NUR 342 - Midterm
-best evidence -clinical expertise -patient preferences/values
3 components of EBP
What would be an example of nonprobability convenience sampling? A. A sign is posted in the hallway of the college asking students if they would be interested in participating in a study. B. Individuals are randomly selected from a list of all employees at a hospital. C. Every eligible patient admitted to the surgical unit over a six-month period is selected for inclusion in the study.
A
Match the following statements to the appropriate randomization concept. Random sampling Random assignment to intervention A. Researchers obtained a list of all students enrolled in the nursing college, and then randomly selected 50 students to invite them to participate in the study. B. Participants were randomized to receive either 81 mg of aspirin once a day or a placebo once a day for six months.
A - random sampling B- Random assignment to intervention
What are some potential ethical issues that may arise in qualitative research? (Select all that apply). a. Research may become emotionally attached to participant b. The goals of the researchers, participants, funding agency, and other stakeholders may differ c. A participant may overlook the consequences and risks of participating in research A researcher's personal biases may affect data collection
A, B, C, D
What type of information might you see in a research problem statement? (Select all that apply.) a. A description of the background or history of the problem b. A description of gaps in the literature c. A definition and overview of the problem d. An explanation of potential consequences if the problem is not addressed
A, B, C, D
What are the 3 components of evidence-based practice? (Choose only 3). a. Clinical expertise b. Best evidence c. Technology d. Patient preferences and values
A, B, D
What is an evidence hierarchy? a. The ordering or ranking of evidence sources according to their strength of evidence. b. A step-by-step process to evaluate the evidence of research studies. c. The ordering or ranking of evidence sources according to their significant findings. d. A method by which to extract evidence from research studies.
A.
Which of the following is a statement of purpose? a. Our study aimed to compare the hospitalization rates for acute myocardial infarction for hospitals located in rural communities to those located in urban communities. b. Our study is critically needed because there is a lack of prior evidence of the effect of home health on hospital readmission rates. c. In 2021, over 30 million individuals received primary care services from Federally Qualified Health Centers, which provide important access to care for socioeconomically disadvantaged communities. Nurse turn-over in acute care clinical settings is a critical issue that particularly impacts hospitals in rural communities.
A.
In the context of research, what is an ethical dilemma? a. The review and approval of a study by an Institutional Review Board. b. A situation where the participant's rights and the study requirements are in direct conflict. c. The decision to exclude some participants from the study, based on specified criteria. A situation where a participant decides to withdraw from a research study.
B.
What is the informal agreement by minors (e.g., children) to participate in a study called? a. Self-determination b. Assent c. Consent d. Full disclosure
B.
Which of the following is a statement of purpose for a research study? a. Children with asthma are at increased risk of respiratory illnesses, which may result in multiple visits to the emergency department during childhood. b. The primary objective was to evaluate the frequency of emergency department use over a five-year period among children with asthma. c. There is a lack of studies that have examined emergency department use over time for children with asthma and acute respiratory illness.
B.
Which of the following would be found in a statement of purpose? a. A description of the findings from previous studies b. A statement identifying the main objective or goal of the study c. A summary of the significance of the problem d. A description of the gaps in the literature
B.
Which one of the following statements is correct? a. Ethnography can be used to develop or expand theory b. Results from qualitative research are usually not generalizable c. Qualitative studies are usually used to test hypotheses d. The data collection methods for qualitative research is the same as those for quantitative research
B.
- right to freedom from harm and discomfort -maximize benefits and minimize harm -right to protection from exploitation
Beneficence
Did the benefits to participants outweigh any potential risks or actual discomfort they experienced? Did the benefits to society outweigh the costs to participants?
Beneficence
Were participants subjected to any physical harm, discomfort, or psychological distress? Did the researches take appropriate steps to remove, prevent, or minimize harm?
Beneficence
do no harm, maximize benefits, minimize harm, right to freedom from harm, right to protection from exploitation
Beneficence
Was the study approved and monitored by an institutional review board, or other similar ethics review committee?
Beneficence Respect for Persons and justice!
A research participant can voluntarily agree to be involved in a study. This is associated with which ethical principle? a. Right to fair treatment b. Right to privacy c. Right to self-determination d. Beneficence
C.
The data collected for the study is determined to be trustworthy and accurate. b. There is too much data collected on a particular concept for a study, thus researchers decide to focus on collecting data for a different concept of interest. c. The point at which no new information is obtained from participants, thus researchers decide to end recruitment and/or stop data collection. d. Data collection has been completed for all participants who were recruited for the study.
C.
What is the Outcome in the following PICOT question? In patients with arthritis, how does daily meditation compared to no meditation affect their level of pain over six months? a. Patients with arthritis b. Meditation c. Pain level d. Six months
C.
A nurse in the ICU cared for a patient who had undergone a new surgical procedure for a brain aneurism, requiring special post-operative care by nurses. He wanted to describe his experience working with this patient, because he felt this knowledge would be helpful to other nurses. He conducted a descriptive study of this patient.
Case Report
A nurse researcher suspects that early childhood stress is associated with mental illness in teenagers. She recruits teens who are currently receiving treatment for mental illness at an outpatient treatment center. She then identifies a group of teens from the local high school who do not have mental illness. She administers a survey to both groups asking them about stressful events as a young child, then compares the results of both groups to test her hypothesis.
Case control
A nurse researcher wants to examine the risk factors for mobility impairment among older adults in assisted living communities. He selects a sample of older adults in assisted living, and measures their risk factors and mobility level at baseline and every 6 months for 2 years. At the end of the study, he analyzes the data to determine which risk factors contributed to a loss of mobility over time.
Cohort
Researcher recruits participants from a convenient population; e.g., posts an announcement about a study in a hallway
Convenience sampling
a nurse researcher mailed a survey to patients who had been discharged from the hospital after surgery. The survey asked questions related to their post operative recovery and use of pain medication. no other data collection was done. the researcher then analyzed the data from the survey.
Cross-sectional
A nurse researcher has a hypothesis that a diabetes is a causal factor for pancreatic cancer. Which one of the following statements would support his hypothesis? A. Pancreatic cancer is usually diagnosed before diabetes. B. After controlling for genetic factors, the statistical association between diabetes and pancreatic cancer is weak. C. Among people with pancreatic cancer, having diabetes AND a gene linked to pancreatic cancer is common, while having diabetes and no gene for pancreatic cancer is rare. D. There is a statistically significant association between having diabetes and being diagnosed with pancreatic cancer.
D
Which of the following would be a barrier to implementing evidence-based practice in your clinical workplace? a. Nursing staff receive 4 hours per week of paid time for professional development activities, including participation on quality improvement and research projects. b. The department where you work has extensive opportunities for nurses to be involved in clinical research. c. All nursing staff are required to attend monthly inservices and presentations that describe current best practices for clinical care. d. Leadership at your hospital limits research activities to medical staff, and does not encourage or support participation by nursing staff.
D
If you want specific information about how the authors interpreted their study findings or results and described the implications for nursing practice, your best approach would be to look in which one of the following sections of a research article? a. Methods b. Introduction c. Results d. Discussion
D.
The following statement is from an abstract of a research study. What type of study design was used? A total of 45 older adult participants were randomly assigned to a daily physical activity intervention group (n=21) and a control group (n=24). A. Quasi-experimental study design B. Qualitative study design C. Non-randomized controlled trial D. Randomized controlled trial
D.
Researcher seeks to gain an insider's perspective; will become immersed in the culture
Ethnography
Match the qualitative research method with the correct example. -Ethnography -Phenomenology -Grounded theory a. A study aimed to identify factors that influenced professional accountability among emergency nurses. The researcher took the role of a complete participant in the study in order to understand emergency nurses' environment from an insider's perspective. He collected observational data from the nurses in their natural setting. b. A study aimed to understand how RNs implement nursing practice in correctional institutions. The researcher used an inductive process to construct a framework for understanding interactions between RNs, prisoners, and correctional officers. He collected data through semi-structured interviews and field notes. Recruitment and sampling was influenced by the emerging data. c. A study aimed to examine the lived experience of patients with a colostomy. The researcher wanted to gain an in-depth understanding of how people with colostomies live with this medical condition, and what meaning it has in their lives. She collected data through semi-structured interviews.
Ethnography - A Phenomenology -C Grounded Theory - B
Ranking of studies according to their level of evidence; the higher on the pyramid, the higher the level of evidence
Evidence Hierarchy
What is the lowest level of evidence on the evidence hierarchy?
Expert opinion, case reports, etc.
True or false? a researcher would describe the limitations of the study in the results section of the report?
False - discussion section
True or false? A review and summary of literature is typically found in the methods section of the research report?
False - introduction section
Were adequate steps taken to safeguard participants privacy? How was confidentiality maintained? Were privacy rule procedures followed (if applicable)? Was a certificate of confidentiality obtained?
Justice
fairness in subject selection, right to fair treatment and privacy, equitable distribution of benefits and burdens of research
Justice
were groups omitted from the study without a justifiable rationale, such as women (or men), minorities, or older people?
Justice
o Expanded description of the research problem including more details § E.g., history/background/scope of problem, current status, overview of other literature that has addressed problem, gaps in previous literature, consequences for not addressing the problem, rationale for why the current study is needed to address these gaps
Problem statement
A nurse researcher wants to examine the effect of patients' body position on their blood pressure level. The study will be most likely a: Quantitative study Qualitative study
Quantitative study
What is the highest level of evidence on the evidence hierarchy?
RCT - systematic review
o 3 properties: intervention, control, and random assignment of intervention o Gold standard study design: highest level of evidence for a single study o Best study design for determining cause-effect relationships o Sometimes it is not feasible or ethical to do a RCT, thus researcher must use another study design (e.g., quasi-experimental) o Use of control group
Randomized controlled trials (RCTs)
o Assessment of a study's strengths, limitations, quality
Research critique
Were appropriate informed consent procedures used? If not, were there valid and justifiable reasons?
Respect for persons
Were participants deceived in any way? Were they fully aware of participating in a study and did they understand the purpose and nature of the research?
Respect for persons
Were vulnerable groups involved in the research? If yes, were special precautions used because of their vulnerable status?
Respect for persons
autonomy, voluntary participation, informed consent (right to self-determination and full disclosure)
Respect for persons
was any type of coercion or undue influence used to recruit participants? Did they have the right to refuse to participate or to withdraw without penalty?
Respect for persons
-right to self-determination; people are autonomous beings -right to full disclosure (informed consent) -persons with diminished autonomy (vulnerable persons) are entitled to protection
Respect for persons/human dignity
Determined by data saturation: ongoing data analysis determines that no new information is being identified from data collection, thus, researcher ends participant recruitment and data collection
Sample size in qualitative research
Researcher begins with small sample and asks them to refer other potential participants, who then refer other participants, etc
Snowball sampling
-Researcher determines who to sample/recruit based on ongoing data analysis during the study -Used in grounded theory
Theoretical sampling
o Use of multiple sources of information to draw conclusions o Can increase credibility and validity of study findings
Triangulation
True or False Nursing research can be used to help solve clinical problems.
True
True or false? A research problem statement provides an overview of the problem and identifies a rationale for why the study is needed.
True
Researchers use triangulation to increase the credibility of their interpretation of research findings and conclusions. a. True b. False
True.
The Nuremberg Code was one of the first established sets of ethical standards. a. True b. False
True.
Purpose of research
answer questions related to interventions, diagnoses, prognoses, etiology, description of problem, meaning of problem
o Usually focused on one or a few patients/participants o Low level of evidence: does not produce generalizable information
case series/case report
o Subjects selected based disease/outcome condition/case status o Can only be Retrospective because the outcome has already happened o Middle level of evidence
case-control
o 3 major criteria: 1) cause must precede effect, 2) relationship between cause and effect must be present, 3) relationship must not be entirely explained by confounder
causality
what are examples of vulnerable groups?
children, prisoners, pregnant women, homeless people, disabled people
o Subjects selected based on exposure or characteristics of interest o Subjects are followed over time (longitudinal) to determine who experiences the outcome o Prospective OR retrospective o Middle/high level of evidence
cohort
o Examines relationships between variables o Does NOT prove causation
correlational design
o Data collected at single point in time o Middle level of evidence: cannot establish cause-effect relationship
cross-sectional
o Gaining trust from participants o Preparing for intensity, emotional exhaustion o Relationships with participants o Reflexivity
data collection issues in qualitative research
o Primary (new) vs. secondary (existing) data o Different types of data collection § Self-reports (interview, questionnaire, survey), observation, biophysiologic measures
data collection methods
o Unstructured interviews, Semi-structured interviews, Focus group interviews, Joint interviews, Diaries and journals, Photo elicitation, Photovoice, Videos, Narratives
data collection methods used in qualitative research
aims to observe, describe, study various aspects of a phenomenon
descriptive research
Situation where participant's rights and researcher goals/study requirements are in conflict
ethical dilemmas
o Competing interests (e.g., goals of researcher and clinician) o Researcher using own students or own patients as participants o Capturing data from non-participants unintentionally o Role conflict (e.g., role as researcher vs. clinician) o Disseminating findings while maintaining confidentiality
ethical dilemmas
making up data or results
fabrication
manipulating data or results inaccurately
falsification
Researcher is developing a theory or conceptual framework; tries to understand how concepts are related
grounded theory
-testable statement -two or more variables needed -directional vs. nondirectional
hypotheses
· Ways that researchers can protect participants
informed consent, confidentiality, debriefings, referrals, protection of vulnerable groups, IRB review
- right to fair treatment -fairness in subject selection -fairness in distribution -research should not unduly involve persons from groups unlikely to benefit -right to privacy
justice
o Data collected at two or more intervals over a period of time o Same subjects followed over time o Case-control and cohort studies are longitudinal
longitudinal
probability that the condition/disease is not present when the test is negative
negative predictive value
o Sometimes called "Natural" experiment o No random assignment of intervention: main difference between RCT and quasi-experimental o Subject assignment to intervention already determined before study begins: e.g., researcher does not assign o High level of evidence, but not as high as RCT o Control group may or may not be present
non-randomized control trials (quasi-experimental)
o No manipulation, no intervention o Also called "observational" study
nonexperimental study design
§ Individuals do NOT have equal chance of being selected; sampling bias present § Convenience § Quota § Consecutive § Purposive
nonprobability sampling
What are characteristics of qualitative research?
o Emergent design: develops as the study is being conducted o Flexible o Studies people in their natural environment o Data is analyzed as it is being collected § This differs from quantitative research where data is collected first, then analyzed
o Unstructured participant o Unstructured nonparticipant o Types of information collected from observation
observation
Researcher wants to understand people's lived experience
phenomenology
appropriation of another person's work without giving credit
plagiarism
probability that the condition/disease is present when the test is positive
positive predicitive value
§ All individuals have equal chance of being selected; sample is representative of true population § Simple § Stratified § Systematic
probability (random) sampling
Purposeful selection of participants; selecting specific cases that will most benefit the study
purposive sampling
Researcher intentionally selects participants who are most likely to be informative for the study
purposive sampling
transferability
qualitative research
generalizability
quantitative research
ways to control bias in research
randomness, blinding
looking back vs. looking forward in time
retrospective vs. prospective
probability that a test result will be positive when the condition/disease is present
sensitivity
probability that a test result will be negative when the condition/disease is not present
specificity
Aim, goal, purpose, objective statement
statement of purpose