anne Hathaway who was 26 years old at that time, and they had three children. There was another gap where some scholars referredRead MoreRace, Religion, and the Significance of Stereotypes in Othello1688 Words   |  7 Pagesperiod. In particular, one can discover much about the prevailing attitudes of a society through its literature. Shakespeare, specifically, has written multiple works that incorporate generalizations of his era. For example, Shylock from The Merchant of Venice served as the archetypal Jew of the late 16th century. Othello explicitly includes race and religion as a fundamental part of the motivations behind the characters’ actions. In Othello, Shakespeare portrays Othello as a character that transcendsRead MoreThe Merchant Of Venice By Michael Radford1886 Words   |  8 Pages Shakespeare is known for the creativity and timelessness of his plays. The play The Merchant of Venice definitely captures the essence of universality. Different groups of people, even individuals, can connect to the character Shylock. Each person has their own view or interpretation of who Shylock is and what he represents. The movie The Merchant of Venice, directed by Michael Radford, portrays Shylock as a victim who suffers from violent discrimination. He finally retaliates only to find thatRead MoreWilliam Shakespeare s The Merchant Of Venice1970 Words   |  8 Pagesrecurrence with Shakespeare’s plays that the titles are reflective of the protagonists featured within. For example, the famous titles of Julius Caesar and Hamlet tell the tragedies of those respective characters. However, when it comes to William Shakespeare’s fourteenth play, The Merchant of Venice, it can be argued that Antonio, the m erchant, is not who the play is about. In fact, there is not just one character, but instead multiple that fit the description of the protagonist. The main plot, or rather

Health Care Ethics free essay sample

The Bartling case was about whether William Bartling had the right, over the objection of his physicians and the hospital, to have life-support equipment disconnected despite the fact that withdrawal of such devices will surely hasten his death. When he entered Glendale Adventist Hospital in California in 1984, he was known to be suffering from emphysema and diffuse arteriosclerosis, coronary arteriosclerosis, abdominal aneurysm, and inoperable lung cancer. At the end, He had to use mechanical respiratory and chest tube to assist his breathing in the ICU. Although each of these conditions could individually be lethal, he was not diagnosed as terminally ill. At first, Mr. Bartling asked his physicians to remove the ventilator but they refused. Then Mr. Bartling attempted to remove the ventilator tubes but was unsuccessful. Eventually, to prevent his attempt, he was placed in restraints so that the tubes could remain in place. The case was taken to Los Angeles Superior Court by Mr. We will write a custom essay sample on Health Care Ethics or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Scott. Because he was not considered terminally ill, the court refused either to allow the respirator to be disconnected or to order that Mr. Bartling’s hands be freed. At the second time, the case was taken to the California Court of Appeal. However, the result was that Mr. Bartling had the right to make his own decision, which was obviously different with the first time. So I think the main issue in this case is about patient’s decision-making capacity, specifically, when patient is able to make make the decision of his own medical treatments.

Middlefield Hospital Essay Example

Middlefield Hospital Essay Middlefield Hospital is a 450 bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the fill array of inpatient and outpatient services. The Hospital has a reputation for quality care in the area. Problem: The Hospital’s turnover rate exceeds 20% and there are over 100 nursing vacancies. Factors that may contribute to the turnover is that a new hospital has recently opened in our market area that has produced competition for Middlefield, employee morale has deteriorated over the past 12 months, and Essex University is considering eliminating its nursing degree program because of the difficulty recruiting quality instructors. Strategy: In order for Middlefield to strive and serve our patients with quality care and motivate our staff to stay employed with us long-term, we must change our operational strategy. First and foremost, we must invest in our employees. We have to offer our employees incentives and motivate them to stay and grow within our organization. Next, we must improve our community relations and form an alliance with Essex University to ensure the pipeline of new recruits continues to come through our doors for careers in nursing and other healthcare fields. And last but not least, we need to develop a triad of care, provide our patients with the best possible care at an affordable price. Recommendation: We will write a custom essay sample on Middlefield Hospital specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Middlefield Hospital specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Middlefield Hospital specifically for you FOR ONLY $16.38 $13.9/page Hire Writer As the new Chief Executive Officer (CEO) of Middlefield Hospital, I have the following suggestions that I hope will improve our organization and better accommodate our patients’ needs and employee satisfaction. (1) Invest in technology and equipment that will make the experience more productive and cost effective. (2) Expand our services to include preventive counseling and education. (3) Possibly become a teaching hospital for new nurses, doctors, and allied personnel, while providing quality affordable care for our patients. (4) Provide opportunities for our staff to teach at Essex University (5) Reduce the 20% turnover rate and reduce the nursing vacancy rate by offering recruiting incentives and retention bonuses, and continuing education. Middlefield Hospital is in an urban area where patients should have access to the best quality healthcare possible. Middlefield needs to offer their patients a triad of care, which includes access, cost and quality of care. There are many factors why a patient may not be able to access care, such as lack of health insurance or financial resources, therefore Middlefield needs to ensure the population that we are affordable and the patient will receive the best possible care regardless of their financial situation. Cost refers to the total expenditures related directly and indirectly to the provision of healthcare. It is imperative that the hospital manages these costs as effectively and efficiently as possible so that these costs do not reflect to our patients and their care. Quality of care can be conceptualized by two measures, process and outcome. Process measures look at the specific components of providing care and assesses whether these concepts are effective in achieving the desired outcomes, i. e. , did the patient receive the appropriate care for the diagnosis in the ER? Outcome measures evaluate the end result of care and assess whether treatment has produced the desired outcomes, i. e. , did the patient have a heart attack after entering the emergency room or was the heart attack avoided? This leads me to Preventative and Curative Approach to healthcare. The Curative approach refers to a system of care that is based upon treating illness or alleviating symptoms. People fall sick unexpectedly; they can be fine one moment and have the flu the next moment. In a situation like this the curative approach to health is appropriate. However, the Preventative approach, which is preventing illness rather than curing it, is more productive. The hospital can save a lot of money if they do not have to run extensive tests and procedures for diabetes and heart disease and other diseases that could have been stabilized if the patient used proper care. An effective strategy would be to offer classes on diet and exercise and other preventive measures such as smoking cessation programs just to name a few. Employee motivation-Recruiting Qualified health care professionals employed by Middlefield hospital should teach classes at Essex College and the clinical internship should be conducted at Middlefield hospital. That way Middlefield will know that new recruits will already know the proper procedure and will be qualified to work at the hospital upon graduation. This solution will benefit both parties because Middlefield can look forward to qualified new recruits and Essex has qualified teachers with real life experience for their healthcare programs. Employee Motivation- Retention Ways that Middlefield Hospital can motivate employees is to offer intrinsic and extrinsic rewards and offer them an opportunity to climb the corporate ladder. Extrinsic rewards are mostly financial and tangible, such as, wages, raises, bonuses, and benefits. Employees need to feel assured that they are offered a competitive salary and they will be able to take care of their obligations. Although extrinsic rewards a short term remedy to the problem it is still important and needs to be addressed. Intrinsic rewards on the other hand are more effective for employee retention and include: * Sense of meaningfulness, a sense of purpose * Sense of choice- use your judgment and feel responsible * Sense of competence- qualified * Progress- feeling of accomplishing something. An employee can offer intrinsic rewards by promoting the employee to a higher position where they are in charge of a department or project and acknowledging their accomplishments by offering incentives, such as extrinsic rewards. An employee is more likely to stay with a company long-term if they feel appreciated and have a sense of meaningfulness. Our employees are our most valuable asset and we have to make them â€Å"feel at home. † Middlefield Hospital should encourage our employees to climb the corporate ladder. Middlefield should offer continuing education and promotions within the company to motivate our employees to stay. Many people chose to look for work elsewhere or go back to school to change their careers because they are not making enough money and/or they are bored. At Middlefield Hospital, we encourage all of our employees to always strive for more, no matter what their position might be. Education and/or finances should not deter any of our employees from going to the next level. Let’s say for example, Maria was hired to work in environmental and clean the hospital earning $9. 50 /hr, if Maria chooses she should be able to take a course which is provided by the hospital so that she can earn her certified nurse’s assistant license (CNA), making $12. 50/hr. Maria doesn’t have to stop there; she can continue taking advantage of the classes and opportunities offered by Middlefield until she becomes a Registered nurse (RN) making $30/hr. Middlefield should offer their employees endless possibilities. Conclusion There are endless possibilities for Middlefield hospital to offer the best quality care for their patients and motivation for their employees. If the techniques suggested are applied, Middlefield hospital would see a vast improvement in their operation and employee retention.

buy custom The Great Trade-Off Illusion essay

buy custom The Great Trade-Off Illusion essay It is crucial to note that people create organizations and firms in order to leverage their collective resources with an aim of pursuing common goals. Hart (2011) argues that as organizations and firms pursue these given goals, they interact with others within the larger context known as the society. Based on their goals, firms can be classified as either non-profit, for profit, or governmental. As a result of scarce resources, it has become extremely crucial for organizations to adopt sustainable ways of carrying out their activities or otherwise, they may fail to operate in the foreseeable future. For instance, many firms that rely on fossil fuels have experienced a drastic reduction in their profits in the last five years. This is due to the sharp increase of this commodity in the international markets, where oil prices per barrel have surged by almost 300% to at least $147 in 2011 in comparison to 2008 (Hart, 2011). As a result of this, it has become crucial for firms to adopt modern ways of carrying out business to enhance profitability, both in the short and long-run. However, as indicated by Friedman (1970), sustainable ways of carrying out business remains highly controversial. Some people who deeply thought why business exists or the general purpose of itdo not agree with societal obligations of companies, especially towards sustainable development. The paper will critically examine the issue of the great trade-off illusion in relation to the perspectives of Milton Friedman and Charles Handy. As indicated above, the importance of enhancing social activities in the place where they operate cannot be underrated. However, in the past, the issue of participation in societal activities by firms has faced stiff criticism from such scholars as Milton Friedman and Charles Handy. Friedman, a Nobel prize-winning economist, argued that the issue of corporate social responsibility distracts leaders from attaining the set economic goals. He believed that the social responsibility of any business is to increase profits. Further, he argued that any society benefits enormously when businesses focus more on maximizing their financial success (Friedman, 1970). On the other hand, Handy is critical of overemphasizing the share prices as the key metric for the success of any corporate organization. He candidly proposes that the main aim of a business is not to make profit only but to use the profit obtained in enhancing the livelihood of families of those who are engaged in business activities (Handy, 2002). It is crucial tto note that this narrow view by some leaders has led to unsustainable operation of firms in the societies where they operate. Hart (2011) argues that organizations should pay for all the negative consequences linked to their operations. Paradoxically, this type of end-of-pipe approach by various leaders and firms has resulted in what is called great trade-off illusion (Hart, 2011). It is a general belief that in order to meet the set societal obligations, businesses must enormously sacrifice their financial performances. Consequently, this misapprehension has made many businesses across the world view aspects like an envir onmental impact as one of the negative responsibilities as opposed to exploring all the creative possibilities that it are entailed (Hart,2011). Generally, in order to realize all the available sustainable opportunities, firms should develop new mindsets, which would enable them to develop full contextual solutions to the real problems faced. This should be done in a way that natural diversity and local culture are upheld (Hart, 2011). It is based on the factor that traditional assumptions concerning businesses should be discouraged, thus forging relationships that are built on respect, understanding, and trust to all the stakeholders involved. Buy custom The Great Trade-Off Illusion essay

Personality and the Workplace Paper Situational Analysis Essay

Personality and the Workplace Paper Situational Analysis - Essay Example For the purpose of this study, humanistic or existential will be the personality perspective in focus. The scenario will involve two parties of equal rank who will develop a conflict based on perceived socio-cultural differences. Both of them are associated to cultural groups, have had no significant histories of conflict with co-workers and are both being considered for promotion. Humanistic perspective will be applied to the analysis of the scenario with a particular focus on how personality affected the situation. In doing so, recommendations for the resolution of the existing conflict and preventing future ones can be determined. The conflict develops between the Product Development Manager (PDM) and the Sales Manager (SM) of a company due to the former's proposition that the new product, a new type of breakfast cereal should acquire halal certification. The PDM believes that gaining such a certification, reflecting that the product conforms to Muslim religious conditions for food preparations will reflect the product's sensitivity to the Muslim community and follow the merchandising strategies being implemented by international retail companies (Patton, 2006). However, the SM believes that because of considering the existing delay in the launching of the product, the certification has to be foregone and furthermore, he believes that the certification will not impact significantly the sales performance of the product which he considered as his primary priority. Interview of both managers reveal that though they often have had to work together, they have little knowledge of the other's private life. Upon further review, there seems to be also little common ground in their backgrounds. The PDM migrated to the country from Pakistan in his teens with his family because of threats of violence from extremist Muslims. His father supported their family by being through his professorship in one of the city's leading universities. He grew up in a traditional household and has had strong ties to the Muslim community particularly in the promoting cultural and social awareness. He believes strongly in social and religious tolerance and often deliberately avoids having to voice out personal opinions on sensitive socio-cultural issues. In contrast, the SM has been often described as and "all-American guy". He grew up in a predominantly Caucasian community and has strong ties with community through his involvement in local sports and recreation clubs. His interest in business was encouraged by his parents, both of whom had very successful business careers. He is very task-oriented, young in comparison to the other managers, has very strong opinions and does not hesitate to express himself. Analysis In the case presented, the contrasting personalities of the PDM and SM contribute to their conflict. Since part of conflict is being attributed to race, ethnicity or culture, there is heightened sensitivity in the reaction of the parties involved (Kibria, 2000). Because these factors are considered intimately with identity and self-esteem, communication and interaction can be significantly impeded (Reeve, 2005). Current research show that personality interaction is greatly influenced by external factors, particular if such factors impact social perceptions or characterizations (Biesanz et al,

How to use a Rubber in Mobile Phones Case Study

How to use a Rubber in Mobile Phones - Case Study Example These devices represent one of the most advanced (sophisticated) technologies ever developed by human beings (Karim 2010). Through them people can communicate with each other, surf on the internet, listen to music, watch videos, and play games among other functionalities. The various functionalities of mobile phones are normally enhanced by design and use of a variety of components in their manufacture. In this regard, mobile phones normally consist of several components, and these components are made from a wide variety of materials (Chan 2007). The materials from which mobile phones components are made include plastics, rubber, magnets, paper and metals among others. This paper, therefore, aims at investigating how rubber is currently used in the design and manufacture of mobile phones. The paper also aims at investigating the alternative areas in mobile phone design and construction that rubber can be used. Main parts of mobile phone and their use The main components of mobile pho nes are: battery, SIM card, circuit board, keyboard, speaker and microphone, antenna, software, and Liquid Crystal Display screen (commonly abbreviated as LCD screen) among others (Mueller 2013). Circuit board Circuit board is amongst the most important components of a mobile phone. ... The chips on the circuit board can perform numerous calculations (always millions of calculations) in a single second. The circuit board chips’ calculations are normally performed to decompress or compress voice stream (Harris 2006). Other than chips, another component that is available in the mobile phone circuit board is digital signal processor (commonly abbreviated as DSP) (Mueller 2013). This component is designed to perform operations related to manipulation of digital signals at greater speeds in a single second. Another component that is available in mobile phone circuit board is micro-processor. The microprocessor is responsible for three main functions; these functions are stated below: i. Coordination of all the functions of the mobile phone circuit board. ii. Processes commands as well as control signals related to connecting mobile phone to base station (also known as the cell phone tower). iii. Handles as well as coordinates the functions of display and keyboard. (Mueller 2013) Other components that are associated with mobile phone circuit board are ROM (the read only memory) and chips associated with flash memory. These components are responsible for the running and storage of the mobile phone’s operating system and software applications (Mueller 2013). Mobile phone’s speaker and Microphone Other than the circuit board, speakers and microphones are other important components of mobile phones. It is through the speakers as well as the microphones that communications between individuals are made possible (Harris 2006). Mobile phone microphone is responsible for converting the sound signals to electrical signals. The

Nursing Research and Evidence-Based Practice Essay Example for Free

Nursing Research and Evidence-Based Practice Essay I did not understand why I had to take a research class when all I wanted to do was be a staff nurse in a critical care unit. Research? Evidence-based practice? Why are these topics in the nursing program? I have enough to do just learning all the content in my clinical courses. What do research and evidence have to do with developing my nursing abilities? I trust the faculty, the textbooks, and clinical experience to prepare me for nursing. I’m already getting what I need to know. That was my earlier attitude. Now that I am practicing, I have a new appreciation for nursing research and the evidence it provides for application to practice. I have an entirely different way of addressing clinical questions. I’m starting to ask questions about how I can improve the care I give to patients and how I can be involved in my workplace’s efforts to improve care for the patients it serves. I have discovered by purposeful reading in my practice area that research reports and research summaries contain many implications that apply to practice in the critical care unit.  ¦ QUESTIONS TO CONSIDER WHILE READING THIS CHAPTER: 1 How can faculty encourage students to read research journals? 2 How does research affect nursing practice? 3 How can nurses motivate colleagues to base their practice on research? KEY TERMS Clinical nurse researcher (CNR) An advanced practice nurse who is doctorally prepared and directs and participates in clinical research. Clinical nurse specialist (CNS) An advanced practice nurse who provides direct care to clients and participates in health education and research. Clinical practice guideline (CPG) an evidence-based guide to clinical practice developed by experts in a particular ? eld for direct application in clinical environments. Control group Subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. When a true experimental design is not used, this group is usually called a comparison group. Data collection The process of acquiring existing information or developing new information. 104 Nursing Research and Evidence-Based Practice CHAPTER 6 105 Empirical Having a foundation based on data gathered through the senses (e. g. , observation or experience) rather than purely through theorizing or logic. Ethnography A qualitative research method for the purpose of investigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior. Evidence-based practice The process of systematically ? nding, appraising, and using research ? ndings as the basis for clinical practice. Experimental design A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena. Generalizability The inference that ? ndings can be generalized from the sample to the entire population. Grant Proposal developed to seek research funding from private or public agencies. Grounded theory A qualitative research design used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process. Meta-analysis Quantitative merging of ? ndings from several studies to determine what is known about a phenomenon. Methodologic design A research design used to develop the validity and reliability of instruments that measure research concepts and variables. Naturalistic paradigm A holistic view of nature and the direction of science that guides qualitative research. Needs assessment A study in which the researcher collects data for estimating the needs of a group, usually for resource allocation. Phenomenology A qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Pilot study A smaller version of a proposed study conducted to develop or re? ne methodology, such as treatment, instruments, or data collection process to be used in a larger study. Qualitative research A systematic, subjective approach used to describe life experiences and give them meaning. Quantitative research A formal, objective, systematic process used to describe and test relationships and examine cause-and-effect interactions among variables. Quasi-experimental research A type of quantitative research study design that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. Randomization The assignment of subjects to treatment conditions in a random manner (determined by chance alone). Secondary analysis A research design in which data previously collected in another study are analyzed. State-of-the-science summary A merging of ? ndings from several studies concerning the same topic. Examples include meta-analysis with a quantitative approach and integrative review with a descriptive approach. Survey A nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. Triangulation The use of a variety of methods to collect data on the same concept. LEARNING OUTCOMES After studying this chapter, the reader will be able to: 1 Summarize major points in the evolution of nursing research in relation to contemporary nursing. 2 Evaluate the in? uence of nursing research on current nursing and health care practices. 3 Differentiate among nursing research methods. 4 Evaluate the quality of research studies using established criteria. 5 Participate in the research process. 6 Use research ? ndings to improve nursing practice. 106 UNIT ONE The Development of Nursing CHAPTER OVERVIEW This chapter provides basic knowledge regarding the research process and the ultimate importance of evidence-based nursing practice. The intent is to inspire an appreciation for nursing research and to show how it can improve nursing practice and how results can be translated into health policy. Nursing research is de? ned as a systematic approach used to examine phenomena important to nursing and nurses. A summary of major points in the evolution of nursing research in relation to contemporary nursing is presented. A description of private and public organizations that fund research is given, and their research priorities are listed. Major research designs are brie? y described, and examples of each are given. Nurses of all educational levels are encouraged to participate in and promote nursing research at varying degrees. The process of locating research and evidence for practice is reviewed. Students are introduced to the research process and guided in the process of critically appraising published research and research syntheses. Ethical issues related to research are examined, and historical examples of unethical research are given. The functions of the institutional review board (IRB) and the use of informed consent in protecting the rights of human subjects are emphasized. DEFINITION OF NURSING RESEARCH Research is a process of systematic inquiry or study to build knowledge in a discipline. The purpose of research is to develop an empirical body of knowledge for a discipline or profession. Speci? cally, research validates and re? nes existing knowledge and develops new knowledge (Burns and Grove, 2007). The results of research process provide a foundation on which practice decisions and behaviors are laid. Research results create a strong scienti? c base for nursing practice, especially when deliberately and carefully evaluated for application to speci? c clinical topics (Melnyk and Fineout-Overholt, 2005). In recent decades the nursing discipline has begun to pay much greater attention to the necessity of participating in research. Nursing research is a systematic approach used to examine phenomena important to nursing and nurses. Because nursing is a practice profession, it is important that clinical practice be based on scienti? c knowledge. Evidence generated by nursing research provides support for the quality and cost-effectiveness of nursing interventions. Thus recipients of health care—and particularly nursing care—reap bene? ts when nurses attend to research evidence and introduce change based on that evidence into nursing practice. The introduction of evidence-based change into the direct provision of nursing care may occur at the individual level of a particular nurse or at varied organizational or social levels. In addition to nursing research aimed at affecting the direct provision of nursing and health care to recipients of nursing care, nursing research also is needed to generate knowledge in areas that affect nursing care processes indirectly. Research within the realms of nursing education, nursing administration, health services, characteristics of nurses, and nursing roles provides evidence for effectively changing these supporting areas of nursing knowledge (Burns and Grove, 2007). Today the importance of nursing research to the discipline is recognized. However, much nursing history underlies the current state of acceptance. EVOLUTION OF NURSING RESEARCH Nursing research began with the work of Florence Nightingale during the Crimean War. After Florence Nightingale’s work, the pattern that nursing research followed was closely related to the problems confronting nurses. For example, nursing education was the focus of most research studies between 1900 and 1940. As more nurses received their education Nursing Research and Evidence-Based Practice CHAPTER 6 107 in a university setting, studies regarding student characteristics and satisfactions were conducted. As more nurses pursued a college education, staf? ng patterns in hospitals changed because students were not as readily available as when more students were enrolled in hospitalaf? liated diploma programs. During this period, researchers became interested in studying nurses. Questions such as what type of person enters nursing and how are nurses perceived by other groups guided research investigations. Teaching, administration, and curriculum were studies that dominated nursing research until the 1970s. By the 1970s more doctorally prepared nurses were conducting research, and there was a shift to studies that focused on the improvement of patient care. The 1980s brought nursing research to a new stage of development. There were many more quali? ed nurse researchers than ever, widespread availability of computers for collection and analysis of data, and a realization that research is a vital part of professional nursing (Polit and Beck, 2006). Nurse researchers began conducting studies based on the naturalistic paradigm. These studies were qualitative rather than quantitative. In addition, instead of conducting many small, unrelated research studies, teams of researchers, often interdisciplinary, began conducting programs of research to build bodies of knowledge related to speci? c topics, such as urinary incontinence, decubitus ulcers, pain, and quality of life. The 1990s brought increasing concern about health care reform, and now in the twenty-? rst century, research studies focus on important health care delivery issues, such as cost, quality, and access. Research ? ndings are being used increasingly as the basis for clinical decisions. Evidencebased practice (EBP) can be de? ned as the process of systematically ? nding, appraising, and using research ? ndings as a basis for making decisions about patient care. The rise of technology and the worldwide access and ? ow of information have transformed the decision-making processes of practitioners. Helpful informational websites for busy practitioners are listed in Box 6-1. No longer do nurses simply compare outcomes of patient care with other units in the B O X 6–1 Helpful Websites l f l b i National Guideline Clearinghouse—resource for evidence-based clinical practice guidelines www. guidelines. gov US Department of Veterans Affairs Clinical Practice Guidelines www. healthquality. va. gov AHRQ Healthcare Innovations Exchange—innovations and tools to improve health care www. innovations. ahrq. gov/index. aspx The Evidence-Based Medicine Education Center of Excellence—extensive list of databases, journals, and textbooks http://library. ncahec. net/ebm/pages/resources. htm U. S. National Institute for Health Consensus statements http://consensus. nih. gov Centre for Evidence-Based Nursing, based at University of York—United Kingdom www. york. ac. uk/healthsciences/centres/evidence/cebn. htm The Joanna Briggs Institute, based at Royal Adelaide Hospital and the University of Adelaide, Australia—multiple evidence resources for practice www. joannabriggs. edu. au Cochrane Center—resource for evidence-based clinical practice guidelines www. cochrane. org 108 UNIT ONE The Development of Nursing same hospital. Nurses and other health care professionals are more likely to look for solutions, choices, and outcomes for patients that represent the best available knowledge internationally (Hamer and Collinson, 2005). RESEARCH PRIORITIES Why set priorities for research in the nursing discipline? Can nurses do research in areas that match personal areas of interest? The answer to the second question is, yes, certainly. But nursing exists to provide high-quality nursing care to individuals in need of health-promoting, health-sustaining, and health-restoring strategies. The main outcome of research activity for a nurse is to eventually put the knowledge gained to work in health care delivery. Research priorities, often set by groups that fund research, encourage nurse researchers to invest effort and money into those areas of research likely to generate the most bene? t to recipients of care. Of course the funding opportunities offered by such groups do not hurt the research enterprise either. Research costs money. Thus nurses engaged in research often match personal interests with funding opportunities that are available during the planning phase for a proposed investigation. Two major sources of funding for nursing research are the National Institute of Nursing Research (NINR) and the Agency for Healthcare Research and Quality (AHRQ) (formerly known as the Agency for Health Care Policy and Research [AHCPR] and reauthorized as AHRQ by Congress in 1999). Both of these organizations are funded by federal congressional appropriations. Private foundations and nursing organizations also provide funding for nursing research. National Institute of Nursing Research As part of the National Institutes of Health (NIH), the NINR supports research on the biologic and behavioral aspects of critical health problems that confront the nation. The NINR’s research focus encompasses â€Å"health promotion and disease prevention, quality of life, health disparities, and end-of-life† (NINR Strategic Plan 2006-2010, 2006). A small sampling of potentially supported research topics includes those aimed at: ? Determining disease risk and treatment through utilizing genetic information ? Determining effective health-promotion strategies for individuals, families, and communities ? Discovering approaches that encourage people to effectively take responsibility for symptom management and health promotion ? Assisting in identi? cation and effective management of symptoms related to acute and chronic disease ? Improving clinical settings in which care is provided ? Improving the quality of care giving in settings such as long-term care facilities, the home, and the community ? Understanding predisposition to disease, socioeconomic factors that in? uence health, and cultural health practices that either protect from or expose to risk for health problems ? Improving symptom management for those at end of life The areas of research emphasis published by the NINR are useful guides for investigators developing proposals but are not considered to be prescriptive in nature. Investigators bring to bear their own unique expertise and creativity when proposing research in harmony with NINR priority research areas. Annually the NINR conducts a roundtable discussion with multiple nursing organizations to obtain the feedback of the disciplines regarding the need for continued or new research Nursing Research and Evidence-Based Practice CHAPTER 6 109 emphases. Information obtained is used in setting future research agendas and making decisions about funding of proposals submitted by researchers (Of? ce of Science Policy and Public Liaison, NINR, 2009). The NINR website details current announcements regarding research priorities (www. ninr. nih. gov/ResearchAndFunding). Agency for Healthcare Research and Quality The AHRQ broadly de? nes its mission as â€Å"improving the quality, safety, ef? ciency, and effectiveness of health care for all Americans† (AHRQ, 2009a). As an agency of the U. S. Department of Health and Human Services, the AHRQ’s health-related aims are to reduce the risk of harm by promoting delivery of the best possible health care, improve health care outcomes by encouraging the use of evidence to make informed health care decisions, transform research into practice to facilitate wider access to effective health care services, and reduce unnecessary costs (AHRQ, 2009a). Since the inception of the agency in 1989, strategic goals have centered on supporting improvements in health outcomes, strengthening measurement of health care quality indicators, and fostering access to and cost-effectiveness of health care. The 1999 reauthorizing legislation expanded the role of the agency by directing the AHRQ to: ? Improve the quality of health care through scienti? c inquiry, dissemination of ? ndings, and facilitation of public access to information. ? Promote patient safety and reduce medical errors through scienti? c inquiry, building partnerships with health care providers, and establishment of centers for education and research on therapeutics (CERTs). ? Advance the use of information technology for coordinating patient care and conducting quality and outcomes research. ? Establish an of? ce on priority populations to ensure that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are addressed by the agency’s research efforts. The research-related activities of the AHRQ are quite varied, but a recent shift emphasizes a more deliberate translation of research evidence into practice. In a process similar to that used by the NIH, investigators are invited to submit research proposals for possible funding through grant announcements. A listing of current areas of the agency’s research interests can be found online at www. ahrq. gov/fund/portfolio. htm. The AHRQ actively promotes EBP, partially through the establishment of 14 EBP centers (EPCs) in the United States and Canada. EPCs conduct research on assigned clinical care topics and generate reports on the effectiveness of health care methodologies. Health care providers may then use the evidence in developing site-speci? c guidelines that direct clinical practice. AHRQ also actively maintains the National Guideline Clearinghouse (www. guidelines. gov), an website that makes available to health care professionals a wide array of clinical practice guidelines that may be considered in health care decision making. Another recent addition to AHRQ’s initiatives is the Healthcare Innovations Exchange (2009b), which provides a public source of information about innovations taking place in health care delivery. Submitted innovations are reviewed for the quality of achieved outcomes, providing evidence as a foundation for decision making by others who may be searching for or considering similar innovations. Although most AHRQ activities are intended to support health care professionals and institutions, the agency supports health care recipients by designing some information speci? cally for dissemination to the lay public (AHRQ, 2009a). 110 UNIT ONE The Development of Nursing Private Foundations Federal funding is available through the NIH and the AHRQ. However, because obtaining money for research is becoming increasingly competitive, voluntary foundations and private and community-based organizations should be investigated as possible funding sources. Many foundations and corporate direct-giving programs are interested in funding health care projects and research. Computer databases and guides to funding are available in local libraries. In addition, grant-seeking enterprises often purchase subscriptions that allow computer access to enhanced listings of funding foundations that include information about the types of projects those foundations typically fund. Though subscriptions are expensive, costs are often balanced by the ef? ciency with which suitable funding prospects are identi? ed. An example of such a service is Prospect Research Online (www. iwave. com). Private foundations, such as the Robert Wood Johnson Foundation (2009a, 2009b) or the W. K. Kellogg Foundation (2009), offer program funding for health-related research. Investigators should be encouraged to pursue funding for small projects through local sources or private foundations until a track record is established in research design and implementation. After several years of experience in the research arena, investigators are more likely to be successful in securing funding through federal sources, such as the NIH. Nursing Organizations Sigma Theta Tau International (STTI), the American Nurses Association (ANA), and the Oncology Nurses Society (ONS), are a few of the nursing organizations that fund research studies. STTI makes research grant awards to increase scienti? c knowledge related to nursing practice. STTI supports creative interdisciplinary research and places importance on identifying â€Å"best practices† and benchmark innovations. Awards are made at the international and local chapter levels. The ANA awards small grants through the American Nurses Foundation. Specialty nursing organizations offer grants to support research related to their specialty. For example, the ONS awards grants that focus on issues related to oncology. To summarize, multiple potential sources of funding are available for research projects. The individual or group wishing to conduct research will need to carefully develop a proposal, search for a possible funding source, and submit the proposal. Libraries and the Internet provide ample information about the many foundations and organizations interested in funding research endeavors. Most research institutions establish of? ces that help in the search and procurement of funding. Thus researchers are supported in their work of knowledge building. COMPONENTS OF THE RESEARCH PROCESS The research process involves conceptualizing a research study, planning and implementing that study, and communicating the ? ndings. The process involves a logical ? ow as each step builds on the previous steps. These steps should be included in published research reports so that the reader has a basis for understanding and critiquing the study (Box 6-2). STUDY DESIGNS Study designs are plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer speci? c research questions. Research studies are classi? ed into two basic methods: quantitative and qualitative, two distinctly different approaches to conducting research. The researcher chooses the method based on the research question and the current level of knowledge about the phenomena and the problem to be studied. Quantitative research is a formal, objective, systematic process in which numeric