Nursing Research Exam 1
boolean operators
AND, OR (grouping tg of like terms within returned results), and NOT used in search strings to refine the scope of the search define the relationships between words or groups of words in a literature search
systematic review and meta-analysis
Collects all previous studies on the topic and statistically combines their results combining results from multiple studies
levels of evidence: Quantitative
I: systematic review/meta-analysis of RCTs II: RCT III: quasi-experimental studies IV: nonexperimental studies
levels of evidence
I: systematic review/meta-analysis of RCTs II: RCT III: Quasi-experimental studies IV: nonexperimental studies V: meta-synthesis VI: qualitative VII: expert opinion, committee reports
Levels of evidence: Reviews
Level I: systematic review/meta-analysis of RCTs Level V: meta-synthesis
level I: systematic review/meta-analysis of RCTs
MOST rigorous, systematic data that can be generated - combining results from multiple studies
concept
an image or symbolic representation of an abstract idea can be CONCRETE (BP, weight) or ABSTRACT (hope/spirituality)
consumer's goal of the literature review
answer a clinical question or solve a problem to improve patient outcomes evaluate for credible findings
PICO template for etiology
are ___(p) who have ________(I) at _______ (inc/dec) risk for/of _______(O) compared with _________(P) with/without. ________(C)?
PICO template for diagnosis or diagnostic test
are ____ (I) more accurate in diagnosing _________(P) compared with ________(C) for _________(O)?
pico (i)
area of healthcare that is of interest (e.g. nursing intervention, treatment, diagnostic study)
secondary useful source
article that contains results but is NOT the original study! publications written by person(s) other than the person who conducted the study or developed the conceptual model NOT considered empirical research
EBP goal
assess and use NEW knowledge
critical reading identifies...
assumptions - key concepts and methods - if conclusions match the findings
hypothesis theory base
consistent with existing theory and research findings
conceptual definition
conveys general meaning that defines or explains the concept as it is rooted in theoretical literature
researcher's goal of the literature review
develop the K foundation necessary to design a sound study generate research questions and hypotheses determine all that is known on a research topic
is there an independent variable with a qualitative study?
NO!!
does QI require new knowledge
NO!!! it's refining a process!!! refine, test, and reevaluate!!!
statistical hypothesis
NULL hypothesis NO relationship bn IV and DV null is rejected with statistically significant findings
PICO question
Population Intervention Comparison Outcome
nondirectional hypothesis
Predicts the existence of a relationship, not its direction ex: There is a relationship between baccalaureate nursing students' intramuscular injection competency and simulation training.
Q v Q: objectivity
Quant: OBjective (hard fact- ex: # ppl with a condition, test result) Qual: SUBjective (opinionated- ex: practice environment description)
Q v Q: data type
Quant: numeric Qual: words
Q v Q: study questions
Quant: tests relationships, differences, cause-and-effect, intervention effectiveness Qual: looks for meaning
research hypothesis
SCIENTIFIC hypothesis an EXPECTED relationship of variables
results
WHAT the outcomes were
discussion
WHY the study mattered (significance) HOW the study compares with similar ones WHAT the study adds to existing literature - limitations - conclusions
introduction/background
WHY the study was conducted - study purpose (usually at end of intro) - lit review - theoretical framework
model
a graphic or symbolic representation of a phenomenon
T or F: the lit review mainly should use primary sources; that is, research articles and books by the original author
True
quasi-experimental studies
studies of cause and effect similar to experimental design but using convenience samples or existing groups to test interventions something in the environment we are manipulating, something we change to cause an outcome
critical appraisal- quality
study's design, implementation and analysis
literature review
summary of current empirical and theoretical knowledge about a particular practice problem that provides a bases for the study conducted - a summary or synthesis of what we know (existing K)
research perspective of a lit review
systematic and critical appraisal provides the development and foundation of a research study provides the development and foundation of the theoretical framework ESSENTIAL to all quantitative and qualitative research studies
what is nursing research?
systematic, rigorous, critical investigation that aims to answer questions about nursing phenomena
literature review of a QUANTITATIVE study
theoretical or conceptual framework primary and secondary sources research Q and hypothesis data analysis, discussion, conclusions, implications, recommendations
research evidence
what is behind the WHY of what we are doing for our patients
study purpose, aims, and objectives
what the researcher hopes to achieve terms used interchangeably reflects the research question
variables
what's being studied something that varies (i.e. stress levels, weight) How is X related to Y?
uses of quality improvement
within organizations to improve outcomes to benchmark against other hospitals (e.g. rates of infection, 30-day readmissions) for accredidation
Randomized Controlled Trial (RCT)
experimental method in which participants are randomly assigned to intervention groups and decide if intervention makes a difference compared to a group that didn't receive treatment/therapy/etc.
T or F: commentary in a peer-reviewed journal is considered research
false
you are considering giving a patient an injection for pain, whose report would you feel most comfortable evaluating - the report of a family member or nurse's aide (i.e., _________) or the report by the patient (i.e., ___________)?
fam members: secondary source patient: primary source
Lit review from the EBP perspective
focus on critical appraisal of research studies, systematic reviews, clinical practice guidelines, other relevant docs helps det evidence to inform clinical decision making PICO question
PICO template for prevention
for _______(P) does the use of ______(I) reduce the future risk of __________(O)n compared with _________(C)?
PICO template for meaning
how do ______(P) diagnosed with ________(I) perceive. ___________(O) during ____________(T)?
Pico (E)
measure of interest (effect of intervention)
where can you search for evidence?
pre-appraised literature (published review of the literature) primary sources print and electronic index (CINAHL, PubMed) books journal-refereed/peer reviewed search engines
what types of sources should be mainly used in a lit review?
primary
conducting a lit review
process of examining extensive number of research and theoretical sources to generate a picture of what's known, not known, and has inconsistently found about a clinical problem
pico (p)
pt or group of patients that are the focus of the question
secondary source for lit review
published articles or books written by persons OTHER than the individ who conducted the study or developed the theory. NOT considered empirical research
names of systematic reviews (quant vs qual)
quant: meta-analyses qual: meta-syntheses
hierarchy of levels of evidence
quantitative OVER qualitative!
what type of resource is the BEST choice?
referred or peer-reviewed journal articles (contain the latest info)
4 types of hypotheses
research statistical directional nondirectional
primary source for lit review
research articles and books by the ORIGINAL author
testability
research questions must be testable (measurable) by quantitative or qualitative methods propose a relationship between IV and DV in a way that the relationship can be measured
critical appraisal
research role of BSN- prepared nurses to implement evidence-based practices objectively and critically evaluate a research article's content for scientific merit and application to practice consider the study's strengths, weaknesses, and nature of evidence
what does clinical inquiry lead to?
research, evidence-based practice, or quality improvement
Purpose: research vs EBP vs QI
research: creates new K EBP: application of new K QI: test an existing process
Process: research vs EBP vs QI
research: generalizable or transferrable EBP: problem solving approach, INVOLVES clinicians, patients, and families QI: rapid cycle (Plan, Do, Study, Act)
goals: research vs EBP vs QI
research: generate NEW K EBP: access and USE NEW K QI: improve a process within a clinical system using EXISTING K
a nurse researcher find four useful resources. What is an appropriate next action?
review the resources in the articles
theory
set of interrelated concepts that provides a systematic view of a phenomenon allows relationships to be proposed and predictions to be made HOW VARIABLES RELATE TO ONE ANOTHER
operational definition
specifies how the concept will be measured defines what instruments will be used to assess presence of the concept and the amount or degree to which the concept exists
pico (C)
standard care to compare to intervention
construct
complex concept; comprised of more than one concept- designed to fit a purpose (e.g) maternal-infant bonding, health-related QOL
what is the first thing a nurse researcher would do after a research problem or idea has been identified?
conduct a literature review
critical investigation
"skeptic" lens - asking a lot of follow-up questions to dig deeper
appraising research questions for their significance
"so what?" - what is the potential contribution/benefit of answering this research question? - research questions should have the potential to extend scientific nursing knowledge
critical appraisal- quantity
# of studies, participants
influence for research questions
- clinical experience - identifying gaps in literature - question's potential significance - can the research be done?
critiques of each reviewed study should include...
- strengths - weaknesses - limitations of the design - conflicts - gaps in info
refereed or peer-reviewed journal
-A panel of scholars who are experts review submitted manuscripts. -Usually the reviews are "blind" to promote objectivity; that is, the manuscript to be reviewed does not include the name of the authors. -The reviewers use a set of scholarly criteria to judge whether a manuscript meets the publication standards of the journal.
5 steps of EBP practice
1. ask a question 2. find best evidence (start with a literature review to find types of articles we want (RESEARCH STUDIES)) 3. evaluate evidence (in terms of quantitative and qualitative) 4. apply information 5. evaluate outcomes
first 3 steps of the EBP process
1. ask clinical questions 2. identify and gather evidence 3. critically appraise and synthesize the evidence or literature
3 pieces of evidence based practice
1. research evidence 2. clinical practice 3. patient family values and preferences
in each article that you review, you should determine the...
1. research question and hypothesis 2. design and method 3. outcome of the analysis 4. CRITIQUE it! what's the level of evidence? how good was the article? --> EVERY study has limitations!
how far back can you go?
3, max 5 yrs landmark studies may be included in absolutely essential to background of the problem
what is the ideal time frame for a literature search?
5 years
V: meta-synthesis
A synthesis of a number of qualitative articles on a focused topic using specific qualitative methodology.
when is the research hypotheses developed
BEFORE the study is conducted
which source provides the most information on nursing evidence-based practice?
CINAHL
methods
HOW the study was conducted
PICO template for prognosis/predictions
In ________ (P) how does ________(I) compared to ________(C) influence _______(O) over ________(T)?
associative relationship (hypothesis)
X and Y are systematically related--> variable change in relation to each other
causal relationship (hypothesis)
X causes a change in Y --> cause and effect
directional hypothesis
a hypothesis that makes a specific prediction about the direction of the relationship between two variables ex: Baccalaureate nursing students who receive simulation training will be more competent in intramuscular injection in an actual patient care setting than students who do not receive simulation training.
what does clinical inquiry begin with?
a question or curiousity
theoretical framework
a set of interrelated principles designed to explain a particular phenomenon and to provide a point of view; a map for understanding relationships bn or among vars in a quant study the basis for the development of research questions or hypotheses
components of a research article
abstract introduction/background methods results discussion
primary Essential source
actual original study and the results that come from it publications written by the persons who conducted the study or developed the conceptual model
empirical research
based on observed and measured phenomena and derives K from actual experience rather than theory or belief
identifying significance
benefit (who?) applicability (to practice setting) untested theoretical concepts existing knowledge (does it extend or challenge current K) nursing practices/practices (why does it matter? what are the implications for nurses?)
how is nursing research rigorous?
best practices for undergoing research
abstract
clear overview of purpose, methods, results, conclusions
critical appraisal- consistency
do the studies have similar or different conclusions?
main question of critical appraisal
does the study and its conclusions make sense?
independent variable
effects dependent variable may be manipulated in experimental studies
outcome of the analysis diagram!
everything stems from what already have and know!
research hypotheses
formal statements of expected relationships among 2 or more variables predicts the expected outcome of a study (researcher attempts to answer the Q) provides direction for collection, analysis, and interpretation of data
purpose of clinical questions
guide EBP form the basis for searching the literature to identify relevant research evidence
clinical practice
how we should implement the practice changes that we make
how to write a research question
idea brainstorming lit review identifying variables formulate research question
PICO template for intervention/therapy
in _________(p), what is the effect of ______(I) on __________(O) compared with ________(C) within ________ (T)?
population
large collection of individuals (or objects) that is the focus of a research study
cochrane library
leading resource for systematic reviews in health care
literature review of a QUALITATIVE study
little is known about topic slightly more abbreviated than quant but same steps
aim of qualitative research
looks for meaning of a lived experience; researchers seek to understand a human experience within a defined context
scientific method sequence
observation --> question --> research--> hypothesis--> experiment--> data --> conclusion
nursing phenomena
things perceived by our senses with a nursing focus ex: how their relationships with others are ex: confidence in self bc pt will be successful in regiment
does the summary of each reviewed study reflect the essential components of the study design?
type and size of sample reliability and validity of instruments consistency of data collection procedures consistency of data collection procedures appropriate data analysis identification of limitations
how is nursing research systematic?
use of a scientific method (certain way of doing something)
quality improvement (QI)
uses available knowledge using data to monitor outcomes of care design and test changes in practice (improve quality and safety of care delivery)
how are theoretical or conceptual frameworks usually illustrated?
using a diagram
levels of evidence: Qualitative
v: meta-synthesis VI: qualitative
dependent variable
variable of interest NOT manipulated changes with independent variable
what components does the hypothesis include
variables population predicted outcome
testable hypothesis
variables can be observed, measured, analyzed
