Research

Critical Appraisal

Critically appraised topic - a quick summary of a clinical question an an appraisal of the best evidence that typically begins with a clinical bottom line (i.e., best practice recommendation).

➢ Ethnography:

Culture, roles, life ways, cultural behavior (cultural description questions) Seeks an insiders' view

Measurement error

Difference between what exists in reality and what is measured by a research instrument

Nonmaleficence

Do no Harm! Researchers' obligation to avoid, prevent, or minimize harm to humans in studies Participation is required from subject & must not be subject to unnecessary risks/harm/discomfort

Interval

Equal interval distances, absence of a zero point; for example, temperature Temperature is the most commonly used example of an interval scale. The difference between the temperatures of 70 and 80 degrees F is the same as the difference b/w 30 and 40 F degrees.

Nausea and vomiting are common side effects among patients on chemotherapy and interventions to date have been only moderately successful in reducing these effects. New interventions that can reduce or prevent these side effects need to be identified.

Example of a problem statement:

➢ Phenomenology:

Experience, lived experience, meaning, essence (meaning questions) Focus is on people's subjective experiences and interpretations of the world.

Characteristics of phenomenology

Focuses on the description and interpretation of people's lived experience Asks: What is the essence of the experience and what does it mean from participant's point-of-view

Purpose of a literature review: For non- researchers:

For researchers: • Identification of a research problem • Orientation to what is known and not known • Determination of gaps or inconsistencies in a body of research • Assistance with interpretation of findings For non- researchers: • Acquiring knowledge on a topic • Evaluating current practices • Developing evidence-based clinical protocols and interventions

Phase 2: design and plan phase (quantitative)

Research design Identify population design the sample plan specify methods to measure research variables finalize research plan safeguard methods for subjects.

Qualitative studies

Research questions include the phenomenon of interest and the group or population of interests.

Multi site studies→

Researchers sometimes engage in these settings because the use of multi sites offers a larger or more diverse sample of study participants

Likert Scale

Responses are on an agree to disagree, good-to-bad, positive to negative, or excellent to terrible continuum Responses to items are summed to compute a total scale score.

Justice

Fundamental ethical principle in Belmont Report & Institutional Review Board (IRB) Participants' right to fair treatment Right to privacy Equal distribution of research benefits & burdens Based on study requirements & not vulnerability do not exploit vulnerable populations

Data collection for ethnography

Gain entrance to culture; immerse self in culture; acquire informants; gather data through direct observation & interaction with the people Analysis - describe characteristics of the group Outcomes - description of the group

Dichotomous questions:

Have been hospitalized as an inpatient at any time in past 5 years? Yes No

Coercion

In a research context, the explicit or implicit use of threats (or excessive rewards) to gain people's cooperation in a study. • Stipend - a generous monetary incentive. Example: Monetary incentive offered to encourage the participation of an economically disadvantaged group might be considered midly coercive because such incentives may place undue pressure on prospective participants

Qualitative Study

Informants or Study participants→ The individuals cooperating in the study who play a much active role rather an a passive role Researcher or investigator→ The person who conducts the research In a qualitative study, studies are often undertaken by a research team rather by a single researcher.

Qualitative Data

Information in NARRATIVE descriptions: Data Can be obtained through conversations with participants, obtaining narrative records such as diaries Relationship→ a bond or connection between two or more phenomena • Ex. The relationship between smoking and lung cancer Often expressed in quantitative terms "more than, less than"

Quantitative Data

Information in NUMERIC form. Data in Quantitative studies Primarily measures. For an example in a study of depression: "Thinking about the past week, how depressed would you say you have been on a scale from 0 to 10?" The numeric values are the data

Steps in linear phase 2

Step 6- Selecting a Research Design Step 7- Developing the protocols for the intervention • Intervention protocol- specifies exactly what the intervention will entail (ex. Who would administer it, how frequently and over how long a period the treatment would last, and so on) • The goal is to have all subjects in each group treated in the same way. (However in nonexperimental research, this is not necessary) Step 8- Identifying the population Step 9- Designing the sampling plan Step 10- Specifying methods to measure variables • Data collection plan • Step 11- Developing Methods to safeguard human/animal rights • Step 12- Reviewing and finalizing the research plan • Proposal- a document communicating a research problem, proposed procedures for solving the problem, and when funding is sought, how much the study will cost.

Quantitative Study

Subjects or Study Participants → the people being studied in a quantitative study Respondents→ people who provide information by answering questions. Eg. filling out a questionnaire

Steps in Linear phase 1

• Step 1- Formulating and Delimiting the problem • Formulating good research questions • Step 2- Reviewing the Related Literature • Literature Review • Step 3 - Undertaking Clinical Fieldwork • Step 4 - Defining the framework and developing conceptual definitions • Step 5- Formulating Hypotheses • Hypotheses- predictions of expected outcomes; they state the relationships researchers expect to observe in the study data.

sampling

• The process of selecting a portion of the population to represent the entire population

Visual Analog

• Used to measure subjective experiences (e.g., pain, nausea) • Measurements are on a straight line measuring 100 mm • End points labeled as extreme limits of sensation

Data

→ pieces of information obtained in a study

Attrition Bias

➢ All studies may lose participants - however, when a prospective study lasts a long time, people tend to drop out.

Systematic random Sampling

➢ Choosing every kth case or person from some list or group (e.g. every 10th persons on a patient list). ➢ It can be done in such a way that an essentially random sample is drawn

Stratified Random Sampling

➢ Population is first divided into two or more strata, then random selection is done • Enhances representativeness by ensuring equal representation of important characteristics (e.g. gender). • Example: researchs may sample either proportionately (in relation to the size of the stratum) or disproportionately. If a population of students in a nursing school in the US consisted of 10% AA, 5% Hispanic, 5% Asians, and 80% whites, a proportionate sample of 100 students, stratified on race or ethnicity, would consist of 10,5,5 and 80 students from the respective strata. Researchers often use a disproportionate sample whenever comparisons between strata of unequal size are desired. In this example, the researcher might select 20 AA, 10 Hispanic, 10 Asian, and 60 whites to ensure a more adequate representation of the viewpoints of the racial minorities.

Cluster (Multistage) Sampling

➢ Successive random sampling of units from larger to smaller units (e.g., states, then zip codes, then households) • Widely used in national surveys: Larger sampling error than in simple random sampling, but more efficient example: Taking a random sample of hospitals in Houston, take all patients with the condition of interest within these hospitals.

Considerations for instrument selection and or development

Instrument selection is dependent on the type of population: Example, homeless population that requires a face to face interview style of instrument.

Data collection for Grounded theory?

Interview, observation, record review, or combination In-depth interviews and observations Data collection, data analysis, sampling occur simultaneously analytic approach takes a line by line analysis and constantly compares the data searching for themes/categories.

Inferential Statistics

Law of Probability; draw a conclusion about a population based on sample results - Estimation of Parameters - estimate single population characteristic (ex. Mean Value) - Hypothesis Testing

data collection in phenomenology ?

Main data source: In-depth conversations with participants who have the experienced Researcher identifies themes

Dependent variable

(outcome) Not manipulated... but observed or measured The consequence or presumed effect that varies with a change in the independent variable variable that the researcher is interested in understanding, explaining or predicting

o ANOVA (Analysis of Variance)

- Parametric Procedure = 3 or more Groups • Test "Mean" differences in 3 or more groups; Statistic Computed: F Ratio • Compare variability between groups and variability within groups

Descriptive Statistics

- summarize & describe data - Mean, Median, Mode - measures of Central Tendency - Frequencies - Statistic

Implied consent

- the assumption that completing and returning a questionnaire reflects the respondent voluntarily consents to participates

Phase 4: Analytic Phase

Analyze data interpret results

Coding the data

Coding is defined as marking the segments of data with symbols, descriptive words, or category names.

Nuremberg Code (1949)

Most important document in the history of the ethics of medical research One of the first international efforts to establish ethical standards. Created following the Nuremberg trails when Nazi human experimentation was made public

Descriptive Design

No manipulation of variables, just observing, describing, and documenting aspects of a situation Researchers seek to describe relationships between variables May be qualitative

Credibility

OVERRIDING GOAL OF QUALITATIVE RESEARCH. Refers to confidence in the truth of the data and interpretations of them.

Transcribing the data-

Taking the audio tape interviews and field notes and transcribing them verbatim and must be ensured that the transcription is accurate and validly reflects the totality of the interview experience

Selection Bias

Occurs when difference between people who are chosen to participate in a study & those who do not. Self-selection bias occurs when participants volunteer for a study. The reason why they volunteer is often related to interest in the study question and this may create bias. most challenging threat to the internal validity of studies not using an experimental design (e.g., nonequivalent control group designs, case-control designs), but can be partially addressed using the control mechanisms (page 246)

T-Tests

Parametric Test = 2 Groups • Compare & Analyze differences between 2 groups; Statistic Computed: T Statistic

Characteristics of ethnography

Participant perspective Outsiders Researcher observation What things mean from an analytical, anthropological perspective

Sample Size Determinants

Population Type of study Previous studies Resources - funding, feasibility, and time Location

➢ Grounded theory:

Processes, social structures, social interactions (process questions) Purpose - theory development Used in discovering what problems exist & how persons handle them

Autonomy

Providing informed consent to patient/subject Independence.

example of research mortality

The most severely ill patients might drop out of an experimental condition because it is too demanding

Informed Consent

The participants have adequate information regarding the research, comprehend the information, and have the power of free choice thus they are enabled to consent or decline participation voluntarily.

Grounded Theory

Qualitative Research Seeks to describe and understand the key social, psychological, and structural processes that occur in a social setting. Focus on a developing social experience Core variable - central in explaining whats going on

Phenomenology

Qualitative Research concerned with the lived experiences of humans An approach to thinking about what life experiences of people are like and what they mean

Ethnography

Qualitative research: Primary research tradition within anthropology, provides a framework for studying the patterns, lifeways, and experiences of a defined cultural group in a holistic fashion. The aim is to learn from (rather than to study) members of a cultural group to understand their world view as they perceive and live it.

Randomized Control Trials

Quantitative Most powerful designs for testing hypotheses of cause and effect relationships Gold standard for intervention studies Highest quality evidence regarding the effects of intervention

Cohort

Quantitative Groups may be prospective (presumed cause forward to a presumed effect) • stronger • more costly o retrospective (the past affects the future)

Non experimental Research

Quantitative Research Researchers are bystanders, the collect data without introducing treatment or making changes Observational Study

Experimental Research

Quantitative Research researchers actively introduce an intervention or treatment a. Controlled trial or clinical trial b. This research is designed to test causal relationships—to test whether the intervention caused changes in the dependent variable.

Probability sampling technique

Random selection of elements from a population. Should not be confused with random assignment. Everyone in the population has an equal, independent chance of being selected.

Research mortality

The treat that arises from attrition in groups being compared (Attrition: the loss of participants over the course of a study, creating bias by changing the composition of the sample initially drawn) If different kinds of people remain in the study in one group versus another, then these differences, rather than the independent variable, could account for observed differences on the outcome variables at the end of the study.

Triangulation

The use of multiple methods to collect and interpret data about a phenomenon, so as to converge on an accurate representation of reality Is the use of multiple sources or referents to draw conclusions about what constitutes the truth.

Declaration of Helsinki (1964)

World Medical Association (WMA), amended six times since 2008. Statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data

o Emergent design

a design that emerges during the course of data collection

Systemic Review (overview) ROL

a review in which evidence on a topic has been systematically identified, appraised and summarized according to predetermined criteria

Sample

a subset of the population samples are more practical and less costly than collecting data from an entire population, the risk is that the sample might not adequately reflect the population's traits.

Theory

a systematic abstract explanation of some aspect of reality. Plays a role in both quantitative and qualitative research.

• Convenience sample

Volunteer sample) qualitative weakest form of sampling & most commonly used method in many disciplines. leads to risk of bias using the most conveniently available people as participants. Likely to be used when researchers need to have potential participants come forward and identify themselves.

Conceptual model

a theory in quantitative studies with the use of deductive reasoning, make predictions about how phenomena would behave in the real world if the theory were true. This theory is tested through research.

Deontology

actions are right or wrong based on their characteristics; ethical terms define right and wrong

Data set

all the pieces of data that researchers gather in a study

Concepts→

an abstraction based on observations of behaviors or characteristics (ex. Fatigue, pain) in quantitative studies. In qualitative studies this is called phenomena.

Bias

any influence that distorts the results of a study and undermines validity

General review: ROL

any summary of the literature

Random Error

arises from random fluctuations in the measurements o Transient factors, situational factors, variations in administration of procedure, and processing data o Does NOT bias direction of the Mean Typically will not effect results. Occurs when experiment is repeated many times, get a mean value random errors - studied through statistical analysis of repeated measurements (mean, standard deviation, and variance are often used)

conceptual files

creating a physical file folder in which all the materials relating to that category was inserted). Creating such a file was cumbersome and labor-intensive but often done before the advent of computers.

Quantitative purpose statements

identifies the key study variables and their possible interrelationships as well as population of interest.

Problem statements should

identify the nature, context, & significance of problem being addressed arouse interest in the topic communicate information essential to reader's comprehension of what follows be broad enough to include central concerns be narrow enough to serve as a guide to study design

Qualitative purpose statement

indicates the nature of the inquiry, the key concept or phenomenon, and the group, community or setting under the study.

Inter rater

involves having two or more trained observers or coders make simultaneous, independent observations

Test retest

major problem with this is that many traits do CHANGE OVER TIME, independently of the instrument's stability.

Simple Random Sampling

most basic probability sampling design sampling frame - a list of all population elements ➢ Involves random selection of elements from the sampling frame • For example, all names in a hat, or random number tables. If nursing students at the University of Connecticut were the accessible population, then a roster of those students would be the sampling frame. Or the researcher might use a telephone directory as a sampling frame.

o Parametric Test -

most commonly used in research; more powerful than Nonparametric • Focus on population parameters • Measured on interval scale (ex. Fahrenheit degrees)

Utilitarianism

most good for the greatest number of people

Pilot Study

o A small scale version, or trial run, done in preparation for a major study

Reliability

o Degree of consistency with which an instrument measures the attribute it is designed to measure. An instrument is reliable to the extent that its measures reflect true scores. Concerns a measure's accuracy

Dependability

o Refers to stability (reliability) of data over time and over conditions "Why would study findings be repeated if the inquiry were replicated with the same (or similar) participants in the same (or similar) context?" Credibility cannot be obtained in the absence of dependability; just as validity cannot be achieved in the absence of reliability.

Transferability

o Refers to the extent to which qualitative findings can be transferred to (or have applicability in) other settings or groups. (analogous to generalizability)

Validity

o The degree to which inferences made in a study are accurate and well founded; in measurement, the degree to which an instrument measures what it is intended to measure.

Systematic Errors

o Will bias the direction of the score o consistent and repeatable o will not change o can be studied through intercomparisons, calibrations, and error propagation - very common type of error

Site→

overall location for the research. Can be an entire community (ex. A Haitian neighborhood in Miami) or an institution within a community (ex. A clinic in Seattle)

Phase 1 : Conceptual phase quantitative study

phase 1: formulate problem review the lit, form hypothesis undertake clinical feildwork Define framework/ develop conceptual definitions.

Quantitative data collection

primary methods are self reports (ex. Interviews), observations (ex. Observing children's behavior), and biophysiologic measurements.

Journals

primary research articles

NUDIST and NVivo

programs intended to help users organize and analyze non-numerical or unstructured data. allows users to classify, sort and arrange information; examine relationships in the data; and combine analysis with linking, shaping, searching and modeling Qualitative software doesn't actually analyze the text. It simply makes it easier for you to do that.

Construct

refers to an abstraction or mental representation inferred from situations or behaviors. different from a concept, in that constructs are abstractions that are deliberately and systematically constructed by researchers for a specific purpose.

Confirmability

refers to objectivity, that is, the potential for congruence between two or more independent people about the data's accuracy, relevance or meaning.

Anonymity

researchers can not link participants to their data. The most secure means of protecting confidentially. Anonymous

Purpose statement (statement of purpose):

researchers summary of the overall goal. • Establishes the direction of the inquiry and captures the substance of the study.

Level of Significance

risk of making a Type I error in stat analysis; established beforehand; frequently used values → p = 0.05 (5%) and 0.01 (1%)

primary research articles

secondary sources

Central tendency-

the index of typicalness found in the center of a distribution. The three indexes of central tendency: the mode, median, and mean.

Research design

the overall plan for obtaining answers to the questions being studied and for handling various challenges to the worth of the study evidence

Gain entrée-

the process of gaining access to study participants through the cooperation of key actors in the selected community site (gate keepers)

Declarative research question

the purpose of this study is to assess the relationship between the dependency level of renal transplant recipients and their rate of recovery.

Settings→

the specific places where information is gathered • Naturalistic settings- in the field; some are done in highly controlled lab settings • Fieldwork→ The activities undertaken by qualitative researchers to collect data out in the field. A "naturalistic setting."

Independent variable

treatment: In experimental studies X is manipulated by the researcher... has the presumed effect on the dependent variable ...Y Example: What is the effect of the new drug treatment on patient's recovery?

Grey literature

used but not meant for the purpose of research; ex .funding reports, in-house documents, meeting minutes, student absenteeism

Process consent

used mainly for qualitative, ongoing studies, researchers continuously renegotiate the consent, allowing participants to play a collaborative role in the decisions-making process regarding their ongoing participation

network/snowball/chain sampling

variant of convenience sampling. Early sample members are asked to refer other people who meet the eligibility criteria. Most often used when the population is people with characteristics who might be difficult to identify (e.g., people who are afraid of hospitals).

Interrogative research question

what is the relationship between the dependency level of renal transplant recipients and their rate of recovery.

Cross-sectional design

• Collection of data at one point in time (or multiple times in a short time period, such as 2 hours and 4 hours postop). • Less persuasive than longitudinal. • Economical and easy to manage.

o Nonparametric Test

• Do Not estimate parameters • Measured on nominal or ordinal scale • Less restrictive assumptions about distribution of critical variables in analysis

Purpose of a literature review: For researchers:

• Identification of a research problem • Orientation to what is known and not known • Determination of gaps or inconsistencies in a body of research • Assistance with interpretation of findings

Appropriate style/wording for a literature Review

• Limit the use of direct quotes • Opinions should be used sparingly if at all and should be explicit about their source, Reviewers own opinions do not belong in the paper

Semantic Differentials

• Require ratings of various concepts • Rating scales involve bipolar adjective pairs, with 7-point ratings • Ratings for each dimension are summed to compute a total score for each concept

Causality & research Design

• Research designs vary in their ability to support the criteria for causal inference. • Experimental designs offer the strongest evidence of whether a cause (an intervention) results in an effect (a desired outcome). o High on evidence hierarchy

Eligibility criteria

• Specific characteristics that delimit the study population, or inclusion criteria. Researchers establish criteria to determine whether a person qualifies as a member of the population - although populations sometimes are defined in terms of characteristics that people must not possess through exclusion criteria (e.g., excluding people who do not speak English).

3 aspects of reliability

• Stability • Internal consistency • Equivalence

Ordinal

Ranked data; unequal intervals; for example, rating scales Categories must be exclusive and exhaustive. Ordinal data are considered to have unequal intervals (i.e., no certainty that the intervals between the ranked categories are equal). example: a greater difference may exist between mild and moderate pain, than between excruciating and severe pain. Example Question: How satisfied were you with the care that you received while in hospital? 1- 10 scale. 1 being not satisfied at all and 10 really satisfied.

Research Design Quantitative: Quasi-experimental

- Practical, Acceptable for broader group of people Causal inferences cannot be made as easily as with experiments - Control trials without randomization but intervention included; some may not include a control group - Without equal randomization it cannot be assumed that the experimental and comparison groups are equivalent at the outset - The term "comparison group" is sometimes used in lieu of "control group" to refer to the group against which outcomes in the treatment group are evaluated - The hallmark is the effort to introduce some controls, such as baseline measurements

Research Design (Quantitative) Experimental (characteristics of a true experiment)

- Randomized control trial (RCT) Manipulation, Control Randomization

Hypotheses :

A hypothesis is a statement of the expected relationship between two or more variables in a population Null Hypothesis: statistical hypotheses: Example: Older patients are just as likely as younger patients to fall.

Problem statement

A statement articulating the research problem and indicating the need for a study through the development of an argument. • It is a statement about what is problematic about the topic of interest in a specific population • It identifies an area of concern in which there is a gap in the knowledge base needed for nursing practice.

Type II

An error created by accepting the null hypothesis when it is false The researcher concludes that NO relationship exists when in fact it does→ a false-negative finding)

Type I

An error created by rejecting the null hypothesis when it is true The researcher concludes that a relationship exists when in fact it does NOT→ a false-positive finding)

Developing a category scheme

Category schemes are structured grouping of category levels used to organize and assign data. Once category are developed data can be better organized. High-quality category schemes use underlying concepts and concept clusters found while reading the data.

Phase 5: Dissemination Phase

Communicate findings Utilize findings in practice.

Saturation of Data

Data saturation: guiding principle in sampling: sampling to the point at which no new information is obtained and redundancy is achieved

Non-probability

NO randomization; every element does not have a chance for inclusion. Usually in quantitative studies. Less likely to produce representative samples, yet most research samples in nursing and other disciplines are nonprobability samples.

The Belmont Report (1978)

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Provided a model for many of the guidelines adopted by disciplinary organizations in the U.S. fundamental ethical principles for all human subject research: Respect the person, Beneficence, Justice

Instruments and Tools commonly used with different study designs & different populations

Self-report: ➢ Questionnaires, Interviews, Focus groups, • Life histories, • Think-aloud method, • Diaries and journals, • Critical incidents interviews Direct Observation of people's behaviors: ➢ Participant, Non-participant Biophyiologic measure: to assess important clinical variables

Phase 1: in Quantitative Studies - "Linear"

The Conceptual Phase -creativity, deductive reasoning, grounding in existing research evidence

Phase 2 in Linear quantitative study

The Design and Planning Phase - researchers make decisions about the study site and about the methods and procedures to be used to address the research question.

o External Validity

The degree to which results from a study can be generalized to settings or samples other than the one studied. • Ex. Whether results from a smoking cessation program found effective with teens in Boston can be generalized to teens throughout the U.S.

Hawthorne effect

The effect on the dependent variable resulting from subjects' awareness that they are participants under study

o Internal Validity

The extent to which it is possible to make an inference that the independent variable is truly causing or influencing the dependent variable.

Nominal

Unordered categories; for example, gender, ethnicity or diagnoses Data can be organized into categories. The categories must not be orderable. In other words, one category cannot be rated higher than another. The categories may differ in quality, but not quantity. Example Question: what is your gender? ....F or T

Phase 3: Empirical Phase

collecting the data Prepare data for analysis

Beneficence

fundamental ethical principle seeks to maximize benefits for study participants & prevent harm In the Belmont Report & upheld by the Institutional Review Board (IRB)

Data saturation:

guiding principle in sampling: sampling to the point at which no new information is obtained and redundancy is achieved

Ratio:

highest form of measurement Mutually exclusive categories, exhaustive categories, rank ordering, equal spacing between intervals, continuum of values and absolute zero; for example, weight, volume. Weight, length and volume zero point, at which a value of zero indicates the absence of the property being measured. For example, it is okay to say that someone who weighs 200 lbs is twice as heavy as someone who weighs 100 lb.

Sampling plan

specifies in advance how the sample will be selected and how many subjects there will be.

Meta-analysis

statistical technique summarizes the results of several studies into a single numerical estimate, giving more weight to results from larger studies