Study Guide for
Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice 8th Edition
Geri LoBiondo-Wood, PhD, RN, FAAN Proessor and Coordinator, PhD in Nursing Program University o exas Health Science Center at Houston School o Nursi Nursing ng Houston, exas Judith Haber, PhD, APRN, BC, FAAN Te Ursula Springer Leadership Proessor in Nursing Associate Dean or Graduate Programs New York University College o Nursin Nursingg New York, New York Study Guide prepared by: Carey A. Berry, MS, BSN, RN Formerly,, Clinical Nurse Formerly Gastrointestinal Surgical Oncology M.D. Anderson Cancer Center Te University o exas Denver, Colorado Jennifer Yost, PhD, RN Assistant Proessor School o Nursing, Faculty o Health Sciences McMaster University Hamilton, Ontario Canada
3251 Riverport Lane St. Louis, Missouri 63043
Study Guide or Nursing Research: Methods and Critical Appraisal or Evidence-Based Practice, Eighth Edition
978-0-323-22643-1
Copyright © 2014 by Mosby, Inc., an imprint of Elsevier Inc. Copyright © 2010, 2006, 2003, 1998 by Mosby, Inc., an affiliate of Elsevi er Inc.
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Notices
Knowledge and best practice in this �eld are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current inormation provided (i) on procedures eatured or (ii) by the manuacturer o each product to be administered, to veriy the recommended dose or ormula, the method and duration o administration, and contraindications. It is the responsibility o the practitioner, relying on their own experience and knowledge o the patient, to make diagnoses, to determine dosages and the best treatment or each individual patient, and to take all appropriate saety precautions. o the ullest extent o the law, neither the Publisher nor the authors assume any liability or any injury and/or damage to persons or property arising out o or related to any use o the material contained in t his book.
International Standard Book Number: 978-0-323-22643-1
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Printed in the United States o America Last digit is the print number: 9 8 7 6 5 4 3 2 1
Introduction Inormation bombards us! Te student lament used to be, “I can’t �nd any inormation on X.” Now the cry is, “What do I do with all o the inormation on X?” Te ocus shifs rom �nding inormation to thinking about how to use and �lter inormation. What inormation is worth keeping? What should be discarded? What is useul to clinical practice? What is �uff? Where are the gaps? Tinking about the links between inormation and practice is critical to the improvement o the nursing care we deliver. As each o us strengthens our individual understanding o the links b etween interventions and outcomes, we move nursing’s collective practice closer to being truly evidence-based. We can “know” what intervention works best in what situation. “Helping people get better saely and efficiently” begins with thinking. Our intent is that the activities in the Study Guide will help you strengthen your skills in thinking about inormation ound in the literature. Te activities are designed to assist you in evaluating the research you read so you are prepared to undertake the critical analysis o research studies. As you practice the appraisal skills addressed in this Study Guide, you will be strengthening your ability to make evidence-based practice decisions grounded in theory and research. What an incredible time to be a nurse! GENERAL DIRECTIONS
1. We recommend that you read the textbook chapter �rst, then complete the Study Guide activities or that chapter. 2. Complete each Study Guide chapter in order. Te Study Guide is designed so that you build on the knowledge gained in Chapter 1 to complete the activities in Chapter 2, and so orth. Te activities are designed to give you the opportunity to apply the knowledge learned in the textbook and actually use this knowledge to solve problems, thereby gaining increased con�dence that comes only rom working through each chapter. 3. Follow the speci�c directions that precede each activity. Be certain that you have the resources needed to complete the activity beore you begin. 4. ake the posttest in each Study Guide chapter afer you have completed all o the chapter’s activities. Te answers or the posttest items can be ound in the answer key. I you answer 85% o the questions correctly, be con�dent that you have grasped the essential material presented in the chapter. 5. Clariy any questions, conusion, or concerns you may have with your instructor. ACTIVITY ANSWERS ARE IN THE BACK OF THIS BOOK
Answers in a workbook such as this do not ollow a ormula like answers in a math book. Many times you are asked to make a judgment about a particular problem. I your judgment differs rom that o the authors, review the criteria that you used to make your decision. Determine i you ollowed a logical proCopyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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Introduction
gression o steps to reach your conclusion. I not, rework the activity. I the process you ollowed appears logical, and your answer remains different, remember that even experts may disagree on many o the judgment calls in nursing research. Tere will continue to be many “gray areas.” I you average an 85% agreement with the authors, you can be sure that you are on the right track and should eel very con�dent about your level o expertise. Carey A. Berry, MS, BSN, RN Jennier Yost, PhD, RN
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Contents PART I Chapter 1
OVERVIEW OF RESEARCH AND EVIDENCE-BASED PRACTICE
Integrating Research, Evidence-Based Practice, and Quality Improvement Processes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Jennier Yost
Chapter 2
Research Questions, Hypotheses, and Clinical Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Jennier Yost
Chapter 3
Gathering and Appraising the Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Jennier Yost
Chapter 4
Teoretical Frameworks or Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Jennier Yost
PART II Chapter 5
PROCESSES AND EVIDENCE RELATED TO QUALITATIVE RESEARCH
Introduction to Qualitative Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Jennier Yost
Chapter 6
Qualitative Approaches to Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Jennier Yost
Chapter 7
Appraising Qualitative Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Jennier Yost
PART III Chapter 8
PROCESSES AND EVIDENCE RELATED TO QUANTITATIVE RESEARCH
Introduction to Quantitative Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Carey A. Berry
Chapter 9
Experimental and Quasi-Experimental Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Carey A. Berry
Chapter 10
Nonexperimental Designs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Carey A. Berry
Chapter 11
Systematic Reviews and Clinical Practice Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Carey A. Berry
Chapter 12
Sampling ....................................................................65 Carey A. Berry
Chapter 13
Legal and Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Carey A. Berry
Chapter 14
Data Collection Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Carey A. Berry
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Contents
Chapter 15
Reliability and Validity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Carey A. Berry
Chapter 16
Data Analysis: Descriptive and Inerential Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Carey A. Berry
Chapter 17
Understanding Research Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Jennier Yost
Chapter 18
Appraising Quantitative Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Jennier Yost
PART IV Chapter 19
APPLICATION OF RESEARCH: EVIDENCE-BASED PRACTICE
Strategies and ools or Developing an Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Jennier Yost
Chapter 20
Developing an Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Jennier Yost
Chapter 21
Quality Improvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Carey A. Berry
Answer Key
...........................................................................134
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CHAPTER 1
Integrating Research, Evidence-Based Practice, and Quality Improvement Processes
1
1
Integrating Research, Evidence-Based Practice, and Quality Improvement Processes INTRODUCTION
One goal o this chapter is to assist you in reviewing the material presented in Chapter 1 o the text written by LoBiondo-Wood and Haber. A second and more undamental goal is to pro vide you with an opportunity to begin practicing the role o a critical consumer o research. Succeeding chapters in this study guide �ne-tune your ability to evaluate research studies critically. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
evidence-based practice.
and meta-synthesis. research studies. studies.
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CHAPTER 1
Integrating Research, Evidence-Based Practice, and Quality Improvement Processes
Activity 1 Column A
1. _____
Systematic investigation about phenomena
2. _____
Studies conducted to understand the meaning o human experience
3. _____
Column B
in a systematic review
4. _____
Critically evaluates a research report’s content based on a set o criteria to evaluate the scienti�c merit or application to practice
5. _____
Studies conducted to test relationships, assess
b. c. d. e.
Meta-analysis Research Qualitative Systematic review
practice g. Quantitative h. Clinical guidelines i. Quality improvement
6. _____
Summary and assessment o a group that
7. _____
Clinical practice based on the collection, evaluation, and integration o clinical expertise, research evidence, and patient preerences
8. _____
Systematically developed statements that provide recommendations to guide practice
9. _____
Systematic use o data to monitor outcomes o care
Activity 2
Match the term in Column B with the appropriate phrase in Column A. erms rom Column B will be used more than once. Column A
1. _____
Getting a general sense o the material
2. _____
Clariying unamiliar terms with text
3. _____
4. _____
Questioning assumptions
5. _____
Rationally examining ideas
6. _____
7. _____
Allowing assessment o study validity
Column B
b. Critical reading
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CHAPTER 1
Integrating Research, Evidence-Based Practice, and Quality Improvement Processes
3
Activity 3
Complete each item with the appropriate word or phrase rom the text. 1. Key variables, new terms, and steps o the research process should be identi�ed ollowing a(n) ________________ understanding o a research article. 2. With ________________ understanding o a research article, you should be able to state the main purpose o the study in one or two sentences. 3. Analysis o an article will allow understanding o the __________ o a study; synthesis will allow understanding o the ____________ article and all steps in the rese arch process. Activity 4: Evidence-Based Practice Activity
a. Melvin et al., 2012: _____________________________________________________ b. Alhusen et al., 2012: ____________________________________________________ c. Murphy et al., 2012: ____________________________________________________ 2. Find a research article in your area o practice and determine the level o evidence or the article. Activity 5
Match the term in Column B with the appropriate phrase in Column A. Column A
1. _____
implementation, and analysis
2. _____
Column B
a. Consistency b. Quality c. Quantity
report similar �ndings 3. _____
Number o studies that have evaluated
strength o the �ndings rom the data analyses
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Integrating Research, Evidence-Based Practice, and Quality Improvement Processes
Activity 6
Using Appendix A (Tomas et al., 2012), determine where in the article the ollowing steps o the research process are identi�ed: 1. Research problem: __________________________________________________________ 2. Purpose: _________________________________________________________________ 3. Literature review: __________________________________________________________ ______________________________ ________________________________________________
6. Research design: ___________________________________________________________
______________________________________________________
8. Legal-ethical issues: _________________________________________________________
______________________________________________________________
10. Validity and reliability: ______________________________________________________
___________________________________________________
______________________________________________________________
13. Results: __________________________________________________________________ ________________________________________ __________________________________
POSTTEST -
soning abilities. Use these abilities to read the ollowing abstract, and then identiy con-
presented.
(57.4%) participants reported having physical limitations in at least one item on the physi
in this sample o individuals over 60 years o age is consistent with epidemiological studies o pain. . . . Pain was signi�cantly associated with greater unctional disability in both physi
living with pain. Contrary to previous research, race was not related to pain in this sample (Horgas et al., 2008).
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Integrating Research, Evidence-Based Practice, and Quality Improvement Processes
5
b. List any unamiliar concepts or terms that you would need to clariy.
similarity between research and evidence-based practice.
between research and evidence-based practice.
similarity
REFERENCES ment and health practices on neonatal outcome in low-income, urban women. Research in Nursing & Health, 35, 112-120.
Horgas A. L., Yoon S. L., Nichols A. L., et al. (2008). Te relationship between pain and unc Research in Nursing & Health, 31 (4), 341-354.
stress symptoms in US Army couples: Te role o resilience. Research in Nursing & Health, 35, 164-177. ing or women afer a miscarriage. Cochrane Database o Systematic Reviews, 3,
motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39 (1), 39-49. Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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CHAPTER 2
Research Questions, Hypotheses, and Clinical Questions
2
Research Questions, Hypotheses, and Clinical Questions INTRODUCTION
Tis chapter ocuses on identiying research questions, hypotheses, and clinical questions. I de veloped correctly, research questions can be very helpul to you as a research consumer because they concisely describe the essence o the research study. Research questions present the idea that is to be examined in the study. Hypotheses, which extend rom the literature review and research questions, are predictions that provide a vehicle or testing the relationships between variables. For the nurse who considers using the results o a given study in practice, the two primary concerns are to locate and critique the research question and the hypotheses. Te research question or hypotheses provide the most succinct link between the underlying theoretical base and guide the design o the research study. Although similar to research questions, clinical questions are developed by the nurse to provide answers to clinical situations. Clinical questions, ramed using the PICO (population, intervention, comparison, outcome) ormat, are the basis or searching the literature to identiy the best available evidence or clinical situations. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
6
-
research process.
evidence-based practice. search report.
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CHAPTER 2
Research Questions, Hypotheses, and Clinical Questions
7
Activity 1
Match the terms in Column B to the appropriate phrase in Column A. Column A
1. _____ 2. _____ 3. _____ 4. _____ 5. _____ 6. _____
Statement about the relationship among two or more variables other variable Nonmanipulated variable that the researcher is interested in understanding, explaining, or predicting Property o the research question that variables must lend themselves to observation, measurement, and analysis Concepts or properties that are operationalized and studied Statement that presents the idea(s) to be examined in the study
Column B
a. estability b. Independent variable c. Variables
e. Research question . Hypothesis
Activity 2
A good research question exhibits three characteristics. Critique the research questions below to determine i each o the three criteria is present. Following each problem statement is a list representing the three criteria (a, b, and c). Circle yes or no to indicate whether each criterion is met. Te research question:
c. Implies the possibility o empirical testing
1. Te purpose o this study was to compare substance involvement among adolescent smokers in a psychiatric inpatient acility who had received either a motivational interviewing intervention or brie advice or smoking cessation (Brown et al., 2009). Criterion a: Yes No Criterion b: Yes No Criterion c: Yes No 2. Te purpose o this study was to determine i a predictive relationship exists between
Criterion a: Criterion b: Criterion c:
Yes Yes Yes
No No No
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Research Questions, Hypotheses, and Clinical Questions
3. Te purpose o this study was to describe the experience o the use o community services,
a related disorder (Winslow, 2003). Criterion a: Yes No Criterion b: Yes No Criterion c: Yes No
4. Te purpose o this study was to assess sel-perception o body weight among a selected sample o aipei, aiwan, high school students and other weight-related actors such as weight management practices, weight management goal, weight satisaction, perception o physical attractiveness, and normative perceptions o schoolmates regarding weight loss (Page et al., 2005). Criterion a: Yes No Criterion b: Yes No Criterion c: Yes No -
ment during hospitalization or cancer treatment (Rustøen et al., 2009). Criterion a: Yes No Criterion b: Yes No Criterion c: Yes No
Activity 3
Research questions are used to guide all types o research studies. Identiy whether you would expect a quantitative or qualitative research study design rom the research questions in Activity 2. Key:
a. Quantitative b. Qualitative
1. _____
2. _____
Te purpose o this study was to compare substance involvement among adolescent smokers in a psychiatric inpatient acility who had received either a motivational interviewing intervention or brie advice or smoking cessation (Brown et al., 2009). Te purpose o this study was to determine i a predictive relationship exists be
3. _____
Te purpose o this study was to describe the experience o the use o community
4. _____
Te purpose o this study was to assess sel-perception o body weight among a selected sample o aipei, aiwan, high school students and other weight-related actors such as weight management practices, weight management goal, weight satisaction, perception o physical attractiveness, and normative perceptions o schoolmates regarding weight loss (Page et al., 2005).
management during hospitalization or cancer treatment (Rustøen et al., 2009).
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CHAPTER 2
Research Questions, Hypotheses, and Clinical Questions
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Activity 4
Te ability to distinguish between independent and dependent variables is crucial in critiquing a research hypothesis to determine whether it is a succinct statement o the relationship be
the ollowing research hypotheses.
(Zeigler et al., 2009).
a. Independent variable: -
dependent o illness severity (Moore et al., 2009). a. Independent variable:
3. Tere is no
acute bronchospasm (Stein & Levitt, 2003). a. Independent variable:
4. People who report more requent or more recent dental prophylaxes are more likely to have better glycemic control (aylor et al., 2005). a. Independent variable:
5. More supportive / less negative parenting is associated with lower resting blood pressure and
a. Independent variable:
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CHAPTER 2
Research Questions, Hypotheses, and Clinical Questions
Activity 5
ake each hypothesis rom Activity 4 and label it with the appropriate abbreviation rom the key provided. Key:
1. _____
Regular provision o iron improves iron status o breast-ed inants without ad-
4. _____
o lie, independent o illness severity (Moore et al., 2009).
the patients with acute bronchospasm (Stein & Levitt, 2003). People who report more requent or more recent dental prophylaxes are more likely to have better glycemic control (aylor et al., 2005).
Activity 6
Critique the ollowing hypothesis. Arican-American women with higher levels o depression will have higher blood pressure levels, more cardiovascular risk actors, greater stress, and lower social support (Artinian et al., 2006). 1. Is the hypothesis clearly stated in a declarative orm? Yes No
Yes
No
3. Are the variables measurable or potentially measurable? Yes No 4. Is the hypothesis stated in such a way that it is testable? Yes No
Yes
No
6. Is the direction o the relationship in the hypothesis clearly stated? Yes No
supported or not supported? Yes No
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CHAPTER 2
Research Questions, Hypotheses, and Clinical Questions
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Activity 7
Clinical questions ofen arise rom clinical situations. Using the PICO ormat or ormulating clinical questions helps practicing nurses identiy the best available evidence on which to base clinical and health care decisions. In the ollowing clinical questions, identiy the our components o clinical questions. 1. In children presenting to the emergency department with acute long-bone ractures, is in
P: _____________________________________________________________________ I: _____________________________________________________________________ C: _____________________________________________________________________ O: _____________________________________________________________________
P: _____________________________________________________________________ I: _____________________________________________________________________ C: _____________________________________________________________________ O: _____________________________________________________________________ 3. What are the experiences o men afer laparoscopic radical prostatectomy? (Mick, 2009) P: _____________________________________________________________________ I: _____________________________________________________________________ C: _____________________________________________________________________ O: _____________________________________________________________________ POSTTEST
Reer to the article by Tomas et al. (2012) in Appendix A o your textbook. 1. Highlight the research question.
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CHAPTER 2
Research Questions, Hypotheses, and Clinical Questions
research question:
a. Clearly identiy the variable(s) under consideration? b. Speciy the population being studied? c. Imply the possibility o empirical testing? 4. Put the research question into the PICO ormat or clinical questions.
5. List the variables being studied. Identiy the independent variable(s) and dependent variable(s).
6. Is there a hypothesis stated by the researchers? I yes, highlight the hypothesis. Is the hypothesis directional or nondirectional?
REFERENCES pressure in urban Arican-American women. Progress in Cardiovascular Nursing, 21(2), Child: Care, Health, and Development, 34 (2), 194-203.
adolescents receiving motivational interviewing or smoking cessation during psychiatric hospitalization. Addictive Behaviors, 34
obese children than routine care. Evidence-Based Nursing, 11, 43.
Mick, J. (2009). Men were surprised by the severity o symptoms they experienced afer laparoscopic radical prostatectomy. Evidence-Based Nursing, 12 Page, R. M., Lee, C., Miao, N. (2005). Sel perception o body weight among high school students in aipei, aiwan. International Journal o Adolescent Medicine and Health, 17 (2), 123-136. Rustøen, ., Gaardsrud, M., Leegaard, M., & Wahl, A. K. (2009). Nursing pain management: A qualitative interview study o patients with pain, hospitalized or cancer treatment. Pain Management Nursing, 10 gram. eaching and Learning in Nursing, 3(4), 131-136.
Stein, J., & Levitt, M. A. (2003). A randomized, controlled double-blind trial o usual-dose versus high-dose albuterol via continuous nebulization in patients with acute bronchospasm. Annals o Emergency Medicine, 10(1), 31-36. Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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Research Questions, Hypotheses, and Clinical Questions
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Frequency o dental prophylaxis and glycemic control in type 2 diabetes. Journal o Dental Hygiene, 79
Tomas, M. L., Elliott, J. E., Rao, S. M., et al. (2012). A randomized clinical trial o education or motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39 (1), 39-49. analysis. Public Health Nursing, 20 children with closed long-bone ractures. Evidence-Based Nursing, 11, 42.
Ziegler, E. E., Nelson, S. E., & Jeter, J. M. (2009). Iron status o breasted inants is improved
American Journal o Clinical Nutrition, 90
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CHAPTER 3
Gathering and Appraising the Literature
3
Gathering and Appraising the Literature
INTRODUCTION
Te phrases literature review or review o the literature reer to a key step in the research process or researchers, as well as or consumers o research. For researchers, the literature review is the section o a research study in which the researcher retrieves, critically appraises, and synthesizes previously existing knowledge. It is this literature review that is then used as the basis or the development o research questions and hypotheses by the researcher. Similarly, as consumers o research, nurses involved in evidence-based practice are also responsible or reviewing the literature. Tey systematically gather, critically appraise, and synthesize the best-available evidence to establish its strength, quality, and consistency to determine its applicability to practice. Tis chapter will help you learn more about how to critique the literature review perormed by researchers and how to conduct a literature review as a consumer o research to address clinical questions. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
14
-
practice.
vestigator and the research consumer.
-
quality improvement projects.
and print database sources or conducting a literature review. opment o a literature review.
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CHAPTER 3
Gathering and Appraising the Literature
15
Activity 1
Sometimes it is difficult to understand the distinction between primary and secondary sources
injection or pain, whose report would you eel most comortable evaluating—the report o a amily member or nurse’s aide (i.e., secondary source) or the report by the patient (i.e., primary erature in part on whether it is generated rom primary or secondary sources so that you know whether you are reading a �rst-hand report or someone else’s interpretation o the material. textbook). Next to each reerence, indicate whether it is a primary (P ) or secondary (S) source.
Sometimes it is helpul to retrieve the abstract or ull text o the reerence.
Journal o raumatic Stress, 8
Combat stress injury: Teory, research, and management.
Compassion atigue (pp. 1-20). New York, NY:
Brunner/Mazel.
-
male and male victims and perpetrators o partner violence with respect Journal o Interpersonal Violence, 23
Activity 2 -
ture is being conducted by a researcher or a consumer o research, attempts should be made to retrieve articles rom reereed or peer-reviewed journals. Below is a selected list o reerences
indicate whether it is a peer-reviewed journal (PR) or non–peer-reviewed journal (NPR). Note:
It may be helpul to look up the journal online.
Journal o Marital and Family Terapy, 21
lence and abuse among active duty military women. Violence Against Women, 9,
violence screening tools. Journal o American Medical Women’s Association, 56 ,
Depression and Anxiety, 18 ,
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Gathering and Appraising the Literature
history. Journal o Interpersonal Violence, 22
use o mental health services, and attrition rom military service afer return-
Journal o the American Medical Association, 295, 1023-1032.
Activity 3: Web-Based Activity
print versions located in libraries, the Internet has become a major source or researchers and consumers o research conducting reviews o the literature. wo o the most common Internet sources are (1) online bibliographic and abstract databases and (2) online search engines.
Activity 4: Web-Based Activity vices or �nding current best evidence. Evidence-Based Medicine, 6 lution o inormation services or evidence-based healthcare decisions. Evidence-Based Nursing, 10 Evidence-Based Nursing, 12
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Gathering and Appraising the Literature
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Activity 5
Te review o the literature is usually easy to �nd. In the abridged version o a research study, it is most requently labeled Review o Literature or Relevant Literature or something comparable. It may also be separated into a literature review section and another section titled Conceptual Framework praising the literature review o research studies is a necessary step or both researchers and
to answer the ollowing questions.
question?
2. Is the literature review organized using a systematic approach?
to evaluate the study or strengths, weaknesses, or limitations, as well as or con�icts or gaps in inormation that relate directly or indirectly to the area o interest?
-
ent between and among studies?
appropriate reerences?
provide recommendations or implementing the study or evidence-based practice/quality improvement project?
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Gathering and Appraising the Literature
POSTTEST -
ing questions.
whether it is a primary (P ) or secondary (S (PR) or not peerreviewed (NPR).
with maternal tobacco use. Seminars in Neonatology, 5 , 231-241.
o maternal attachment during pregnancy. Nursing Research, 30 ,
blacks-household-wealth-disparity.
question?
to evaluate the study or strengths, weaknesses, or limitations, as well as or con�icts or gaps in inormation that relate directly or indirectly to the area o interest?
-
ent between and among studies?
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CHAPTER 3
Gathering and Appraising the Literature
19
appropriate reerences?
provide recommendations or implementing the study or evidence-based practice/quality improvement project?
REFERENCES ment and health practices on neonatal outcome in low-income, urban women. Research in Nursing & Health, 35 , 112-120. Evidence-Based Nursing, 12 vices or �nding current best evidence. Evidence-Based Medicine, 6 lution o inormation services or evidence-based healthcare decisions, Evidence-Based Nursing, 10 stress symptoms in US army couples: Te role o resilience. Research in Nursing & Health, 35
motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39
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20
CHAPTER 4 Theoretical Frameworks for Research
4
Theoretical Frameworks for Research
INTRODUCTION
It is not uncommon or beginning consumers o research to �nd the theoretical part o a study to be their least avorite component. However, nursing science is the result o the interchange between research and theory. Tis chapter provides an overview o the use o theoretical rameworks or nursing research. An understanding o theoretical rameworks will help you examine the logical, consistent link among the theoretical ramework, concepts in the study, and methods o measurement. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
and consistency o a ramework guiding research.
Activity 1
Identiy the steps the researcher must address when deciding to study a concept or construct. 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________
20
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CHAPTER 4 Theoretical Frameworks for Research
21
Activity 2
Match the de�nition in Column A with the appropriate term in Column B. Column A
1. _____
A graphic or symbolic representation o a phenomenon that assists the reader to visualize the key concepts or constructs and their identi�ed interrelationships.
2. _____
A complex concept that usually is comprised o more than one concept that is built or constructed to �t a purpose.
3. _____
Set o interrelated concepts that provides a systematic view o a phenomenon.
4. _____
Image or symbolic representation o an abstract idea.
5. _____
6. _____
Column B
a. Teory b. Concept c. Conceptual de�nition d. Operational de�nition e. Model . Construct
presence o the concepts and will be used to describe the amount or degree to which the concept exists. Goes beyond the general language meaning ound in the dictionary to de�ne or explain the meaning o a concept.
Activity 3
Te theories developed speci�cally by and or nurses can be classi�ed into three categories. Identiy the categories below, then identiy which o the theories is the most abstract and which o the theories is the least abstract. 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ Activity 4
In nursing research, theories are used in the research process. Identiy three ways in which theories are used in the research process. 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________
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CHAPTER 4 Theoretical Frameworks for Research
Activity 5
In a study to test a theory, researchers ollow certain steps. Put the ollowing steps in sequential order rom 1 (�rst step) to 4 (last step). a. _____ Interprets the �ndings considering the predictive ability o the theory b. _____ Chooses a theory o interest and selects a propositional statement to be examined
Activity 6: Web-Based Activity
Access the ollowing website: www.jcu.edu.au/soc/nursoc/html_pages/nursing_research.htm Go to #7, Conceptual Teoretical Frameworks, and explore the conceptual rameworks presented. POSTTEST -
tion. For questions 1 through 8, match the description in Column A with the appropriate type o nursing theory in Column B. (Te type o nursing theories in Column B are used more than once, and more than one can apply to the description in Column A.) Column A
1. _____
Composed o a limited number o concepts
2. _____
Sometimes reerred to as conceptual models
3. _____
Focused on a limited aspect o reality
4. _____
Narrow in scope
5. _____
Most abstract level o theory
6. _____
All-inclusive conceptual structures that tend to include views on the person, health, and the environment
7. _____
8. _____
Usually limited to speci�c populations or a �eld o practice
Column B
a. Grand b. Situationspeci�c c. Middle range
For questions 9 through 15, answer rue () or False (F). 9. _____
Use o non-nursing theories is not important or providing evidence-based care.
10. _____
Correlational research designs are requently used in studies that use a theory as a ramework or a study.
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CHAPTER 4 Theoretical Frameworks for Research
23
11. _____
Beginning with theory gives a researcher a logical way o collecting data to describe, explain, and predict nursing practice.
12. _____
Certain grand theories are better than others with respect to nursing research.
13. _____
Qualitative research designs are used to test a theory.
14. _____
Teories are only used in qualitative research designs.
15. _____
Teory-generating research is inductive; it uses a process by which generalizations are developed rom speci�c obser vations.
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24
CHAPTER 5
Introduction to Qualitative Research
5
Introduction to Qualitative Research
INTRODUCTION Qualitative research is a term ofen applied to naturalistic investigations—research that involves
studying phenomena in places where they are occurring. Qualitative research approaches are based on a perceived perspective or holistic worldview that says there is not a single reality. Instead, reality is viewed as based on perceptions that differ rom person to person and change over time; meaning can only be truly understood i it is associated with a speci�c situation or context. Qualitative research is about understanding phenomena and �nding meaning through examining the pieces that make up the whole. Trough different orms o qualitative nursing research methods, each method o investigation presents a unique approach to studying the phenomena o interest to nurses and the discipline.
Evidence-based practice has been primarily ocused on �ndings that come rom systematic reviews o the literature that use models examining the effectiveness o interventions. As acceptance has grown or the use o evidence-based practice in nursing, arguments about the place o qualitative research in this process have arisen. Questions o interest to nursing that have not been previously or thoroughly studied are ofen best investigated using qualitative methods. When new perspectives are introduced to practice, the use o qualitative investigation may be the best way to gain early understanding that can later be studied using empirical measures. However, reviews o qualitative research about a given topic can also provide meaningul insight into practice issues that can be directly applied in clinical settings. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
24
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CHAPTER 5
Introduction to Qualitative Research
25
Activity 1
Chapter 5 o the textbook provides an overview o qualitative research and introduces a variety o terms that have important implications or understanding qualitative research. ake some time to de�ne the ollowing terms and be sure that you can differentiate them. a. Naturalistic settings: b. Sample: c. Purposive sample: d. Recruitment:
. Setting: g. Temes:
Activity 2
Compare qualitative research with quantitative research or the ollowing steps in the research process. Qualitative
Quantitative
Sample recruitment
collection
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26
CHAPTER 5
Introduction to Qualitative Research
Activity 3
Review Appendix C (Seiler & Moss, 2012). Find and summarize the ollowing elements. Element
Summary
Purpose Method Sample and setting
POSTTEST
1. Identiy whether each o the ollowing belies re�ects the quantitative or the qualitative research method. a. _____ Statistical explanation b. _____ Interviews c. _____ Multiple realities d. _____ Naturalistic setting e. _____ Predetermined number o participants . _____ Quotations 2. Put the ollowing components o a qualitative research report in sequential order rom 1 (�rst step) to 7 (last step) and provide a brie description o each.
_____
Sample:
_____
Review o the literature:
_____
Study setting:
_____
Findings:
_____
Study design:
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CHAPTER 5
Introduction to Qualitative Research
27
REFERENCE
Seiler, A., & Moss, V. A. (2012). Te experiences o nurse practitioners providing health care to the homeless. Journal o the American Academy o Nurse Practitioners, 24, 303-312.
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28
CHAPTER 6
Qualitative Approaches to Research
6
Qualitative Approaches to Research
INTRODUCTION
Qualitative research continues to gain recognition as a sound method or investigating the complex human phenomena less easily explored using quantitative methods. Qualitative research methods provide ways to address both the science and art o nursing. Qualitative methods are especially well-suited to address phenomena related to health and illness that are o interest to nurses and nursing practice. Nurse researchers and investigators rom other disciplines are continuing to discover the value o �ndings obtained through qualitative studies. Nurses can be better-prepared to critique the appropriateness o a research design and identiy the useulness o the study �ndings when the unique differences between quantitative and qualitative research approaches are understood. Although there are many designs or qualitative research, �ve methods are most commonly used by nurses. Tese methods are phenomenology, grounded theory, ethnography, and case study. A newer methodology known as community-based participatory research that is gaining increased respect rom nursing scientists who are investigating behavioral phenomena is also described in this chapter. Understanding and care are concepts related to behaviors that are important to nurses in the practice o clinical nursing care in a variety o settings across the liespan. Each o these qualitative methods allows the researcher to approach the phenomena o interest rom a different perspective. Each offers the investigator a different perspective and suggests �ndings that address different realms o human experience. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
28
methods.
topics as ethics, criteria or judging scienti�c rigor, and combination o research methods.
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CHAPTER 6
Qualitative Approaches to Research
29
Activity 1
Match the ollowing de�nitions in Column A with the appropriate terms in Column B. Column A
1. _____
No new data emerging
2. _____
Select experiences to help the researcher test ideas and gather complete inormation about developing concepts
Column B
a. Teoretical sampling b. Emic c. Etic
3. _____
Outsider’s view
e. Bracketed
4. _____
g. Key inormants
5. _____
6. _____
Symbolic categories that include smaller categories
7. _____
communication skills and who are willing to teach the ethnographer about the phenomenon Activity 2
Six qualitative research methods are discussed in the textbook in relation to �ve basic research elements. Use your textbook to compare research elements o each o the different types o qualitative methods. Brie�y describe a key aspect o each element or the different qualitative methods. Tis activity will assist you to compare and contrast the similarities and differences in these methods. 1. Identifying the phenomenon
Phenomenology
Grounded theory
Ethnography
Case study
Community-based participatory research
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CHAPTER 6
Qualitative Approaches to Research
2. Structuring the study
Phenomenology
Grounded theory
Ethnography
Case study
Community-based participatory research
3. Data collection
Phenomenology
Grounded theory
Ethnography
Case study
Community-based participatory research
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CHAPTER 6
Qualitative Approaches to Research
4. Data analysis
Phenomenology
Grounded theory
Ethnography
Case study
Community-based participatory research
Phenomenology
Grounded theory
Ethnography
Case study
Community-based participatory research
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31
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CHAPTER 6
Qualitative Approaches to Research
Activity 3
and answer the ollowing questions.
1. What research design was used to conduct this research study?
3. What important procedures and methods were used to collect data in this study? 4. What methods were used during data analysis? Activity 4
Te �ve qualitative methods o research are the phenomenological, grounded theory, ethnographic, case study, and historical methods. For each characteristic listed below, indicate which method o qualitative research it describes. Use the abbreviations rom the key provided. Some characteristics may be described by more than one method. Key:
A = Phenomenological B = Grounded theory C = Ethnographic
1. 2. 3. 4. 5. 6. 7. 8. 9.
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 11. _____ 12. _____ 13. _____ 14. _____ 15. _____ 16. _____ 17. _____ 18. _____ 19. _____ _____ 21. _____
Uses “emic” and “etic” views o subjects’ worlds
Central meanings arise rom subjects’ descriptions o lived experience Focuses on a dimension o day-to-day existence
Studies the peculiarities and commonalities o a speci�c case
States that individuals’ history is a dimension o the present Attempts to discover underlying social orces that shape human behavior Attention is given to a single case
Focuses on describing cultural groups Uses constant comparative method during data analysis
Can include quantitative and/or qualitative data Subjects are currently experiencing a circumstance Collects remembered inormation rom subjects
May use photographs to describe current behavioral practices May not include exhaustive literature search Uses an inductive approach to understanding basic social processes
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CHAPTER 6
Qualitative Approaches to Research
33
POSTTEST
1. _____ 2. _____ 3. _____ 4. _____ 5. _____
Qualitative research ocuses on the whole o human experience in naturalistic settings. External criticism in historical research reers to the authenticity o data sources.
be as large as those usually ound in quantitative studies. Te researcher is viewed as the major instrument or data collection. Qualitative studies strive to eliminate extraneous variables.
6. o what does the term saturation in qualitative research reer?
b. Subject exhaustion
a. Questionnaires sent out to subjects b. Observation o subjects in naturalistic settings
d. All o the above 8. Te qualitative method that includes an inductive approach using a systematic set o procedures to create a theory about basic social processes is known as which o the ollowing? a. Phenomenology b. Grounded theory c. Ethnography d. Case study e. Community-based participatory research 9. What is the qualitative method that attempts to construct the meaning o the lived experience o human phenomena? a. Phenomenology b. Grounded theory c. Ethnography d. Case study e. Community-based participatory research
culture on the health behaviors o urban Hispanic youth? a. Phenomenology b. Grounded theory c. Ethnography d. Case study e. Community-based participatory research
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CHAPTER 6
Qualitative Approaches to Research
11. What qualitative method would be most appropriate or studying a amily’s experience with cystic �brosis? a. Phenomenology b. Grounded theory c. Ethnography d. Case study e. Community-based participatory research
a. b. c. d. e.
Phenomenology Grounded theory Ethnography Case study Community-based participatory research
13. Which data analysis process is not used with grounded theory methodology? a. Bracketing b. Axial coding c. Teoretical sampling d. Open coding REFERENCE the homeless. Journal o the American Academy o Nurse Practitioners, 24
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CHAPTER 7 Appraising Qualitative Research
35
7
Appraising Qualitative Research
INTRODUCTION
Qualitative research provides an opportunity to generate new knowledge about phenomena less easily studied with empirical or quantitative methods. Nurse researchers are increasingly using qualitative methods to explore holistic aspects less easily investigated with objective measures. In qualitative research, the data are less likely to involve numbers and most likely will include text derived rom interviews, ocus groups, observation, �eld notes, or other methods. Te data tend to be mostly narrative or written words that require content rather than statistical analysis. Te important contributions being made to nursing knowledge through qualitative studies make it important or nurses to possess skills that enable them to evaluate and critique qualitative research reports. Tis chapter describes the criteria needed to evaluate and critique qualitative research reports. Published research reports, whether they are quantitative or qualitative, must be viewed by the reviewers as having scienti�c merit, demonstrate rigor in the research conducted, present new knowledge, and be o interest to the journal’s readers. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
report.
Activity 1
on the body o knowledge about human phenomena, and consider how the knowledge might be applicable to nursing. Learning and applying a critiquing process is the �rst step in this pro-
more than once.
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35
36
CHAPTER 7 Appraising Qualitative Research
Column A
“One main question was asked at the start o the interview: “Will you please describe to me your experiences in providing health care to the homeless?”
rom data analysis o signi�cant statements rom the nine interviews.”
in this study using the principles o phenomenology to guide data collection and analysis.”
“Te participants were obtained, using purposive and snowball sampling methodology, rom NPs practicing or at least 6 months in southeast and northeast Wisconsin clinics that provided health care to the homeless.”
“Tereore, it was the goal o this study to address this gap in the literature in an effort to more ully understand the experiences o NPs in volved in providing health care to the homeless.”
“Te theme, ‘how the relationship develops’ and its related subthemes, ‘establishing trust’ and ‘hearing their story’ identi�es ways or NPs to overcome the barriers to receiving health care perceived by homeless patients …”
“Following each interview, audio-taped recordings were transcribed verbatim.”
“Homelessness is an increasing social and public health problem and provides unique challenges or health care proessionals and the health care system.”
clustered into themes and urther separated into subthemes.”
Column B
phenomenon o interest b. Purpose
g. Findings
recommendations
offers just tremendous opportunities to help.
that’s what a nurse is about, is to help.”
“Tis study helps to �ll the gap in the literature and will assist health care providers to gain insight into the experience and learn what it takes to become successul in such an important and much needed role.”
“Field notes were collected.”
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CHAPTER 7 Appraising Qualitative Research
37
Activity 2
Te textbook discusses overall purposes o qualitative research. Identiy the our purposes o qualitative research that the textbook identi�es.
4. Activity 3
When critiquing a qualitative study, the ollowing are important components o the analysis o data. Identiy how you would know that the ollowing components have been addressed in a qualitative study.
Activity 4: Web-Based Activity the term qualitative research can be a way to gain additional understanding about many as-
pects o this research approach. However, it is essential to identiy a ew quality starting
and ollow the link to the International Journal o Qualitative Methods. ex perience or theory and note the variety o research methodologies used to explore this concept.
valuable resource or learning more about the various methods o qualitative research.
You may want to spend some time reviewing these websites to learn more about the state o qualitative research methods. Your instructor may want to assign some particular activities rom these websites to assist you in learning about qualitative research.
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CHAPTER 7 Appraising Qualitative Research
POSTTEST
aim o qualitative research.
view.
as possible the “insider’s” view o the phenomenon being studied.
Column A
data in a condensed ormat.
Tings that are perceived by our senses.
-
Te view o the person experiencing the phenom-
Column B
a. Phenomena
d. Teme
parate qualitative investigations.
experiences. REFERENCES
to the homeless. Journal o the American Academy o Nurse Practitioners, 24
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CHAPTER 8
Introduction to Quantitative Research
39
8
Introduction to Quantitative Research
INTRODUCTION
Te phrase research design is used to describe the overall plan o a particular study. Te design is the researcher’s plan or answering speci�c research questions in the most accurate and efficient way possible. In quantitative research, the plan outlines how the hypotheses will be tested. Te design ties together the present research problem, the knowledge o the past, and the implications or the uture. Tus the choice o a design re�ects the researcher’s experience, expertise, knowledge, and biases. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
research design. control and �delity as they affect research design. internal validity . external validity .
Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
39
40
CHAPTER 8
Introduction to Quantitative Research
Activity 1
glossary or help with terms.
Column A
1. _____
Te antecedent variable
2. _____
Sampling selection where each element has an equal chance or selection into the control or intervention group
3. _____
Methods to keep the study conditions constant during the study
4 _____
Methods to ensure that data collection procedures remain consistent or all subjects
5. _____
Te vehicle or hypothesis testing or answering research questions
6. _____
Small, preliminary study
7. _____
8. _____ 9. _____
Column B
b. Internal validity d. Research design
h. Independent variable
j. Pilot study
l. Randomization
and not uncontrolled actors, lead to the results o the study
to the larger population
the results o a study
10. _____
Group that receives the treatment in a study
11. _____
Presumed effect o the experimental variable on the outcome
12. _____
Activity 2
For each o the ollowing situations, identiy the type o threat to internal validity rom the list below. Ten explain the reason this is a problem, and suggest how the problem can be corrected. History Instrumentation Maturation
Mortality Selection bias esting
1. Te researcher tested the effectiveness o a new method o teaching drug dosage and solution calculations to nursing students using a standardized calculation exam at the beginning, midpoint, and end o a 2-week course.
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CHAPTER 8
Introduction to Quantitative Research
41
2. In a study study o the results results o a hypertension teaching program program conducted at at a senior center, center, blood pressures taken by volunteers using their personal pe rsonal equipment were compared beore and afer the program.
a smoking cessation program.
4. Te smoking cessation rates rates o an experimental group group consisting consisting o volunteers or or a smoking cessation program were compared with the results o a control group o people who wanted to quit on their own without a special program. 5. Tirty percent o the subjects subjects dropped out o an experimental study study o the effect o a jobtraining program on employment or homeless women. More than 90% o the dropouts were single homeless women with at least le ast two preschool-aged children, while the majority o subjects successully completing the program had no preschool-aged children. 6. Nurses on a maternity unit want want to study study the effect o a new hospital-based teaching pro-
-
ticipants by the researchers 1 month afer discharge. Activity 3 Research design is an all-encompassing term or the
overall plan to answer the research questions, including the method and speci�c spe ci�c plans to control other actors that could in�uence the t he results o the study study.. o become acquainted with the major elements el ements in the design o a study study,,
questions.
1. What was the setting or the study? study?____________ ________________________ ________________________ _____________________ _________ 2. Who were were the subjects? _____________ __________________________ __________________________ __________________________ _______________ __ 3. How was the sample selected? _____________ __________________________ __________________________ _______________________ __________ 4. What were the exclusion exclusion criteria? _____________ _________________________ _________________________ _____________________ ________ 5. Were there any signi�cant differences between the study groups? _____________________ _____________________ _________________________________________________________________________ 6. What instruments instruments were used, and how was was constancy maintained maintained between groups? groups?_______ _________________________________________________________________________ 7. Which group group served as the control group? _______________ ____________________________ ________________________ ___________
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CHAPTER 8
Introduction to Quantitative Research
Activity 4
1. Is the design appr appropriate? opriate?
2. Is the control control consistent with the research research design?
3. Tink about the easibility o this study. study. What are some o the easibility challenges or this study?
5. What are are the threats to internal validity validity,, and how did the investigators investigators control or each?
6. What are are the threats to external validity, validity, and how did the investigators investigators control or each?
Activity 5: Web-Based Activity
grants awarded that would be considered quantitative or qualitative and are interested in determining i other nurse scientists sc ientists are working in your area o interest. Start at the NINR website and describe how you could use this site to get a sense o the qualitative/qua qualitative/quantitativ ntitativee ratio and the topics under study.
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CHAPTER 8
Introduction to Quantitative Research
43
awarded grant was qualitative or quantitative quantitative in nature? Read through the �rst 10 citations and
area o interest?
Note: URLs or websites may change. I you receive an error message at the URL listed above,
go to your avorite search engine and type in, “National Institute Institute or Nursing Research”; this should lead you to the desired site.
own university library. Go to your campus home page and type in “library,” then type in “research”” or “nursing research.” search research.” Tis can be an excellent e xcellent source or ull-text journals; however however,, they are usually password-protected, so you will need nee d to obtain a password rom your library to access them. Activity 6: Evidence-Based Practice Activity
ollowing statements is likely true, based on your reading, and describe how you agree or disagree with the statements. 1. I a study study discusses a population o o interest to you in the literature literature review section, but doesn’tt actually sample rom doesn’ rom your population o interest, that study would be useul use ul or answering your evidence-based practice problem.
2. Te study study you have selected tests an intervention. intervention. Te authors describe using a randomized-controlled trial design where all subjects have an equal chance to be in the control or intervention group, a manual was created to train the interventionists or this th is study,, and there was in-person training beore study be ore the intervention started that included role playing; interventions were recorded and 25% o the recordings were reviewed by the study team to assess consistency; ollowing the intervention, subjects perormed the skills taught in the intervention at the end o the teaching session and again afer 3 months o perormper orming the intervention independently. Te authors do not describe speci�cally h ow they knew
authors maintained intervention �delity?
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CHAPTER 8
Introduction to Quantitative Research
interested in did not produce a statistically signi�cant result. Would you include this study?
practice problem on this population?
POSTTEST
the major components o the research design.
a. Use your own words to state the purpose o the study.
b. What theoretical model did the authors base the study on?
c. Who are the subjects?
d. Who was excluded?
e. What instruments were used?
. How do the researchers attempt to control elements affecting the results o the study?
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CHAPTER 8
Introduction to Quantitative Research
45
2. Fill in the blanks by selecting rom the ollowing list o terms. Not all terms will be used.
Mortality Internal validity
Feasibility Selection bias Reliability Maturation
History
a. ___________________ is used to hold steady the conditions o the study. b. ___________________ is used to describe that all aspects o a study logically ollow rom the problem statement. c. Te believability between this study and the world at large is known as ___________________. d. Te developmental, biological, or psychological processes known as ___________________ operate within a person over time and may in�uence the results o a study. e. ime, subject availability, equipment, money, experience, and ethics are actors in�uencing the ___________________ o a study. . Selection bias, mortality, maturation, instrumentation, testing, and history in�uence the ___________________ o a study.
creates a situation known as ___________________.
REFERENCES and health practices on neonatal outcomes in low-income women. Research in Nursing & Health, 35, 112-120.
National Institute o Nursing Research. Retrieved November 20, 2012 rom http://ninr.nih.gov/.
motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39
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CHAPTER 9
Experimental and Quasi-Experimental Designs
9
Experimental and Quasi-Experimental Designs
INTRODUCTION
Tis chapter contains exercises or two categories o design: experimental and quasiexperimental. Tese types o designs allow researchers to test the effects o nursing actions and make statements about cause-and-effect relationships. Tereore, they can be very helpul in testing solutions to nursing practice problems. However, a researcher chooses the design that allows a given situation or problem to be studied in the most accurate and effective way possible. Tus, not all problems are amenable to immediate study by these two types o design. Rather, the choice o design is dependent on the development o knowledge relevant to the problem, plus the researcher’s knowledge, experience, expertise, preerences, and resources. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
46
designs.
based practice.
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CHAPTER 9
Experimental and Quasi-Experimental Designs
47
Activity 1
Fill in the blank or each o the ollowing descriptions with a term selected rom the list o types o experimental and quasi-experimental designs. Some terms may be used more than once and not all terms may be used. Afer-only Afer-only nonequivalent control group Experimental rue experimental
One-group Nonequivalent control group Solomon our-group ime series
1. ___________________ designs are particularly suitable or testing cause-and-effect relationships because they help eliminate potential alternative explanations (threats to validity)
2. Te type o design that has two groups identical to the true experimental design, plus an experimental afer-group and a control afer-group is known as a(n) ___________________ design. 3. A research approach used when only one group is available to study or trends over a longer period o time is called a(n) ___________________ design. 4. Te ___________________ design is also known as the post-test-only control group design in which neither the experimental group nor the control group is pretested. -
trol group, but was unable to conduct pretests or to randomly assign subjects to groups, the study would be known as a(n) ___________________ design.
6. Te ___________________ design includes three properties: randomization, control, and manipulation. 7. When subjects are unable to be randomly assigned into experimental and control groups but are able to be pretested and posttested, the design is k nown as a(n) ___________________ design. Activity 2
Review the study by Tomas et al. (2012) in Appendix A o the textbook, and then answer the ollowing questions.
Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
48
CHAPTER 9
Experimental and Quasi-Experimental Designs
3. One important condition o experimental designs is the relationship between the causal and effect variables.
Activity 3
Te education department in a large hospital wants to test a program to educate and change nurse’s attitudes regarding pain management. You have access to the ollowing questionnaires: the Quick Pain Survey (QPS), the Pain Knowledge and Attitudes Questionnaire (PKQ), the Headache Assessment ool (HA), and the Survey on Pain in the Elderly (SPE). Your responsibility is to design a study to examine the outcome o this intervention program. to
indicate which o the our groups receive the pretest and posttest pain questionnaire, and which receive the experimental teaching program. Pretest
Teaching
Posttest
Group A
__________
__________
__________
Group B
__________
__________
__________
__________
__________
__________
__________
__________
__________
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CHAPTER 9
Experimental and Quasi-Experimental Designs
49
Activity 4
1. You may be questioning why anyone would use a quasi-experimental design i an experimental design has the advantage o being so much stronger in detecting cause-and-effect
Activity 5: Web-Based Activity
1. Use your library access to enter PubMed or go to http://www.ncbi.nlm.nih.gov/pubmed/
type” unselect any article types that are chosen and scroll to the bottom. Select only “ran-
Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
50
CHAPTER 9
Experimental and Quasi-Experimental Designs
Activity 6: Evidence-Based Practice Activity
a research article provides. Review Figure 1-1 in the textbook, and determine the level o evidence or each o the ollowing. 1. A committee o neonatal experts at your local hospital issues an opinion paper
2. An advanced-practice oncology nursing society conducted an evidence-based study o systematic reviews and issued a clinical practice guideline about catheter inection prevention 3. A single phenomenological study o the lived experience o being homeless and pregnant 4. A large randomized controlled clinical trial 5. A single study that used a nonequivalent control group design
POSTTEST
a. _____
b. _____
Fify teen mothers are randomly assigned into an experimental parenting support group and a regular support group. Beore the program and at the end o the 3-month program, mother-child interaction patterns are compared between the two groups. Patients on two separate units are given a patient satisaction with care ques
c. _____ d. _____
e. _____
discharge. Te patients on one unit receive care directed by a nurse case manager, and the patients on the other unit receive care rom the usual rotation o nurses. Patient satisaction scores are compared. Students are randomly assigned to two groups. One group receives an experimental independent study program and the other receives the usual classroom instruction. Both groups receive the same posttest to evaluate learning. A study was conducted to compare the effectiveness o a music relaxation program with silent relaxation on lowering blood pressure ratings. Subjects were randomly assigned into groups and blood pressures were measured beore, during, and immediately afer the relaxation exercises. Reading and language development skills were compared between a group o children with chronic otitis media and a group o children without a history o ear problems.
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CHAPTER 9
Experimental and Quasi-Experimental Designs
51
-
amples. Use the numbers rom the key provided.
1 = Afer-only 2 = Afer-only nonequivalent control group 3 = rue experiment 4 = Nonequivalent control group 5 = ime series 6 = Solomon our-group
b. _____
c. _____
or both groups. Babies who tested positive on toxicology screening at birth are randomly assigned into groups to receive either routine care or a special public he alth nurse intervention program. Health outcomes are tested and compared at 6 months. A school nurse clinic is set up at one school. Health care outcomes are measured at the end o a year rom that school and compared with health outcomes at a comparable school that does not have a clinic.
receiving routine home health care or to one o two groups with a new diabetic teaching program. Patients in one o the control groups and in one o the teaching groups took a test o diabetic knowledge as soon as they were assigned to a group. Patients in the other two groups were not pretested. All patients completed a posttest at the conclusion o the 3-week program. A second high school without the program served as a control group. An
. _____
program was completed. rends in patient alls were summarized each week 1 year beore and or the
program.
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52
CHAPTER 10
Nonexperimental Designs
10
Nonexperimental Designs
INTRODUCTION
Nonexperimental designs can provide extensive amounts o data that may help �ll in the gaps ound in nursing research. Tese designs help us clariy, see the real world, and assess relationships between variables, and they can provide clues that direct uture, more controlled research. In this way, experimental, quasi-experimental, and nonexperimental designs complement each other. Each provides necessary components o our knowledge base. Nonexperimental designs allow us to discover some o the territory o nursing knowledge beore trying to rearrange parts o it. It can be the base on which knowledge is built and urther re�ned with quasi-experimental and experimental research. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
52
practice guidelines.
clinical practice guidelines. designs.
appear in research reports. guidelines.
analysis, integrative reviews, and clinical practice guidelines.
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CHAPTER 10
Nonexperimental Designs
53
Activity 1
diagram to �nd each answer. Te words will always be in a straight line. Tey may be read up or down, lef to right, right to lef, or diagonally. When you �nd one o the words, draw a
�nished, not all words will be used. Tere are no spaces or hyphens between the words in the
the terms will be used more than once to �ll in the blanks in the statements below. Experimental Design Puzzle
U I G Q
O I R W G E U W
C C U N
N
F O
I W
R
U O M C N K M W J
G I P U G Z C R O I J K X E E M I O K G U F G F V
U I E Q W H Y Q E R B Q F I Z U Q E J E O O C I O K K E N B H N P U E O U P Q N E W J
N X O I C X E H V O R R O R Z V Y U E M E I B H H O B Y N B Z W
Y C H I
W H I U Z R
M H G H U O O I I
E X P O
F
C O V F K C H E V
1. Tis type is better known or the breadth than the depth o data collected. ____________
3. Te main question is whether or not variables covary. ____________ 4. Tese words mean afer the act. ____________ 5. Tis eliminates the conounding variable o maturation. ____________ 6. Tis quanti�es the magnitude and direction o a relationship. ____________ 7. Collects data rom the same group at several points in time. ____________ 8. Can be surprisingly accurate i the sample is representative. ____________ 9. Uses data rom one point in time. ____________
presumed independent variable. ____________
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CHAPTER 10
Nonexperimental Designs
Activity 2 -
priate number in the list below.
Advantages
Disadvantages
Correlation studies
______________
______________
Cross-sectional
______________
______________
Ex post acto
______________
______________
______________
______________
Prospective
______________
______________
Retrospective
______________
______________
______________
______________
Advantages
Disadvantages
and data analysis.
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CHAPTER 10
Nonexperimental Designs
55
Activity 3
Each o the ollowing are descriptions o nonexperimental studies. For each example, determine the type o design used rom the list provided. Not all designs are used as examples, and some will be used more than once. C E
Correlation studies Cross-sectional Ex post acto
M
Methodological Meta-analysis
P R
Prospective Retrospective
Remember, some studies use more than one type o nonexperimental design. -
termine their priorities or health education classes and events. ype o design: _____
height and weight. Children were assessed yearly and were included in the study up to the age o 18 years; data was collected or 10 consecutive years. ype o design: ____
health-seeking behaviors. Te data was collected on one occasion. ype o design: ____
Medical records o 1,000 postpartum women were examined to determine dietary choices and the relationship o a vegetarian or vegan diet with inant birth weight. ype o design: ____
adults living in isolated rural areas. ype o design: ____
or relevance to the domain o content by a panel o eight experts using content validation. ype o design: ____
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CHAPTER 10
Nonexperimental Designs
-
tion on board exam pass rates in the nursing literature. Te study used statistical analysis
simulation on board pass rates. ype o design: _____ Activity 4
maternal-etal attachment, health practices during pregnancy, and neonatal outcomes. Te
1. ype o design: ____
Activity 5
I you wanted to test a relationship between two variables in the past such as the incidence o
Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 10
Nonexperimental Designs
57
Activity 6: Web-Based Activity
Tis activity will assist you in �nding nursing research survey instruments i you are considering gathering data or a nonexperimental survey study. Use two search engines (Google, Google
determine which is the most helpul to you.
the results you obtain.
e. Now place quotation marks around your search terms and search the ollowing: nurs
obtain.
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CHAPTER 10
Nonexperimental Designs
Activity 7: Evidence-Based Practice Activity
1. What is the value o nonexperimental studies, such as ones that demonstrate a strong rela
a. None b. Tey provide evidence only or training purposes.
regarding changes in practice. d. Tey lend support or attempting to in�uence the independent variable in a uture intervention study. 2. Which o the ollowing nonexperimental designs provides a quality o evidence or evidence-based practice that is stronger than the others, because the researcher can deter
a. Cross-sectional
3. When you, the research consumer, are using the evidence-based practice model to consider a change in practice, you will initially make your decision based on the strength and quality o evidence provided by the meta-analysis. Following this, what other two characteristics
a. b. c. d. e.
Clinical expertise Patient values Te strength o the evidence Te quality o the evidence Te literature review
POSTTEST
Choose rom among the ollowing words to complete the posttest. Each word may be used one time; however, this list duplicates some words because they are used in more than one answer. Comparative Correlational Cross-sectional Cross-sectional
Exploratory Ex post acto Interrelational
Methodological Prospective Prospective
Retrospective Retrospective
Variables
Retrospective
1. In comparative surveys, the researcher does not manipulate the ___________________, but assesses data in order to provide evidence or uture nursing intervention studies. 2. ___________________ is the broadest category o nonexperimental design. 3. Te category rom item #2 can be urther classi�ed as ___________________, ___________________, and ___________________.
Haber, includes ___________________ studies.
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CHAPTER 10
Nonexperimental Designs
59
5. Te researcher is using ___________________ design when examining the relationship between two or more variables. 6. ___________________ designs have many similarities to quasi-experimental designs. 7. ___________________ design used in epidemiological work is similar to ex post acto.
a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ 9. ___________________ studies collect data at one point in time, while
present events to events that have occurred in the past.
12. Te ___________________ researcher is interested in identiying an intangible construct
protocol. REFERENCE
and health practices on neonatal outcomes in low-income, urban women. Research in Nursing & Health, 35
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CHAPTER 11
Systematic Reviews and Clinical Practice Guidelines
11
Systematic Reviews and Clinical Practice Guidelines INTRODUCTION
Systematic reviews and clinical practice guidelines that assess multiple studies based on a single clinical question are an important element in many evidence-based practice problems. Tese studies provide an important means or organizing and analyzing the quality, consistency, and quantity o research �ndings. Tus, it is important to have an understanding o the differences between the types o systematic reviews and clinical guidelines and to develop critiquing skills, so that when you �nd meaningul results or your clinical question, you can have a solid oundation or understanding the conduct and content o these studies. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
Activity 1
Fill in the blanks or the ollowing statements. 1. A(n) _______________________ is a orm o ________________________; however, the statistical analysis inherent in this type o study differentiates it rom other broad categories o reviews. 2. A(n) __________________ is the most general category o review and synthesizes the �ndings o quantitative or qualitative studies without using a statistical analysis. 3. A(n) ___________________ provides Level I evidence. 4. Statements or recommendations that are systematically developed or clinicians are known as _______________________.
_______________________ are developed using a scienti�c process.
60
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CHAPTER 11
Systematic Reviews and Clinical Practice Guidelines
61
Activity 2
and provide your reasoning about which components add to or ul�ll the ollowing qualities o a high-quality systematic review.
________________________________________________________________
_________________________________________________________________________ 2. ransparency and reproducibility: _____________________________________________ _________________________________________________________________________ 3. Rigorous search: ___________________________________________________________ _________________________________________________________________________ 4. Validity assessment:_________________________________________________________ _________________________________________________________________________ 5. Systematic presentation: _____________________________________________________ _________________________________________________________________________ Activity 3
All o the ollowing statements are about systematic reviews and clinical guidelines. For each statement, determine the type(s) o reviews or guidelines described by the statement and write
by more than one type o review or guideline. SR MA IR
Systematic review Meta-analysis Integrative review
1. A summary o studies, systematically ound in the literature; ocuses on a clearly stated question with a critical appraisal o the �ndings in a that area 2. A method or searching and integrating the literature related to a speci�c clinical issue 3. A review that uses statistical methods to assess and combine studies o the same design 4. May review research literature, theoretical literature, or both. May include quantitative and/or qualitative research
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CHAPTER 11
Systematic Reviews and Clinical Practice Guidelines
5. Statements or recommendations that link research and practice to guide practitioners
evidence table showing the quality and strength o the evidence upon which the guideline is based
effect
quality and applicability to practice
10. Te broadest category o review
Activity 4: Web-Based Activity
Tis activity will assist you in �nding a clinical guideline online.
org. b. Using the tabs at the top o the page, click on “All about SBS/AH.”
1. What type o clinical guideline is this? What is your rationale or your answer?
2. What group was this guideline developed or?
3. What was the purpose o this guideline?
4. How does this guideline apply to clinical practice?
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CHAPTER 11
Systematic Reviews and Clinical Practice Guidelines
63
Activity 5: Evidence-Based Practice Activity
1. What is the value o systematic reviews in evidence-based practice? List at least three.
2. You have a strong meta-analysis and other supporting literature on your clinical question. What else do you need to consider beore you might think about a change in clinical practice?
3. When you, the research consumer, are evaluating a meta-analysis to consider a change in practice, which two o the ollowing characteristics are most important to consider when critiquing the evidence? a. Te number o authors in the study b. Te strength o the evidence c. Te readability o the literature review d. Te quality o the evidence e. Inclusion o patient preerence in the study
center column rom the ollowing list: Systematic review o qualitative studies, A
Level of Evidence
Description
Level I Level II Level III Level IV Level V Level VI Level VII
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Source
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CHAPTER 11
Systematic Reviews and Clinical Practice Guidelines
POSTTEST
Fill in the blanks to complete the posttest. 1. ____________ _________________________ __________________ _____ is the broadest category o o review. review. 2. A systematic review is a summary o the ___________________ ___________________ research literature literature on a ocused clinical question.
uses statistical methods or the analysis o studies.
4. In a systematic review, review, it is important that _______________ _______________________ ________ independently evaluates and critiques the studies included and _________________ in the review. 5. A(n) ______________ _________________________ ___________ provides the ______________ ___________________________ ___________________ ______ because it analyzes and integrates the results o many studies.
________________ ___________ _____ o the studies.
7. It isis important or a consumer consumer o the literature literature to evaluate evaluate systematic reviews or potential potential ______________. 8. A(n) ____________________ ______________________ is a graphic graphic depiction o the results results o a number o studies; it can also be called a(n) ________________________. ________________________. 9. ________________________ ________________________ guidelines are developed using a scienti�c process including including a rigorous literature literature search, completion o an evidence table, and summary o the qual
_______________________.
10. A researcher who conducts a systematic review __________________ __________________ conduct conduct the studies used in the review, rather, rather, they use data rom _________________ and synthesize the inormation ollowing a set o systematic methods or combining evidence. REFERENCE -
shake.org.
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CHAPTER 12
Sampling
65
12
Sampling
INTRODUCTION
Sampling is a process o selection in which individuals, objects, animals, or events e vents are chosen to represent the population o a study. study. Te ideal sampling s ampling strategy strategy is one in which the elements e lements truly represent the population being studied while controlling or any source o bias. Te speci�c research question(s) determine(s) the selection o the sample, variables to measure, and a sampling rame. Te sampling strategies are important important and should enable the choice o a sample that represents the target population and controls or bias as much as possible to ensure that the research will be valid. Reality modulates the ideal with the consideration o sampling in relation to efficiency, practicality, practicality, ethics, and availability o subjects, which can c an alter the ideal strategy or a given study. LEARNING OUTCOMES
On completion o this chapter, chapter, you should be able to do the ollowing:
popula population, tion, sample, sample, and sampling. and pro nonprobability and probabili bability ty sampling. sampling. -
pling strategies.
o evidence provided by study �ndings.
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65
66
CHAPTER 12
Sampling
Activity 1
words.
1. Sample: ____________ ________________________ _________________________ __________________________ __________________________ ________________ ___ Population: Popula tion: ____________ __________________________ ___________________________ __________________________ ________________________ ___________
__________________________ _____________ _________________________ _________________________ _________________________ ____________
2. arget population: ____________ _________________________ __________________________ ___________________________ ____________________ ______ Accessible population: ___________ ________________________ __________________________ __________________________ __________________ _____
__________________________ _____________ _________________________ _________________________ _________________________ ____________
_________________________ ____________ __________________________ __________________________ ____________________ _______
_________________________ _____________ _________________________ __________________________ ____________________ _______
__________________________ _____________ _________________________ _________________________ _________________________ ____________
Activity 2
Key:
P = Probability sampling N = Nonp Nonprobability robability sampling
b. _____ c. _____ d. _____
Purposive sampling Simple random sampling Quota sampling
. _____
Strati�ed random sampling
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CHAPTER 12
Sampling
67
Activity 3 -
lowing list. Write a letter that corresponds to the strategy in the space preceding the sampling
b. c. d. e.
Quota sampling Purposive sampling Simple random sampling Strati�ed random sampling
-
reate nursing students consisted o students enrolled in junior- and senior-level
to participate until a total sample representing 10% o the junior-level students and 10% o the senior-level students was obtained.
-
list o all patients giving birth in the county during the �rst 6 months o the year. consisted o cognitively impaired people with no physical impairments or other psychiatric illness.
charged home within the last 6 months.
6. _____
participants. Te patients were randomly assigned using a computer-based program into one o two groups. o study the educational opportunities or nurses in various ethnic groups, a list sisted o 10% o the nurses in each ethnic group, selected according to a table o random numbers.
inants and a control group o 83 inants. A computer program that generated random numbers made assignment to intervention or control group.
Activity 4
Yes
No
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68
CHAPTER 12
Sampling
Yes
No
Maybe
2. List one advantage o using the sampling strategy described in this study.
3. List one disadvantage o using the sampling strategy described in this study.
Activity 5 -
ments are rue () or False (F). 1. _____ population. 2. _____ sel-selection o subjects. 3. _____ Nonprobability sampling strategies are more time-consuming than probability strategies. 4. _____ _____
population increases. 6. _____ 7. _____
-
pling strategies listed. Strati�ed random sampling uses a random selection procedure or obtaining sample subjects.
Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 12
Sampling
69
Activity 6 -
tique the sampling process used in this study. Reer to the study by Tomas et al. (2012) in
had a concurrent cognitive or psychiatric condition or substance abuse problem that would pre vent adherence to the protocol, had severe pain unrelated to their cancer, or resided in a setting where the patient could not sel-administer pain medication (e.g., nursing home, board and care acility). Te study was approved by the institutional review board and research committee at each o the sites. o test the interaction o time (change in scores rom pre- to post-study) by
in Figure 1, o the 1,911 patients who were screened, 406 were eligible to participate, 322 pro vided written inormed consent, and 289 completed baseline assessments afer being random
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70
CHAPTER 12
Sampling
Activity 7: Web-Based Activity http://www.census.gov
down that percent.
i on the lef side o the screen.)
Activity 8: Evidence-Based Practice Activity evidence-based practice as the integration o best research evidence with clini
to improve practice outcomes with individuals, amilies, and other health care proessionals.
Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 12
Sampling
71
this question.)
POSTTEST
2. Sampling strategies are grouped into two categories: ___________________ sampling and ___________________ sampling. 3. ___________________ sampling is the use o the most readily accessible people or objects as subjects in a study. -
ness, but the disadvantage is the labor in drawing a sample.
-
ment o subjects to treatment groups.
those o the population.
7. ___________________ criteria are used to select the sample rom all possible units and ___________________ may be used to restrict the population to a homogenous group o subjects. 8. ypes o nonprobability sampling include ___________________, ___________________, and ___________________ sampling. 9. Successive random sampling o units that progress rom large to small and meet sample eli
occurs (new data no longer emerge during data collection).
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Sampling
REFERENCES Research in Nursing & Health, 35, 164-177.
motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39 (1), 39-49. http://www.census.gov.
Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 13
Legal and Ethical Issues
73
13
Legal and Ethical Issues
INTRODUCTION
Patient advocacy is one o the primary roles o a proessional nurse. Nowhere is this more important than in the �eld o research. Te nurse must be a patient advocate, whether acting as the researcher, a participant in data-gathering, a provider o care or research subjects, or a research consumer. A multitude o legal and ethical issues exist in research; nurses must be aware o, assess, act on, and evaluate these issues. In addition, nurses need to be knowledgeable about the purpose and unctions o the institutional review board (IRB) and the ederal regulations on which they are based. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
use o human subjects in research.
considerations. manner.
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73
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CHAPTER 13
Legal and Ethical Issues
Activity 1
Fill in the blanks with the correct term rom the ollowing list (not all o the terms will be used). Bene�cence
Institutional review board HIPAA
Justice Nursing research committee Unauthorized research Unethical research study
1. ___________________ reviews proposals or scienti�c merit and congruence with the institutional policies and missions. 2. ___________________ reviews research proposals to assure protection o the rights o human subjects. 3. Te idea that human subjects should be treated airly and should not be denied a bene�t to which the subject is entitled is ___________________. 4. A study o existing data that is o minimal risk to subjects may be a candidate or a(n) ___________________. 5. Te U.S. Public Health Service studied the effects o untreated syphilis on AricanAmerican sharecroppers in uskegee, Alabama, and withheld penicillin treatment even afer penicillin was commonly available. Tis is considered a(n) ___________________.
create standards or electronic data exchange ___________________.
Activity 2
List the three ethical principles relevant to the conduct o research involving human subjects. Tese were included in the Belmont Report (1979) and ormed the basis or regulations affecting research sponsored by the ederal government. 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________
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CHAPTER 13
Legal and Ethical Issues
75
Activity 3
Read the ollowing example o a research consent orm. Ten review the list o the elements o inormed consent that ollows the example. For each item in the list o elements o inormed consent, put either a “√” i the element is included in the consent or a “0” i it is absent rom the consent. Summarize your �ndings in a paragraph at the end o the exercise. Research Consent Form Agreement to Participate in Research Responsible Investigator itle of Protocol: A web-based interactive program to engage nurses in learning
o pain management
principles
We are recruiting nursing students to test a web-based interactive program to engage nurses in learning principles o pain management. Tere are three learning outcomes or this pro
management o side effects o pain management, and (3) to provide accurate and complete patient teaching regarding pain and side effect management. At the end o the simulation, you will receive 3 scores, one or how well you managed patient care in each o these areas. It will take about 30 minutes to complete the simulation. Te simulation is available online at http://www.cdl.edu/painless. You can complete the simulation as many times as you like; each time you will be presented with a new set o variables or the patient, Mr. Sanchez. Te variables are programmed to appear randomly. We hope that this activity will enhance your knowledge related to providing pain management or your patients. Tere are no known risks or participation. I you agree to participate, we welcome you and would like you to complete a pre- and posttest, as well as a short evaluation orm afer you complete the simulation. Your participation is voluntary, and you may withdraw at any time and or any reason. Tere is no penalty or not participating or withdrawing. Te personal bene�ts or participation include assisting aculty and yoursel to understand more about the effectiveness o this innovative educational intervention and to increase your knowledge. Tere are no costs to you or any other party. I will ask you to print a copy o your scores rom the simulation, and complete the pre- and
character string and will not be identi�ed with you personally. Tere is no risk to you.
-
stand that your participation is voluntary and that choosing not to participate in this study, or in any part o this study, will not affect your relations with San Jose State University. You may reuse to participate in the entire study or in any part o the study; you are ree to withdraw at any time without any negative effect on your relations with San Jose State University. Te results o this study may be published, but any inormation that could result in your
Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
76
CHAPTER 13
Legal and Ethical Issues
Tis project has been reviewed and approved according to the San Jose State University Human Subjects Institutional Review Board procedures governing human subjects research. Your signature indicates that you have been ully inormed o your rights and voluntarily agree to participate in this study. You will be given a copy o this signed orm. By signing this orm, I agree to participate in this study. ______________________
______________________
Elements of Informed Consent
1. 2. 3. 4.
_____ _____ _____ _____
itle o protocol Invitation to participate Basis or subject selection Overall purpose o the study
7. _____
Potential bene�ts
9. 10. 11. 12. 13.
Financial obligations Assurance o con�dentiality In case o injury compensation HIPAA disclosure Subject withdrawal
_____ _____ _____ _____ _____
16. _____
Identi�cation o investigators
Activity 4
extra protection as research subjects.
1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________
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CHAPTER 13
Legal and Ethical Issues
77
Activity 5
Match the violation o ethical principle described rom the ollowing list with the examples presented below. More than one violation may have occurred in the examples that are cited. List all that were violated.
b. c. d. e. . g.
Subjects not inormed they could withdraw rom study at any time Subjects not inormed or offered the effective treatment that was available Lack o inormed consent No evidence o IRB approval prior to start o research Right to air treatment and protection Principles o inormed consent violated or incomplete disclosure o potential risk, harm, results or side effects was given
1. Write the letter(s) describing violation afer the description o the study. -
ing psychotropic medications o 50 patients under treatment or schizophrenia. wentythree subjects suffered severe relapses afer their medications were stopped. Te goal o the study was to determine i some schizophrenics might do better without medications that had deleterious side effects. Patients were not inormed that their symptoms could worsen or about the severity o a potential relapse. _________________ 2. List the letter(s) that correspond(s) to the ethical violation(s) listed. Te United States Public Health Service conducted a study rom 1932-1973 on two groups o poor Arican-American male sharecroppers. One group had untreated syphilis and the other did not. reatment was withheld rom the group diagnosed with syphilis, even afer it became generally available and known to be effective. Steps were taken to prevent inected subjects rom obtaining penicillin. Te researchers wanted to study the effects o untreated syphilis. _________________ Activity 6
Tis activity assesses the utilization o procedures or protecting basic human rights. Review the
was obtained, and whether the author described obtaining permission rom the institutional review board.
1. Tomas et al. (2012): ________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 2. Alhusen et al. (2012): _______________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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3. Seiler & Moss (2012): _______________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 4. Melvin et al. (2012):_________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Activity 7: Web-Based Activity www.dontshake.org.
1. Identiy the source o this website.
2. What populations are served by this organization?
3. What are some special legal and ethical research considerations or this population?
Activity 8: Evidence-Based Practice Activity
You are a nurse working in a postpartum unit. I you decided to make a change in your practice based on an evidence-based practice article, but �rst wanted to check to be certain that no misconduct had occurred in the conduct or reporting o the study, where would you �nd this inormation?
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POSTTEST
1. It is necessary or researchers and nurses to protect the basic human rights o vulnerable
Yes, because _______________________________________________________________ No, because _______________________________________________________________ 2. A researcher must receive IRB approval (beore / afer) beginning to conduct research in volving humans.
which documents would you want to see that demonstrate approval rom which group(s)? __________________________________________________________________
4. Should a researcher list all the possible risks and bene�ts o a participating in a research study even i some people may reuse because these items are listed in detail? Yes
No
___________________.
6. What are two o the risks o scienti�c raud or misconduct? _________________________ _________________________________________________________________________
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14
Data Collection Methods
INTRODUCTION
Observe, probe Details unold Let nature’s secrets Be stammeringly retold.
—Goethe
Te ocus o this chapter is basic inormation about data collection. As a consumer o research, the reader needs the skills to evaluate and critique data collection methods in published research studies. o achieve these skills, it is helpul to have an appreciation o the process or the critical thinking “journey” the researcher has taken to be ready to collect the data. Each o the preceding chapters represented important preliminary steps in the research planning and designing phases prior to data collection. Although most researchers are eager to begin data collection, the planning or data collection is very important. Te planning includes identiying and prioritizing data needs, developing or selecting appropriate data collection tools, and selecting and training data collection personnel beore proceeding with actual collection o data. Te �ve types o data collection methods differ in their basic approach and in the strengths and weaknesses o their characteristics. Readers should be prepared to ask questions about the appropriateness o the measures chosen by the researcher to gather data about the variable o concern. Tis includes determining the objectivity, consistency, quanti�ability, observer inter vention, and/or obtrusiveness o the chosen data collection method. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
80
research study.
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Activity 1
Review each o the articles reerenced below. Be especially thorough in reading the sections that relate to data collection methods. Answer the questions in relation to what you understand rom the article. For some questions, there may be more than one answer. Study 1
Tomas et al., 2012 (in Appendix A o the textbook). 1. Which data collection method(s) is/are used in this research study? a. A physiological measure b. An observational measure c. An interview measure d. A questionnaire measure e. Records o available data -
nation do the investigators provide?
Study 2
Alhusen et al., 2012 (in Appendix B o the textbook). 1. Which data collection method is used in this research study? a. A physiological measure b. An observational measure c. An interview measure d. A questionnaire e. Records o available data 2. Rationale or appropriateness o data collection method:
Study 3
1. What data collection method is used in this research study? a. A physiological measure b. An observational measure c. An interview measure d. A questionnaire e. Records o available data 2. What were the strengths o using this method?
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Study 4
Melvin et al., 2011 (in Appendix D o the textbook). 1. What data collection method is used in this research study? study? a. A physiological measure b. An observational measure c. An interview measure d. A questionnaire e. Records o available data 2. Describe the data collection.
3. What are two two possible problems problems with sel-report methods that that might have affected affected the responses given by participants? How did the researchers try to be sensitive s ensitive to trauma and obtain accurate responses?
Activity 2
Answer the questions below, and �nd the words in the puzzle.
1. Baccalaureate-pr Baccalaureate-prepared epared nurses are _____________ ___________________ ______ o research. 2. ___________________ ___________________ methods use technical instruments to collect data about patients patients’’ physical, chemical, microbiological, or anatomical status. 3. ____________ ___________________ _______ is the distortion o o data as as a result o the observer’s observer’s presence.
are important.
5. ___________________ ___________________ data data collection method is subject to problems problems o availability availability,, authenticity, and accuracy. 6. ___________________ ___________________ measurements are are especially useul when there are a �nite number number o questions to be asked and the questions are clear and speci�c. 7. Essential in the critique o data collection methods is the emphasis on on the approp appropriateness, riateness, ___________________, ____________ _______, and ___________________ o the method me thod employed. 8. ___________________ ___________________ raises ethical questions (especially inormed consent issues); issues); thereore, it is not ofen used in nursing. 9. ___________________ ___________________ ____________ ___________________ _______ is the consistency o observations between two or more observers. Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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10. ___________________ ___________________ is the process o translating translating the concepts/variables into into measurable phenomena. 11. ___________________ ___________________ is a ormat that that uses closed-ended items, and there are a �xed number o alternative responses. 12. ___________________ ___________________ is the method or objective, systematic, and quantitative quantitative description o communications and documentary evidence. 13. Tis exercise is supposed supposed to be ___________________! ___________________! D E L V E S S A A B A W O P E G S N O R N S Y S E F L K E F A K S A H U A Y B E B H P O N E R O Y B K E R E Y O D A V S B R A R E S O B M E X U E A E V V N Y E S S H A P P X E Y E A U Y A B L E A A K E V A
R S N R A N E M A R L E R A R N D S U G Q U E A E A L N E N D E B B O L
A S S E F O R K A Z O N A L Z V E R B Y D N E A J H B S A L E E R R S N O V N O A M A P V E E M A H V W K A N A L Y S S S R S A D V K A P B O E S O N N A R H L L R E A L A E O O D A D S G N O S E R V E W S E S S P A A L P H A O S A N D L D O N N E A L M E N K E A B O
Y O A A S O A P
E S U D Y U U
P V A N O R E A O A R G D P S N M O N S
S P A P E O N X B V S E A E R L R R V A D A O E E R G O R E N E S O L O V O E A F R B U N N V L A R O U M Y
S O B J E
V
Y
O N S U M E R R S
Activity 3
You are reviewing a study, and concealment is necessary; in other words, there is no other way to collect the data, and the data collected will not have negative consequences or the subject. 1. Name at least one population where concealment is not not uncommon.
2. How would you obtain subjects’ consent?
3. What is the major major reason or using concealment?
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Activity 4
You are asked to participate in discussions about impending research in your community. community. Te purpose o the study is to identiy the health status, belies, practices, preventive services currently known and used, and accessibility/availability o health service needs or the residents o your rural community community..
collection method. Review each method and discuss the pros and cons or choosing a speci�c data collection method. State your rationale or your �nal selection. What would be your thinking about instruments and types?
Activity 5
Some questions will have more than one answer answer..
1. What is a primary advantage o physiological measures? a. Te measuring tool never affects the phenomena being measured.
d. Teir objectivity objectivity,, sensitivity sensitivity,, and precision e. All o the above
2. Sel-report measures are usually usually more useul than observation measures in obtaining inorinormation about which o the ollowing? a. Socially unacceptable or private behaviors
c. When the researcher is interested in character traits d. All o the above
3. Which o the ollowing would be considered disadvantages disadvantages o using observational data collection methods?
b. Ethical concerns may be increasingly signi�cant signi�cant to researchers using observational data collection methods. d. All o the above
collection? a. Whenever expense is a concern or or the researcher b. When a researcher is interested in obtaining obtaining inormation inormation directly directly rom the subjects c. When the researcher researcher needs to collect data rom rom a large large group group o subjects who are are not easily accessible d. When accuracy is o the utmost importance to the researcher Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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5. Which o the ollowing would be considered advantages o using existing records or available data to answer a research question? a. Te use o available data reduces the risk o researcher bias in data collection. b. ime involvement in the research study can be reduced by the use o available records or data.
trends. d. All o the above
Activity 6: Web-Based Activity
Go to your library home page. Select your avorite database (some to try: PubMed, Scopus, ment” AND “tool” AND “development.” How many nursing-speci�c assessment tools can you identiy in the �rst 20 citations? What was the ocus o the different tools? Did you see any tools you are amiliar with? Now choose an area o nursing that you are interested in and search or data measurement tools in that area. Some potential topics include all prevention, pressure ulcers, depression, inection, anxiety, quality o lie, pain, and satisaction. Activity 7: Evidence-Based Practice Activity
use in your practice.
1. What were some o the methods used in studies included in this review? Were the methods appropriate?
2. Would you change your practice based on the evidence provided in this study? Explain your answer.
3. Afer looking at the Results and Discussion sections o the article you reviewed, how would you improve the data collection methods o the studies under review to strengthen the evidence?
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POSTTEST
Read each question thoroughly and then circle the correct answer. 1. What is the process o translating concepts that are o interest to the researcher into observable and measurable phenomena? a. Objectivism b. Systematization c. Subjectivism d. Operationalization 2. Answering research questions pertaining to psychosocial variables can best be answered by using which data-gathering technique(s)? a. Observation
c. Questionnaires d. All o the above
a. b. c. d.
repetition. dualism. consistency. recidivism.
a. b. c. d.
intrarater reliability. interrater reliability. consistency reliability. repetitive reliability.
5. Physiological and biological measurement might be used by nurse researchers when studying which o these variables? (Select all that apply.)
b. Hypertensive clients’ responses to a stress test
d. Te degree o pain relie achieved ollowing guided imagery 6. Scienti�c observations should ul�ll which o the ollowing conditions? a. Observations are consistent with the study objectives. b. Observations are standardized and systematically recorded. c. Observations are checked and controlled. d. All o the above
shelter and occasionally stayed overnight. Te people staying in the home were told that this person was conducting a research study. Te researcher reely engaged in conversation and openly observed the homeless. What is the observational role o the researcher?
c. No concealment without intervention d. No concealment with intervention
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a. b. c. d.
Extensive �eld notes are recorded. Subjects are inormed what behaviors are being observed. Te researcher requently records interesting anecdotes. All o the above
9. Which o the ollowing is not consistent with a Likert scale?
10. Although it is acceptable to use multiple instruments within a research study, the study is more acceptable i only one method is used or the data collection. a. rue b. False 11. Social desirability is seldom a concern or researchers when the data collection method used in the study is interviews. a. rue b. False 12. A researcher desires to use a questionnaire in a study but cannot �nd one that will gather the inormation desired about a particular variable. Te decision is made to develop a new instrument. Which o the ollowing should the researcher do? a. De�ne the construct, ormulate the items, and assess the items or content validity b. Develop instructions or users and pilot the instrument c. Estimate reliability and validity d. All o the above 13. Te researcher who invests signi�cant amounts o time in the development o an instrument has a proessional responsibility to publish the results. a. rue b. False
be observed in the written research report?
b. Te problems o bias and reactivity are addressed with observational measures c. Tere is a clear explanation o how interviews were conducted and how interviewers were trained d. All o the above
subjects received the same inormation and data was collected rom all participants in the same manner. a. rue b. False
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REFERENCES ment and health practices on neonatal outcome in low-income, urban women. Research in Nursing & Health, 35, 112-120. stress symptoms in US Army couples: Te role o resilience. Research in Nursing & Health, 35,
Seiler, A., & Moss, V. A. (2012). Te experiences o nurse practitioners providing health care to the homeless. Journal o the American Academy o Nurse Practitioners, 24, 303-312. Tomas, M. L., Elliott, J. E., Rao, S. M., et al. (2012). A randomized clinical trial o education or motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39
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CHAPTER 15
Reliability and Validity
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15
Reliability and Validity
INTRODUCTION
I a riend tells you, “Hey, I ound a new restaurant that you will really love,” you will consider that inormation rom at least two perspectives beore you spend your money there. First, does this person understand your taste in ood? Second, has this person given you good inormation about ood in the past? You answer “no” to the �rst question. You preer seaood served in an elegant setting, and your riend preers pizza served in a place with sawdust on the �oor. Using this inormation, you will consider your riend’s opinion to be invalid or you. You will never give this restaurant another thought. But i you answer “yes” to the �rst question because you share similar tastes in ood, you will move on to the second question. You remember the tough ettuccini, the superb Southern ried chicken, the unbaked pizza dough, and the hockey-puck biscuits rom earlier recommendations. It is likely that while you and your riend share ood preerences, her inormation is not reliable. You can’t trust her to give you good inormation over time. I you are eeling like an adventure, you may try the new restaurant or you may not. Validity and reliability o the data collection instruments used in a study are to be regarded in the same way that you would consider your riend’s advice about restaurants. Is the instrument valid? Does it provide me with accurate inormation? Is the instrument reliable? Does it provide me with consistent inormation whenever it is used? Consideration o both validity and reliability in�uences your con�dence in the results o the study. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
reliability. validity. Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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-
ity o evidence provided by the �ndings o a research study and applicability to practice.
Activity 1
Either random error (R) or systematic error (S) may occur in a research study. For each o the ollowing examples, identiy the type o measurement error and how the error might be corrected. 1. _____ Te scale used to obtain daily weights was inaccurate by 3 lbs. less than actual weight. Correction: _______________________________________________________________ 2. _____
Students chose the socially acceptable responses on an instrument to assess attitudes toward AIDS patients.
Correction: _______________________________________________________________ 3. _____
Conusion existed among the evaluators on how to score the wound healing.
Correction: _______________________________________________________________ 4. _____
Te subjects were nervous about taking the psychological tests.
Correction: _______________________________________________________________
Activity 2
Validity is the extent to which a measurement tool actually measures the concepts it is supposed to measure. Use the terms rom the ollowing list to complete each o the items in this activity. (Not all terms will be used, and some terms may be used more than once.) Concurrent validity Construct validity Divergent validity Hypothesis testing Context experts
Content validity Convergent validity Content validity index Multitrait-multimethod approach Face validity
Contrasted groups Criterion-related validity Factor analysis Predictive validity
1. __________________ o the instrument was evaluated by exploratory actor analysis (EFA) and con�rmatory actor analysis (CFA). Samples sizes or EFA and CFA were 632 and 578, respectively. 2. ___________________ is a rudimentary type o validity testing where colleagues, experts, or subjects read the instrument to evaluate i it re�ects the concept the researcher is trying to measure. 3. “_____________________ was established by clinical experts and pregnant women” (Alhusen et al., 2012). Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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4. Te authors and six doctoral students developed a one-page questionnaire entitled “ravel Health.” Occupational health nurses (n = 10) with graduate-level training and experience in travel health rated the scale’s items or relevance to the construct and a _________________ was calculated using the average o the responses rom the experts. 5. Te current study showed that when the Fatigue Symptom Scale and the IRED Scale were given to the same subjects and a correlational analysis was perormed, there was ____________________________ based on the positive correlation between both measures o the concept o atigue. 6. Construct validity, an assessment o the relationship between the instrument and the underlying theory, can be measured in several ways. List three o these: ___________________, ___________________, and ___________________. 7. An instrument is being developed to measure physical activity in knee injury patients. Te instrument was administered to a group o patients the day beore surgery and another group o patients 6 months afer surgery. A t groups. Tis is a ___________________________ test o construct validity. Activity 3
An instrument is considered reliable i it is accurate and consistent. I the concept be ing studied is stable, the same results should occur when measurement is repeated. 1. Tree concepts related to reliability include __________________, _________________, and __________________. 2. Give an example o each o the two types o tests or stability.
3. In what instance would it be better to use an alternate orm rather than a test-retest measure or stability?
4. Homogeneity is a measure o internal consistency. All items on the instrument should be complementary and measure the same characteristic or concepts. For each o the ollowing examples, identiy which o the ollowing tests or homogeneity is described: (1) Item-total correlations (2) Split-hal reliability (3) Kuder-Richardson (KR-20) coefficient (4) Cronbach’s alpha a. _____ Te odd items o the test had a high correlation with the even numbers o the test. b. _____ Each item on the test using a 5-point Likert scale had a moderate correlation with every other item on the test. c. _____ Each item on the test ranged in correlation rom 0.62 to 0.89 with the total. d. _____ Each item on the true-alse test had a moderate correlation with every other item on the test. Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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5. Review the ollowing inormation about one o the instruments used in the study in Appendix D o the text: “Post-traumatic stress symptoms (PSS). For this study, PSS was operationalized as an individual’s endorsement o symptom items on the PSD Checklist (PCL), including problems with sleep, avoidance, memory, concentration, emotional connections, or mood. Tis measure consists o 17 items, scored on a 5-point Likert-type scale, regarding severity o various symptoms diagnostic o PSD. Te PCL has been widely used in both military and civilian populations to measure the prevalence o presumed PSD and or group comparisons on levels o PSS. Cronbach’s α reliabilities have ranged rom 0.92 in civilians to 0.97 in military populations. Validity has been supported by the statistically signi�cant correlations between PCL scores and the Clinician-Administered PSD Scale. Te PCL scores range rom 17 to 85, with higher scores indicative o greater PSS. Recent
screen or levels o PSS high enough to cause interpersonal problems. In many studies, the agnosis o PSD, we chose to use the more sensitive lower number or this study, to capture more variability in levels o PSS. Te Cronbach’s α was 0.96 in our sample.” a. What is a Likert scale? How would you expect items on the PCL to look based on your knowledge o a Likert-type scale?
b. What inormation is given to the reader about the PCL?
c. How does this inormation in�uence your level o con�dence in the results o this study?
Activity 4: Web-Based Activity
In this activity you will complete a search or instruments used to measure a nursing concept o interest to you. For this search you will use the PubMed database. You can complete the search even without library access; you just may have difficulty accessing the contents o the articles you �nd. Start at your library webpage and access PubMed or go to www.ncbi.nlm.nih.gov/ pubmed. I you have never completed a search using MeSH terms, ollow the link to the MeSH database rom the PubMed main page to learn more about MeSH terms and ollow the link to “help” with using MeSH. Most good searches use more than one MeSH term. 1. Tink o a nursing concept you are interested in, and look it up in the MeSH database to
2. Search or your term combined with one or two o the ollowing terms to �nd instruments related to your interest (choose the terms closest to your interest): psychometrics, questionnaires, outcome assessment, pain measurement, checklist, assessment, health care sur vey, health survey, validation studies, process assessment, patient satisaction, methodology (or any other term you can think o). I you �nd too many results, try adding another search Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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term to narrow your search. I you �nd no results or a ew results that don’t match your interest, try to make your search less speci�c (use the MeSH dictionary to �nd a term less speci�c than your term using the MeSH categories and subheadings). 3. I you know o an instrument you are interested in, search or it by name. 4. Find the psychometric studies related to your instrument by searching or the ollowing terms or search strings combined with the name o the instrument you have ound: (reliability or reproducib* or inter rate or interrater or valid* or test retest or predictive or psychometric*) measure* (i.e., measures, measurement), assess* (i.e., assessment, assessed), sel-report, exercise, valid* (i.e., valid, validation, validity), reliab* (i.e., reliable, reliability), reproducible. Your search should include titles, abstracts, keywords, and ull texts. 5. Review what you have ound on the reliability and validity o your instrument with what you have learned in this chapter. Is this a well-validated instrument or a new instrument with little testing?
work with a librarian to learn how to use PubMed.
Activity 5
In this activity, you will use the critiquing criteria listed in Chapter 15 o the text to think about the Tomas et al. study in Appendix A o the text. 1. How many instruments or data collection were used in this study? 2. For the Functional Assessment o Cancer Terapy–General (FAC-G): a. What inormation on validity was included in the article?
b. Did the authors report on any tests o reliability?
c. Name some appropriate tests o reliability or this instrument.
d. Would a Kuder-Richardson-20 test be a good test o reliability? Why or why not?
e. Has this instrument been previously used in this population?
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. I you wanted inormation on validity, where would you look?
g. Where in the article would you look to see how the results o this study compared with FAC-G scores rom other studies?
Activity 6: Evidence-Based Practice Activity
Now think about the Alhusen et al. (2012) study. Look at the reliability and validity measures o the instruments used in the study. Assume you are a nurse who cares or neonates and their mothers. How would you use the results o this study to guide your practice?
POSTTEST
Using the ollowing terms, complete the sentences or the type o validity or reliability discussed. (erms may be used more than once.) Content Factor analysis Convergent Divergent Concurrent
est-retest Cronbach’s alpha Alternate or parallel orm Interrater
1. In tests or reliability, the sel-efficacy scale had a(n) _____________________ o 0.88, demonstrating internal consistency or the new measure. 2. Te ABC social support scale demonstrated _____________________ validity with correlation o 0.84 with the XYZ interpersonal relationships scale. 3. _____________________ validity was supported with a correlation o 0.42 between the ABC social support scale and the QRS loneliness scale. 4. Te investigator established _____________________ validity through evaluation o the cardiac recovery scale by a panel o cardiac clinical nurse specialists. All items were rated 0 to 5 or importance to recovery and only items scoring above an average o 3 were kept in the �nal scale. 5. Te results o the _____________________ were that all the items clustered around three actors, lending support to the notion that there are three dimensions o coping. 6. Te observations were rated by three experts. Te _____________________ reliability among the observers was 94%.
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7. o assess _____________________ reliability, subjects completed the locus o control questionnaire at the beginning o the project and 2 weeks later. Te correlation o 0.86 supports the stability o the concept. 8. Te Heart Health and Recovery est (HHR) was developed by the interdisciplinary heart health group. Tey established _____________________ validity by reviewing the literature reviewing concerns identi�ed by patients recovering rom a cardiac event, and had the items critiqued by a panel o experts. 9. Te results o the HHR that measured threat were highly correlated with the results o a test measuring negative emotions. Tis established _____________________ validity. 10. Te interdisciplinary heart health study group reported that internal consistency reliabilities o the �ve actors o the HHR were computed with the _____________________ statistic. REFERENCES
Alhusen, J. L., Gross, D., Hayat, M. J., et al. (2012). Te in�uence o maternal-etal attachment and health practices on neonatal outcome in low-income, urban women. Research in Nursing & Health, 35, 112-120. Melvin, K. C., Gross, D., Hayat, M. J., et al. (2012). Couple unctioning and post-traumatic stress symptoms in US Army couples: Te role o resilience. Research in Nursing & Health, 35, 164-177. Tomas, M. L., Elliott, J. E., Rao, S. M., et al. (2012). A randomized clinical trial o education or motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39 (1), 39-49. US National Library o Medicine. National Institutes o Health. (January 10, 2013). Retrieved rom http://www.ncbi.nlm.nih.gov/pubmed.
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Data Analysis: Descriptive and Inferential Statistics
16
Data Analysis: Descriptive and Inferential Statistics INTRODUCTION
Measurement is critical to any study. Te practitioner is interested in the similarity between the measurements used in a study and those usually ound in his or her practice. Te researcher thinks about how to measure relevant variables while reading the literature and thinking through the theoretical rationale or the study. Both the practitioner and the researcher wonder about how much aith they can put in the measurements reported. Practitioners and researchers know that the perect set o measurements does not exist. Te researcher’s task is to clearly de�ne the variables, choose accurate measurement tools, and clearly explain how the statistical tools were used. Your task as a practitioner who critically reads research is to consider the researcher’s explanation o how and why speci�c descriptive and inerential statistics were used and ask, “What do these numbers tell me?” Descriptive statistics are valuable or summarizing data and allowing us to look at salient eatures about a group o data, but practitioners usually want more inormation. Tey want to be able to read about an intervention used with a speci�c group o individuals and consider the useulness o that intervention with the patients in their care. Te use o inerential statistics provides a way or practitioners to look at the data in a study and decide how e asily the results can be generalized to the patients they see on a daily basis. Initially, numbers tend to be intimidating. Te best way to eliminate this source o intimidation is to jump in and play with the numbers. Keep reminding yoursel that you have the intelligence and skills to do this. Use the mantras o “I think I can. I think I can,” and “Practice, practice, practice,” and you will have data analysis mastered. Also keep in mind that this is a lielong learning process. Tere will still be times when you read a study with a new twist to the use o a statistical procedure, and back you’ll go to the reerence books, or pick up the phone to call a colleague. Tis chapter is designed to help you with the skills part o the task. First, the exercises in this chapter will provide you with some practice in working with the concept o me asurement. Second, you will have the opportunity to think through some o the decisions relevant to the use o descriptive and inerential statistics. Te bulk o your effort will be spent digesting data rom the studies included in the text.
96
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97
LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
study and determine their applicability to practice.
Activity 1
to the library, or set them on the desk while working on the Internet. Use them when reading research reports. Beore long, you will be able to read a piece o research without reerring to the stack o statistical assistants, and you will master the best shortcut o all: memorizing the statistical notation. Flipping through the pages o a book looking or a statistical symbol beore
Gather the ollowing supplies: package o 3 × 5 index cards, preerably lined on one side; pens or a combination o pens and highlighters with different colors; one broad-tipped, black-ink
side.
inerential statistics—relationship card over to the lined side.
ored pens, write on the lef side o the card the ollowing list:
With one o the col-
2 variables; interval measure 2 variables; nominal or ordinal >2 variables; interval measure >2 variables; nominal or ordinal Next to the descriptors at the lef, write the tests used or each type o data.
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inerential statistics—difference card over to the lined side. With one o the
pens, write on the lef side o the card the ollowing list:
colored
2 groups; interval measure 2 groups; nominal or ordinal
Next to the descriptors at the lef, write the tests used or each type o data. descriptive statistics card. Write on the lef
ing list:
side o the card the ollow-
nominal measurement ordinal measurement interval measurement ratio measurement Next to the descriptors at the lef, write the tests used or each type o data.
assistants.
mean).
on the key card on the appropriate line using the appropriate color. I you need assistance
Mathematical average o all scores Interval or ratio data Most-used measure o central tendency, ofen used in tests o signi�cance Affected by every score, extreme scores can lead to big changes
Best point or summarizing interval or ratio data
8. Tese cards will �t into an envelope or any o the small plastic cases that can be purchased rom the local bookstore. Tey will slip into a bookbag, briecase, or backpack with ease.
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Data Analysis: Descriptive and Inferential Statistics
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Activity 2 Column A
Amount o emesis
Gender
Satisaction with nursing care
Use or nonuse o contraception
Number o eet or meters walked
Blood type
Body temperature measured with centigrade thermometer
Body temperature measured with Kelvin thermometer
Column B
a. Nominal b. Ordinal c. Interval
Activity 3
I you have taken a course in statistics, you are amiliar with the statistical notation used to reer
not yet taken a statistics course, this exercise will provide you with enough inormation to recognize some o the statistical notations. Tis is a reverse crossword puzzle; thereore, the puzzle is already completed. Your task is to
in the spaces provided ollowing the puzzle and clues.
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CHAPTER 16
1
M
I
Data Analysis: Descriptive and Inferential Statistics
C
K
E
Y
M
O
U
2
S
O
T
D
A
E
4
3
N
E
U
x
D
R 5
A
N
T
R
O 6
D 7
8
M
M O
D R
E
K
H
O
9
M
D
V
E
E
I
A
A
O
N
G
S
S
K
I
E
N
E
O
U
S
W E 10
S
D
T 11
M
E
D
I
A
N
G
E
O 12
R
A
N
Clues
a. Measure o central tendency used with interval or ratio data
c. Measure o variation that shows the lowest and highest number in a set
e. Old abbreviation or the mean
g. Describes a distribution characterized by a tail h. Abbreviation or standard deviation j. Gooy’s best riend
m. Describes a set o data with a standard deviation o 3 when compared to a set o data with a Across
Down
3.
2.
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Data Analysis: Descriptive and Inferential Statistics
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Activity 4 th percentile
data collection. Neonatal outcomes were dichotomized as adverse outcome or no adverse outcome; thereore, multiple logistic regression was used to test the relationships between
a. Name the variable o interest. b. Identiy the level o measurement o this variable. 2. “In univariate logistic regression, MFA was regressed on adverse neonatal outcome and
c. Identiy the level o measurement o the independent variable. 3. “First, the data were explored or gender differences by individual respondents as previously
o clinical levels o distress, all respondents were then sorted into high or low scores or
the couples as dyadic units, respondent couples were then sorted into groups based on their < > >
was used to examine group membership relationships; the results showed there were no signi�cant differences between male and dual military couples on the likelihood o report
a. What is a dyad? Why do the authors address this concept?
What does this test measure?
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CHAPTER 16
Data Analysis: Descriptive and Inferential Statistics
Activity 5
Null hypothesis Practical signi�cance Sampling error
Parameter Probability Statistic
Nonparametric statistics Parametric statistics
Statistical signi�cance
groups in the study or no association between the variables under study. Its useulness to a study is that it is the only relationship that can be tested through the use o statistical tools.
drawn rom a population.
statistics.
-
tolic blood pressure in a sample o healthy individuals likely would have little
the ordinal or nominal level o measurement.
p
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CHAPTER 16
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Data Analysis: Descriptive and Inferential Statistics
2 n p
2
a. Sample size
n
p
Activity 6
Te data in this table contains inormation rom a hypothetical study. Use the statistical assis able 1 Demographic data (n = 12)
Participant
Age
27
2 3
Antithyroid antibody status
Other autoimmune diseases
Female Female Female
–
No No Addison’s disease No No
Gender
Income
–
32
Female Male Female
7
78
Female
8 9
missing
missing
missing
5
53
Female Female Female
32 58
Male Male
–
Years since thyroid disorder diagnosis
3 9 2
arthritis Multiple sclerosis No No
missing 8
arthritis No No
22
3 5
2. What levels o measurement are represented by the data in this table?
3. For the data in the last column, Years since thyroid disorder diagnosis, what is the mean? Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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5. For the data in the last column, Years since thyroid disorder diagnosis, what is the mode?
Activity 7
a. Tomas et al. b. Alhusen et al. c. Seiler & Moss d. Melvin et al. 2. What data were summarized and/or explained through the use o the descriptive statistics described in your textbook? a. Tomas et al. b. Alhusen et al. c. Seiler & Moss d. Melvin et al. 3. Were the descriptive statistics used appropriately? a. Tomas et al. b. Alhusen et al. c. Seiler & Moss d. Melvin et al.
others? I so, why do you think this occurred?
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5. Now turn to the inerential statistics. Which o the our studies in the appendices used some type o inerential statistic to manage the data? a. Tomas et al. b. Alhusen et al. c. Seiler & Moss d. Melvin et al.
a. Tomas et al. b. Alhusen et al. c. Seiler & Moss d. Melvin et al. Activity 8: Web-Based Activity
“Scotland Study.”
population parameter. While it is possible that the true value lies outside this estimate,
in this report. Based on what you know about con�dence levels and your reading about measures o variability, what can you say about the differences in the con�dence intervals?
b. What are some other statistics used in this report?
Activity 9: Evidence-Based Practice Activity Evidence-based practice means that you base practice decisions on
the best evidence available. In the ideal world, this means practitioners would have a stack o experimental studies with clear conclusions that have direct relevance to an immediate clinical concern. Obviously, this is seldom the case. We use our brains and the best practice inormation available, and intervene and evaluate.
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Assume that the shaken baby statistics rom Activity 8 have been consistently reported across several studies o varying designs and sample sizes. What, i any, implications would exist or
POSTTEST
mean and standard deviation o waiting time in minutes is reported below. Which outpa-
Clinic 1
Clinic 2
25
2. You are responsible or ordering a new supply o hospital gowns or your unit. Which mea
answer.
3. Matching exercise or measures o central tendency: Draw a line connecting the measure o central tendency with the correct description. Mode
Median
Arithmetical average, most stable
Mean
Middle score
Fill in the blanks or the ollowing statements.
variables.
8. I a researcher accepts a null hypothesis that is not error.
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REFERENCES ment and health practices on neonatal outcome in low-income, urban women. Research in Nursing & Health, 35, stress symptoms in US Army couples: Te role o resilience. Research in Nursing & Health, 35, -
shake.org.
the homeless. Journal o the American Academy o Nurse Practitioners, 24
motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39
Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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CHAPTER 17
Understanding Research Findings
17
Understanding Research Findings
INTRODUCTION
As the last sections o a research report, the Results and Conclusions sections answer the question “So what?” In other words, it is in these two sections that the investigator “makes sense” o the research, critically synthesizes the data, ties them to a theoretical ramework, and builds on a body o knowledge. Tese two sections are a very important part o the research report because they describe the generalizability o the �ndings and offer recommendations or urther research. Well-written, clear, and concise Results and Conclusions sections provide valuable inormation or nursing practice. Conversely, poorly written Results and Conclusions se ctions will leave a reader bewildered, conused, and wondering how or i the �ndings are relevant to nursing. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
108
-
research article.
priately discussed.
report.
related to a study’s results, limitations, generalizability, and applicability to practice.
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Understanding Research Findings
109
Activity 1 -
tions o a research report will enable you to interpret the research �ndings and critique research reports. Identiy the section in which the ollowing inormation rom the research report may be ound. Put an R in the blank space i the inormation would be ound in the Results section and a D 1. _____ ables/�gures to present large amounts o data
3. 4. 5. 6. 7.
Analysis o each question/hypothesis Strength and quality o the evidence Statistical tests used to analyze the data Statistical sofware program Recommendations or practice and uture research
_____ _____ _____ _____ _____
Activity 2
Match the term in Column B with the appropriate de�nition in Column A. Column A
1. _____ 2. _____ 3. _____ 4. _____ 5. _____
Values that quantiy the probable value range within which a population parameter is expected to lie Inerences that the data are representative o similar phenomena in a population beyond the study’s sample Te results, conclusions, interpretations, recommendations, and implications or uture research and nursing practice o a study Te researchers’ suggestions or the study’s application to practice, theory, and urther research Treats to a study’s internal or external validity
Column B
a. Findings b. Generalizability
d. Con�dence interval e. Recommendations
Activity 3
For questions 1 through 6, answer rue ( ) or False (F ). 1. _____ Rarely one study should be a recommendation or action. 2. _____ I the results o a study are not supported statistically or are only partially supported, the study is irrelevant and should not have been published. 3. _____ Good tables repeat what the researchers have written in the text. 4. _____ �ndings. Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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CHAPTER 17
5. _____ 6. _____
Understanding Research Findings
All studies have limitations. Statistically signi�cant �ndings are the sole means or establishing a study’s merit.
POSTTEST -
ine the logic o the hypothesis(es) or researcher question(s) posed, the theoretical ramework, the methods, and the analysis o the study. Using the criteria below, critique the Results and
in the text.
1. Are the results o each o the hypotheses presented? 2. Is the inormation regarding the results concisely and sequentially presented? 3. Are the tests that were used to analyze the data presented?
5. I tables or �gures are used, a) do they supplement and economize the text, b) do they have precise titles and headings, and c) are they not repetitious o the text? 6. Are the results interpreted in light o the hypotheses and theoretical ramework and all o the other steps that preceded the results? 7. I the data are supported, does the investigator provide a discussion o how the theoretical ramework was supported? 8. How does the investigator attempt to identiy the study’s weaknesses—that is, threats to internal and external validity—and strengths, as well as suggest possible solutions or the research area?
the �ndings?
11. Are any recommendations or uture research stated or implied? REFERENCE stress symptoms in US Army couples: Te role o resilience. Research in Nursing & Health, 35, 164-177.
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CHAPTER 18 Appraising Quantitative Research
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18
Appraising Quantitative Research
INTRODUCTION
Chapter 18 in the textbook includes two thorough critiques o two quantitative studies. Te �rst study critiqued is one by Sherman et al. (2012) that examined the effectiveness o interventions (psychoeducation or psychoeducation plus telephone counseling) or promoting the physical, emotional, and social adjustment o women with early stage breast cancer. Te second critique is o a study by Cerdan et al. (2012) that examined the effect o asthma severity on caregivers’ quality o lie. Critiquing criteria that were presented in all previous chapters were combined and used. Te results in Chapter 18 are complete critiques o two separate studies. Both o these critiques re�ect the level o analysis desired or an article that the registered nurse had decided was relevant to practice. I you want to produce a critique at this level o thoroughness, it will take time. It would not be uncommon or a novice reader o research to use two to three hours (maybe more) to complete such a critique. Usually novice readers o research �nd the task tedious and, not inrequently, difficult. Te more ofen you read and critique studies in this manner, the easier (and more interesting) reading research becomes. Te easier it becomes, the more quickly you can complete a critique. o get started, you just have to pick an article, dive in, and do it. One way o getting started is to commit to work to improve your critiquing skills. For example, you could commit to �nding one research study every week that is relevant to an area o nursing you are interested in or a question you have related to nursing practice and critique that article using the steps outlined in the textbook. At the end o a year, you could have read almost our dozen studies. As mentioned earlier, the level o reading and critiquing is most ofen used when you have a reasonable expectation that a speci�c study will be useul in your proessional practice. But not all relevant articles will be ound in the journals that are devoted speci�cally to your area o clinical expertise. Ofen you may �nd yoursel searching through several electronic databases or numerous journals to �nd studies that can be useul. When you do �nd a study that appears to be practice-relevant, you need to assess the article quickly so you can decide whether you should be spending the time to critically appraise the study.
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CHAPTER 18 Appraising Quantitative Research
LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
report.
practice.
Activity 1
Tis quick reading o articles demands the reader consider the same aspects o a study that you would consider i completing a more detailed critique, but in a more super�cial manner. Tis tional reading is essential, but is requently overlooked in regard to analytical skills. Frequently, proessional reading must be squeezed into a small window o available time. Improving your quick reading skills will help you sort through the reading required to maintain and expand your knowledge base. But what is this inspectional reading? It is the second level in a set o skills described by Adler
early in ormal education. Level two is inspectional reading. Level three is analytical reading where the reader is trying very hard to understand what the author is attempting to share, and is the level o reading required to produce a critique o a research study. Level our is syntopical reading, which requires intense effort to synthesize ideas rom many sources. Inspectional reading has two components. Te �rst is called “systematic skimming” and the second is called “super�cial reading.” Systematic skimming is the �rst thing anyone should do when approaching a research study. It
requires only a ew minutes to skim an article—but it may take up to an hour i you are skimming a complete book. Let’s assume that you are going to skim a hard copy o a research study.
-
lar to the clinical question that I have?” Or more speci�cally, are the components o your
population and the situation. I your answer is “no,” it is likely OK to put this study down and move on to the next study or search or another study. I your answer “unsure” or “yes”, proceed to super�cial reading o the article. Super�cial reading requires that you read the article rom beginning to end without stopping.
ry your best not to take notes, not to highlight (hide your highlighter so you won’t even be Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 18 Appraising Quantitative Research
113
tempted), or use a dictionary to understand words that you do not know. ry not to even stop to think “I wonder what they meant by that?” Te key to this step … Just read. When you have completed the article, take a deep breath and ask yoursel these questions:
discussion?
on to the next article. I the answer is “maybe” put it in a “come-back-to-later” stack. I the answer is “yes,” proceed to more detailed reading while writing down notes that would be necessary to complete a critical appraisal, such as the two examples ound in Chapter 18.
Activity 2
Te article by Tomas et al. (2012) in Appendix A o the textbook has been used or several activities throughout this Study Guide. However, it is quite possible that you have not read it completely, at one time, rom beginning to end. For this activity, consider the ollowing scenario: You currently work as a registered nurse in an inpatient adult oncology unit. As part o in volvement in your unit’s journal club, every other month you are responsible or identiying a research study that is relevant to practice. o help you �nd a relevant research study, you have been asking your colleagues what they think is the most important issue on the unit or patients. Te issue o pain management and control is identi�ed as one o the priority issue areas. Now, read the study by Tomas et al., practicing the use o systematic skimming and inspectional reading strategies. When you have done so, answer the questions that ollow. Systematic skimming:
the scenario?
Super�cial reading:
discussion?
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CHAPTER 18 Appraising Quantitative Research
Activity 3
Ofen in practice, nurses are asked to summarize their critical appraisal o a research study within a very short timerame (i.e., 2 to 3 minutes). Consider the same scenario as in Activity 2 and the study by Tomas et al. (2012) in Appendix A. Keeping in mind that this study has been used or several activities throughout the textbook and Study Guide, review the study in terms o the critical appraisal criteria provided in Chapter 18 o the textbook. In no more than �ve sentences, summarize the ollowing or the study by Tomas et al. (2012).
Practice” sections rom the two critical appraisal examples in Chapter 18 as a guide.)
signi�cant?”)
POSTTEST
Tere is no posttest or this chapter. Enjoy the break! REFERENCES How to Read a Book. New York: Simon & Schuster.
motivational interviewing based coaching compared to usual care to improve cancer pain management. Oncology Nursing Forum, 39
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CHAPTER 19
Strategies and Tools for Developing an Evidence-Based Practice
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19
Strategies and Tools for Developing an Evidence-Based Practice INTRODUCTION
Maintaining a clinical practice that incorporates new evidence can be challenging. Tis chapter will assist you in becoming a more efficient and effective reader o the literature by providing you with a ew important tools to assist you in determining the merits o a study or your practice and patients. LEARNING OUTCOMES
Afer reading this chapter, you should be able to do the ollowing:
-
tise and patient preerences.
Activity 1
ormat also helps the nurse determine the clinical category to which a research study belongs. Follow the instructions below.
Terapy () Diagnosis (D) Prognosis(P) Causation/Harm (C/H)
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Strategies and Tools for Developing an Evidence-Based Practice
(Peters, 2008)
a. P ____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
_____________________________________________________________________
a. P ____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
_____________________________________________________________________
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Strategies and Tools for Developing an Evidence-Based Practice
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a. P ____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
_____________________________________________________________________
a. P ____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
_____________________________________________________________________
Activity 2: Web-Based Activity
As mentioned above, determining the clinical category o a research study will help in your search or the best-available evidence. Access the ollowing online bibliographic databases and
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2. Medline
Activity 3
1. _____ 2. _____ 3. _____ 4. _____ 5. _____
Column A
in order to prevent one adult rom being diagnosed with a new malaria inection
proportion o patients with a negative test as not having malaria
Column B
variable
variable
reduction
7. _____ 8. _____
positive rapid screening test having malaria Percentage o patients diagnosed with malaria
10. _____ 11. _____
develop a new malaria inection
the proportion o patients with positive tests as having malaria
reduction
needed-totreat
predictive value
negative rapid screening test will not have malaria
relative to not receiving the vaccination
Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
predictive value
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Strategies and Tools for Developing an Evidence-Based Practice
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Activity 4 -
sure bandages ofen reduce the patients’ mobility and increase patients’ reports o discomort, you perorm a literature review to see i pressure bandages are effective or reducing bleeding.
below.
n -
phy procedure was completed and once hemostasis was achieved through >10 minutes o manual compression, patients were allocated to the study groups.
Activity 5 Copyright © 2014, 2010, 2003, 1 998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
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n
day versus > 1 hour per day)
nosed with eating disorders (n
C ) or discrete variables (D).
a. _____ b. _____
Parents’ marital status Eating alone
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Strategies and Tools for Developing an Evidence-Based Practice
121
Activity 6: Web-Based Activity mal individual care. Evidence-Based Nursing, 11 , 103-104. Evidence-Based Nursing, 4
POSTTEST ) or False (F
2. _____
Articles should be screened to determine i the setting and sample in the study are similar to my clinical situation.
4. _____
Speci�city is the term used to describe the proportion o individuals with a disease
8. _____
Prevalence
who test positive or it.
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REFERENCES Emerging Inectious Diseases, 11 mal individual care. Evidence-Based Nursing, 11 , 103-104. trial. Heart Lung, 27, Evidence-Based Nursing, 1, 55. prevention interventions. Evidence-Based Nursing, 4 , 100-104. Evidence-Based Nursing, 4 creased discomort. Evidence-Based Nursing, 2 , 84. Cochrane Database o Systematic Reviews, 18 clinic patients. Evidence-Based Nursing, 6 , 23.
in�uences, and the onset o eating disorders in a prospective population-based cohort. Pediatrics, 111, 315-320.
Evidence-Based Nursing, 6 , 120. Evidence-Based Medicine, 13 British Medical Journal, 334, 403. more than advanced moist wound therapy. Evidence-Based Nursing, 11
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CHAPTER 20
Developing an Evidence-Based Practice
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20
Developing an Evidence-Based Practice
INTRODUCTION
Engaging in evidence-based practice has become an expected standard in the delivery o health care services. Although there are concentrated efforts on methods to acilitate the translation o research �ndings into practice, nurses can engage in evidence-based practice through the de velopment, implementation, and evaluation o evidence-based changes in practice. Tis chapter presents an overview o evidence-based practice, and the process or applying evidence in practice to improve patient outcomes. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
practice.
Activity 1
Although the terms research utilization and evidence-based practice are ofen used interchangeably, they are not exactly the same. Answer the ollowing to help you differentiate between the two terms. research utilization and evidence-based practice.
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.
a. _____________________________________________________________________ b. _____________________________________________________________________ c. _____________________________________________________________________ Activity 2
one o the ollowing.
a. Conduct o research
d. Evidence-based practice
Place the letter (a, b, c, d) that best describes each activity in the space provided. (Some letters will be used more than once.) 1. _____ Te RN submits an article to his or her health care agency’s in-house practice newsletter about the research study he or she participated in. 2. _____ As a member o the health care team, the RN was involved with developing a plan o care or a patient using the �ndings rom one meta-analysis and several research studies. 3. _____ wo RNs are involved with data collection or a study comparing two types o dressings or postoperative incisions. 4. _____ Te RN has read about an intervention that will reduce the pain associated with
she decides that trying the intervention would be a good idea and proceeds to de velop an implementation plan.
Te two o them have decided to publish the results o their work.
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Developing an Evidence-Based Practice
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Activity 3
number “1” or the �rst step.
b. _____
o the body o evidence Select a topic
e. _____ . _____
Form a team Evaluate the evidence-based change in practice
h. _____ i. _____
Write the evidence-based practice standard Retrieve the best-available evidence
Activity 4
Fill in the blanks with the appropriate word(s) rom the text.
�nancial data, or recurrent clinical problems; whereas ___________________ triggers are ideas generated when staff read research, listen to scienti�c papers at research conerences, or encounter evidence-based practice guidelines published by ederal agencies or specialty
2. A team is responsible or the development, implementation, and evaluation o an evidence -
ect and who are critical to its successul implementation.
C ____________________; O ____________________
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Developing an Evidence-Based Practice
Activity 5
synthesis o the best-available evidence, it is then important to determine i these recommen yes (Y) or no (N) as to whether the ollowing should be considered in making this decision. Te extent to which: 1. _____ there is consistency in �ndings across studies/guidelines.
3. _____
a signi�cant number o studies/guidelines with sample characteristics similar to those to which the recommendations will be used. the studies support current practice. the authors o the studies and/or guidelines are well-known in their �eld. easibility exists or use in practice.
4. _____ 5. _____ 6. _____ Activity 6
Although a practice change may be evidence-based, its adoption depends on several actors.
evidence-based practice change.
adoption o evidence-based practice innovations.
a. _____________________________________________________________________ b. _____________________________________________________________________ 2. Match the term in Column B with the appropriate interpretation in Column A. Column A
a. _____
Practitioners within the local group setting who are expert clinicians, are passionate about the innova
and have a positive working relationship with other health proessionals b. _____
Key individual or group o individuals who will be directly or indirectly affected by the implementation o the evidence-based change in practice
c. _____
Ongoing auditing o perormance indicators, aggregating data into reports, and discussing the �ndings with practitioners during an evidence-based change in practice
d. _____
Practitioner who is considered by the local group as being dedicated, competent, and trusted to evaluate new inormation in the context o group norms
Column B
1. 2. 3. 4.
Audit and eedback Opinion leader Change champion Stakeholders
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Developing an Evidence-Based Practice
127
promoting the use o evidence-based practices. Place a “Y” next to those you think have a positive effect and a “N” next to those you do not think have a positive effect on evidencebased practices. a. Mass media ____ b. Change champions ____
d. Opinion leaders ____ Activity 7: Web-Based Activity
Retrieve and review the ollowing: lines. Evidence-Based Nursing, 8 , 68-72. tion o research �ndings. Implementation Science, 7 Tomas, L. (1999). Clinical practice guidelines. Evidence-Based Nursing, 2 , 2.
POSTTEST
1. What was the overall topic o the evidence-based practice guideline(s)?
2. Who were members o the evidence-based practice guideline team?
3. Who, i anyone, would you identiy as “stakeholders” in the evidence-based practice guide
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Developing an Evidence-Based Practice
the body o evidence?
6. Was the research evidence (existing clinical practice guidelines, systematic reviews [including meta-analyses and/or meta-syntheses], and primary sources/individual research stud
recommendations?
8. Was the evidence-based practice change written in detail?
identi�ed?
11. Was the evidence-based practice change evaluated? Was it successul?
12. What were the strategies used by the evidence-based change team to promote the adoption o the evidence-based practice change?
REFERENCES
cche.net/usersguides/guideline.asp.
lines. Evidence-Based Nursing, 8 , 68-72. experience. Progress in Pediatric Cardiology, 18, 75-83. Tomas, L. (1999). Clinical practice guidelines. Evidence-Based Nursing, 2, 2.
itler, M. G., Mentes, J. C., Rakel, B. A., et al. (1999). From book to bedside: Putting evidence to use in the care o the elderly. Joint Commission Journal on Quality Improvement, 25 545-556.
EvidenceBased Dentistry, 7 , 1. Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 21
Quality Improvement
129
21
Quality Improvement
INTRODUCTION
We’ve all had moments as nurses or as patients where we can see how the efficiency o a health care process could improve or how saety could be increased. As nurses, we are on the ront lines providing care and we have the tools to affect changes in health care that can make a meaningul difference or our patients. Not every improvement in care is due to a large scienti�c study and, in act, many improvements in the quality o care come rom small changes based on quality improvement (QI). QI uses data to improve the quality and saety o health care by monitoring outcomes o care processes. QI employs improvement methods to continuously aim or better care by designing and testing changes. QI complements EBP and research efforts to improve care. Efficiency, access, saety, timeliness, and patient-centeredness problems in clinical settings are ideal candidates or quality improvement solutions. Nurses play key roles in QI activities, and as a nurse you will probably be involved in QI activities in your proessional capacity. With a basic understanding o QI, you will be prepared to play your role in improving care or your patients. LEARNING OUTCOMES
On completion o this chapter, you should be able to do the ollowing:
consumer choice and guide clinical QI activities. in each phase o the improvement process.
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CHAPTER 21
Quality Improvement
Activity 1
Quality improvement efforts are one part o the wider effort to improve patient care. QI, evidence-based practice, and research have many similarities that may be conusing. In this exer
the �nal chapter in your book.
Quality Improvement
Evidence-Based Practice
Research
Purpose
control
Human
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CHAPTER 21
Quality Improvement
131
Activity 2
Now that you have thought about the differences between QI, EBP, and research, let’s examine some o the similarities. Write a short sentence or two about what you see that is similar among QI, EBP, and research.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________ 3. _________________________________________________________________________ _________________________________________________________________________ 4. _________________________________________________________________________ _________________________________________________________________________ 5. _________________________________________________________________________ _________________________________________________________________________
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CHAPTER 21
Quality Improvement
Activity 3
Quality improvement ollows similar steps to the nursing process. In this exercise you will describe how the QI process steps parallel and differ rom the nursing process. Quality Improvement
Nursing Process
describes and actual or potential problem.
nursing orders to provide care that will
Validate that the care plan is accurate.
status with stated goals. Were goals
Activity 4: Web-Based Activity
have worked in during your clinical experience or a hospital in your area.
problem areas that need some work?
3. Based on your experience and readings, brainstorm some potential QI solutions to these problem areas. Copyright © 2014, 2010, 2003, 1998 by Mosby Inc., an imprint o Elsevier Inc. All rights reserved.
CHAPTER 21
Quality Improvement
133
Activity 5: Evidence-Based Practice Activity
inventory, changing work environments, time management, managing variation, designing systems to avoid mistakes, and ocusing on products or services.
reading. Have you done a literature search on any o these topics?
-
book. Is your article a research study or a QI study? What were the critical clues that helped
POSTTEST
that is _________, ____________________, ______________________________, ___________________, _________________, and _______________________.
when perormance is below the accepted standard and in need o QI.
_____________________________________________________, ___________________ _______________________, and _____________________________________________.
4. A lead QI team should include representatives rom the proessions involved in patient care, __________________, ________________________, and _______________________.
may be due to ______________________________.
were developed to promote publication o QI studies.
7. PDSA stands or ________________ ____________________ _____________________ __________________ , and is part o the ____________________________________. REFERENCE -
talcompare.hhs.gov.
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134
Answer Key
Answer Key
CHAPTER 1
Activity 6
1. 2. 3. 4. 5. 6. 7.
Introduction Abstract, Introduction Introduction Introduction Introduction Abstract, Introduction Abstract, Methods (Sample & Setting), Results (Sample) 8. Not stated 9. Methods (Instruments) 10. Methods (Instruments) 11. Methods (Procedures) 12. Methods (Data Analysis) 13. Results 14. Discussion 15. Conclusions & Implications or Nursing Practice
Activity 1
1. 2. 3. 4. 5. 6. 7. 8. 9.
c d b a g e h i
Activity 2
1. 2. 3. 4. 5. 6. 7.
b b a b a a b
POSTTEST
Activity 3
1. Preliminary 2. Comprehensive 3. Parts; whole Activity 4
1. a. Level IV (cohort study) b. Level IV (cross-sectional study) c. Level 1 (systematic review with meta-analysis) 2. Answers will vary Activity 5
1. b 2. a 3. c 134
1. a. Concepts: pain, disability b. Will vary or each student. c. Will vary or each student. Possibilities include the ollowing: How was pain de�ned, and do you agree with that concept o pain? Does limitation in one item on a scale equal unctional disability? How do the patients de�ne unctional disability? 2. Both research and evidence-based practice begin with a question. 3. In research, the question is explored with a design appropriate to the question and speci�c methodology to contribute to new knowledge. In evidence-based practice, the question is used to guide the search or knowledge (research) to address the question.
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Answer Key
4. Both qualitative and quantitative research aim to generate new knowledge using designs appropriate to the question being asked. 5. Qualitative research seeks to interpret the meaning o phenomena, whereas quantitative research seeks to test hypotheses using statistical methods to explore phenomena.
Activity 6
CHAPTER 2
Activity 7
b d a c e
Activity 2
1. 2. 3. 4. 5.
Yes Yes Yes Yes Yes Yes Yes
1. P = children with long bone ractures in ED I = intranasal entanyl C = intravenous morphine O = pain control 2. P = obese school-age children and their parents I = group intervention C = routine care O = weight loss 3. P = men afer laparoscopic radical prostatectomy I = none C = none O = experiences
Activity 1
1. 2. 3. 4. 5. 6.
1. 2. 3. 4. 5. 6. 7.
135
Yes; Yes; Yes Yes; Yes; No Yes; Yes; Yes Yes; No; Yes Yes; No; Yes
POSTTEST
Activity 3
1. 2. 3. 4. 5.
a a b a b
Activity 4
1. a. b. 2. a. b. 3. a. b. 4. a. b. 5. a. b.
Iron Iron status Family-centered care Health-related quality o lie continuous albuterol (usual or high dose) peak �ow dental prophylaxes glycemic control parenting blood pressure and heart rate
Activity 5
1. 2. 3. 4. 5.
DH NDH NDH DH DH
1. Te authors state that the purpose o this study was to “test the effectiveness o two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving unctional status and quality o lie” (Melvin et al., 2012). 2. Quantitative 3. a. Yes b. Yes c. Yes 4. P = Patients diagnosed with cancer experiencing pain with a lie expectancy greater than six months; I(1) = motivational interviewing-based coaching; I(2) = education; C = usual care; O = attitudinal barriers to pain management, pain, and quality o lie 5. IV = motivational interviewing-based coaching or education; DV = attitudinal barriers to pain management, pain, and quality o lie 6. Yes; Te article states that “the authors hypothesized motivational interviewing-based coaching group would demonstrate greater bene�t (i.e., decreasing attitudinal barriers;
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136
Answer Key
decreasing pain intensity; and improving pain relie, unctional status, and quality o lie) greater than either the conventional education or usual care groups” (Tomas et al., 2012). It is a directional hypothesis. 3. 4.
CHAPTER 3 Activity 1
1. 2. 3. 4.
P S S P
Activity 2
1. 2. 3. 4. 5. 6.
PR PR PR NPR NPR PR
5.
6.
Activity 3
1. 2. 3. 4.
124 Approximately 540,000 CINAHL CINAHL
Activity 4
1. “Studies” and “Syntheses” are ound in each o the versions, and include the same type o evidence in each pyramid. Although “Systems” are in each version o the pyramid, in the 4S Pyramid this level includes evidencebased textbooks (i.e., Clinical Evidence, UpoDate) that shif into the “Summaries” level in the 5S and 6S Pyramids. “Summaries” appear in the 5S and are still in the 6S Pyramid, with the same description in both the 5S and 6S. Te “Synopses” level in the 4S and 5S Pyramids is broadened to two levels, “Synopses o Syntheses” and “Synopses o Studies” in the 6S Pyramid. Activity 5
1. Yes. Te authors stated the purpose o the study (research questions) and hypotheses in the last paragraph beore the “Methods” section begins. 2. Yes. Te literature discusses important concepts such as “cancer pain” and “pain
management interventions” and “coaching.” Te literature review �rst discusses inormation about pain management in general and then discusses types o interventions; i.e., psychoeducational and coaching. No Somewhat. Te literature review provided details about the types o studies and identi�es the limitation o some o the studies; however, the strengths are not identi�ed. Tere is some discussion o differences between studies. For example, among psychoeducational interventions, those that were less laborintensive were not as successul in decreasing cancer pain. Yes. Although limited to mostly the �ndings, the literature review provides a brie summary and provides the reerences or each research and conceptual article. Yes. “Given the limitations o previous intervention studies, additional research is warranted using approaches that can be implemented in the outpatient setting” (Tomas et al., 2012). In the literature review, the authors discuss that additional studies are needed to test different interventions on cancer pain education. In addition, the authors indicate that psychoeducational interventions may be effective, but they may be considered labor-intensive and not tested in outpatient settings. Te authors also indicate that studies have shown that coaching may be a useul strategy to improve cancer pain management.
POSTTEST
1. “Studies”, the last level 2. a. P, NPR b. P, PR c. S, NPR 3. Yes 4. Yes. Te authors stated the purpose o the study and hypotheses in the last ull paragraph beore the “Teoretical Model” section begins. 5. Yes. Te literature review provides inormation about birth rates among lowincome and Arican-American women and then discusses actors known to in�uence neonatal outcomes (mother’s health practices and maternal-etal attachment). 6. No.
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Answer Key
7. No. 8. Yes. Although the �ndings are limited, the literature review provides a brie summary along with the corresponding reerences. 9. Yes. Te authors state that “No longitudinal studies were ound that examine these variables in relation to neonatal outcomes. An enhanced understanding o the role that MFA plays in neonatal outcomes o those subject to disparities, by virtue o race or socioeconomic status, is necessary to improve understanding o the relationship between health practices and adverse neonatal outcomes. Extant literature supports the in�uence o maternal health practices on neonatal outcomes, but less is known about actors that contribute to a woman’s ability to engage in those positive health practices.” CHAPTER 4 Activity 1
1. describe and explain the concept or construct. 2. devise a way to identiy and con�rm the presence o the concept or construct. 3. determine a method to measure or quantiy the concept or construct. Activity 2
1. 2. 3. 4. 5. 6.
e a b d c
Activity 3
1. Grand; most abstract level o theory 2. Middle range 3. Situation-speci�c or micro-range; least abstract level o theory Activity 4
1. Teory is generated as the outcome o a research study. 2. Teory is used as a research ramework, as the context or a study. 3. Research is undertaken to test a theory.
137
Activity 5
a. b. c. d.
3 1 4 2
POSTTEST
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
b, c a c b a a b b t t t
CHAPTER 5 Activity 1
a. Naturalistic setting: where people live every day; homes, schools, communities. b. Sample: group o people that the researcher will interview or observe in the process o collecting data to answer the research question. c. Purposive sample: nonprobability sampling where a researcher selects subjects considered typical o the population. d. Recruitment: �nding and engaging participants in the research. e. Data saturation: point where enough data have been collected that the inormation being shared becomes repetitive; no new ideas are emerging. . Setting: places where participants are recruited and the data are collected. g. Temes: overarching, broad categories o meaning.
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138
Answer Key
Activity 2 Qualitative
Quantitative
Sample Recruitment
Until data saturation
Predetermined number o participants
Data Collection
Naturalistic setting; numbers
Statistics and numbers
Activity 3 Element
Summary
Purpose
“Te purpose o this study was to determine the experiences o NPs who provide health care to the homeless in order to gain insight into their unique experience and learn what it takes to be successul in their role” (p. 305)
Method
Qualitative research
Sample and Setting
NPs practicing or at least 6 months in southeast and northeast Wisconsin clinics that provided health care to the homeless
Data Collection
Demographic questionnaire and open-ended interview (6) Data analysis: how did the researcher take the raw data—words—and analyze them to �nd commonalities and differences; usually you will �nd an example (7) Findings: a presentation o the results, a description o the phenomenon, and the role or theme
POSTTEST
1. a. b. c. d. e. . 2. (1)
(2) (3) (4) (5)
Quantitative Qualitative Qualitative Qualitative Quantitative Qualitative Review o the literature: extensive, systematic, critical review o most important published scholarly literature on the topic Study design: blueprint or a study Sample: representative units rom a population, description o process or selection Study setting: description o where subjects were recruited and where data collection occurred Data collection: description o how inormed consent was obtained, what occurred between contact with the participant and the end o the interview, how were data collected, was a recording made, how long was the interview
CHAPTER 6 Activity 1
1. 2. 3. 4. 5. 6. 7.
d a c e b g
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Answer Key
139
Activity 2 1. Identifying the phenomenon
Phenomenology
Study o day-to-day existence or a particular group o people
Grounded Teory
Interested in social processes rom perspective o human interactions or patterns o action and interaction between and among various types o social units
Ethnography
Study o the description and interpretation o a cultural or social groups and systems
Case Study
A ocus on an individual, amily, community, an organization, or some other complex phenomenon
Community-Based Participatory Research
A study to systematically assess the voice o a community to plan contextappropriate action
2. Structuring the Study
Phenomenology
Asks about the lived experience, research perspective is bracketed, sample has either lived in the past or is living the experience being investigated.
Grounded Teory
Questions address basic social processes and tend to be action-oriented. Te researcher brings some knowledge o the literature but exhaustive review is not done beore beginning the research. Te sample would be participants who are experiencing the circumstance and selecting events or incidents related to the social processes being studied.
Ethnography
Questions are about lieways or patterns o behavior within a social context o a culture or subculture. Te researcher attempts to make sense o world rom insider’s point o view. Te sample ofen consists o key inormants who have special knowledge, status, or communication skills and who are willing to teach the ethnographer about the phenomenon o interest.
Case Study
Questions about issues that serve as a oundation to uncover complexity and pursue understanding. Te perspective o the researcher is re�ected in the questions. Researchers may choose the most common cases or instead select the most unusual ones.
Community-Based Participatory Research
Assumes that a phenomenon may be separated rom its context. Researchers recognize that engaging members o the study population as active and equal participants, in all phases o research, is crucial.
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140
Answer Key
3. Data Collection
Phenomenology
Written or oral data may be collected.
Grounded Teory
Data are collected through interviews and skilled observations o individuals interacting in a social setting.
Ethnography
Participant observation, immersion, inormant interviews
Case Study
Use o interview, observations, document reviews, and other methods
Community-Based Participatory Research
Engage stakeholders in discovering the answers to the community problems
4. Data Analysis
Phenomenology
Move rom the participant’s description to the researcher’s synthesis o all participants’ descriptions.
Grounded Teory
Data collection and analysis occur simultaneously, use theoretical sampling, constant comparative method, and axial coding.
Ethnography
Data are collected and analyzed simultaneously, searching or meaning o cultural symbols in the inormants’ language.
Case Study
Data are ofen collected and analyzed simultaneously, re�ecting and revising meanings.
Community-Based Participatory Research
Tis stage o research is the “think” phase and is where what has been learned is interpreted or analyzed. Te research has the role o linking the ideas provided by the stakeholders in an understandable way so that evidence or speci�c ways to address the problem can be provided to the community group.
5. Description of the Findings
Phenomenology
A narrative elaboration o the lived experience.
Grounded Teory
Descriptive language and diagrams to show theory connections to the data.
Ethnography
Large quantities o data that provide examples rom the data and propositions about relationships o phenomena.
Case Study
Chronologically developed cases, a story that describes case dimensions or vignettes that emphasize various aspects o the case.
Community-Based Participatory Research
Inormation obtained in earlier research stages sets the stage or community planning, implementation, and evaluation.
Activity 3
1. Te article states that the research design used in this study is a “qualitative, naturalistic approach … using the principles o phenomenology.” 2. Te authors used purposive samples identi�ed through snowball sampling o “NPs practicing
or at least 6 months in southeast and northeast Wisconsin clinics that provided health care to the homeless.” 3. Te procedures are a demographic questionnaire and open-ended interviews. On main question, ollowing by urther probing questions were used. Field notes were
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Answer Key
collected during the interview and throughout the data collection process. Audiotaped interviews were transcribed verbatim. 4. Data were analyzed using descriptive phenomenology described by Spiegelberger. Te researcher read the transcripts while listening to the recordings to immerse in the data. Data were clustered into themes. Activity 4
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.
C B A A B D C A C D C C B A D A (could also be true o B or C) A (could also be true o B or C) C C (could also be true o A) B B
POSTTEST
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
F F a d b a c d a, b, d, or c
CHAPTER 7
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
141
e c d b h a g h e
Activity 2
1. Qualitative research provides the opportunity to give voice to those who have been disenranchised and have no history. 2. Qualitative research creates solutions to practical problems. 3. Qualitative research initiates the examination o important concepts in nursing practice, education, or administration. 4. Qualitative research discovers evidence about a phenomenon o interest that can lead to instrument development. Activity 3
1. Credibility reers to qualitative research steps taken to ensure the accuracy, validity, and soundness o the data. Credibility can be con�rmed when the inormants recognize the reported �ndings as their personal experience. 2. Auditability is a research process that allows the work o a qualitative researcher or a person critiquing a research report to ollow the thinking and/or conclusions o a researcher. Auditability can be con�rmed when others, not engaged in the research, are able to ollow the audit trail o the primary researchers. 3. Fittingness (or transerability) is a term used to answer these three questions: “Are the �ndings applicable outside the study?”, “Are the results or eelings meaningul to people not involved in the research?”, and “Are the �ndings meaningul to others who are in similar situations?” Fittingness is con�rmed when the reader is provided with an opportunity to determine the useulness o the data outside the study.
Activity 1
1. g
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142
Answer Key
Activity 4: Web-Based Activity
Your instructor may want to direct you to view some speci�c Internet links to learn additional speci�c aspects o qualitative research. POSTTEST
1. 2. 3. 4. 5. 6. 7. 8. 9.
t t d a b c
CHAPTER 8 Activity 1
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
h l e k d j b a c g i
consequently, the effect o these in�uences is difficult to differentiate rom the effect o the independent variable. Suggested remedies: data rom some cohorts may be excluded rom the analysis; i the whole sample was affected, the author should include this inormation in the study or may elect to redo the study. 4. Selection Bias – Te subjects in a study may not be a representative sample o the population o interest. Suggested remedy: random assignment o subjects to groups. 5. Mortality – Loss o subjects rom the study. Suggested remedies: analysis o the subjects who remain in the study and those who dropped out to determine i there was a difference, examination o where the subjects dropped out; or instance, did more subjects drop out o the experimental group than the control group? Researchers may oversample to ensure that they will have an adequate sample even afer attrition. Tey may also use a pilot study to determine i there is a actor in the experimental or control group that may lead to differential loss o subjects. 6. Maturation – A process that operates within an individual as a unction o time that is external to the study. Suggested remedy: use a short time interval between the testing periods. Activity 3
Activity 2
All o the ollowing are threats to internal validity. Treats to internal validity are alternate explanations o the relationship between the variables and they are potential sources o bias. 1. esting – Te scores on an instrument may improve just rom taking the test again, but this effect is hard to distinguish rom changes due to the experimental variable. Suggested remedies: Soloman 4 design or use equivalent orms o the instrument. 2. Instrumentation – Te differences in variables are due to changes in measurement, not due to the study. Suggested remedies: calibration o study equipment; or or observational data, use similar training or all data collectors. 3. History – Events inside or outside the study have an effect on the dependent variable;
1. Te study setting was outpatient oncology clinics including three VA acilities in Caliornia, a county hospital in Caliornia, a community-based practice in Caliornia, and a VA clinic in New Jersey. 2. Te subjects were 318 patients with cancerrelated pain. 3. A convenience sample was selected by the ollowing method: clinic staff identi�ed and screened potential participants or eligibility and obtained inormed consent. Patients were eligible or participation i they were able to read and understand English, had access to a telephone, had a lie expectancy greater than 6 months, and had an average pain intensity o 2 or more on a scale rom 0-10, where higher scores indicate more pain. 4. Concurrent cognitive or psychiatric condition, substance abuse problem that would prevent adherence to the protocol, severe pain unrelated to their cancer, or residence in
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Answer Key
a setting where the patient could not seladminister pain medication. 5. Yes, the groups differed on KPS score but there were no other signi�cant demographic or clinical differences. 6. Te Barrier Questionnaire (BQ), to measure attitudinal barriers, the Brie Pain Inventory (BPI) to measure pain, the SF-36 to measure unctional status, the FAC-G to measure quality o lie. Constancy was maintained by extensive research team training in enrollment, data collection, and interventions. All interventions were standardized across clinic sites. Te research associates were also trained in attention-control phone calls. Te nurse interventionists were trained in motivational interviewing and change theory by a cognitive behavioral psychologist and in speci�c procedures related to the coaching protocol. Tere were also monthly team meetings. Patients and clinicians at the study sites were blinded to the patient’s group assignment. Patients in the coaching group received our 30-minute telephone sessions plus the same intervention as the education group. Te education group watched a video on managing cancer pain and a written a pamphlet on managing pain. Te control group viewed a video on cancer. Patients in the control and education groups received our attention-control phone calls. 7. Te usual care group acted as the control.
3.
4.
5.
Activity 4
Your critique may differ rom the critique below. Look or similarities in the major points and reer to your textbook i you have questions. 1. Yes, the design is appropriate. Te study authors wanted to evaluate the effectiveness o two interventions to decrease attitudinal barriers to cancer-pain management versus usual care and they used a randomized controlled trial to do this. 2. Yes, the methods used or control are consistent with the research design. Control is managed by ruling out extraneous or mediating variables that would compete with the independent variables as an explanation or the study’s outcome. Tomas et al. maintain control o extraneous variables by using research team training, written
6.
143
protocols or nurse interventionist training and coaching interventions, monthly team meetings, consistent data collection procedures, attention-control telephone calls in the usual care and education groups, and randomization o the sample into groups based on strati�cation by pain intensity and cancer therapy. ime, the study collected data at baseline and again at 6 months: data collection occurred over a long period. Subject availability: the study used outpatient cancer patients. Equipment required included questionnaires, telephones, written materials, video viewing equipment. Yes, the problem ties in nicely with the study ramework (the ranstheoretical Model o change theory). Te authors provide a solid literature review as a strong basis or the intervention. Treats to internal validity include: history, instrumentation, mortality, and selection bias. Te authors also noted that patients in the attention-control call groups reported signi�cant problems during the calls, thereby possibly obscuring some o the effect o the coaching intervention. o reduce the effects o selection bias, participants were strati�ed and then randomly assigned to groups at each clinic site. o reduce the effects o mortality, the study ended 6 weeks afer the coaching intervention, but in hindsight, the investigators would have added another assessment immediately afer the end o the coaching intervention to gather data rom patients who completed the intervention but were too sick or died beore completing the questionnaires. Selection, reactive effects, measurement effects a. Selection: sample was comprised mainly o middle-aged, married men b. Reactive effects: it is possible that there could have been some positive outcomes simply rom being included in the study and receiving phone calls. Tis possibility was discussed by the authors in relation to the education and usual care groups where some patients used the attentioncontrol phone calls to report signi�cant problems to the research assistant. Tese problems were then reported to the clinical team (ethically, this was the right
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Answer Key
response, but this may have blunted the effect o the coaching intervention). c. Measurement: instruments that were given at more than one point in time during the study include the BQ, BPI, SF36, and the FAC-G. Activity 5
It is possible to ascertain rom the titles whether a study was most likely qualitative or quantitative. Results will depend on the year selected. However, this is an excellent site to learn about the most current unded research studies that are taking place. I you �nd a topic that is o interest to you, you may want to look or an article by the author, or i it is not yet published, you could contact the author as his or her university affiliation is listed. Activity 6
1. Since your population o interest was not included in the study, you would not include the data rom this study in the evidence reviewed or your problem. However, the literature cited by the author in the literature review may be a source o inormation or your review and should be investigated urther. 2. Te authors describe nearly all o the potential methods or maintaining constancy. You expect this because it was an intervention study and requires the highest levels o �delity. Te authors may not have described how they knew subjects had understood the intervention prior to the return demonstration, but they tested the subject ability and retested afer a period away rom the study. You would probably choose to trust that intervention �delity was maintained i you elt that the steps taken, and described, in the report were adequate. 3. Yes. A negative �nding in your area is just as important as a positive �nding. Your critiquing criteria would assess validity o the study, any potential weaknesses would be noted, and the results would be included in your evidence. 4. Yes. You would likely need help rom a librarian to develop a literature search to identiy populations similar to your population. You would decide i the included studies were clinically relevant to your population.
POSTTEST
1. a. Purpose: o examine relationships between maternal-etal attachment, health practices during pregnancy (rest/exercise, saety, nutrition, avoiding harmul substances, obtaining health care, and obtaining inormation), and neonatal outcomes (gestational age, birthweight) in a sample o Arican-American pregnant women reporting low educational attainment and low SES. b. Rubin’s (1967) theory o maternal role attainment (MRA) and Mercer’s expansion o the MRA, the “Becoming a Mother” (BAM) (2004) theory. c. Poor (>95% receiving Medicaid), AricanAmerican (>95% rom the inner city) in the Mid-Atlantic region, >16 years old, between 24-28 weeks gestation with a singleton pregnancy, able to speak English. d. Previous treatment with tocolytic therapy, diagnosed preeclampsia or gestational diabetes, diagnosed with a chronic medical condition, abnormal diagnostic result during the current pregnancy, history o spontaneous etal or inant death. e. Maternal-Fetal Attachment Scale (MFAS), Health Practices in Pregnancy Questionnaire II (HPQ-II), pregnancy outcomes (electronic chart review), demographic and pregnancy inormation. . Te authors controlled or income, pregnancy wantedness, preeclampsia, and gestational diabetes through their inclusion/exclusion criteria and during statistical analyses. 2. a. Control b. Constancy c. External validity d. Maturation e. Feasibility . Internal validity g. Selection bias CHAPTER 9 Activity 1
1. Experimental 2. Solomon our-group
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Answer Key
3. 4. 5. 6. 7.
ime series Afer-only Afer-only nonequivalent control group rue experimental Nonequivalent control group
Activity 2
1. Yes, this study used a true experimental design. Tis study had random assignment to groups and the group assignment was concealed. Tere were several processes used to maintain control: manipulation o the independent variable, random assignment to group, use o a control group, preparation o intervention and data collection protocols. Finally, the study also had manipulation, whereby different types o treatment were compared. 2. An experimental design is the best way to test cause and effect since it allows the researcher
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to eliminate threats to internal validity. Tey must meet the ollowing conditions to iner causality: Te independent and dependent variables must be associated, the cause must precede the effect, and the relationship must not be explained by another variable. 3. a. Te independent variables include: motivational interviewing-based coaching and conventional education b. Dependent variables include: attitudinal barriers, pain intensity, pain relie, unctional status, and quality o lie 4. Difficulty in keeping coaching intervention ocused on pain, difficulty with attentioncontrol phone calls turning into clinical support calls, high attrition due to death or disease progression, and more attrition in the coaching group.
Activity 3
1.
Group A Group B Group C Group D
Pretest
Teaching
Posttest
X
X X
X X X X
X
Note: Te groups may be arranged in any order, but the our-group pattern must be ollowed.
2. Te nurses would be randomly assigned to each o the groups using a table o random numbers or computer random assignment. 3. Te pain knowledge and attitudes questionnaire would be used as a pretest. 4. Te teaching program is the experimental treatment. 5. Te pain knowledge and attitudes questionnaire is also the posttest or outcome measure. 6. Te Solomon our-group design is ideal or experimental studies in which the pretest might affect the outcome. In this case, the questionnaire might change nurses’ knowledge and attitudes about pain management. Te researcher will be able to compare results or nurses receiving the teaching and not receiving the teaching with and without the pretest.
7. Tis type o design is particularly effective in ruling out threats to internal validity that the beore-and-afer groups may experience. It is effective or highly sensitive issues, which might be affected by simply completing a questionnaire as a baseline pretest. 8. A disadvantage o the Solomon our-group design is that a large number o subjects must be available or assignment into the our groups. Activity 4
1. Quasi-experimental designs may be more practical, more easible, and more adaptable to real-world practice. In many studies important to nursing, it is not possible to randomize subjects into groups or practical or ethical reasons.
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Answer Key
2. Te researcher must careully examine other actors that could account or differences between groups. 3. Te clinician must careully critique the research study and also look or other actors, which might explain the results o the study. Te results o any study with any design must be evaluated to determine i other actors in�uence the �ndings. Te results should also be compared with the �ndings o other similar studies.
Activity 6: Evidence-Based Practice Activity
1. 2. 3. 4. 5.
Level V Level I Level VI Level II Level III
POSTTEST
1. a. b. c. d. e. 2. a. b. c. d. e. .
Activity 5: Web-Based Activity
1. Tis number will vary depending on when the search is conducted. 2. Te types o articles will vary depending on when the search is conducted, but ofen you will �nd editorials, review articles, and research studies. 3. Tis number will vary depending on when the search is conducted. 4. Tis number will vary depending on when the search is conducted.
E Q E E Q 3 1 2 6 4 5
CHAPTER 10 Activity 1 L
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H V O H H O A R R O I U S
L G R S D L D U R Z L D O T U E I O I S Q S E D L V W O F I U W S J J E L O S Y U H I A G D K X O A C I Q W R E E T O K T A S A M I K E N B
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1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Survey Longitudinal Correlational Ex post acto Cross-sectional Correlational Longitudinal Survey Cross-sectional Comparative
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D U O O K L H N P H O B Z V F M C N G U L U E O L Y N R K C K A M F G U P Q S B Z L L
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Answer Key
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Activity 2 Advantages
Correlation studies Cross-sectional Ex post acto Longitudinal Prospective Retrospective Survey
A3 A1, A8 A4 A2, A6 A2, A7 A4 A1
Activity 3
1. 2. 3. 4. 5. 6. 7.
ES: Exploratory survey L: Longitudinal, or P: prospective CS: Cross-sectional R: Retrospective, or E: Ex post acto C: Correlational M: Methodological MA: Meta-analysis
Activity 4
Disadvantages
1. Longitudinal, descriptive 2. Yes: Higher MFA will be negatively related to adverse neonatal outcomes. Higher MFA will be positively related to improved health practices during pregnancy. Improved health practices during pregnancy will be negatively related to adverse neonatal outcomes. Health practices during pregnancy will mediate the relationship between MFA and adverse neonatal outcomes. 3. Inclusion criteria: participants had to be 16 years or older, between 24 and 28 weeks gestation with singleton pregnancies, and able to speak English. Exclusion criteria: prior to data collection they had been treated with tocolytic therapy, diagnosed with preeclampsia or gestational diabetes, diagnosed with a chronic medical condition (e.g., chronic hypertension, diabetes mellitus), or had an abnormal diagnostic result (e.g., known etal anomaly, abnormal results on �rst or second trimester screening tests) during the current pregnancy. Additionally, women reporting a history o
D1, D3, D4, D7 D2, D5 D1, D2, D3, D4, D5, D7 D2, D8, D9 D3, D4, D7, D8 D1, D2, D3, D4, D5, D7 D5, D7 etal (spontaneous abortion afer 24 weeks gestation) or inant death were excluded. Te inclusion criteria and the timing during pregnancy were chosen to try to increase the chances o MFA as the pregnancy progresses and MFA should increase. Te exclusion criteria were chosen because o their known effect on neonatal outcomes. Te aims o the study would be harder to demonstrate i the exclusion criteria were not used and they conounded the data. 4. Data were collected rom the participants at one point during weeks 24-28 o their pregnancy. Additional data were collected rom the medical record during this period and also within 48 hours o delivery. Activity 5
Ex post acto design Activity 6: Web-Based Activity
1. Answers or this activity will vary depending on when the search is conducted. 2. Answers or this activity will vary depending on when the search is conducted. Activity 7: Evidence-Based Practice Activity
1. d 2. b 3. a, b
POSTTEST
1. 2. 3. 4.
Variables Survey Descriptive, exploratory, comparative Relationship-difference
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5. 6. 7. 8. 9. 10. 11. 12.
Answer Key
Correlational Interrelational Retrospective a. Cross-sectional b. Longitudinal/prospective c. Retrospective/ex post acto Cross-sectional; longitudinal Prospective Retrospective Methodological
CHAPTER 11 Activity 1
1. 2. 3. 4. 5.
Meta-analysis, systematic review Integrative review Meta-analysis Clinical practice guidelines Expert-based guidelines, evidence-based guidelines
Activity 2
1. In a good systematic review, the aims are clearly stated as a PICO statement and the eligibility and relevance criteria are well described and are predetermined. Te reader can clearly see how the search relates to the aims and how studies included in the review �t eligibility criteria. 2. ransparency and reproducibility are important to convey in the methods section. Te reader should eel con�dent that based on the article, they could recreate the literature search, data extraction, bias assessment, data combination, and quality appraisal and reach the same conclusions as the authors. Te authors should also ully describe their inclusion and exclusion criteria and the rationale behind them. 3. Te authors ully describe their search strategy, we look or evidence that they combed through all relevant databases and used their sources to search or literature in literature cited sections, bibliographies, etc. A good description o a rigorous search will leave the reader assured that all eligible studies have been located. 4. A good systematic review will document how the authors determined validity and reliability o the studies in the review (did they use a quality appraisal system? I so, which one?).
Te authors will provide their grading scheme or determination o quality in the included studies. Te reader will understand how the authors appraised the literature and how this appraisal led to the author’s conclusions in the paper. Te experience and quali�cations o all reviewers should also be brie�y described. 5. Te authors provide the reader with a way to identiy the studies used in the review and their �ndings and quality. Ofen, this is done in a table ormat. A good-quality table will allow the reader to understand the �ndings and will ofen lead naturally to a discussion where the author can easily synthesize the �ndings o the included studies. Activity 3
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
SR, MA, IR SR, IR MA IR ECG, EBCG EBCG MA ECG ECG, EBCG IR MA
Activity 4
1. It is an expert-based clinical guideline. Te guideline was based on a panel o national experts in child abuse. Te policy provides guidelines or doctors, but does not provide an evidence table upon which the practice guideline was based. 2. Pediatricians 3. “Te American Academy o Pediatrics recommends that pediatricians develop skills in the recognition o signs and symptoms o abusive head injury, including those caused by both shaking and blunt impact, consult with pediatric subspecialists when necessary, and embrace a less mechanistic term, abusive head trauma, when describing an in�icted injury to the head and its contents. “Te goal o this policy statement is not to detract rom shaking as a mechanism o AH but to broaden the terminology to account or the multitude o primary and secondary injuries that result rom AH, some o which contribute to the ofen-permanent and
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Answer Key
signi�cant brain damage sustained by abused inants and children.” 4. Te guideline provides pediatricians with 5 recommendations or practice including: learning the signs and symptoms, steps to providing a thorough assessment, subspecialist consultants who may be helpul, correct terminology or diagnosis and communication, and prevention efforts.
Activity 5
1. Systematic reviews can provide evidence or developing practice; reviews based on multiple RCs provide stronger evidence. A metaanalysis can provide Level I evidence, the higher level o evidence. Systematic reviews can help clinicians to manage the expanding volume o research literature. Te systematic review process and critiquing process help clinicians understand how to rate and use the inormation gleaned rom multiple studies. 2. Clinical expertise and patient values or preerence 3. b and d
4. Level of Evidence
Description
Source
Level I
Meta-analysis o RCs
C
Level II
A well-designed RC
C
Level III
Quasi-experimental study
C
Level IV
Single nonexperimental study
C
Level V
Systematic review o qualitative studies
B, C
Level VI
Single descriptive or qualitative study
A
Level VII
Opinion o authorities, report o expert committee
A, E
POSTTEST
1. Integrative review 2. Quantitative 3. Systematic review and meta-analysis, meta-analysis 4. More than 1 person, excluded 5. Meta-analysis, highest level o evidence 6. Analysis 7. Bias 8. Forest plot, blobbogram 9. Evidence-based practice, expert-based guidelines 10. Does not, published studies CHAPTER 12 Activity 1
1. Sample: Set o units that are selected to represent an entire population. Population: Well-de�ned set that has certain speci�ed properties, may be de�ned broadly or narrowly.
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Differences: Te population is the entire set o units with speci�ed characteristics. Te entire population is not ofen easible to include in a study. Te sample is a subset o the population that is selected to represent the entire population. 2. arget population: Te entire population that meets the sampling criteria. Accessible population: A population that meets the target population criteria and that is available to the researcher. Differences: Te target population is the whole, whereas the accessible population is the slice that is available to the researcher. 3. Inclusion criteria: Population descriptors used to select a sample. Exclusion criteria: Characteristics that restrict the population to make it more homogeneous. Differences: Tese terms describe the same concept. Inclusion, exclusion, eligibility, and delimitations are all terms used to describe subject attributes that researchers consider
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Answer Key
when determining i the individual is part o a population. Activity 2
1. Probability sampling uses random selection and is more rigorous. Nonprobability sampling uses nonrandom methods and there is no way to ensure that each element has a chance or inclusion in the sample. 2. a. N b. N c. P d. N e. P . P Activity 3
1. 2. 3. 4. 5. 6. 7.
b d a c d e d
Activity 4
types o service, we compared active duty (n = 38 individuals), National Guard or reserve (n = 18 individuals), and soldiers who had lef the Army and returned to civilian lie afer their most recent deployment (n = 35 individuals). 2. Subjects were accessible to the researcher, the researcher was able to assemble a sample meeting the inclusion criteria, and was able to get preliminary data on the role o resilience in military amilies. 3. Greater risk o bias, voluntary participation may skew results, less generalizability than other sampling methods 4. Te researchers used multiple methods to recruit subjects (Facebook, veteran service organization blogs, veteran-targeted publications, �iers at military treatment acilities). Tese methods may help other researchers reach this population or uture studies. Activity 5
1. a. Yes, the sample is adequately described. Te inclusion criteria were noted as (a) one or both members o the couple had been deployed to OIF or OEF while serving in the US Army, (b) both members could read and speak English, and (c) both members had been in a selde�ned ‘‘committed relationship’’ or at least 1 year. In addition, both members o the couple had to be willing to consent to participate in the study. b. No, there were no statistically signi�cant differences. c. Convenience d. Nonprobability e. Te sampling unit was the couple. . Packets were mailed to 85 couples, 66 couples returned completed surveys (77.6% response rate). Surveys were returned by couples in which the male was the service member (n = 39) and in which both members o the couple were in the military (n = 27). Seven packets were returned by only one member o the couple and thereore were not included. o more ully explore differences between
1. 2. 3. 4. 5. 6. 7.
rue rue False False rue rue False
Activity 6
1. Yes, the characteristics o the sample were well described. 2. Adults with cancer-related pain receiving care at outpatient clinics. 3. Te sample included mostly patients with lung, prostate, and head and neck cancers. 4. No. Te sample contained 90% men in the control group, 95% in the education group, and 84% in the coaching group. 5. Yes. Te criteria were: able to read and understand English, access to a telephone, a lie expectancy longer than 6 months, average pain intensity score o 2 or higher as measured on a 0-10 scale, with higher scores meaning more pain. 6. Based on the material provided in the article, you could answer yes. Te delimitation or exclusion criteria speci�ed participants who had a concurrent cognitive or psychiatric condition or substance abuse problem that
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Answer Key
7.
8. 9.
10.
would prevent adherence to the protocol, severe pain unrelated to their cancer, or resided in a setting where the patient could not sel-administer pain medication. Te convenience sample was obtained by recruiting patients rom six outpatient oncology clinics (three Veterans Affairs [VA] acilities, one county hospital, one community-based practice in Caliornia, and one VA clinic in New Jersey). A convenience sample introduces more bias than any other sampling method; samples may not be representative o the population. Te sample size appears appropriate or this study. Te authors state “o test the interaction o time (change in scores rom pre- to post-study) by assignment to the three treatment groups (i.e., control, education, or coaching), a sample size o 240 was needed to detect a medium effect ( = 0.25; h2 = 6% o explained variance).” Te authors had completed surveys rom 289 participants afer randomization to groups. Yes, the study was approved by the institutional review board and research committee at each o the study sites.
Activity 7: Web-Based Activity
1. Answer will depend on state chosen and census year. 2. Answer will depend on state chosen and census year 3. “White. A person having origins in any o the original peoples o Europe, the Middle East, or North Arica. It includes people who indicate their race as “White” or report entries such as Irish, German, Italian, Lebanese, Arab, Moroccan, or Caucasian.” “Black or Arican American. A person having origins in any o the Black racial groups o Arica. It includes people who indicate their race as “Black, Arican Am., or Negro”; or report entries such as Arican American, Kenyan, Nigerian, or Haitian.” 4. Te sample was 3.8% Black, 90.1% white. Comparisons between able 1 in the study and census data will depend on the state chosen and the year o the census data.
Activity 8: Evidence-Based Practice Activity
151
Te sample and sampling strategy is one variable that will in�uence the strength o the evidence provided by the study. Te evidence rom a metaanalysis o all randomized controlled trials is more in�uential in making practice change decisions than rom a single descriptive or qualitative study with a convenience sample. POSTTEST
1. Power analysis 2. Probability; nonprobability 3. Convenience 4. Simple random 5. able o random numbers 6. Strati�ed random 7. Inclusion, exclusion criteria 8. Convenience, quota, purposive 9. Multistage or cluster 10. Data saturation CHAPTER 13 Activity 1
1. 2. 3. 4. 5. 6.
Nursing research committee Institutional review board Justice Expedited review Unethical research study HIPAA
Activity 2
1. Bene�cence 2. Justice 3. Respect or person Activity 3 Elements of Informed Consent
1. 2. 3. 4. 5. 6. 7. 8.
√ √ 0 √ √ √ √ 0
itle o protocol Invitation to participate Basis or subject selection Overall purpose o the study Explanation o bene�ts Description o risks and discomorts Potential bene�ts Alternatives to participation
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Answer Key
9. 10. 11. 12. 13. 14. 15. 16.
Financial obligations Assurance o con�dentiality In case o injury compensation HIPAA disclosure Subject withdrawal Offer to answer questions Concluding consent statement Identi�cation o investigators
√ √ 0 0 √ √ √ √
Activity 4
1. 2. 3. 4.
Te elderly Children Pregnant women Te unborn
Other correct responses include those who are emotionally or physically disabled, prisoners, the deceased, students, and people with AIDS; also potentially includes oversubscribed research populations (organ transplantation patients, AIDS patients, “captive” and convenient populations). Activity 5
1. a, c, d, , g 2. a, b, c, d, , g (Also, presume “e” was not adhered to because the study began in 1932 beore IRBs and ormal consent were required.) Activity 6
1. Appendix A, Tomas et al., in the “Sample and Settings” section under “Methods,” write, “Te study was approved by the institutional review board and research committee at each o the sites.” Under “procedures”, write, “Prior to beginning participant recruitment, all research team members were trained extensively so that the procedures or enrollment, data collection, and interventions were standardized across all clinic sites. Research associates (RNs or psychology interns) were trained in procedures or evaluating potential participants, approaching them, obtaining consent to participate, and administering the instruments and videotapes. Patients were identi�ed by clinic staff and screened or eligibility by the research associate, who then approached eligible patients, explained the study, and obtained written inormed consent…. Participants received a $25 gif certi�cate afer completing each set o questionnaires.”
2. Appendix B, Alhusen et al., document in the “Data Collection Procedures” section o the article that “Institutional Review Board approval was obtained prior to participant recruitment. Eligible participants were approached about enrollment in the study during their prenatal care visits. I a woman expressed an interest in participating, but had not reached 24 weeks gestation, her contact inormation was obtained. Te �rst author recontacted her and met with her to complete study instruments prior to a scheduled appointment that occurred between 24 and 28 weeks gestation. Afer a complete description o the study, inormed consent was obtained rom those women who agreed to participate. Participants were interviewed in a private space at each o the three study clinic sites. Interviews lasted approximately 30 minutes. Te interviews were conducted by the �rst author or one o two undergraduate nursing students who received research compliance and study procedures training. Participants were compensated $15 or their participation.” 3. Appendix C, Seiler et al., report in the “Data Collection Instruments” section, “Approval rom a university Institutional Review Board was obtained prior to data collection. Each participant received an inormation letter that ully described the study, including the contact inormation o the researcher, a reminder that they could choose not to participate at any time and that they would be able to obtain the results o the study i interested. Inormed consent was obtained rom each participant to complete the demographic questionnaire and to audio record the interview. All identiying data were kept con�dential in a locked �le and were not included in the research report. No harm resulted rom participating in the interview process. Te participants bene�ted by sharing their �rst-hand experiences o providing health care to the homeless and aiding the interviewer and others to gain an understanding o their role.” 4. Appendix D, Melvin et al., provide the least detailed description o how they protected human rights. Tey state in the “Participants” section under “Methods” that “Both members o the couple had to be willing to consent to participate in the study.”
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Answer Key
Under the “Procedures” section, they state “Demographic data were collected at the initial contact with one or both spouses, and included sel-reported age, gender, military status (e.g., active duty, reserves), military rank (i applicable), race, ethnic status, current relationship status and duration, total number o marriages, number o children, and educational level. Study recruitment method also was documented (e.g., Facebook, newspaper, snowball).” Activity 7: Web-Based Activity
1. Te National Center on Shaken Baby Syndrome 2. Te center educates parents and proessionals and conducts research to prevent shaking and abuse o inants in the United States. 3. Ethical challenges to research with this population are that inants are considered a vulnerable population, as are pregnant women—a potential group or research on education and interventions to prevent inant abuse. Additionally, i there were an allegation o child abuse, the accused person may be a target or research to understand inant abuse. Children and inants cannot give inormed consent, thus research on this group must be in consultation with an IRB. I a researcher ound evidence o child abuse, he or she would be legally required to report it. Research trials on the effects o shaking abuse would be unethical. Tere are also other legal and ethical questions surrounding this population. Activity 8: Evidence-Based Practice Activity
You could check the Federal Register or other government documents or websites to determine i misconduct had occurred, or check the journal or a correction or ollow-up research report.
5. Inormed consent 6. Risks to subjects may be greater than bene�ts, a patient’s basic human rights could be violated, and results o a study would be questionable. CHAPTER 14 Activity 1 Study 1 (Tomas et al.)
1. d 2. Six instruments were used: a demographic questionnaire, the Karnosky Perormance Status (KPS) scale, the Brie Pain Inventory (BPI), Barriers Questionnaire (BQ), Short Form Health Survey (SF-36), and the Functional Assessment o Cancer TerapyGeneral (FAC-G).Te demographic questionnaire allowed researchers to collect age, education level, gender, ethnicity, marital status, living arrangements, and employment. Te KPS measures unctional status on a scale rom 0-100 where higher scores indicate higher unction, the BPI is a sel-report instrument to measure the intensity and quality o pain. Te BQ measures 8 attitudinal barriers to cancer pain management. Te SF-36 measures unctional status across 8 domains. Te FAC-G measures quality o lie. Questionnaires allow sel-report data to be collected; measuring quality o lie could not be accomplished through physiological instruments. Questionnaires are particularly useul or collecting data on experiences, eelings, behaviors, or attitudes. Te authors did not �nd statistically signi�cant changes in the scales over the course o the intervention; one possible reason they listed was that these measures were not sensitive enough to capture the changes ollowing the intervention. Study 2 (Alhusen et al.)
POSTTEST
1. Yes, because extra precautions should be taken to protect the rights o vulnerable populations, but this would not preclude undertaking research. 2. Beore 3. Inormed consent documents, IRB approval rom the appropriate agency. 4. Yes
153
1. c/d/e 2. Te participants were interviewed or about 30 minutes by the author or a nursing student and during that time they completed the three instruments: the Maternal-Fetal Attachment Scale (MFAS), the Health Practices in Pregnancy Questionnaire-II (HPQ-II), and a demographic and pregnancy measure. Additionally, neonatal outcomes
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154
Answer Key
and maternal physical health risk actors were extracted rom the medical record. Maternaletal attachment and health practices are an experience, eeling, behavior, or attitude and a questionnaire is the appropriate method or collecting this data. Te medical record contains the record o neonatal outcomes and maternal physical health risk actors and is the appropriate place to collect this type o data. Te rationale or use o an interview in this study was not described by the authors and the participants may have been able to complete the study instruments without the interview. Study 3 (Seiler et al.)
1. c/d 2. Te researchers wanted to understand the experiences o nurse practitioners who provide health care to the homeless. Interviews were audiotaped and used open-ended questions to learn about the experiences o nine nurse practitioners. Tere is a gap in knowledge o the experiences o advanced-practice nurses in caring or the homeless, since this study is building a knowledge base where there has not been previous research, the use o an interview is appropriate, and the use o a phenomenology lens allows the researchers to explore, analyze, and describe this experience. Te authors also used a short demographic questionnaire to collect data on gender, race, marital status, amily income, and NP position status. Te interview method provides the most �exibility when used with open-ended questions to learn about the experience o caring or the homeless. One weakness o using a small sample such as this is that it lacks generalizability and may not be representative o the experience o all NPs who care or the homeless. Study 4 (Melvin et al.)
1. d 2. Te surveys used included: the Postraumatic Stress Symptoms Checklist (PCL),
the Revised Connor-Davidson Resilience Scale (R-CD-RISC), the Revised Dyadic Adjustment Scale (RDAS), the adapted gender-neutral Women’s Experience o Battery (WEB), the raumatic Experience Questionnaire (EQ), and a demographic data measure that included age, gender, military status, military rank, race, ethnic status, current relationship status and duration, total number o marriages, number o children, and educational level, dates o deployment, location, and job while deployed. 3. Te researchers kept the order o study survey measures constant to ensure that participants answered questions about their lietime history o trauma prior to answering questions about PSD. Both members o a couple had to agree to participate in the study. Surveys were mailed to both members o a couple in separate envelopes, and the participants were reminded that questions should be answered independently and that answers should not be discussed prior to returning the surveys. Although the researchers measured coercion and interpersonal violence, the study did not provide an avenue or researchers to report violence to clinicians or others in contact with the participants. Te authors suggest that screening or violence in clinical settings should occur to protect both members o these military couples. Activity 2
1. Consumers 2. Physiological 3. Reactivity 4. Interviews 5. Records 6. Questionnaire 7. Objectivity, consistency 8. Concealment 9. Interrater reliability 10. Operationalization 11. Likert scale 12. Content analysis 13. Fun
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A I E F O
S R
K
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S Z
Y E O S
S P
P E
E
R
T
A
L
I
Z
A
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O
R E
N E V E M A I
E
R
A
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D N E A U H B S D A L E E R R O Y O V N O C A A U M A P V E P U M A H V W K I C A L Y S I S P V R S A D V A N P I B I O I O
E D B
N E S S P E L P H I B S A N D
C
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O L O G I C A L L
L
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C H L A E O D S
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R B Y C A J
R
Activity 3
1. Children; interactions between people where the investigator is not part o the interaction; psychiatric patients; classrooms 2. Te consent is usually o the type where permission to observe or a speci�ed purpose is requested. Te speci�c behaviors that are to be observed are not named. Te use o the data and degree o anonymity are explained. In some situations, the subjects will be asked to review the data afer the observation and beore inclusion in the data pool. 3. Reactivity is the major concern, when the investigator has reason to believe that his or her presence will change the nature o the subjects’ behavior. Activity 4
Answer Key
Physiological measures would be o minimal use since the data being sought would not involve actual measures o the residents’ physiological status. Not particularly interested in current blood pressure, temperature, urinary output, etc. Could consider using observation; or example, sitting in an emergency department and observing the types o health care concerns that
V
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R D N
E A A O S
E
W
A O D O M
E
B
C
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I
R E C O R D S
C A S A A G P N N M N T O O N S
X B V S A E L R I V D A O E I G O E N S O O V O E F R U N N V A R O U M
S
enter. Would need to think about whether this would be observation with concealment. Would need to wrestle with the notion o what is private inormation and what is public domain inormation. Also, would an emergency department pro vide inormation about all o the residents o the community and their health needs? Could use questionnaires and collect data rom all types o health care providers. Could provide a lot o data in a short time. Wonder how busy they would be and what would be the probability o their �lling out the questionnaire? Do health providers have an idea o the health belies and practices o all o their patients? Could use an interview. Is costly in terms o researcher time, but could provide more detailed inormation because subjects could be asked to expand on speci�c items. But who should be interviewed? How does one get into their offices/ homes, etc.? Need to get some inormation rom the people who actually live here. How could you reach a cross-section o the residents o your rural community? Could they be called? What about those people without a telephone?
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Answer Key
Better check out the census data to get a clearer picture o what is being dealt with. Probably have some morbidity and mortality data collected by the state health department. Would probably use existing records to get a �rst sense o what the parameters o “health” are in this community. Ten talk to some people about who knew the most about this area and arrange some interviews with these individuals. Tese would be guided interviews with open-ended items to encourage the sharing o as much inormation as possible. Would also seek a way to collect data rom a variety o health care users; or example, surveys in the waiting room o various agencies, maybe the crowd at a mall, at a county air. One data collection instrument would not be sufficient to collect the inormation needed about the areas addressed.
CHAPTER 15 Activity 1
1. S; avoided by proper calibration o the scale. 2. S; decrease error by providing instructions, ensuring con�dentiality, or other means to allow students to reely express themselves. 3. R; lessen by training research assistants and using strict protocols or rulebooks to guide analysis. 4. R; decrease their anxiety by addressing their concerns, providing comort measures, or other efforts that might decrease their anxiety. Anxiety may alter the test responses. Activity 2
Activity 5
1. 2. 3. 4. 5. 6.
Activity 6: Web-Based Activity
Activity 3
1. 2. 3. 4. 5.
d a d a, b, c d
Answers will vary depending on when the search is conducted and what database is used. Activity 7: Evidence-Based Practice Activity
Answers will vary depending on the topic chosen, when the search is conducted, and what database is used. POSTTEST
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
d d c b b d c d b b b d a d a
Construct validity Face validity Content validity Content validity index Construct validity or convergent validity Convergent validity; contrasted groups; divergent validity; actor analysis; hypothesis testing 7. Contrasted groups 1. Stability; homogeneity; equivalence 2. est-retest methods could be accomplished by giving the same test again at a later date and seeing i the two scores are highly correlated. Parallel or alternate orms, such as alternate versions o the same test, could also be used to establish stability. 3. Alternate orms would be better i the testtaker is likely to remember and be in�uenced by the items or the answers rom the �rst test. 4. a. 2 b. 4 c. 1 d. 3 5. a. A Likert scale is commonly used when measuring psychosocial variables or attitudes. It asks respondents to respond to a question using a scale o varying intensity between two extremes. We would expect the scale to ask i the respondent strongly agrees or disagrees with a statement or i the statement is “most like me or least like me” on a scale rom 1-5 where one is anchored by being least like me.
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Answer Key
b. Was developed to measure posttraumatic stress symptoms in military and civilian populations. Was reported to be valid based on correlations between the PCL and the clinician-administered PSD scale. c. Te inormation provided or the instrument would increase con�dence in the results o the study. Based on the descriptions, the instrument chosen was appropriate. I a greater understanding o the instruments is needed, the original articles reerenced in this study would be a good place to start. Additional studies o the measures used could also provide inormation on recent changes or adaptations o the measures. Activity 4
Results will depend on the search term chosen and availability o psychometric testing inormation on the chosen instrument. Activity 5
1. Six instruments, the Karnosky Perormance Status (KPS) scale, the Brie Pain Inventory (BPI), Te Barriers Questionnaire (BQ), the Short Form Health Survey (SF-36), the Functional Assessment o Cancer TerapyGeneral (FAC-G), and a demographic questionnaire developed or this study. 2. a. No speci�c inormation on validity was given, but the author states that reliability and validity are well-established and does give a reerence. b. No c. Cronbach’s alpha, test-retest reliability, item-total correlations and inter-item correlations or each domain in the scale, split-hal, parallel or alternate orm. d. No, it is used or yes/no ormat questionnaires; the FAC-G uses a 5-point Likert scale. e. Yes, the authors state that it has been used in patients with cancer and in patients with cancer-related pain. . You would start with the reerence given or reliability and validity and you may complete a search o reliability and validity on this instrument. g. You would read the discussion section; the authors do compare their results to
157
other studies and discuss the differences on subscale scores. Tis is also a good place to look or discussion about threats to internal or external validity. Activity 6: Evidence-Based Practice Activity
First, this study would need to be put into context. It would need to be known what other studies were available in the same area. I a decision were being made based solely on the published reliability and validity inormation, it would not be considered a strong study. o qualiy this statement, there may be more inormation about the reliability and validity o the instruments. Some o it may have been cut to meet required article length. Some inormation is given, and what is presented is valuable and does lead to some con�dence in the results—certainly more con�dence than i they had been using several newly constructed instruments. A �nal answer would be “it depends.” Some questions would need to be asked and a deeper literature search on maternal-etal attachment would need to be done. POSTTEST
1. Cronbach’s alpha 2. Concurrent 3. Convergent 4. Content 5. Factor analysis 6. Interrater 7. est-retest 8. Content 9. Convergent 10. Cronbach’s alpha CHAPTER 16 Activity 1
You will have your set o completed cards. Activity 2
1. 2. 3. 4. 5.
d c d a a, b, or c, depending on the tool used to measure satisaction 6. a
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7. 8. 9. 10. 11.
Answer Key
b d a c d
interdependence can produce signi�cant correlations in survey scores. Tereore our chosen analysis method accounted or interdependence o couple measures.” (Melvin et al. 2012). b. Nominal or ordinal; is a test o the difference between groups
Activity 3 Across
1. j Gooy’s best riend 3. e Old abbreviation or mean 5. b Abbreviation or number o measures in a given data set (the measures may be individual people or some smaller piece o data such as blood pressure readings) 8. m Describes a set o data with a standard deviation o 3 when compared with a set o data with a standard deviation o 12 10. h Abbreviation or standard deviation 11. Marks the “score” where 50% o the scores are higher and 50% are lower 12. c Measure o variation that shows the lowest and highest number in a data set
Activity 5
1. Null hypothesis 2. Parametric statistics 3. Research hypothesis 4. Sampling error 5. Parameter; statistic 6. Correlation 7. ype II error; ype I error 8. Probability 9. Practical signi�cance 10. Nonparametric statistics 11. Statistical signi�cance 12. Research hypothesis; null hypothesis 13. c, b, a, e, d Activity 6
Down
1. l Te values that occur most requently in a data set 2. i 68% o the values in a normal distribution all between ±1 o this statistic 4. d Can describe the height o a distribution 6. g Describes a distribution characterized by a tail 7. k Very unstable 9. a Measure o central tendency used with interval o ratio data Activity 4
1. a. b. 2. a. b. c.
adverse neonatal outcomes nominal dichotomous variable Maternal-etal attachment (MFA) adverse neonatal outcome In order to use inerential statistics, we know that it must be at interval or ratio level. Te MFAS used a Likert scale and there is no stated absolute zero, so it must be interval level. 3. a. A dyad is two individuals who are regarded as a pair in the analysis. Te authors used a dyad in their analysis since “Because both spouses completed separate surveys, yet they were describing the same marital relationship, this
1. 2. 3. 4. 5. 6.
N = 12 Nominal, ordinal, interval 7.6 6 3 Limited sample size, N = 12; every score affects the mean
Activity 7
1. a. Yes b. Yes c. Yes d. Yes 2. All studies used descriptive statistics to describe certain characteristics o the sample (e.g., age, sex, ethnicity, marital status, income). a. sample size (N), mean, standard deviation (SD), range b. N, mean, SD, range, median c. N, requency, % d. N, %, mean, SD, Z score 3. a. Yes b. Yes c. Yes d. Yes 4. Yes, the Melvin et al. and Alhusen et al. studies were descriptive studies.
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Answer Key
5. a. b. c. d. 6. a. b.
Yes Yes No Yes Chi square (χ2), ANCOVA Logistic regression, Pearson correlation, bivariate correlation, multiple regression c. None used because this is a qualitative study d. Multiple regression, t-test, chi square (χ2)
2.
Activity 8: Web-Based Activity
1. a. We can surmise that a wider con�dence interval is an indication o more uncertainty in the estimate, since the population standard and standard deviations are estimated rom the data. I there are limited data to estimate the standard deviation, we will expect a wider CI due to this uncertainty. We can eel more con�dent that i we were to sample the same population repeatedly, we would get a con�dence interval that would bracket the true population standard in 95% o the cases. b. Percentages, incidences, median, range, average Activity 9: Evidence-Based Practice Activity
Te nurses should stop and consider how their actions could make a difference. Tey could check out the websites that are listed as reerences on the child abuse prevention site and look or recommendations o experts in the �eld. Tey could anticipate �nding guidelines or ways o preventing abusive head trauma and could evaluate ways to include those recommendations in their practice. Tey could provide literature or education or parents both beore the child is born and during inancy. Tey may also need to devise a way to collect data or an evaluation o the steps they had taken (such as by evaluating the effect o their educational materials, evaluation o how ofen they are providing education during clinic visits, etc.).
3.
4. 5. 6. 7. 8. 9.
At clinic 2, you may have a shorter wait sometimes, but 68% o the wait times would be between 0 and 70 minutes. Te mean would provide inormation about the most common number o hospital gowns needed on your unit, but it is sensitive to outliers. Te median could also be examined, but it is not clear i the hospital gown data has a normal distribution. Perhaps the best method would be to look at both the mean and median to determine the number o gowns or your unit. Te mode may be useul, but again without knowing the distribution o the data, there is no way to know i the gown data has one mode or is bimodal. Te mode would be less useul than the median and mean. Mode------------ Most requent score Median----------Middle score Mean ------------Arithmetical average – most stable Nonsymmetrical, positive, negative Hypothesis Sampling distributions, inerential Null hypothesis ype II error Chi-square
CHAPTER 17 Activity 1
1. 2. 3. 4. 5. 6. 7.
R D R D R R D
Activity 2
1. 2. 3. 4. 5.
d b a e c
POSTTEST
1. Tis is a matter o personal preerence and o probability. At clinic 1 you would have a longer average wait time, but 68% o the wait times would be rom 30 to 50 minutes.
159
Activity 3
1. 2. F 3. F
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Answer Key
4. 5. 6. F POSTTEST
1. Te researchers identi�ed our hypotheses. Tey were that (1) couple unctioning as perceived by each member o the couple would be negatively associated with PSS in one or both members o the couple, (2) the relationship between couple unctioning and PSS would be increased in magnitude by lower level o resilience, younger age, emale gender, lower military rank, increased levels o trauma exposure, and marital con�ict resolution problems, (3) difference in perceptions o couple unctioning between emale or dual military soldier couples, and (4) that SS would be present in 12-70% o civilian spouses in the study sample. Te results o each hypothesis are presented in the Results section. 2. Inormation regarding the results or each hypothesis is presented concisely. In addition the researchers present the inormation on each hypothesis sequentially, stating “the �rst hypothesis” and “second hypothesis” when presenting the results or the �rst two hypotheses. Te last two hypotheses are presented sequentially, but not labeled as such. 3. Te tests that were used to analyze the data are identi�ed or the �rst hypothesis (general linear mixed model) and or the third hypothesis (Chi-square analysis). 4. Yes, the results are presented objectively. Te researchers avoided opinions or reactionary statements about the data. 5. able 1, able 2, and able 3 are used to supplement the presentation o the results. Tere is inormation (mostly data or numbers) that is only ound in the tables. Only a minimal amount o inormation in the tables is repetitive o the text. Tis inormation was ofen the mention o a P value or the results in both the table and text. All o the tables have precise headings. 6. Although the results are interpreted in light o the hypotheses, the researchers do not apply the �ndings back to the theoretical ramework that was chosen to guide the study.
7. Although the some o the hypotheses were supported (i.e., the second hypothesis was not supported), the researchers did not provide a discussion o how the theoretical ramework was supported. 8. Te researchers make several statements about the weakness o the study. For example, they discuss the low reliability o the rauma Event Questionnaire and the cross-sectional study design. Te also identi�ed study strengths. For example, they ound PSS demonstrated a similar effect on couple unctioning in both male and dual military couples who have deployed, which is a �nding not previously reported. 9. Te researchers discuss the study’s clinical relevance throughout the discussion section. For example, they state that “the �nding that couples with high resilience also had higher couple unctioning despite high levels o PSS provides a starting place or the development o preventative interventions.” Te researchers also indicate that “nurses and other healthcare proessionals should also ensure accurate documentation o trauma history and reerrals or treatment during interactions with military couples as indicated.” 10. Te researchers avoid making any grand generalizations. Much o the discussion is related to previous literature on similar topics. In addition, the researchers go so ar as to state the reasons why they believe that “the complex nature o how couples are affected by combat-related PS cannot be ully explained in the sample.” 11. Te researchers state recommendations or uture research. For example, the researchers state that determining the direction o the relationship between coercion, interpersonal violence, and couple unctioning is an “important goal or uture research.” In addition, the researchers also state that “the relationships in this study should be urther explored using other methods, such as longitudinal data collected beore and afer deployment, to better evaluate causality patterns and the presence o mediators.” Further recommendations are provided in the �nal paragraph o the study.
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Answer Key
CHAPTER 18
161
Activity 3
Activity 2
Please note that what ollows are the results o one inspectional reading o the study by Tomas et al. (2012). You You are not expected to agree with these �ndings. Some o you may agree, but some o you may not. Systematic skimming : In reading the title, ab-
stract, the biographies, and the discussion, the ollowing conclusions were made: Te biographical inormation o the authors/researchers authors/r esearchers indicates that they have a clinical nursing background in oncology and research/statistical methods. Te PICO o the scenario could be P: inpatient clients with cancer, I: interventions or pain management/ control, C: usual care, O: pain. Te PICO o the study is similar to the PICO rom rom the scenario. Te PICO rom the study would be P: outpatient clients with cancer who have a lie expectancy > 6 months and a pain intensity score > 2; I1: video + educational, I2: video + education + coaching; C: video; O: pain intensity intensity,, pain relie, pain intererence, attitudi attitudinal nal barriers, unctional status, quality o lie. Yes, would proceed to super�cial reading. Super�cial reading:
1. Remembered about the study:
experimental study
was strati�ed based on pain and cancer treatment reerences provided board
consider or critical cr itical appraisal. It continues to appear to be relevant to the scenario. scen ario.
An experimental study o moderate to strong quality,, given that the strengths outweigh the limiquality tations, was conducted in a sample o primarily men, 60 years o age, who have been diagnosed with multiple types o cancer, and were seeking outpatient care. Participants Participants were randomized r andomized to receive one o two interventions (education alone or education plus coaching) or usual care. Te only signi�cant differences between the groups were or pain intererence scores and mental health component o the SF-3. Participants Participants who received the education plus coaching intervention had a signi�cantly lower pain intererence scores and higher mental health scores at the end o the study (12 weeks) than those who received education alone or usual care. Based on the �ndings o this one study, a recommendation to not implement an education plus coaching intervention to improve pain management control practices among inpatient adult adult oncology patients could be determined. CHAPTER 19 Activity 1
1. a. b. c. d. e. 2. a. b.
P—older adults I—adiposity, I—adiposit y, cardiorespir cardiorespiratory atory �tness C—none* O—mortality Prognosis P—patients P—pa tients with diabetic oot ulcers I—negative pressure wound therapy (NPW) using vacuum-assisted closure c. C—advanced moist wound therapy (AMW) d. O—wound healing e. Terapy 3. a. P—adolescent clinical patients b. I—CRAFF c. C—none* d. O—screening or substance abuse e. Diagnosis 4. a. P—children b. I—residential exposure to power line magnetic �elds c. C—none* d. O—ALL e. Causation/Harm *Note in some studies, there is no comparison
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Answer Key
Activity 2
1. Terapy; Prognosis; Causation; Review; Qualitative 2. None 3. Clinical rial; Meta-Analysis; Practice Guideline; Randomized Controlled rial 4. Etiology; Diagnosis; Terapy; Prognosis; Clinical Predication Guides 5. PUBMED (Medline)—“Clinical Queries” Activity 3
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
g c h a e j b i k d
Activity 4
bleeding. Implementation issues (i.e., cost, time, manpower) have likely already been addressed. However, However, the study also showed a signi�cant increase in nausea and pain, so perhaps patient preerences may be considered in uture discussions about implementation o pressure bandages. 6. Although there was a signi�cant reduction in bleeding among patients who received the pressure bandages, there is likely research evidence to support the continued implementation o pressure bandages in the given scenario. However, in continuing the implementation, the RN should consider i (a) the population in the study is similar to his or her clinical cl inical situation (target population) and that (b) the application o results o the study to the target population should be done with caution, until higher level evidence (i.e., systematic review, practice guideline) is available. Activity 5
1. Te percentage o patients who had bleeding; discrete/dichotomous. 2. “1.0.” Note: Note: Te null null value value varies varies depending depending on the outcome; or a continuous outcome variable, the null value would be “0.0.” “0.0.” 3. We are are 95% certain that when a patient receives the pressure bandage they will be anywhere rom 0.3 to 0.9 times less likely to experience bleeding than patients who did not receive the pressure bandage. 4. Te risk o bleeding isis 0.52 times times less in patients who received pressure bandages than those who did not n ot receive pressure bandages. Te RR (or treatment effect) is statistically signi�cant because the 95% Con�dence Interval (0.3, 0.9) does not include 1.0 (the null value). 5. Tirty-two (32) patients need to be treated with pressure bandages in order to prevent bleeding in 1 patient. Te NN was calculated �rst by �nding the absolute risk reduction (ARR), then dividing 1 by the ARR. Te ARR = 6.7% – 3.4% = 3.2%. Ten 1 is divided by 3.2% (or 1/0.032) = 31.25, which is rounded up to 32. Because B ecause pressure bandages are already being implemented in the scenario, there is research evidence to support the continued use to decrease
1. P—U.S. P—U.S. teenage teenage girls; I—not applica applicable; ble; C— not applicable; O—eating disorders 2. Tere would be concern that the difference in geographic locations o the target population (Caliornia) and study population (Spain) would be signi�cantly different even though the clinical situatio situationn PICO question and study question are similar similar.. 3. Causation because the clinical situation and study are about determining whether one thing is related to another; based on the study design (cohort study) you would select the CASP ool ool or Cohort C ohort Studies. 4. a. Discrete/dichotomous b. Discrete/dichotomous c. Discrete/dichotomous d. Discrete/dichotomous 5. eenage girls whose parents parents were not married, who ate alone, who read girls’ magazines more than once per week, and who listened to the radio or more than 1 hour per day were at increased odds or developing an eating disorder; all o these variables (except or “reading girls’ magazines more than once per week”) were statistically signi�cantly associated with an increase in odds or developing an eating disorder; the null value is “1.0”; the CI or the variables o “parents’ “parents’ marital status”, “eating alone”, and “listening
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Answer Key
163
to the radio radio”” do not include “1.0,” indicating that these results are statistically signi�cant, whereas the CI or the “reading girls’ magazines more than once per week” (0.91 to 2.2) includes “1.0,” indicating that it is not n ot statistically signi�cant. 6. Although results o this study re�ect a population o teenage girls rom Spain, it is possible that there may be credibility in applying the evidence to the current clinical situation. Although an evidence-based practice change may not be warranted by this one study, a urther review review,, critical appra appraisal, isal, and synthesis o the evidence could lead to changes in screening teenage girls or eating e ating disorders in the target population.
research �ndings, whereas evidence-based practice is ocused on the application o bestavailable evidence, which includes research �ndings in addition to nonresearch �ndings such as case reports and expert expe rt opinion. 2. a. the best-available evidence b. clinical expertise c. patient values
POSTTEST
Activity 3
1. False; an experimental or quasi-experimental study design is usually used or the therapy category o clinical concern used by clinicians; causation/harm studies typically use nonexperimental (longitudinal or retrospective) study designs. 2. rue 3. rue 4. False; sensitivity is the proportion o those with the disease who test positive and speci�city is the proportion o those without the disease who test negative. 5. False; the CI provides the reader inormation about both the statistical and clinical signi�cance o the �ndings. Although �ndings may be statistically signi�cant, the clinician must apply the “low” and “high” end o the con�dence levels to determine clinical signi�cance. 6. rue 7. rue 8. False; likelihood ratio ratio is a term used to describe the number that expresses the sensitivity, speci�city, PPV, NPV, and prevalence or diagnosis clinical category questions.
1. 2. 3. 4. 5. 6.
a. b. c. d. e. . g. h. i. j. k.
b d a c b d
4 1 5 10 2 11 7 9 3 6 8
Activity 4
1. Problem-ocused; Knowledge-ocused 2. Stakeholder(s) 3. Patient, Popula Population, tion, or Problem; Intervention/ reatment; Comparison C omparison Intervention/ reatment; Outcome(s) Activity 5
1. 2. 3. 4. 5. 6.
Y N Y N N Y
Activity 6
CHAPTER 20 Activity 1
Activity 2
1. Evidence-based practice is a broader term that encompasses research utilization. Research utilization is ocused on the application o
1. a. the nature o the innovation (e.g., the type and strength o evidence) b. the manner in which the innovation is communicated 2. a. 3 b. 4
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164
Answer Key
c. d. 3. a. b. c. d.
1 2 Y Y N Y
4. 5. 6. 7. 8.
POSTTEST
1. Pediatric cardiology on 14 diagnosis groups 2. “Appointed CPG coordinator and the collaboration o all members o the healthcare team. Te CPG steering group consists o expert clinicians, including the Vice President o Cardiovascular Critical Care Services, attending cardiologists, anesthesiologists and surgeons, clinical coordinators, nurse practitioners, staff nurses, patient care coordinator, respiratory therapists, nutritionist, and social worker” (Poppleton, Moynihan, & Hickey, 2003, p. 76). 3. It appears that all members o the team could be considered stakeholders; key stakeholders not represented could include patients (i applicable due to age), patients’ amilies, senior hospital leadership (both medical and nursing).
9. 10.
11.
12.
Not indicated Not indicated Not indicated Not indicated; not indicated o a degree; however, recommendations are missing an indication to the evidence to support the recommendations and the grade o the evidence. Not indicated Detailed methodology or how patient data would be collected, including an excerpt rom a sample clinical guideline and a variancetracking sheet or a sample clinical guideline Yes; yes, “the CPG Program has been a successul strategy in a continual effort to provide cost effective care without compromising quality” (Poppleton et al., 2003, p. 83), the authors report several positive outcomes CPG coordinator could be considered both “Change Champion” (due to clinical expertise qualities) and “Opinion Leader” (due to technological qualities), both o which encompass EBP expertise; didactic education (education during orientation and when new CPGs are introduced)
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Answer Key
165
CHAPTER 21 Activity 1 Your answers may vary.
Quality Improvement
Purpose
Evidence-Based Practice
Research
Improve internal practices Change or reinorce nurs- Generate knowledge or processes ing practice
Rigor ←→ Control Protocols less ormal/ rigorous, may change throughout project
Interventions are more strict than QI, but not as controlled as research
ight control o variables
Method
QM/CQI Six Sigma Lean Clinical Microsystems
Iowa model o EBP Johanna Briggs institute model o EBP
Qualitative, quantitative, or mixed methods
Human subjects
Doesn’t usually require IRB approval
Doesn’t usually require IRB approval
Requires IRB approval unless exempt
Data collection
Benchmarking Collecting and monitoring data Rapid cycle
Literature search and appraisal Data collection not as rapid as QI
Observation, sel-report, physiological, medical records, databases Data collection time varies
Results
Improve process
reatments or nursing care are based on the best available evidence
Adds to the body o scienti�c knowledge
Dissemination
Within a unit or an agency Publications, conerences, Scienti�c community, consultations, training publications, conerences programs, changing practitioner behavior through interaction with those who provide direct care
Activity 2 Your answers may vary.
1. All use a systematic process. 2. Te basic process is similar; all use systematic reasoning to address a clinical issue. 3. All provide evidence or quality care; QI provides the lowest strength and
generalizability, while research provides the strongest evidence with the greatest generalizability. 4. Results o all three are disseminated, just on a different range. 5. All are collaborative processes.
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