Computer Use in Nursing Research

OBJECTIVES:

1. Describe general data and computer applications related to proposal development and project implementation in both quantitative and qualitative research.
2. Discuss an overview of computer-based applications that facilitate or support the steps of the research process, including data collection, data management and coding, data analysis, and results reporting.
3. Compare and contrast select computer software applications that can be used in quantitative and qualitative research data analysis related to the steps of the research process.
4. Discuss examples of specific computer applications that have been used in quantitative and qualitative research studies.

KEYWORDS:

• Research Process
• Research Methodology
• Quantitative 
• Qualitative 
• Data Collection
• Data Management
• Data Analysis
• Research Applications
• Computer Application

The uses of computers and software applications are ubiquitous throughout the research process, from the inception of ideas through the selection of approaches, refinement of each stages, capturing the data, synthesizing the results, and presenting it to the world through dissemination. This chapter will provide an overview of the research process for two separate and dissimilar research approaches-quantitative and qualitative-and discuss select computer applications and uses relative to these approaches and specific to the universally understood research steps that are unique to each approach.

The computer has been a tool for researchers in various aspects of the research process and has gone beyond its historic application once limited to number crunching. personal computers, laptops, tablets and even handheld PDAs (personal digital assistants) have become part of the researcher's necessary resources in mounting a research project or study. From word-processing proposals and manuscripts to database management of subjects, contacts, or logistics, nurses have used a range of hardware and software applications that are generic to operations in addition to the tools and devices that are specific devices that are specific to research data collection, analysis, results reporting, and dissemination.

In today's electronic healthcare environments, numerous advances have been made with the sources of data collection relative to general clinical applications in nursing, health, and health services. System implementations for large clinical enterprises have also provided opportunity for nurses and health service researchers to identify and extract information from existing computer-based resources, although the ethical ramifications of using era of Web-based applications has produced a plethora of innovative means of entering data and, subsequently, collecting data in ways that were not possible before. With the advancements in the implementation of clinical systems, acceptable terminology and vocabularies to support nursing assessment, interventions, and evaluation, computers are increasingly being used for clinical and patient care research. Although research is a complex cognitive process, certain aspects of carrying out research can be aided by software applications. For example, examination of patient outcomes can be analyzed quantitatively and qualitatively.

The objective of this chapter is twofold: (1) to provide an overview of general computer and software applications related to the stages of the research process and (2) to describe how computers facilitate the work of the researcher or serve in some capacity as the foundation of the research itself. To begin, the chapter will focus on some of the considerations related to the logistics and preparation of the research proposal, project planning, and budgeting, followed by the implementation of the proposal with data capture, data management, data analysis, and information presentation. The use of literature search systems and online bibliographic retrieval and management applications are discussed in detail the next chapter. The general steps of proposal development, preparation, and implementation are applicable to both quantitative and qualitative approaches.

Proposal Development, Preparation, and Implementation

All research begins with a good idea. The idea typically based on the nurse researcher's identification of a problem that is amenable to study using philosophical and theoretical orientation. The philosophical aspects sets the stage for selecting one's approach to investigating the problem or developing the idea. Good clinical ideas often come from personal experiences, based on the researcher's foundation of knowledge that aids in drawing inferences from real clinical situations. These unfold by way of iterative consideration of problem and process-leading the investigator to evolve an approach to the problem, subsequently a theoretical paradigm to address the problem. Because the theoretical paradigm emerges from these iterative considerations, and because the theoretical perspective will subsequently drive the organization of the research study, it is important to distinguish between these two distinct approaches separately. Each theoretical paradigm directs how the problem for study will unfold. The researchers uses a selected theoretical approach and operationalizes each step of the research process that will become the research design and methodology, either qualitative, quantitative, or some combination of both. Each approach can be facilitated at different points along the proposal development process with select computer applications. These will be described as they relate to the theoretical approach.

Quantitative and Qualitative Approaches

The important distinction to be made between the quantitative and qualitative approaches is that for a quantitative study to be successful, the researcher is obliged to develop fully each aspect of the research proposal before collecting data, whereas, for a qualitative study to be successful, the researcher is obliged to allow the data collected to determine the subsequent steps as it unfolds in the process and/or the analysis. Quantitative research is derived from empiricism and logical positivism philosophical orientations (Weiss, 1995), with multiple steps bound together by precision in quantification. The requirements of a hypothesis-driven or numerically descriptive approach are logical consequences of, or refute the prediction selected a apriori or in advance.

The qualitative approaches are a collection of different research traditions (e.g., phenomenology, hermeneutics, and grounded theory) that share a common view of reality, which consists of the meanings ascribed to the data such as a person's lived experiences (Creswell, 2003). With this view, theory is not tested, but rather, perspectives and meaning from the subject's point of view are described and analyzed. For nursing studies, knowledge development is generated from the patient's experiences and responses to health, illness, and treatments. The requirements of the qualitative approach are a function of the philosophical frames through which data unfold and evolve into meaningful interpretations by the researcher.

General Considerations in Proposal Preparation

Several computer applications have become indispensable in the development of the research proposal and generally in planning for the activities that will take place when implementing the study. The word-processor applications for microcomputers have become the necessary clerical tool to manage the text from numerous sources and assemble them in a cogent and organized package. Microsoft Word (Microsoft Corporation, 2000) and WordPerfect (Corel Corporation,2000) provide capabilities and a platform into which other off-the-shelf applications can be integrated. Tables, charts, and figures can be inserted, edited, and moved as the proposal takes shape. Personal computer applications that allow inserting simple graphic designs give the researcher a powerful means of expressing concepts through art. Line art and scanned images with programs such as Illustrator or Photoshop 7 can be integrated into the document for clear visual effects. References and call outs can be managed with additional software add-ons, including bibliographic managers such as Reference Manager (Institute Information Systems, 1997), Procite (Niles Software, 2003), and Endnote (Niles Software, 2004). Searching online is one function of these applications, and then working between the reference database and the text of the proposal document is efficient and easy, calling out citations when needed with "cite as you write" capability.

Research applications and "call for proposals" are often downloadable from the Internet into a fillable Adobe Acrobat form where individual fields are editable and the documents can be saved, printed, or submitted from numerous opportunities for designing a proposal tailored to potential foundations for consideration of funding. Call for proposals, contests, and competitive grants plays a role in developing the idea in one direction or another, and the links from Web sites give the researcher a depth of understanding of what is expected in the proposal.

Research Study Implementation

A funded research study becomes a logistical challenge for most researchers in managing the steps of these process, maintaining the integrity of the procedures, managing the information and paper flow, and keeping confidential and secure the data collection and storage, which culminates in analysing and reporting the results.

General database applications including Microsoft Access, FileMaker Pro 7 (FileMaker, Inc., 2004), and sophisticated, integrated, and propriety database management applications such as Oracle and Lotus provide the researcher with mechanisms to operationalize the personnel, subjects, forms, interviews, dates, times, and/or tracking systems over the course of the project.

Several other generic computer programs can aid the researcher in daily operations and project management. Spreadsheet applications are invaluable for budgeting and budget planning, from proposal development through project completion. Microsoft Excel (2004a) allows the researcher to manage costs and  calculate expenses over the course of the project period, producing a self-documenting plan by categories to track actual spending and money left.

The general considerations of developing and conducting a research study are based in philosophical approaches and will dictate which methodology the researcher will use to develop the study. Although this subsequently influence the research and computer applications to be used in carrying out the project, the steps of proposal preparation are less specific, and the computer applications are useful in both quantitative and qualitative studies. After identifying the research problem, however, the researcher must proceed through the steps of the research, where computers play an important role that is unique to each methodologies.

THE QUANTITATIVE APPROACH

Data Capture and Data Collection

Data capture and data collection are processes that are viewed differently from the quantitative and qualitative perspectives. Nurses may already be familiar with data collection that is focused on the management of patient care.

Patient monitoring, patient care documentation, and interview data are collected by nurses, although not always for research purposes. Computers are used in data collection for paper-and-pencil surveys and questionnaires as well as to capture physiologic and clinical nursing information in quantitative or descriptive patient care research.

Questionnaire/paper and pencil      

Surveys and questionnaires, traditionally administered in paper-and-pencil forms, can be programmed into a computer application either in a microcomputer or on a Web site accessed through the Internet. Computer are being used for direct data entry in studies where subjects enter their own responses via a computer and simultaneous coding of response to questions and time "on-line" can be captured (Brennan and Ripich, 1994)

General Web-design software such as Microsoft Frontpage and customized Java script programming allows using a database interface for the extraction, and data cleaning into an automated and accurate single-step process. The data from the Internet can be download for analysis.


One type of application. Team Expert Choice (Expert Choice, 2004) uses the analytic hierarchy process, a mathematical technique, with handed keypad technology to elicit group responses and automatically score, analyse, prioritize and present information back to the group graphically. This kinds of groupware can supplement data collection from a focus group to add a quantitative component to the subjective question as it elicits and captures opinion vie pairwise comparisons (Feeg, 1999)


Physiologic Data

The collection of patient physiologic parameters had long been used in physiologic research. Some of these parameters can be measured directly from patient devices such  as cardiac monitoring of heart, rhythm, rate, and fluid or electrolyte. Now that many measurement taken form various types of imaging (e.g. neurologic, cardiovascular and cellular) have become digitized, they can also be entered directly from the patient into a computer program for analysis. Each of these applications is unique to the measures, such as systems to capture cardiac functioning and/or pulmonary capacity, devices that relay contractions, or monitors that picks up electronic signals. 

Data mining is a mechanism of exploration and analysis of large quantities of data in order to discover meaningful patterns and rules applied to large physiologic data sets as well as clinical sources of data. The nature of the data and the research question determine the tool selection, i.e. data-mining algorithm or technique. Tools and consultants exist to help researchers unfamiliar with data-mining algorithm to use data mining for analysis, prediction and reporting purposes. (MSDN Library, 2000)

UNIQUE NURSING CARE DATA IN RESEARCH

Scientists and technologists from a variety of disciplines are working hard to identify the domain of data and information that is transferable across situations, sites, or circumstances that can be captured electronically for a wide array of analyses to learn how the health system impacts the patient is serves. The American Nurse Association (ANA)  has supported the need to standardized nursing care terms for computer-based patient care systems.

Outcomes research and quality indicators have become the data end-points that justify healthcare services. The use of structured terms across heath care settings would provide for comparability of patient care using health patients records. There is new emphasis in the federal government to produce electronic health records (EHRs) and cross-platform compatibility through the development of collaboration efforts across organizations in the government and the information technology industry (Thompson and Brailer, 2004)

DATA CODING

In quantitative studies, the data for the variables of interest are collected in a numerical form. These numerical values are entered into designated fields in the process of coding. Coding may be inherent in software programs for the physiologic data and many of the electronic surveys. The coding may be generated ( by a computer program) from measurements directly obtained through imaging of physiologic monitoring or entered into a computer by a patient or researcher from a printout or a questionnaire/survey into a database program. Most statistical programs contain data editors that permit the entry of data by a researcher as part of statistical application. 

Coding data is a precise operation that needs careful consideration and presents the researcher with challenges that warrant technical or cognitive applications. Coding data is a combination of cognitive decisions and mechanical clerical recording of responses in a numerical form with numerous places for error to occur. There are several ways of reviewing and "cleaning"  the data prior to analyses. Some computer programs allow for the same data to be entered twice (preferably by different people to check for errors)  with the premise that if the double entry does not match, one entry id wrong. One must also check for missing data and take them into considerations in the coding and analyses. Reviewing data fro values outside of those allowable is another way of examining the data errors. It can best be done by examining the multiple printouts produced by the statistical software packages and by perusing for outliers or artefacts carefully. While coding is a process activity in quantitative research to get results, it is a substantive activity for the qualitative researcher as it becomes the essence of the interpretation of data collected.

DATA ANAYSIS

Data analysis in a quantitative study combines a variety of techniques that apple statistical procedures with the researcher's cognitive organization of research questions, results and visual or textual information, translated into tables, charts, and graphs to make the data meaningful. It translates the numeric and conceptual elements of the inquiry into meaningful representations of information. In general, the statistical analyses are ordered by the conceptual arrangement of hypotheses, variables, measurements and relationships and ultimately answers the research questions. There are myriad ways to consider data analysis. The presentation below is organized around the broad types of research of interest in nursing and general research goals and questions. The researcher may use different type of analyses depending on the goal of research. These goals may require different statistical examinations: descriptive/exploratory analyses, hypothesis testing, estimation of confidence intervals, model building through multivariate analysis and structural equation model building. Various type of nursing research may contain a number of these goals. For example to test an intervention using an experimental or quasi-experimental design., one may first perform descriptive/exploratory analyses followed by tests of the hypotheses. Quality improvement, patient outcome and survival analysis studies may likewise contain a number of different types on analyses depending on the specific research questions.

DESCRIPTIVE AND EXPLORATORY ANALYSIS

The researcher may first explore the data means, modes, distribution pattern and standard deviations and examine graphic representations such as scatter plots or bar graphs. Tests of association or significant differences may be explored through chi-squares, correlations and various uni variate, bi variate and trivariate analyses  and examination of quatrilles. During this analysis process, the researcher my recede or transform data by mathematically multiplying or dividing scores by certain log or factor values. New variables can also be created by combining several existing variables. These transformations or "re-expressions" allow the researcher to analyze the data in appropriate and interpretable scales (Behrens and Smith, 1996). The researcher can then easily identify patterns with respect to variables as well as group study subjects of interest. Both commercial statistical packages provide the ability to calculate these tests and graphically display the results in a variety of ways.

SPSS 13 (SPSS Inc. 1999) provides the user with a broad range of capabilities for the entire analytic process. SPSS is a modular, tightly integrated and fully-featured software comprised of SPSS base and range of add-on module. With SPSS, the researcher can generate decision-making information quickly using a variety of powerful statistics, understand and effectively present the results with high-quality tabular and graphical output, and share the results with others using various reporting methods, including secure Web publishing.

SAS 9 ( SAS, 1999) provides the researcher with tools that can help code data in a reliable framework, extract data for quality assurance, exploration or analysis, perform descriptive and inferential data analyses, maintain databases to track, and report on administration activities like data collection, subject enrollment or grant payment, and deliver content for reports in the appropriate format. SAS allows for creating unique programming within the variable manipulations 

Stata 8 ( Statistical Software fro Professionals, 2004) is also a fully integrated statistical package with full database management capabilities and a range of sophisticated statistical tests particularly useful for epidemiologists and physical scientist. All of these statistical packages have evolved to provide ajn integrated collection of tools that assist in aspects of the research study management --- form planning to dissemination --- in addition to the reputable statistical analyses and data manipulation capabilities that they have provedid for many years. 

SAS 9.1.3

SPSS ( VERSION 13.0)

Created for business intelligence needs Created and design forms that can be used for data entry via the Web, The internet or paper Store research data Create analysis files in repeatable fashion Perform descriptive and inferential data analysis Maintain database to track and report on data collection and subject enrollment Manage data with predictive and descriptive modeling, forecasting, simulation and optimization Software is available on Microsoft Windows, Linux and Apple MacIntos platform Comprehensive installation instructions available on the SA website

Designed for academic use Create a variety of charts including bar graphs, three-dimensional bar graphs, pie charts, dot graphs, paneled charts and population pyramids Ability to export tables and charts directly into Microsoft PowerPoint Allows text data strings of more than 25.6 bytes Ability to perform calculations with data and time Ability to share data between SPSS and SAS Provides a variety of add-on modules for customization

As a part of exploratory analysis, simple and multiple regression analyses can be used to examine the relationships between selected variables and a dependent measure of interest. Certain models can be developed to determine which collection of variables provides the best prediction of the dependent measure.

HYPOTHESIS TESTING OR CONFIRMATORY ANALYSES

Hypothesis testing or confirmatory analyses are based on an interest in relationships and describing what would occur if a hypothesis were true. The analysis of data allows us to compare the actual outcomes with the hypothesized outcomes. Inherent in hypothesis testing is the probability (P value) of an event occurring given in a certain relationship. These are conditional relationships based on the variables selected for study and the typical mathematical tables and software for determining P values are accurate only insofar as the assumptions of the test are met (Behrens and Smith 1996).

MODEL BUILDING

An application used for confirmatory hypothesis testing approach to multivariate analysis is structural equation modeling (SEM) (Bryne, 1984). Bryne describes this procedure as consisting of two aspects:

(1) the casual process under study are represented by a series of structural (i.e., regression) equations

(2) these structural relations can be modeled pictorially to enable a clearer conceptualization of the theory under study.

The model can be tested statistically in simultaneous analysis of the entire system of variables to determine the extent to which it is consistent with the data. If goodness of fit is adequate, the model argues for the plausibility of postulated relationships among variable (Bryne, 1984).

META-ANALYSIS

Meta-analysis is a technique that allows researchers to combine data across studies to achieve more instruments. The software application Meta-analysis (Biostat, 2000) provides the user with a variety of tools to examine these studies. It can create a database of studies, import the abstracts of the full text of the original papers, or enter the researcher's own notes. The meta-analysis is displayed using schematic that may be modified extensively as the user can specify which variables to display and in what sequence.

GRAPHICAL DATA ANALYSIS

There are occasions when data need to be displayed graphically as part of the analysis and interpretation of the information of for more fundamental communication of the results of computations and analyses. most statistical packages including SPSS, SAS, STATA,  and even spreadsheets such us Excel, provide the user with tools for simple to complex graphical translations of numeric information thus allowing the researcher to display, store, and communicate aggregated data in meaningful ways. Special tools for spatial representation exist, such as mapping and geographic displays, so that the researcher can visualize and interpret pattern inherent in the data.

Geographic information system (GIS) technology is evolving an integral part of the information infrastructure of visualization tools for researchers. For example GIS can assist an epidemiologist map data collected on disease outbreaks or a health services researcher can communicate graphically areas of nursing shortages.

In summary, the emphasis of the section has provided a brief discussion about the range of traditions, statistical considerations and computer applications that aid the researcher in quantitative data analysis. As computer have continued to integrate data management functions with traditional statistical computational power, the researchers have been able to develop more extensive and sophisticated projects with data collected. Gone are the days of the calculator or punch cards as the computing power now sits on the researchers' desktop or laptops and with speed and functionality at their fingertips.

THE QUALITATIVE APPROACH

DATA CAPTURE AND DATA COLLECTION

The qualitative approach focuses on the activities in the steps of the research process that differ greatly from the quantitative methods in fundamental sources of data, collection techniques, coding, analysis, and interpretation. Thus, the computer becomes a different kind of tool for the researcher in most aspects of the research beginning with the capture and recording of narrative or textual data.

In terms of qualitative research requiring narrative content analysis, the computer can be used to record the observations, narrative statements of subjects, and memos of the researcher in initial word-processing applications for future coding Software applications that aid researchers in transcription task include text scanners, such as Omnipage (Scansoft, 2004b)

QUALITATIVE DATA COLLECTION

In most interview, simple electronic audio taping is often used during interviews, whereby the interview are entered into a word-processing program by clerical assistants in preparation for analysis. The narrative statements entered into a word processor are stored for subsequent coding and sorting according to one's theoretical framework.

Through analysis, categories from the data emerge as interpreted by the researcher. It is important to point out that for both quantitative and qualitative data, the computer application program is only a mechanical, clerical tool to aid the researcher in manipulating the data. Using the internet for direct and indirect data collection in qualitative studied can also provide a vehicle for data analysis that yields a quantitative component as well as the qualitative analysis, Computers are not only able to record the subject's responses to the question but also routinely record the number of minutes the subject was "online and the number of times they "logged in."

DATA CODING

 Historically, qualitative researchers have relied on narrative notes that may often be first audio recorded then transcribed by a typist. Coding qualitative text data was a time-consuming task, often involving thousand of pages of typewritten notes and the use of scissors and tape from the development of coding and categories. With the advent of computer packages, the mechanical aspects of the coding and sorting have been reduced. The researcher must decide on which text may be of interest and use a word-processing program to search for words, phrases, or other markers within text file using any number of word processing software packages.

Some specific packages develop for qualitative research coding and analysis interface directly with the most popular word-processing software packages. The application program Ethnograph was one of the first packages developed specifically for the purpose of managing some of the mechanical tasks qualitative data analysis. In Ethnograph, the narrative Text is first improved and each line is numbered. The text is then "coded" by indicating segments that pertain to a particular code. Once the codes are entered, the Ethnograph program can be instructed to search the text (individually across multiple cases) for specific coded segment.

QUALITATIVE DATA ANALYSIS

Qualitative research, like quantitative research, is not a single entry, but a set of related yet individual traditions, aims, and methods. Some individual traditions within qualitative research are ethnography, grounded theory, phenomenology, and hermeneutics. The distinguishing feature of qualitative research is that the goal is to understand the qualities or essence of phenomena and/or focus on the meaning of these events to the participants or respondents in the study. The forms of data are usually the words of the respondents or informants rather that numbers. Computerization is especially helpful to the researcher in handling large amount of data.

COMPUTER APPLICATION PROGRAMS

A number of general-purpose or specific software packages can be used in qualitative analysis: one package can be used is a free text retrieval program such as that available in a word-processing program; another is any number of standard database management or indexing programs; third is a program specifically developed for the purpose of qualitative analysis. Four of the commonly used special-purpose programs for qualitative analysis are 1.) ETHNOGRAPH 2.)NUD.IST 3.) NVivo, an evolution of NUD.IST4. ) Atlas.ti  a comprehensive application that supports text, graphics, video and audio data. In addition, logic based systems that use "if-then" rules for representation of relationships and conceptual network system are also available (Huberman and Miles, 1999)

GENERAL PURPOSE SOFTWARE

Word-processing programs in current use offer a number of features useful to the qualitative researcher. The ability to search fro certain key words allows the researcher to tag the categories of interest. In addition, such features as cut and paste, and the inclusion of video and audio data enhance the application. Add-on applications specific to integrating multiple elements help the researcher organize a range of data and materials for analysis.

Data management programs (e.g., Excel) can be use to categorize data , link categories and address a number of queries within categories, domains, or themes of interest. For example the researcher can list all clearly adolescents who smoke more than on pack per day who gave birth to preterm babies. These programs work better for discrete rather than unstructured texts.

SPECIAL-PURPOSE SOFTWARE

Several software products have evolve an improved for the specific purposes of analyzing qualitative data. Ethnograph is one such program, which is used after data have been entered using a word-processing program and converted to an ASCII file. Each file can be designated by its context and identifying features with markers provided by the computer program. The researcher can have the program produce a file that numbers each line of the narrative data.

Ethnograph provides a column format permitting numbered lines in the first column and categorical notations in the second column. Using a command entered by a researcher, it can selectively or globally delete or replace coding and produce an output file containing sorted cross-related coded segments from the original text data sets entered via a word-processing gram. The split screen allows researchers to view more that one file at a time, so is useful in constant comparison and contrasting data.

LOGIC BASED-SYSTEMS

These applications use rules for representation of hypotheses. Although some of the retrieval patterns are boolean, such as looking for one code or another in combinations in a text, they may also search for positive and negative cases of a code. The program may also be used to print out matrices if the researcher determines a set of codes for columns and another set for rows. each cell in the matrix then will contain the text segments indexed by both the column and row codes for the cell  (Huberman and Miles. 1999)

CONCEPTUAL NETWORK SYSTEMS

A system known as concept diagrams, semantic nets, or conceptual networks is one in which information is represented in a graphics manner. The objects in one's conceptual system (e.g., age and experiences) are coded and represented by a box diagram. The objects are linked (by arcs) to other objects to show relationships. Like rue-based system, semantic nets have been widely used in artificial intelligence work. In order to view the relationships of an object in the system, the researcher examines the node in the graph and follows the arcs to and from it. 

DATA ANALYSIS FOR QUALITATIVE DATA 

Qualitative data analyses often occur on an ongoing basis with data collection in a reflexive and iterative fashion. There is no clear demarcation of when data collection should end and analysis begin. The process of obtaining, observations, interviews and other data over a period time results in a vast body of data that may be hundreds or thousands of pages of field notes and researcher memos. Although computer applications can aid considerably in organizing and aspects of decision-making about concepts and themes must be made by the researcher. 

As an example, some of the tasks the computer can facilitate in data analysis using grounded theory (one approach to qualitative research) are as follows. Once a researcher has determined which parts of the interviews and observations can be tagged as categories, certain properties or dimensions can be determine and coded. The researcher may engage in "contrast comparison" to compare every incident that has been categorized by the same code and compare its meaning with other incidents similarly categorized. This process should continue until the researcher determines that the categories are internally consistent, fit with the data and are saturated.  Saturation is achieved when the researcher can find no more properties for a category and new data are redundant with the old (Creswell, 2003).

USES AND CAUTION

Software programs for qualitative research save time for the researcher in terms of file management, reducing the manual labor of cutting, pasting, sorting, and manual filing. They may also encourage the researcher to examine the data from different perspective, recording and reorganizing the data in different frameworks. 

One must be mindful that qualitative analysis is a cognitive process, not a mechanical one. The essence of qualitative research is the meaning and interpretation of the data within context. Taft believes that there may be cause for concern when researchers assume the reality of the concepts identified and emphasize their frequency rather than their meaning. The ability of software enhancements to generate quasi-frequency distributions and cross-tabulations may tend to further increase the investigator's confidence in believing such findings and relationships when in fact these maybe and artifact of the way in which the data are manipulated. While computer programs facilitate coding, organization of data and preparation of the data for interpretation, they cannot replace the thinking and decision-making that is at the heart of the qualitative analysis. As in all research, the burden of analysis and interpretation rests on the researchers. 

DISSEMINATION OF RESULTS

While dissemination of results continues to occur by traditional means such as presentations at professional meetings and publication in journal and monographs, online reporting is becoming increasingly common. Some Web sites frequented by nurses are peer review journals such as Online Journal of Nursing Informatics (http://www.cisnet.com/) and selected nursing articles on various professional nursing organizations (e.g., American Journal  of Nursing, Sigma Theta Tau, and National League for Nursing) often allow participants to chat online with presenters or authors of certain articles on designated dates during scheduled times. Nearly all organizations have own Web sites.