All Research Exam Sets

PICOT/PICO/PIO

(population, intervention, comparison, outcome, time frame)

Member checks

A method of validating the credibility of qualitative data through debriefings and discussions with informants

Constant comparison

A procedure used in a grounded theory analysis wherein newly collected data are compared in an ongoing fashion with data obtained earlier, to refine theoretically relevant categories Detects commonalities and variations

Thick descriptions

A rich, thorough description of the context and participants in a qualitative study

Pilot study

A small scale version, or trial run, done in preparation for a major study to assess feasibility - first one done on a smaller scale to see if it will work

Coding for qualitative studies

After a category or scheme is developed, the data are read in their entirety and coded for correspondence to the categories Rarely straightforward, may take several readings Not linear (one paragraph from an interview may contain content for multiple themes)

Questionnaires

Advantages: quick & generally inexpensive, easy to test for reliability & validity, administration is time efficient, can obtain data from widespread geographical areas, anonymity can be guaranteed w/ cover letter - less costly and are advantages for geographically dispersed samples; offer possibility of anonymity, which may be crucial in obtaining information about certain opinions or traits - one of many data collection methods - BEST method for human response data, paper-pencil format, answers given in writing - development of a reliable and valid questionnaire is difficult, many literature resources available for use in the construction - knowledge levels, opinions, attitudes, beliefs, ideas, feelings, perceptions Validity: - rests on validity of the data obtained, governed by the respondents' willingness or ability to provide accurate info Guidelines: - neat and attractive, minimal length, grammatically correct, no errors, clear margins, high-quality printing/paper - preferred language of respondents', appropriate knowledge and reading level (6th grade), avoid slang, colloquialisms, medical/nsg jargon - determine reading levels: flesch reading ease, fog scale level, flesch-kincaid grade level - questions short, less than 20 words, split long questions up, affirmative not negative manner - avoid ambiguous: more than one interpretations - double negative: never doesn't rain - double barreled: do you eat healthy and exercise Questions: - demographic (gather characteristics about sample) - open-closed ended - contingency (if no, go to question six) - filler (reduce emphasis on other questions, researcher has no direct interest) - group all about same topic together, demographic at begin/end, simple then complex - <10 min to complete, 2-3 pgs or less Cover letter: - written clearly and simple instructions, factor of motivation, all mailed questions - elements: ID of the researcher and any sponsoring agency or person, purpose, how participant selected, reason the respondent should answer; length of time to complete, written clearly, important factor, all mailed, how data will be used or made public; deadline for return; offer to inform respondents of results; researcher's contact info, personal signature Distribution: - convenient location, mailing or distribution system, through internet

Theory

An abstract generalization that presents systematic explanation about relationships among phenomena

Quota sampling

type of nonprobability; a nonrandom sampling method in which "quotas" for certain subgroups, based on sample characteristics, are established to increase the representativeness of the sample - ID population strata and figuring out how many people are needed from each stratum

Purposive sampling

type of nonprobability; handpicking sample members - used in qualitative research mostly - other terms used: snowball, networking, "judgemental sampling"

Research utilization

Definition: the use of some aspect of a study in an application unrelated to the original research Applies knowledge to clinical practice, translation into real world Purpose: To improve patient outcomes (cost, education, med errors, decreased hospitalizations, decreased length of stay)

Outcome or response the researcher wants to predict or explain. Change in this variable caused by the independent variable (aka effect variable)

Dependent

Internal validity

Discuss threats History (no control but occurring at same time as study in world), maturation (over time), mortality, selection Bias (unequal group)

Absolute zero

Remember with ratio, absolute zero, must indicate complete absence of whatever it is measuring. Ask yourself if it is realistic to have absolute zero of the variable being measured; most physical biological measures can have 0 and are measured at ratio level, even if it seems they would be dead

Hypothesis

Researcher's prediction/educated guess based on the theoretical framework

In vivo measurements

performed directly within or on living organisms BP, body temp, HR, RR - very accurate and good provision - strong accuracy, objectivity, validity, and precision - may be cost-effective for nurse researchers - BUT caution may be required for their use, and advanced skills may be needed for interpretation

Strata

subpopulations of a population (ex: male & female)

Stimulus or activity manipulated by researcher to cause an effect on dependent variable (aka: treatment variable, experimental variable)

Independent

3 things involved with experimental design?

Manipulation (intervention), randomization of groups, control

Review use of outcomes research

Mostly focused on the process-pt-outcomes nexus

Time-series design

- data collected over extended period, pre and post intervention, or also partway thru intervention - advantage: extended time may allow ability to attribute the change in the DV to the IV (assess effect of orientation on nsg student at diff. weeks)

Data collection factors

- research question(s) or hypothesis(es) - design of the study - amount of knowledge available about the variable(s) Data collection methods: - self-report questionnaires, interviews, physiological measures, attitude scales, psychological tests, observational methods - variety collection: more than one method used; similar results from variety of methods = greater confidence in study findings Selection of data: collection instrument - conduct a lit review, determine measurements on the instrument (reliability = consistency, validity = does it measure what it is supposed to measure) Sources for research instruments: mental measurement yearbooks, instruments for clinical health care research; the measurement of nursing outcomes; health and psychosocial instruments Development of new instruments: - challenging tasks, constructing the instrument, performing a pilot study, considering time, cost, and availability for pilot Data collection criteria: practicality, reliability, validity HINT: projective tests are particularly useful with small children because of their limited vocabularies

One-shot case study (also called preexperimental)

- single group exposed to experimental treatment and observed/measured afterward X O

Maturation threat

Arises from processes occurring as a result of time rather than the independent variable. I.e. wound healing or postop recovery time.

Types of theories

Classical: an abstract generalization that systematically explains relationships among phenomena Descriptive: a theory that thoroughly describes a phenomenon, based on rich observations of it (qualitative) Grand (Macro): a theory that attempts to explain large aspects of human experiences Middle-Range: a theory that focuses on a specific aspect of human experience (e.g. stress), selected number of concepts; more specific and more amenable to empirical testing; Ex. Pender's health promotion model, Mishel's uncertainty in illness theory, relaxation theory - many are from other disciplines

Problem statement

Clearly identified Usually one sentence Too broad? Too many variables?

Nightingale

Concept: linked health with environmental factors such as: Fresh-air Pure water Drainage Cleanliness Light Ex: maintain noise free environment Intervention: reduce environmental stimuli during quiet hours per hospital policy, by dimming lights, reducing alarm voluming, and making policy known to family, friends, and staff

Types of sources: empirical research

Evidence that is rooted in the objective reality and gathered directly or indirectly through senses rather than through personal beliefs or hunches

Correlational research

Examines relationship between or among variables Looks for predictability

Researcher credibility

The faith that can be put in a researcher, based on his or her training, qualifications, and experiences

Mortality/attrition threat

attrition in groups being compared. If different kinds of people remain in the study in one group versus another, then these differences, rather than the independent variable, could account form group differences in outcomes.

Direct observation

observing someone's hair color; a researcher can look at a person/subject and see the trait they are measuring. Physical characteristics, like hair color, eye color, and body type, are all able to be directly observed.

Related citations

searching for similar studies once find good example

Conceptual definitions

the abstract or theoretical meaning of a concept being studied

Snowball sampling

type of nonprobability; the selection of participants through referrals from earlier participants (also called network sampling)

Theoretical framework

Appropriate to the study Nursing and/or other discipline Concepts clearly defines/ relationship

Introduction

Catch interest Briefly explore study area Significance; statistics

Thematic analysis

Cultural themes uncovered in ethnographic research analysis (qualitative research)

Generalization

General statement or concept obtained by inference from specific case studies

PICO

P: population I: intervention C: comparison O: outcome

PICO/PICOT

P: population/patients I: intervention, influence, exposure C: comparison O: outcomes T: time frame

Examples of Violation: Privacy

Private information shared without participant's knowledge or against his/her will → guilt, loss of job/dignity, etc. Merely being participant in study reveals personal & private info about person - participant free to determine: time, extent, circumstances under which private info shared - personal questions, hidden recorders, questions lead to embarrassment/job loss, access to records, Privacy Act of 1974

Purpose/Aim/Goal

Reasons for undertaking study May give specific goals/ objectives

Validity

The measurement context is the degree to which an instrument is measuring the construct it purports to measure.

Instrumentation threat

changes in the measurement of the variables or observational techniques that may account for changes in the obtained measurement (ex: different types of thermometers must be calibrated before and after data collection)

Eligibility criteria

criteria designating specific attributes of the target population, by which people are selected for inclusion in a study - the characteristics that define the population: 1. inclusion criteria 2. exclusion criteria

nonprobability sampling

does not involve selection of elements at random; is rarely representative of the population, will have sampling bias (most nrsg research is this type) - can be a limitation to a study

Control

eliminating actions of other possible variables beyond the independent variable (IV)

Historical research

eyewitnesses or original document

Ethnography

familiarize with literature first; culture, participant observation, field work, emic, key informants

Lit Review should

give overview of what's known about variables-identify in purpose show how those variables have been studied show with whom those variables studied synthesize approaches taken to develop knowledge in area ****not a summary of each source- should compare similarities and differences

Define outcomes and health services research and their goal

health services research: broad interdisciplinary field that studies how organizational structures and processes, health technologies, social factors, and personal behaviors affect access to health care, the cost and quality of health care, and ultimately, people's health and well-being - focus on three major aspects of health care: access, quality, and cost - evaluates the effects and outcomes of the health care "system" on people's health - The GOAL: the goal of HSR is to provide info that will eventually lead to improvements in the health of the citizenry (IOM)

Phenomenology

preliminary search; lived experience, meaning, essence, descriptive/interpretive

Inclusion criteria

specifies characteristics of a population; characteristics that a prospective participant must have to be considered eligible for a study

Exclusion criteria

specifies characteristics that a population does not have

Testing threat

the effect of taking a pretest on the participants answers on a posttest

Deductive reasoning

the process of developing specific predictions from general principles

Tight controls

used to minimize bias and enhance the interpretability of results

Temporal ambiguity

In a causal relationship, the cause precedes the effect. In RCTs, researchers create the independent variable and then observe the outcome, so establishing a temporal sequence is never a problem. In correlational studies, it may be unclear whether the independent variable preceded the dependent variable or vice versa.

Theoretical framework

In a study based on a theory, the framework is called theoretical framework Framework is the conceptual underpinning of a study. Not every study is based on a theoretical or conceptual model, but every study has a framework. It is often not formally acknowledged or described

Complex hypothesis

"Multivariate"- 3+ variables (total) Relationship between 2+ independent variables 2+ dependent variables Both Ex: studying research 30 min/day and sleeping 6 hrs/night will inc test scores, eating a heart healthy diet and walking 30 min a day will improve quality of sleep and decrease stress in BSN nsg students - divide complex hypothesis into 2+ simple hypothesis to avoid partial support crisis when doing statistical analysis - use complex hypothesis when looking at interaction effect

Review of literature

"Written summary of state of evidence" r/t research problem

Simple hypothesis

"bivariate" means 2 variables relationship between 1 independent variable and 1 dependent variable independent variable: cause , first chronologically dependent variable: effect- comes 2nd Ex: what effect does running 3x/wk for 30 min have on BS level Hypothesis: running 3x/wk for 30 min will lower BS levels, taking a 20 min nap will improve focus in research, eating a low carb diet will decrease BS "univariate" - one variable

Face validity

"face" Appears to measure desired construct Experts review instrument to validate it Use of the instrument w/ people w/ characteristics similar to study Based on judgement; no objective criteria for assessment

Justice (#3)

(Belmont report) 1. treated fairly: - don't be late for data collection appt. - don't deny benefit without good reason - don't impose burden without good reason 2. random selection; no bias (don't unduly involve participant from groups unlikely to benefit from results); not select participant b/c "like them" Ex. Exclusion of women, 1993: women and minorities must be recruited unless compelling reason to exclude

Beneficence (#2)

(act in participant's best interest & always act as advocate) - do no harm - maximize possible benefits - secure participant's well-being *competent researchers* (the greater the risk, the greater the benefits need to be) - if researcher knows in advance harm, death, disability will occur, then benefits do not outweigh risks - discomforts can be: physiological, psychological, social, economic

Ethnographic, including emic and etic

(anthropology based) Qualitative research type Informal conversations with 25-50 participants, key informants within that group do more personal interviews Focuses on the patterns and lifeways/worlview through culture/subculture/groups/customs/beliefs/norms of a cultural group or subgroup - based in anthropology Ex. culture = harding, subculture = HCCN - Describes and interprets a culture and cultural behavior You learn about traditions and make observations of the culture - Culture is the way the group of people live, the patterns of activity and the symbolic structures that give such activity significance - Relies on extensive, labor intensive fieldwork (spend time building relationships and being accepted) - Culture is inferred from the group's actions, words, and products of its members - Assumption: cultures guide the way people structure their experiences - Macroethnography (large cultural group ex. Entire hospital, HU) vs. focused ethnography (small cultural group ex. ICU nurses, nursing program) - Seeks an emic perspective (insider's view) of the culture and to reveal tacit knowledge (information about the culture that is deeply embedded in culture) - key informants - Relies on wide range of data sources and three broad types of information: cultural behavior, cultural artifacts, and cultural speech - Participant observation is particularly important - Product/GOAL: an in depth, holistic portrait of the culture under study - Researcher has to be in/a part of the culture, research question that guides study Ethnography samples: mingling with many members of the culture, "big net" approach, informal conversations with 25-30 informants, multiple interviews with smaller number of key informants; typically involves sampling things as well as people

Personality inventories

(can be used to assess personality characteristics) - use self-report measures, assess the differences in personality traits, needs, or values of people Ex. MMPI, EPPS, 16PF also projective techniques: - responses are believed to reflect the subject's internal feelings, subject is asked to: describe the stimuli, tell what the stimuli represents

Bracketing

(descriptive phenomenology) In phenomenological inquiries, the process of identifying and holding in abeyance any preconceived beliefs and opinions about the phenomena under study Bracket out their presuppositions in an effort to confront their data in pure form Maintain a reflexive journal in efforts to bracket

Retrospective design

(effect to cause) Outcome (effect) in present linked to potential cause in past - still have IV and DV Ex. infants with FAS, look at mother's history of alcohol use Weaker than prospective design (cause to effect)

Type 1 and Type II Error

(not on study guide) - Not possible to absolutely say that null hypothesis true or not true, only probably true or probably not true - we make statistical inferences based on incomplete info-so there is always a risk of error - Type I: reject the null when it is true - Type II: accept the null when it is false

Common projective measures

(not on study guide) - inkblot test, thematic apperception test (usually used with kids)

Delphi technique

(not on study guide) Uses several rounds of questions Seeks a consensus on a particular topic, policy, or subject matter from a group of experts Not necessary to bring experts together in a face-to-face meeting - short-term forecasting

Bivariate descriptive statistics

(not on study guide) describes the relationship between two variables. Two types: Crostabulations: A two-dimensional frequency distribution in which the frequencies of two variables are crostabulated. Ex: Do men smoke more heavily than women or vice versa. Correlation: relationships between two variables can be described by correlation methods. The question is "to what extent are two variables related to each other?" Ex: to what degree are anxiety scores and blood pressure values related.

Q Sort

(not on study guide) Subjects sort statements into categories according to their attitudes toward, or rating of, the statements Subjects are presented w/ a # of words or statements that are written on cards or pieces of paper Subjects sort cards or papers into a # of predetermined categories or piles Forced-choice exercise

Propositions

(proposal) a document communication a research problem, proposed methods for addressing the problems, and, when funding is sought, how much the study will cost

Phenomenology

(psychology based) Qualitative research type Focuses on the lived experience/essence of humans (on description and interpretation) - based on psychology - Asks "what is the essence of this phenomenon as experienced by these people? and what does it mean?" - Acknowledges people's physical ties to their world: "being in the world" - Sample: Small number of participants (10 or fewer); participants must have experienced phenomenon of interest, must be able to articulate what it is like to have lived the experience, may sample artistic or literary sources - focuses on the description and interpretation of people's lived experience - Different terms used: Descriptive phenomenology (will use the term bracketing, essence, descriptive, Husserl) and Interpretive phenomenology (hermeneutics, understanding, heidegger, being in the world)

Applied

(quantitative) Conducted for practical purposes; solving an immediate problem Often based on basic research - want to be able to use it to solve a problem

Grounded theory

(sociology based) Qualitative research type seeks to understand key social psychological processes or phases/core variables that people go through (very in depth) - based on sociology - primary data sources: Start with 25-50 people, 20-30 people have in-depth interviews, supplemented with observations and written documents - focuses on the discovery of a basic social psychological problem that a defined group of people experience, elucidates social psychological processes and social structures, has a number of theoretical roots-symbolic interaction, originally developed by sociologists glaser and strauss - *least likely to do a literature review in beginning* - Developed by Glaser and Strauss Theoretical roots in symbolic interaction, which is how people make sense of social interaction - contributed to the development of many middle range theories of phenomena relevant to ns - data collection, data analysis, and sampling occur simultaneously Identifies core categories: - Constant comparison: used to develop and refine theoretical relevant categories. Also continuous comparison of participants - Always related to grounded theory - Focus: on understanding a central concern or core variable (central concern) - A basic social process (BSP) explains how people come to resolve the problem Explores how people define their reality - alternative view: "full conceptual description;" nurse researchers also use an approach called constructivist grounded theory - Charmaz regards Glaser and Strauss' grounded theory as having positivist roots Sample: typically involves samples of 20-30 people, selection of participants who can best contribute to emerging theory (usually theoretical sampling) Grounded theory analysis: uses constant comparative method of analysis, two competing grounded theory strategies - glaserian and straussian; *open coding*

Threats to External Validity of study (Based on Methods)

*Interaction of Testing and Treatment* • occurs when a pretest sensitizes participants to the treatment yet to come *Interaction of Selection and Treatment* • a treatment effect only holds true for the specific sample of participants you selected

Ratio

*ends with "o" so there is a zero* = data is categorized & ranked; distance between ranks is equal & there is a "true" or natural zero Highest level of measurement Inferential analysis 0 = total absence of quantity measured - debate usually exists between interval and ratio level Ex: money in bank account, pain of a person, Kelvin, temp, wt, volume, speed ***most physical human measurements are ratio even if it seems impossible to have zero level and be alive, or even if a 0 score would mean certain death*** -Absoute zero must indicate complete absence of whatever it is measuring

Research problem

*overall goal with research is to ID problem, same with nsg research* An enigmatic, perplexing, or troubling condition Qual- undertaken because a researcher wants to develop a rich, context-bound understanding of poorly understood phenomenon area that doesn't have lot of knowledge - ID and describe but no hypothesis - "meaning of depression" Quant- usually involve concepts that are well developed and for which methods of measurement have been (or can be) developed - predict and control with intervention, outcome, test hypothesis

Nominal

*sounds like "name" you are simply naming categories, dichotomous/categorical* = assignment of objects/events into categories Lowest level of measurement (with no order) Ex: gender, marital status, religious affiliation - demographic questionnaire - MUST BE: mutually exclusive and exhaustive - use descriptive statistics; few statistical tests -> pie charts, mode, range, frequency; no natural order - Ex. gender, marital status, ethnicity, diagnostic, group

Ordinal

*sounds like "order" with natural order" = rank ordered & placed into categories (based on their relative standing on an attribute) Exact differences between rank not possible, zero is arbitrary Can be broken down into nominal data Second level of measurement Ex: mild, moderate, severe (N/V); education levels, military rank - tall, taller, tallest - STILL MUST BE: mutually exclusive & exhaustive - use descriptive statistics; pain scale, pt satisfaction, tumor stage, apgar score; measure attitudes/perceptions - median, percentile, rank

Statement of purpose (Purpose Statement)

*summary of an overall goal: found in intro or abstract* Quant: identifies key study variables identifies possible relationships among variables indicates pop of interest suggests, through use of verbs, nature of inquiry (e.g. to test...,to compare..., to evaluate) usually involve concepts that are well developed and for which methods of measurement have been (or can be) developed Qual: identifies central phenomenon suggests research tradition (e.g. grounded theory, ethnography) indicates group, community, or setting of interest suggests, through use of verbs, the nature of inquiry (e.g. to describe..., to discover...., to explore) - more descriptive wordage undertaken because researcher wants to develop rich, context-bound understanding of poorly understood phenomenon area that doesn't have a lot of knowledge- make theories, test theories in quant

Research questions

*the specific queries the researcher wants to answer in addressing the research problem* - sometimes direct rewording of statements of purpose, worded as questions - sometimes used to clarify or lend specificity to purpose statement in quant studies, typically pose queries about relationships among variables qual studies: research questions often pose queries linked to research tradition Grounded theory: process questions Phenomenology: meaning questions- lived experience Ethnography: cultural description questions

Components of problem statement

*usually in first line after abstract* identification of problem: what is wrong with current situation background: what is nature or context of prob; what do we really understand? scope: how big is prob, and how many people are affected? consequences: what are consequences (or the cost) of not fixing problem knowledge gaps: what info about problem is lacking; comes from review of lit proposed solution: how will study contribute to prob's solution?; to improve pt outcomes, cost, nrsg care, etc.

interpretive phenomenology

- Based on philosophy of Heidegger; Heideggerian: hermeneutics as a basic characteristic of human existence - Gadamer: the hermeneutic circle Hermeneutic: involves a search for paradigm cases - Emphasis on interpreting and understanding experience, not just describing it Bracketing does NOT OCCUR - Relies on in depth interviews and supplementary data sources: texts, artistic expressions, pictures beyond interview

descriptive phenomenology

- Based on philosophy of Husserl and his question: "What do we know as persons?" - Describes human experience - Insists on the careful portrayal of ordinary conscious experience of everyday life → a depiction of "things" as people experience them (uses the senses) - May involve maintaining a reflexive journal (audit trail) Phases of descriptive - Bracketing: the process of identifying and holding in abeyance preconceived beliefs and opinions about the phenomenon under study (must set aside, don't do a review of lit until after) - Intuiting: occurs when researchers remain open to the meanings attributed to the phenomenon by those who have experienced it (participant not researcher is the expert) - Analyzing: extracting significant statements, categorizing, and making sense of essential meanings - Describing: defining the phenomenon (show how you came up with themes, categorize and make sense of interviews)

Concepts Essential to Health Services Research

- Designed to document the quality and effectiveness of healthcare and nursing services - Often focuses on parts of a health care quality model developed by Donabedian: Structure of care (nsg skill mix) Processes (clinical decision making) Outcomes (end results of pt care) - reflect structure (staff/edu), process (satisfied/assess/intervene), and outcomes of nursing care (quantity/quality) (ANA) - access, quality, and cost - major issues: organize/finance, access, practitioner/pt/consumer behavior, quality, clinical eval/outcome research, informatics/clinical decision, health professions workforce - every discipline involved because every action affects another discipline - does HSR shape public policy or does public policy shape HSR? both impact each other

Specific examples of conceptual models/framework

- Ex. Dorthea Orem in self-care framework used in 66 nursing research studies - Ex. Martha Rogers in humans/environment, two energy fields - Ex. Calista Roy in biopsychosocial, adaptive with coping mechanisms, constant interaction with changing environment - Ex. Betty Neuman subject to environmental stressors intra/inter/extrapersonal, holistic, flexible line of defense, such as in critical care nursing

A hypothesis

- Must contain terms that indicate a relationship (example: more than, different from, associated with) Must be written in present test Must be written in a declarative sentence Must contain the population Must contain variables Must reflect the problem statement, purpose statement, and research question Must be empirically testable. - Is articulated almost exclusively in quantitative (no qualitative) studies - Is tested through statistical procedures.

Mix methods

- Research that integrates quant/qual data and strategies in a single study or coordinated cluster of studies - many areas of inquiry can be enriched by triangulating this data, some require mixed methods: pragmatism paradigm (positivist = quant, constructivist = qual) - Advantages: complementarity (avoid limitations for just using one), practicality (complex), enhanced validity (support/greater confidence) - Reasons for use: Start out with Qual then move to quant, need both to answer, helps better analyze secondary data, quant can be difficult to interpret on own, helps to meet objectives - Applications: instrument develop, intervention, hypothesis, theory, explication (see below) - types that involve intervention: clinical trials, evaluation research, nsg intervention research Explication- qualitatively explaining the meaning of quantitative descriptions or relationships QUAN + QUAL = concurrent; both types happening at the same time (convergent parallel) QUAL → quan = sequential; qualitative happens first; collected in phases (exploratory) QUAN → qual = sequential; quantitative happens first; collected in phases (explanatory) QUAL/quan means qual is dominant status, if QUAL/QUAN means codominant status Convergent parallel design: obtain diff, but complementary data about the central phenomenon under study i.e. to triangulate data sources Explanatory design: sequential designs with quantitative data collected in the first phase, followed by qualitative data collection in the second phase Exploratory design: sequential MM design, with qualitative data being collected first

Purpose of review of literature in qualitative and when done

- Some researchers avoid doing one before the study d/t worries that prior studies might influence the conceptualization of phenomenon; others believe a brief one needs to be conducted Typically find a relatively small body of relevant previous work b/c of the type of questions they ask. - less written on topic, help researchers focus on what isn't known, more conceptual articles (not findings of actual study just concept) - helps provide framework - compare researcher's findings with literature - *avoid bias* - *helps ID important themes* - why review research if not conducting a study: add to knowledge (scholarly thinking), critique existing nsg practices, develop EBP, develop or add to a theory, revise nursing curricula, develop policy statements and practice guidelines, support recommendations for innovations

Representative sampling

- a sample whose key characteristics closely approximate those of the population- a sampling goal in quantitative research - more easily achieved with: probability sampling, homogeneous populations, larger samples achieved through power analysis (how many you need in your study to determine statistical significance) - *usually based on ROL, other studies done, support of evidence in lit, involves statistician; not done in qualitative*

Outcomes research

- a subset of health services research - comprises efforts to understand the end results of particular health care practices and to assess the effectiveness of health care services - represents a response to the increasing demand from policy makers and the public to justify care practices in terms of improved patient outcomes and costs - provides evidence about benefits, risks, and results of treatment

Analyzing evidence from searches

- after identifying potentially relevant citations, the references must be: Screened: and gathered (best to work with a copy of the article) Documented: note search actions and results Abstracted and recorded: notes are made of key pieces of information (using a literature review protocol) Evaluating and analyzing: - integrating and synthesizing information across studies for a research literature review have much in common with a qualitative analysis - in both, the primary focus of analyzing the information in a literature review is on identification of important themes - a variety of themes (patterns) can be pursued - Substantive themes: are likely to be especially important: pattern of evidence? findings predominate? how much evidence is there? how consistent is the body of evidence? what are key gaps in the body of evidence? - Methodological themes: what methods have been used to address the question? what are major methodological deficiencies and strengths? - Generalizability themes: to what populations does the evidence apply? do the findings vary for different types of people? - Tips: organize material logically, write objectively, summarize in your own words, use appropriate language, conclude with a concise state-of-the-art summary of the existing evidence

Difficulty with reading research articles and tips

- compactness - page constraints; jargon, objectivity, impersonality, statistical information (last two especially prominent in quantitative research articles) - read regularly, get used to style; read copied articles-underline, highlight, write notes; read slow, read actively, look up technical terms in glossary, don't be intimidated by statistics-grasp gist of story; "translate" articles or abstracts

Measures of variability

- concerned with spread of data; how spread out are the values in a distribution - answer the question "is the sample homogenous or heterogeneous? - is the sample similar or different? *want them to be similar* - means can be the same but differ in ___ describe how much dispersion in sample 1. Range (difference between highest and lowest score) - range is___ - Simplest & most unstable measure of variability - based on only two most extreme scores - indicates total spread of scores - mean deceiving with these two sets of scores - outliers: far outside range of majority Ex: Test scores ranged from 64-95 → range = 31 2. Percentile: percentage a given score exceeds - data point below which lies a certain % of values in a frequency distribution - Ex: score in the 90th percentile is exceeded by 10% of scores *not same as percentage* 3. Standard deviation → measures average deviation of scores from mean; reported w/ mean, based on concept of normal curve - most frequent measure of variability - larger deviation from mean, the larger the SD - the larger the SD is the more variation in the population response - care for all patients using critical pathways to determine "average"

Role of nurses in research

- contribute to idea for clinical inquiry, assist in collecting research info, offer advice to clients about participating in a study, search for research evidence, discuss the implications of a study in a journal club in a practice setting; meeting to discuss research articles (must be able to critique an article) - continuum of participation, from producers of research to skilled consumers of research findings who use research evidence in their practice Principal investigator (MSN, PHD), team member Identifier of researchable problems Evaluator and user of research findings (critique) Advocate for those in research study Participant in research - producers: actively design (usually a grad) - consumers: read and keep up to date

Observational research

- data gathered through visual observation, nurses are well qualified to use this method, carefully developed plan is essential - behaviors observed, who will observe, what procedure, what type of relationship Ex. psycho motor, personal habits, nonverbal, interrater reliability: degree to which two or more raters are observers assign the same rating or score to an observation - range from structured (data collection & expected checklist, observer indicates freq of occurrence) to unstructured (attempts to describe, requires high degree of concentration & attention) - combo: utilizes observation guide, designed with some preconcieved categories, also allows the observer to record additional behaviors, provided both quant/qual data - event (involves observation of entire event Ex. change of shift report) and time sampling (observations of events/behaviors during certain specified times Ex. 2h after dinner)

clinical practice guidelines

- developed or derived from evidence - specific recommendations for evidence based decision making - consensus of experts - determine strongest evidence (user friendly) - AGREE (appraisal of guidelines research and evaluation instrument) - care bundles (multiple interventions done together)

Data collection methods: Qualitative research sampling

- find the experts who can share knowledge, want information rich data sources - Random selection is not productive in qualitative - Researcher is data collection instrument - Researcher keeps a detailed record of decisions and has someone else review it - can change as study progresses, in depth interviews most common method, observation also common (keep field notes and be able to let someone look at them and repeat study) Self-report techniques: - unstructured interviews: controversial, totally flexible - use of grand tour questions (broad, let them tell their story) - semistructured interviews: use of a topic guide (struggles in diet, specific) - focus group interviews: interviews in small groups (5-10 ppl, smaller the better), led by a moderator - diaries: source in historical research, provide intimate detail of everyday life - photo elicitation: interview stimulated and guided by photographic images - photovoice: asking participants to take photos themselves and interpret them Controversy: - some frameworks and criteria aspire to being generic to be applicable across qualitative traditions, other frameworks are specific to a tradition or even to a specific analytic approach within a tradition - proliferation of terminology and of the use of rigor and validity as terms

critiquing data collection process

- find the section, check level of measurement, see if the instruments are described clearly and thoroughly, check to see if a pilot study was performed - questions: did the research report provide info on data collected, was the appropriate level of measurement used, section that described the instrument, describe the instrument thoroughly? used previously? reliability? validity? - read entire research report carefully, try to tell if the best data was obtained from the method, consult research books if not familiar with the methods used

Replication of studies

- findings in original study duplicated - practice cannot/should not be altered on basis of one single study - National institute of nursing research encourages/funds replication research - Homeless and refugees are becoming a large source of research

Statistical tests and significance

- goal is probability - decide test based on level of measurement, type of hypothesis, difference between groups or relationship between 2 or more variables, sample size, how many groups, observations or scores: dependent or independent, how many observations or scores - significant value means relationship or difference probably not caused by chance

Types of models

- helps express abstract ideas with minimal use of words - symbolic representation of some phenomenon Conceptual model Deals with abstractions (concepts) that are assembled because of their relevance to a common theme. Represents a more loosely structured attempt to explain phenomena than theories Can serve as springboards for generating hypotheses - made up of concepts and propositions stating relationship between concepts - most nursing models include person, environment, health, nursing Schematic Model Concept maps Visually represent relationships among phenomena Used in both quantitative and qualitative research Concepts and linkages between them are depicted graphically through boxes, arrows, and other symbols Ex. Pender's Health Promotion Model

Extraneous variables

- interfere with understanding of relational or causal dynamics in study - can be recognized or unrecognized - can be controlled or uncontrolled - if not recognized until study already to process, can not be controlled and called confounding variable (study, sleep, illness, how you feel) - an environmental variable is an uncontrolled variable relating to the setting (noise level in next room, outside noise, A/C) ***can't predict but can control, try to control and limit these variables

Level of measurement considerations & questions to ask with data collection

- level is appropriate for the type of data desired, degree of precision that is desired for the study - When would you need a high level of precision? when there is a lot of risk/harm involved with a wrong value; use the most precise method = RATIO Appropriate level of measurement: - precision- interval or ratio - ranked or categorized sufficient - ordinal - categories of data only needed- nominal Questions: - what, how, who, where, when? What data will be collected: - type of data needed for the study, examples are data to measure- knowledge, attitudes, behaviors How will the data be collected: - research instrument, major decision for the study, examples are: questionnaire, interview - consider physical stamina of patients Who will collect the data: - researcher only person, team of members, consistency of data collection What is the problem if data is not consistently collected in the same way? invalid, inaccurate, unreliable data Where will the data be collection? - setting for data collection, optimum conditions are considered When will the data be collected? - data collection time: month, days, hours - time period for data collection

Research critique key areas

- must be able to evaluate in order to use it, distinguish between best-evidence Thorough examination of all parts of research study: First, read entire article, make initial evaluation Next, evaluate each part in depth Focus on Design - before you see how research actually carries out, can see if other part are congruent Ex: pretest - posttest - should see two groups in problem, hypothesis, sample - often no right or wrong, be objective, give RATIONALE - what, why, how, clarity, significance, str/weakness?

Empirical generalizations

- objective/observable applied to larger group Similar pattern of events found in empirical data of a number of different studies. Statements repeatedly tested and have not been disproved Ex: Studies show women attend church more than men. Therefore "women are more frequent church attendees than men"

Factors affecting data quality in quantitative research

- procedures used to collect the data - circumstances under which data were gathered - adequacy of instruments or scales used to measure constructs - psychometric assessment: evaluates the measure's measurement properties - reliability: extent to which sources are free from measurement error Face validity: whether the instrument looks like it is measuring the target construct Content validity: the extent to which the instrument's content adequately captures the construct Criterion validity: the extent to which the scores on a measure are a good reflection of a "gold standard" - two types: concurrent (comparison) and predictive (ACT) Construct validity: the degree to which evidence about a measure's scores in relation to other variables supports the inference that the construct has been well represented

Case studies

- qualitative - not conducted within a disciplinary tradition - focus on thorough description and explanation of a single case or small number of cases, cases can be individuals/families/groups/organization/communities - data are often collected over an extended period - small number and isolated Ex. cases of Ebola

Descriptive statistics

- researcher's observations -> data - Data: words or numbers, large amounts of data must be gathered, organized, and summarized - data ALONE do not answer research questions or test hypothesis GOAL: describe sets of numbers & make accurate inference about groups based upon incomplete information - measures to condense data, communicate numerical characteristics of samples (demographics of sample) - Definition: summarize, organize, describe, evaluate, interpret, & communicate various characteristics of sample; frequency of occurrence of concept - Purpose: condense objective observations into usable data Types: 1. central tendency: describe average member of sample 2. variability: describe how much dispersion in sample 3. relationships: magnitude & direction of relationships - may be reported in Text or Tables/Graphs

Strategies to enhance quality in qualitative inquiry

- researchers can take many steps to enhance the quality of their inquiries (debate on if qualitative has same validity as quantitative) - consumers can assess quality-enhancement efforts by looking for these steps and assessing their success in strengthening integrity/validity/trustworthiness Data collection - prolonged engagement: investing sufficient time to have in depth understanding - persistent observation: intensive focus on salience of data being gathered - reflexive strategies: attending to researcher's effect on data - comprehensive and vivid recording of information - maintenance of an audit trail, a systematic collection of documentation and materials and a decision trail that specifies decision rules - member checking: providing feedback to participants about emerging interpretations; obtaining their reactions (a controversial procedure: considered essential by some but inappropriate by others) Coding and analysis: - search for disconfirming evidence as the analysis proceeds, through purposive/theoretical sampling of cases that can challenge interpretations - negative case analysis: a specific search for cases that appear to discredit earlier hypothesis - peer review and debriefing: sessions with peers specifically designed to elicit critical feedback - inquiry audit: a formal scrutiny of the data and relevant supporting documents and decisions by an external reviewer Presentation: - thick and contextualized description: vivid portrayal of study participants, their context, and the phenomenon under study - researcher credibility: enhancing confidence by sharing relevant aspects of the research's experience, credentials, and motivation; look at credentials of researcher!!! Interpretation: - in qualitative inquiry: making meaning from the data, relies on adequate incubation - the process of living/dwelling in the data (MUST BE DONE) - similar interpretive issues as in quantitative research: credibility, meaning, importance, transferability, and implications

Preparing a written review

- retrieve promising sources (obtain copies) - screen references/articles - discard irrelevant/inappropriate ones - *Read relevant ones/take notes* - identify new sources through citations; then retrieve - organize references; develop outline - analyze/integrate materials - write review - write abstract of each source, you must know what the lit says in order to argue what is known and not known - note all key idea form your reading of the articles - connect those ideas that are similar - themes or key ideas or variable can become your headings/subheadings

Observation methods:

- structured observation of prespecified behaviors (involves the use of formal instruments and protocols that dictate what to observe, how long to observe it, and how to record the data) - focus of observation, concealment, method of recording observations Direct observation of people's behavior: Advantages: researchers have flexibility. Can be made through the human senses and then recorded manually, but they can also be recorded digitally. Can be used when participants may not provide reliable answers. Usually designed to capture the behaviors of infants, children, or people whose communication skills are impaired.

Critiquing sampling plans: considerations

- the type of sampling approach used (convenience, consecutive, random) - the population and eligibility criteria for sample selection - the sample size with a rationale - a description of the sample's main characteristics (age, gender, clinical status, and so on)

Metasynthesis

- theoretical integration and interpretation of qualitative findings - diverse and complex, not a literature review - frequency effect sizes, themes, integrating findings on experience - represents a family of methodological approaches to developing new knowledge based on rigorous analysis of existing qualitative research findings - the bringing together and breaking down of findings, examining them, discovering essential features, and combining phenomena into a transformed whole - integrations that are more than the sum of the parts-novel interpretations of integrated findings - DEBATE: exclude low-quality, integrate studies based on multiple qual traditions, various typology/approaches/terminology - contains no quantitative data, just combined themes from multiple qual studies - steps: formulate problem, decide on design: selection criteria, search strategy, search for data in the literature, evaluation of study quality, extract data for analysis, data analysis and interpretation QUALITATIVE

Factors encouraging questionnaire return-rate Advantages & disadvantages of questionnaires

- time, hand-addressed, personal signature, motivational info, incentive, neat/clear of instrument, ease of completion, time required to complete, guarantee of anonymity, inclusion of a preaddressed, stamped envelope Advantages: quick&generally inexpensive, easy to test for reliability and validity, admin is time efficient, can obtain data from wide-spread geo areas, anonymity can be guaranteed in cover letter Disadvantages: costly to mail, potential low response rate, respondents may provide socially acceptable answers or fail to answer, respondents may not be represented of the pop, no opportunity to clarify items that may be misunderstood, respondents must be literate, respondents must have no prohibitory physical handicap

Clinical trials

- type of intervention research - assess clinical intervention and test innovative therapy/drug in phases - studies that develop clinical interventions and test their efficacy and effectiveness - undertaken to evaluate an innovative therapy or drug or often designed in a series of phases - emphasis on EBP led to call for trials, practical/pragmatic clinical trials used in making real-world applications phase I: establish safety tolerance and dose; focus is develop the best tx; usually a simple design with no control group. Usually one group pre/post test phase II: seeks preliminary evidence of effectiveness, PILOT TEST using QUASI experimental; look for possible side effects and identify possible refinements; small scale or quasi experimental Phase III: full experimental test of efficacy of tx. RCT with random assignment to tx conditions under control, often in multiple sites; objective= develop evidence about efficacy. Clinical trial most frequently refers to this phase; AKA efficacy study Phase IV: study of the effectiveness of intervention in the general population; emphasizes external validity of an intervention in the general population, emphasis on generalizability

Frequency distribution

- used to calculate rates of occurrence, provide info for data trends over time - divide freq. of event in given time period by all possible occurrences of event during same time period Ex. divide # surgical site infections in a month by total # surgical procedures in that month # of times each event occurs is counted or data are grouped & frequency of each group reported One of the simplest ways to present data *GIVES A GOOD OVERVIEW* < 20 scores = list all (16: 4, 17: 2 etc.) > 20 scores = may group into intervals (16-18: 8; 10-15: 12) but may lose some significant info that way Frequency-symbol is 'f' 'N' meaning number of participants is also used

Visual Analogue Scale (VAS)

- used to measure subjective experiences (pain, N/V) - measurements are on a straight line measuring 100 mm (have pt put mark and then measure with 100 mm ruler) - end points labeled as extreme limits of sensation Presents subjects w/ a straight line drawn on a piece of paper Line is anchored on each end by words or short phrases Phenomenon extremes are listed at ends of the line Subjects are asked to make a mark on the line at the point that corresponds to their experience of their phenomenon Line usually 100 mm in length; EXACT Quantitative data is obtained from measurements of the responses Useful in measuring: nausea, pain, fatigue, SOB

Qualitative Analysis Challenges & Management/Organization & analysis

-No universal rules; no one set way to do an analysis correctly -Voluminous amount of narrative data = lots of intensive work (emotional affect on researcher) -Need for strong inductive powers and creativity -Condensing rich data to fit into concise reports Management and organization: - transcribing the data - developing a coding scheme - organizing the data (manual methods of organization (conceptual files), computerized methods of organization using CAQDAS) General analytic overview: - ID themes (labeling of similar ideas shared by the study participants) or broad categories, search for patterns among themes, variations in the data, develop charting devices and timelines - in some cases, use metaphors to evoke a visual analogy - validate themes (have another researcher review and see if they would come up with the same themes), patterns, weave thematic pieces into an integrated whole Qualitative content analysis - analyze the content of narrative data to ID prominent themes and patterns among the themes - break down data into similar units - code and name units according to content - group coded material based on shared content

Practicality of the instrument

-cost -appropriateness -question to consider: length of time for administration? -training to get results -determine before reliability or validity

Benner's hermeneutic analysis

-search for paradigm cases -thematic analysis -analysis of exemplars - movement of novice to expert (1A -> 2B)

Sources of Evidence for Nursing Practice

-tradition and authority (just in case with no EBP, expert knowledge from Dr originally, textbooks considered authority, nurses that are specialists) -clinical experience, trial and error, and intuition -logical reasoning 1. inductive: observe to general develop theory (Qual) 2. deductive: specific prediction based on theory or already done research and test it out (Quant) -assembled information (benchmarking data and quality improvement and risk data: affect improved outcome) -disciplined research: best method of acquiring reliable knowledge; EBP findings - Qual: theory, inductive - Quant: test it, deductive

Ways to increase internal & external validity of a study

Increase internal validity: single or double-blind study Single blind study: a type of clinical trial in which only the investigators know which treatment (or other intervention) the participants are receiving Double blind study: a situation (usually in a clinical trial) in which two study groups are blinded with respect to the groups that a study participant is in; often a situation in which neither the subjects not those who administer the treatment now who is in the experimental or control group Increase external validity: repetition and use of a diverse sample

Independent/Dependent variables

Independent: cause (intervention) Dependent: effect Ex: Low fat diet (intervention/independent variable) will decrease cholesterol levels (dependent variable/effect) in men between 40 and 60

Elements of Nuremberg Code

Informed consent Study should be for good of society Anticipated results justify experiment (risk benefit ratio) Not permitted if potential harm Risk cannot be greater than humanitarian importance Adequate facilities Qualified researchers Subject/participants can drop out if problems Test animals first - But...NO PROVISION FOR ELDERLY, CHILDREN, OR MENTALLY ILL (provisions for these vulnerable populations didn't come until later)

Three types of descriptive statistics

1. Frequency distribution: Impose order on numeric data. An arrangement of values from lowest to highest and a count or percentage of how many times each value occurred. Positive skew: personal income (less people have higher incomes in US) Negative skew: age at death (less people die young) Many human attributes have a normal distribution 2. Central tendency: indicate what is "typical". (i.e. mean, median, mode) 3. Variability: Two distributions with identical means could differ with respect to how spread out the data is. This is variability. (i.e. range and standard deviation)

Cochrane Collection NINR Research Priorities

1. Promoting health and preventing disease 2. Symptom management and self-management 3. End of life and palliative care 4. Innovation ( Tech) 5. The development of nurse scientists (PhD, pck area of research to focus on and specialize, associated with medical schools and get grants from NIH) - top 5 because of aging population (incr. age = incr. RF illness), rising cost, increased outcomes for pt and ns, expanding scientific knowledge base - Est. in 1993, budget in 2016 just under 150 million dollars - Cochrane collaboration - Cochrane nursing care field: one of 12 fields in the cochrane collection, specifically supporting nsg research - called for systematic up to date reviews of all RCTs of health care - six databases: systematic reviews, abstracts, controlled trials, review of methodology - meta analysis: synthesizing results; analyzing statistics; drawing conclusions re: state of science in that area - electronic database: AHRQ agency for healthcare research and quality (14 EBP centers; priorities improving healthcare quality and reducing medical errors; research into action) - ACE: academic center for EBN - JNC systematic trials r/t HTN -> synthesis and guidelines

Priorities for nursing research - major focus (Why is EBP so important to nsg?)

1. To bridge the gap between nsg research and nsg practice Few RCTs in nsg and fewer meta-analysis Hallmark of profession: *research based* Professional accountability; validate nsg's unique role Holistic wellness - teamwork and collaboration 2. Improve pt outcomes (main goal) Hospital ns staffing and pt mortality; ns burnout; job dissatisfaction more likely Hospitals with higher pt-to-ns ratios: surgical pts had higher 30-day mortality rates (Aiken research study) - Ex of setting needing improvement: pt observation, collab with collegues/clinical faculty (group projects; integrative reviews); IPE activities; journal clubs, policy&procedure manuals, IRB participation ("institutionalized review board"), research days, clinical ladders - some research requires participation, read widely and critically - reduce health disparities in cancer screening, end of life/palliative care, home health care, homeless and refugees - pt education: BSE, TSE, STDs/STIs, otitis media, how to be a knowledgeable pt, avoid getting lost in healthcare maze

Purpose of conceptual framework

1. make scientific findings meaningful and generalizable 2. summarize accumulated facts 3. explain hypotheses and objectives 4 What and why of phenomenon 5. Stimulate further research

Limitations to EBP

1. research quality - study flaws, random error, difficulty obtaining random samples, complex language (stats/research jargon: NIH requires "plain language"), implications not clear 2. Ns characteristics - attitudes, education, skills, resistance to change 3. organizational factors - unit culture (not supportive of research), release time, resources, leadership

Orem

1950s; book published in 1971 Self care: self-care agency, self-care demand, self-care deficit Ex: study evaluated usefulness of telehealth medication counseling among Parkinson's dz pts Universal requisites- common to all people Developmental requisites- result from maturation (adjusting) Health Deviation requisites- result from illness, injury, disease, or its treatment

CURN project

1970s, 5 year study (disseminate, organized change, collaboration) Conduction and utilization of research in nursing Aimed to increase nurses' use of research findings by disseminating research findings, facilitating organizational changes, and encouraging collaborative clinical research Addressed the gap between research and practice & improve pt outcomes - Conclusion: research must be relevant and broadly disseminated - RU (*research utilization*) feasible only if findings are relevant and broadly disseminated - interventions and rationale

Interval

= rank ordered and placed into categories; distance between groups/ranks can be measured Third level of measurement Actual numbers on a scale (equal distances between points on the scale) - zero is arbitrary Inferential analysis Ex: body temperature, wt, ht, Likert scales, hgb, age, celsius - can calculate mean, median, mode - cannot multiply, divide or calculate ratios due to no true zero

Themes

A distinct idea that brings meaning and identity to a current experience and its various manifestations Captures and unifes the nature or basis of the experience into a meaningful whole Emerge from qualitative data and may develop within categories of data Searching for themes involves not only discovering commonalities across participants but also seeking variation Never universal

Research problem

A disturbing or perplexing condition that can be investigated through disciplined inquiry

Representatives of sample is determined how?

A sample whose key characteristics closely approximate those of the population- a sampling goal in quantitative research More easily achieved with: probability sampling, homogeneous populations, larger samples achieved through power analysis Power analysis: statistical formula used to determine sample size needed so results are valid (not by chance); calculated from previous studies/RoL Increase variables = increase sample size

Meta analysis research

A technique for quantitatively integrating the results of multiple studies addressing the same or a highly similar research question Advantages: Objective and power Steps: Problem foundation Design of meta-analysis Search for evidence of literature Evaluations of study quality Extraction and encoding of data for analysis Calculation of effects Data analysis

References

Accuracy, completeness Match text citations

Interviews

Advantages: higher response rate, in-depth responses, wide range of participants, high percentage of usable data, ability to observe verbal & nonverbal behavior - appropriate for more diverse audiences, some people cannot fill out or forget to mail back a questionnaire - opportunities to clarify questions or to determine comprehension - opportunity to collect supplementary data through observation Disadvantages: time consuming, expensive, arrangements may be difficult; participants may be influenced by the interviewer's characteristics, intentionally provide socially acceptable responses, be anxious because answers are being recorded - method of data collection, interviewer obtains responses, face to face encounter or by telephone - purpose: obtain factual data about people, measure opinions, attitudes, and beliefs - schedule: contains a set of questions to be asked by an interviewer - record interview data: entered directly on the interview schedule, recorded on a separate coding sheet, recorded on audiotape, recorded on videotape - interviewer training: responsibility of the study investigator, should be rigorous, should be carried out in groups; provide description of study/purpose/methodology; provide explanation of interview schedule, purpose of each question, meanings of all words, use of probes - unstructured: interviewer directs the course of the interview, conducted like a normal conversation, topics pursued at the discretion of the interviewer; used in exploratory/qualitative research, interviewer may start with broad opening, further questions and probes used, give more freedom in question format, produce more in-depth info, conducted more like a normal conversation, give topics at the discretion of the interviewer - produces more in-depth info, subject's beliefs, attitudes - structured: used a structured set of questions, ask same questions/in same order/in same manner, very objective - semistructured: interviewers ask a certain number of specific questions, additional probes are allowed or encouraged, closed-ended and open-ended question Prior to interview: - intro self, explain purpose, how participant was selected, how obtain info will be used, how long interview will last During: - make comfy, privacy, control noise, use understood language, conversational tone, no right/wrong answers, no pressure, sensitive questions at end After: - ask if they have questions, explain further, thank, compensate, how they can get results Face-to-face influencing factors: ethnic background, age, gender, manner of speaking, manner of dress; telephone = tone and dialect

Vulnerable populations

Age, legal-mental incompetence, terminal, institutionalized (prisoners, children, elders, students, military, deceased, AIDs pts, unborn, pregnant women, physically or emotionally disabled) NO vulnerable population may be singled out because convenient (must justify use) Unless age is critical to the study, use older children Use vulnerable populations only when no other population can meet the study objectives Ex. nursing home residents, >/= 60% senile dementia Alziemher's type (SDAT), for consent: use power of attorney or legal guardian or "best interest standard" or "substituted judgement"

Critical theory research

Aims to critique, transform, raise consciousness, and increase advocacy. Critiques society and envisions new possibilities Knowledge is transactional/subjective: value-mediated and value-dependent Dialogue is designed to transform naivety and misinformation Researcher is transformative agent, advocate, and activist - concerned with a critique of existing social structures and with envisioning new possibilities (GOAL is transformation and changes) - critical ethnography: focuses on raising consciousness in the hope of effecting social change, transformation is a key objective (to take action) - attempt to increase the political dimensions of cultural research and undermine oppressive systems; determine disparities that exist and make change

Assumptions

All studies based on assumptions Universal "all humans need to feel loved"; Common Sense "all respondents will answer honestly" Should flow from Theoretical Framework Stated and Implied

Data collection methods: Snowball sampling

Also known as network sampling, the sample might be restricted to a small network of acquaintances One participant refers another one, who refers another one and so on Ex. used in a population in which the researcher does not have easy access, trying to recruit participants in which it is not very evident that they have that issue such as HIV

IRB's purpose, membership

An Institutional Review Board (IRB) is a committee established to review and approve research involving human subjects. The purpose of the IRB is to ensure that all human subject research be conducted in accordance with all federal, institutional, and ethical guidelines. - federal policy defines research - ONCE HAVE IRB APPROVAL CANNOT CHANGE ANYTHING - human subjects: living individuals in which data is obtained through intervention OR interaction or identifiable private information - At least 5 members, various backgrounds, expertise, diversity in gender, race, profession, culture - 1 member must be primarily nonscientific, 1 member must be primarily outside agency, essential with federal grants to have approval and protection of humans - review to ensure ethical standards are met with regard to protecting rights of human participants, assess adequacy of consent forms, once approval received can begin recruiting participants - must have approval BEFORE recruiting, collecting data, or doing anything - Expedited review: minimal anticipated risks, review by single member of IRB - EXEMPT if Minimal Risk: minimal risk not > than that encountered in daily life Ex. routine physical exam or psych exam - *IRBs also review adequacy of consent forms*

Overarching questions

Are results valid? Bias? Sound scientific methods? What are the results? Do numbers add up? Will results help me care for my patients? Applicability Who conducted it Qualifications , credentials Expertise in that area Sponsors - any conflict of interest Could you search university's website or author info

Watson

At the beginning of every shift, go into pts room, get on the eye level of pts and ask them what you can do for them to make them feel better Concept: Effective caring promotes health and individual or family growth Caring promotes health more than curing A caring environment offers the development of potential and allows the pt to choose the best action for self at that time

Sources for identifying research problems. How to determine or locate nursing research priorities and funding

At the most basic level, originate with researchers' interests Clinical experience Readings in the nursing literature Global political problems Cochran That one website

Descriptive phenomenology

Based on the question of "what do we know as persons?" Describes the human experience (senses) Insists on the careful portrayal of ordinary conscious experience of everyday life, a depiction of "things" as people experience them May involve maintaining a reflexive journal (audit trail) Phases: bracketing, intuiting, analyzing, describing

Comparison of calculated value vs. critical value

Calculated value comes from the data Critical value is set statistically & the stats program determines for you If the calculated value is ≥ the critical value at a p value of ≤.05 → reject the null b/c findings did not occur by chance, findings statistically significant, lends support to research hypothesis - EX. obtained p value .03 - reject null If the calculated value is < the critical value at a p value of >.05 → fail to reject the null b/c findings did occur by chance, findings not statistically significant, does not lend support to research hypothesis - EX. obtained p value .3 - fail to reject null

Structured observations

Category systems -> Checklists - formal systems for systematically recording the incidence or frequency of prespecified behaviors or events - systems vary in their exhaustiveness: - Exhaustive system: all behaviors of a specific type recorded, and each behavior are assigned to one mutually exclusive category - Non-exhaustive system: specific behaviors, but not all behaviors, are recorded Rating scales: ratings are on a descriptive continuum, typically bipolar - ratings can occur: at specific intervals, upon the occurrence of certain events, after an observational session (global ratings)

Causality

Cause IV precedes effect DV - relationship between cause and effect - no influence on confounding variable

Critique key areas

Clarity Significance What was done; Why was done; How was done ALL studies Strengths and weaknesses Substandard if... partial information; unusable, can't replicate study based on info given; doesn't answer questions asked

Title

Clear, concise Brief - not >15 words Focus is apparent; key words Population, and major variables Avoid extraneous words - "A Study of.."

Instruments

Clearly described Scoring procedures; range of poss. Scores Reliability and validity Use in previous studies

Posttest only

Collect data after intervention Risk of skewed sample but may be unknown since no initial baseline was established Easier to implement R x O1 R O1

Longitudinal

Collect data multiple times over extended period of time, collect data at several points Ex. Harvard nurses' health study: over 30 years time period Attrition is problematic if extended time period (dropping out, death, loss of contact; so want to have large enough sample in the beginning to prevent effect on results) - ethnographic/qualitative

Types of articles (conceptual vs. research)

Conceptual- (theoretical) discussions of theories, concepts (hope, empathy, loss) or conceptual models Research- (data-based literature) empirical, scientific, research

Internal criticism in historical research

Concerned with the accuracy of a record

External criticism in historical research

Concerned with the authority of a record or data (has to be authentic and genuine)

Ethics in qualitative

Concerns regarding intimate nature of the relationship that typically develops between researchers and participants

Lit review

Concise, comprehensive Relevance of sources Support and Oppose expected results Classics , then current sources Paraphrase, not long quotes Show how this study will add to body of knowledge

Reliability of measurement (instrument)

Consistency and accuracy that instrument measures the target attribute. Want score 0.80 or greater (1) Stability (of the instrument): Consistency over time, stable & accurate Extent to which scores are similar on two separate administrations of an instrument Evaluated by test-retest reliability Participants complete same instrument on two occasions Appropriated for relatively enduring attributes -things that don't change overtime (i.e. creativity) Ways to measure: Physiological instruments - stable and accurate Questionnaire instruments - test and retesting High correlation coefficient - close to 1.00 (the closer the correlation is to one, the higher the reliability) 0.4 to 0.7 = weak 0.7 to 0.9 = moderate > 0.9 = good Equivalence reliability: Two or more observers use same instrument: Interrater or interobserver reliability - two different forms of instrument: degree to which same results occur, alternate or parallel forms reliability - the degree of similarity between alternative forms of an instrument btw multiple raters/observers using an instrument - most relevant for structural observations - assessed by comparing agreement btw observations or ratings of two or more observers interobserver/interrater reliability Tools for testing reliability: - mechanical device, written questionnaire, human observer - measurement by correlational procedures - reliability assessment involves computing a reliability coefficient range 0-1, less than 0.7 considered unsatisfactory, 0.8 or higher desirable (2) Internal consistency: Individual items measure the same variable One concept or construct (i.e. variable) is measured Sample of items is its main consideration Extent to which all the items on an instrument are measuring the same attribute Alphas greater than or equal to 0.80 highly desirable; accept 0.70 (3) Equivalence: the condition of being equal or equivalent in value, worth, function, etc. The state or fact of being equivalent; equality in value, force, significance, etc

Qualitative research

Constructivist tradition Reality is mentally constructed by individuals, is multiple and subjective Researcher interacts with participants Subjectivity and values are inevitable and desirable - reality differs based on context, inductive, qualitative: researcher interacts face to face with participant (research relationship) - ns drawn to qualitative (we want to understand the pt, ask questions & make difference in life) - focus holistic, interested in subjective, family/pt/significant other - 1970s guide theory; not "subject" in qualitative but use "informant" (they are the expert not the researcher) - more actively involved/engaged with person face to face - broad idea of experiences, themes, inductive: build theory when we don't know a lot about topic; do not test theory, naturalistic setting (people's choice) - look for patterns of association to understand meaning of phenomena, don't identify variables, just explore and learn Dynamic design (changes) holistic!!! Context bound Humans as instruments qualitative info (subjective) - flexible, capable of adjusting to what is learned during data collection - Often involves triangulating various data collection strategies (using more than one type of data collection, interview/observation/data collection tools; triangulation of methods is both quant/qual) - Tends to be holistic, striving for an understanding of the whole Seeks patterns & themes - Requires researchers to be intensely involved and reflexive (keep diary/journal for thoughts related to subject, reason for decisions and reflection) and can require a lot of time (relationship formed between researchers and the participants) - Benefits from ongoing analysis, which guides subsequent strategies - Emergent design: evolves as researchers make ongoing decisions about their data needs based on what they have already learned - used to ID a phenomenon - can use cross sectional and longitudinal studies

pretest-posttest

Control Group Design: Collect data before and after the intervention Establish baseline for comparison Use same measurement tool pre and post intervention R O1 x O2 R O1 O2 Nonequivalent control group: pretest-posttest design: two or more groups, collect data pre and post intervention, comparison group not randomized, weaker since cannot assume groups are equal/similar at outset O1 x O2 O1 O2 Pre-experimental (one group pretest-posttest design): Measure DV before and after intervention Only one group Serves as its own control Risk of bias or skewed data from effect of pretest on the posttest Weak design O1 x O2

Other considerations

Correct grammar, sentence structure, and punctuation Last question "after reading this research report, would i refer it to a colleague?"

Measures of relationships

Correlation: to what extent are variables related?, measures of relationship (not necessarily cause and effect) - is there relationship btw amt of time spent with pt & # of requests for pain med by that pt - ordinal or higher level data - scatter plots - visual representations of strength & magnitude of relationship between 2 variables - perfect + and - correlation - range from -1.00 to +1.00 - 0 = absence of any relationship - strength of correlation demonstrated by how close data points approximate straight line (intensity & direction) - closer correlation coefficient to zero = lower/weaker correlation - closer to 1 (+/-) = higher stronger correlation - ***positive correlation: higher score on one variable, higher score on the other - Ex. temp and pulse rate positively correlated = as one incr. so will the other one - ***OR lower score on one variable, lower score on other - Ex. younger age = shorter stay in hospital - Positive correlation (both go in same direction): as anxiety level incr. pulse rates incr. - Ht & Wt: greater Ht tends to be associated with increased Wt - perfect positive correlation would be where tallest person is heaviest - Negative correlation: higher score on one variable, lower score on other measure - inverse relationship: blood volume decrease, see initial rise in pulse rate - anxiety levels incr. = test scores decr. - high self-esteem = low depression - ***CORRELATION DOES NOT = CAUSATION*** - results that only describe or explain cannot be used to directly ID the cause of the findings

Indirect observation

Data is gathered from participants by extracting biophysiologic material from them and subjecting it to analysis by laboratory technicians chemical measures, microbiologic measures, and cytologic or histologic measures. UA, BMP, ABG

Lit review terms

Data-based lit: research reports based on evidence (empirical=observable/objective/hard data; scientific; research) Conceptual lit: theoretical; discussion of theories, concepts (hope, empathy, loss) or conceptual models - not study but expand on knowledge, can use in paper to explain overall concept, but not reports of actual study Refereed Journal: panel of experts review manuscripts Peer review: manuscript has been read and reviewed by two or more peers

Key terms in qualitative and quantitative research Deductive vs. Inductive reasoning

Deductive: hypothesis -> explore - quantitative, developing specific predictions from general principles, "top down" approach, based on theory or prior research, deduce a hypothesis, make observations, hypothesis testing, and confirm or refute original principle - focused, testing/confirming hypotheses - logically valid, facts Inductive: exploring -> find themes - qualitative, move from specific observations to broader generalizations and theories, "bottom up" approach, observation, pattern, tentative hypothesis, theory - more open-ended and exploratory - not itself logically valid, critical role in discovery of general truths and basis for evidence of value in health care

Sample characteristics of subjects. Age, education, gender, ethnic origin, income, medical diagnosis, etc. Analyzed to develop sample characteristics.

Demographic variables

Sample

Demographics Measures to protect participants Informed consent/ permission, IRB approval Anonymity; confidentiality Should mention any dropouts that occured

Analysis

Descriptive stats on sample characteristics Scores on variables in study Inferential stats if tested hypothesis Hypothesis supported or not Results of specific tests, degrees of freedom, probability values Clear text and tables Completely objective Data- bound

Quantitative research

Determine what's known ID gaps, consistencies, inconsistencies in published lit refine hypothesis help develop theoretical framework help plan methodology (research design, data collection methods, measurement tool, surveys) discover instruments, tools identify successes/failures generate research questions replication of well-designed studies clarify/narrow probs determine what research can best contribute to knowledge ***guides all steps of research process ***support for research proposal

Examples of research utilization by the nurse

Direct use of findings in patient care Ex: studies r/t tympanic thermometer → incorrect placement → errors in placement/measurement → nurses altered technique based on findings Implementing new practice, policy, procedure, and protocol Indirect: - changes in nurse's thinking, enhancing understanding (quit smoking, enhanced senses in blind people) - raising questions: people with HIV long to be touched, energy drinks, length of grief process (~3 yrs) - influencing others: administration, CEOs (need evidence)

Types of hypothesis: Be prepared to read hypothesis (ONE OR THE OTHER): Directional or non-directional

Directional: Predicts the direction of a relationship Advantages: Researcher's expectations are clear. And more precise testing of theoretical propositions Non-directional: predicts the existence of a relationship, not its direction. Reasons for using this type: non theoretical basis for prediction or previous research findings are contradictory.

Sampling/standard error

Discrepancies that inevitably occur when small group (sample) is selected to represent characteristics of larger group (population) - discrepancies that inevitably occur when a small group (sample) is selected to represent characteristics of a larger group (population) - is always some likelihood a sample will NOT accurately reflect the population; findings will be inaccurate - by chance or hypothesis effect? - hypothesis testing: based on rules of "negative inference"

External validity

Discuss limits to generalization Ex; non probability sampling, convenience

Research proposal

Document communicating a research problem, proposed methods for addressing the problem, and, when funding is sought, how much the study will cost

Critique of lit review section of research articles - what to look for regarding strong or weak evidence Questions to ask

Does the review seem thorough and up-to-date? Did it include major studies on the topic? Did it include recent research? Did the review rely mainly on research reports, using primary sources? Did the review critically appraise and compare key studies? Did it identify important gaps in the literature? Was the review well organized? Is the development of ideas clear? Did the review use appropriate language, suggesting the tentativeness of prior finding? Is the review objective? If review was in the introduction for a new study, did the review support the need for the study? If the review was designed to summarize evidence for clinical practice, did it draw appropriate conclusions about practice implications?

Grand (Macro) Theories:

Don't use very much, more abstract Describe LARGE SEGMENTS of human experience Explain the Nature and mission of Nursing Not particularly useful in Behavioral and Applied Sciences Ex: Parse's Human becoming Paradigm

Evidence based medicine

EBM - conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients - integrating best available evidence from systematic research - began early 1990s: McMaster Med. School (Canada): started EBP, now includes research from all healthcare disciplines, not just Doctors Ex. 12 hour shift when adverse pt outcomes result - Sigma Theta Tau International "an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served"

Methodologic Studies

Entails investigations of the methods for conducting rigorous research Focuses on development/validation/evaluation of research tools and instruments

Empiricism

Evidence rooted in objective reality and gathered using one's senses as the basis for generating knowledge Theory that human knowledge comes predominantly from experiences gathered through the 5 senses

Exhaustive v. Exclusive

Exhaustive system: all behaviors of a specific type recorded, and each behavior is assigned to one mutually exclusive category Ex: recording every action a child takes while playing with another child Nonexhaustive system: specific behaviors, but NOT all behaviors, are recorded. Ex: count every time a child hits another child, but not including biting Exclusive: deciding what criteria the study will not include; who does not fit into a specific population Inclusive: criteria that prospective participants must have to be considered eligible for a study

Experimental vs. Quasi experimental

Experimental: a method of research in the social sciences (such as sociology or psychology) in which a controlled experimental factor is subjected to special treatment for purposes of comparison with a factor kept constant. Control vs. experimental group Quasi-experimental: a type of design for testing an intervention in which participants are not randomly assigned to treatment conditions; also called a nonrandomized trial or a controlled trial without randomization

Interfere with understanding of relational or causal dynamics in study (could be recognized or unrecognized. Can be controlled or uncontrolled). If not recognized until study already in process, can not be controlled, and is called a confounding variable

Extraneous variables

Scientific/Research misconduct

Fabrication: adding data that never existed Falsification: changing data that was obtained or omit Plagiarism: copying Forging of Data: signing informed consent for someone else Dishonest manipulation of design or methods: not holding true to original intent Ghostwriting: writing under someone else's name Conflict of Interest: unfair bias, disagreements - future ethical dilemmas: animal research/transplants, fetal tissue, women of childbearing age, biotech, genetics, STUDIES MUST NOW JUSTIFY EXCLUSION OF WOMEN, STUDIES MUST INCLUDE OTHER CULTURES unless a reason not to ***nurses were involved in the misconduct in 1/2 of them: were aware, identified participants, delivered tx, collected data ***primarily occur in med schools, hospitals, research institutes: data in graphs can appear more significant - nurses must: assure pt's rights, support development of new knowledge, support need for nurses on IRBs; ask: will participating cost the pt more? Will I be required to administer meds/tx in clinical trials? Written research protocols? Can I refuse to participate? Expressing ethical concerns?

Middle range theories: (use more of this)

Focus on SELECTED NUMBER of concepts More specific than Grand theories Empirical testing Ex: Pender's Health Promotion model, Mishel's Uncertainty in Illness theory Many middle- range theories are from other disciplines

Focus of outcomes research (driving forces); What is NSI?

Focuses on the end result of patient care (found in an elsevier online textbook) - In order to explain the end results, nurse researchers also must understand the processes used to provide patient care. - NSI: nsg sensitive indicators = pt outcome solely r/t nsg care received - reflect structure (staff/edu), process (satisfied/assess/intervene), and outcomes of nursing care (quantity/quality) (ANA)

Conclusion

Generalization Data- based, but sometimes may go beyond data Author demonstration meaning and worth Answers "so what"

Systematic reviews

Integration of multiple studies on a topic - umbrella for metasynthesis and meta-analysis - top of evidence hierarchy - the systematic and rigorous integration and synthesis of evidence is a cornerstone of EBP - impossible to develop "best practice" guidelines, protocols, and procedures without organizing and evaluating research evidence through systematic review - narrative, qualitative integration (traditional review of quantitative or qualitative results)

Systematic reviews definition and Meta analysis vs Metasynthesis

Integration of multiple studies on a topic Meta analysis: synthesis of findings from multiple quantitative studies on same topic including RCTs (ex: factors r/t compassion fatigue in HCP, effects of ns-pt ratios on job satisfaction) - technique for integrating quantitative research findings statistically Metasynthesis: synthesize/interpret results from previous qualitative studies on same topic (ex: lived experiences of pts with COPD) - less about reducing information and more about interpreting it

Leininger

Intervention: allowing a healer to come and pray bless pt before surgery Concepts: Care must be centered around culture Our responsibility to preserve pts culture Care will vary depending on pts culture

Physiological measures

Involve the collection of physical data from subjects ex: wt, A1C, BMI Measures are objective and accurate Advantages: precision and accuracy Disadvantages: Expertise for using devices

Content analysis

Involves analyzing content of narrative data to identify prominent themes and patterns among the themes Breaks down data to smaller units, coding and naming according to the content represented, then grouping coded material based on shared concepts

Data collection methods: Theoretical sampling

Involves decisions about where to find data to develop an emerging theory optimally Usually used with grounded theory - preferred sampling method in grounded theory research, involves selecting sample members who best facilitate and contribute to the development of the emerging theory

Content validity

Items to represent the content Ways to measure → comparison w/ literature, panel of experts in subject area, test blueprint designed for content/level Degree to which an instrument has an adequate sample of items for the construct being measured Evaluated by expert evaluation, a quantitative measure - content validity index (CVI) - will also determine if number and type of questions are adequate

Principles to guide research; definitions, examples of application and violation:

Justice: Treated fairly Do not be late for data collection appointment. Don't deny benefits without good reason Don't impose burden without good reason Random selection: no bias; don't select participants because you "like them" Beneficence: Act in participant's best interest and always act as advocate DO NO HARM Maximize possible benefits Secure participant's well-being Competent Researchers "Greater the Risk, Greater the Benefit" Benefits do not outweigh risks if the researcher knows in advance that harm or death will occur Discomforts can be: physiological, psychological, social, and economical Respect: Self-determination: Must be voluntary, without coercion Autonomy: Free to participate or free to withdrawal at any time without penalty

Purposes of hypothesis

Lend objectivity to investigations Test theoretical propositions Advance scientific knowledge of nursing Guide research design Dictate statistical analysis used Show researcher's expectations.

Confidence level and level of significance; means what? Minimum acceptable level of significance

Level of significance = probability of making a Type I error (rejecting a null hypothesis that is, in fact, true) .05 means accepting risk that out of 100 samples, a true null hypothesis would be rejected 5 times OR 5% chance the result really occurred by chance - or 95/100 cases, a true NH would be correctly accepted - 5% occurred by chance, or willing to risk being wrong 5% of the time p= Minimum level of significance in nsg studies is .05 = standard minimum level for alpha in scientific research - a = .01 significance level means 1/100 cases reject true NH (don't put zero in front of decimal) - larger sample size promotes likelihood that extreme cases will cancel out each other - do not prove hypothesis: but "null has high probability of being incorrect" - *rejecting null shows support for scientific hypothesis* - probability of incorrectly rejecting true null - "significance" does not reflect importance or meaningfulness, means results not likely due to chance at some specified level of probability - nonsignificant results: probability high that observed difference or relationship could be result of chance (non reproducible) - diff that researchers with help of statistical inference, consider real, are said to be statistically significant - diff that could easily be caused by chance are not considered real and are nonsignificant; does not mean research hypothesis is not correct - "are or are not significant" Confidence level/confidence interval = probability level in which null hypothesis can be rejected w/ confidence & research hypothesis can be accepted w/ confidence If they have a confidence level of 95%, researchers risk being wrong 5 times out of 100 - probability level in which null hypothesis can be rejected with confidence and research hypothesis can be accepted with confidence - how willing is the researcher to be wrong when declaring that one group really is different from the other group on the variable being measured? Probability: likelihood an event will occur.

Types of sources: secondary

Lit Reviews are Secondary Written by persons other than individuals who conducted research or developed theory Discussion or critique of theory; summary of research study Ex: Kozier's chapter on Human Needs Helpful if primary not available Another person's viewpoint/interpretation- may omit or misinterpret valuable info

Major steps in EBP/EBM (probably same as key elements?):

How is it actually practiced? - Asking clinical questions that are answerable with research evidence (crucial first step) - Searching for and collecting relevant research based evidence that addresses the question to answer - Appraising and synthesizing the evidence - Integrating the evidence with your own clinical expertise, patient preferences, and local context - Assessing/evaluate the effectiveness of the decision, intervention, or advice

Assent vs. Consent

How to obtain informed consent: Assent: affirmative, agreement to participate, explain to kid in way they understand Children 6-7 years + (and older but <14) ALSO permission from parents required Consent: 14 years + can give with parent permission unless otherwise specified (greater level of cognitive ability) 18 years + can give own Includes: Study purpose, researcher identified, potential risks, compensation, anonymity, specific expectations regarding participation, voluntary nature of participation, and potential costs and benefits. [SEE SUPPLEMENT PACKET] ***In a qualitative study, the consent may be continuously renegotiated due to the ongoing process

Content of Research Journal Articles

IMRAD Format: Title and abstract Introduction Method Results And Discussion - References - presentations at professional conferences, oral and poster - papers often subjected to peer review, peer reviews are often blind (reviewers are not told names of authors and vice versa) Title & Abstract: - qualitative studies: title normally includes the central phenomenon and group under investigation - quantitative studies: title communications key variables and the population (PICO components) - abstract: brief description of major features of a study at the beginning of a journal article Components of the introduction: - description of central phenomena, concepts, variables - study purpose, research questions, or hypotheses - review of lit, theoretical/conceptual framework - study significance, need for study Method section: quantitative studies - research design, sampling plan, methods of measuring variables and collecting data, study procedures, including procedures to protect participants, analytic methods and procedures - Qualitative studies: discuss many of the same issues as quantitative researchers but with different emphases, provide more information about the research setting and the context of the study, describe the researchers' efforts to enhance the integrity of the study Results section: - Findings: quantitative studies: the names of statistical tests used, the value of the calculated statistic, statistical significance, level of statistical significance-index of how probable it is that the findings are reliable - Findings: qualitative studies: findings often organized according to major themes, processes, or categories identified in the analysis; almost always includes raw data - quotes directly from study participants Discussion section: - interpretation of results, clinical and research implications, study limitations and ramifications for the believability of the results

Rosenthal effect

If a researcher believes that their experiment is likely to results in a particular outcome, that bias will affect how the researcher conducts their work. The results will very likely sway towards the direction the researcher wanted, invalidating any study results "nonexperimental effect" interviewer's influence on respondents' answers

Literature Review

NOT ON TEST Purpose: - integrate research evidence to sum up what is known and not known; communicate the state of evidence to others, lay the foundation for new studies, help researchers interpret their findings - *written summary of the "state of the evidence" r/t a research problem* - KNOW: *determine what's known: (1) ID gaps, consistencies, inconsistencies in published lit; (2) refine hypothesis, (3) help develop theoretical framework, (4) help plan methodology (design, data collection method, groups)* - what we know and don't know - *guides all steps of the research process*: instruments, tools, successes/failures, research questions, replication of well-designed studies, clarify/narrow problem, determine what research can best contribute to knowledge - *must have lit review as support for research proposal* Benefit: (So WHAT?) - develops lifelong skills (thinking and analyzing), helps YOU contribute to creating and sharing knowledge, learning process, validity, helps clarify for yourself It should: - give overview of what's known about the variables (ID in the purpose) - show how these variables have been studied in the past - show with whom those variables studied - synthesize approaches taken to develop knowledge in this area (method)

Etic (outsiders view)

Outsiders view of experiences of a culture The worlds and concepts they use to refer to the same phenomena as insiders Tacit knowledge: information about a culture that is so deeply embedded in cultural experiences that members do not talk about it or may not even be consciously aware of it (qualitative)

Sampling bias

Over-representing or under-representing population segment in terms of key characteristics Distortions that arise when a sample is not representative of the population from which it was drawn

Informed consent

Participants have adequate info about the study, comprehend the info and have the power of free choice, enabling them to consent or decline participation voluntarily - "knowing consent" - must be signed and dated, understandable (not >5th grade reading level) - do not ask participants to waive rights - "reasonable subject" standard was followed: if mentally impaired/incompetent treating reasonably without intending harm and considering needs - incompetence: temporary: inebriated, permanent: senile dementia, subjective/transitory: psychosis - just because it's not discussed in research report does not mean was not obtained; often with self-report questionnaires not obtained in writing but implied when participant completes and returns questionnaire - researcher and caregivers of participants must be fully committed to informed consents & patient's rights before during and after research - researcher identified, credentials, contact info - participant selection process (explain how chosen): participants, respondents, informants; exclusion of women & minorities - purpose: participant's reading level; honest - ALL ASPECTS of study explained when, where, time involvement, activities; if not desirable to inform fully prior to study-must do so after (Debriefing) & how to contact researcher - includes: potential risks (psych/physio/privacy), potential benefits (don't want to be too great->bias), compensation (may lead to bias), alternative activities (offer control group treatment after study; fill out consent here or take home); anonymity - refuse withdraw without penalty for any reason - offer to answer all questions, how results will be available

Quantitative research

Positivist paradigm reality exists (same for everyone) Real world is driven by natural causes Researcher is independent from those researched (not closely connected) Values and biases are to be held in check - deductive: use theory already done & test it, objective and empirical and measurable Focus: EBP application of research findings to clinical decision making to *improve patient outcomes* - nurses accountable for safe, efficient, cost effective care Systematic: controlled process, orderly procedures with a specified prespecified plan Objective Orderly procedures Process to gather/analyze info measured by instruments, formal measurement before analyzing Instruments used to convert info to numbers Statistics used to manage those numbers Researcher draws conclusion about findings (detailed step by step) Control over context, limit control bias External/Empirical evidence -> Guide clinical practice (data to have for data's sake → information received by the means of senses) Seeks generalizations (objective) Emphasizes deductive reasoning Begins with educated guess about relationships between concepts or question about what is to be explored or described (research question) Bases hypothesis or research question on theoretical framework Structured process Seeks to control or limit bias What (problem/focus), Why (purpose), Who (pop), When (data collection times), Where (setting), How (data collection method) 3 things experimental design must have: manipulation, control, randomization (of groups) - assumptions without verification - understanding the underlying *cause* of phenomena previously studied - scientific method, empirical evidence, generalizability

Hypothesis:

Predicts relationship between 2 or more variables. Tests theoretical propositions in the "real world". - Another definition is "*the researcher's predictions about relationships among variables*". It also suggests the predicted relationship between the independent variable and the dependent variable. Needs: relationship between variables being studied Not needed: qualitative studies, single variable descriptive studies also called univariable/simple

Types of sources: primary

Primary written by persons who conducted the research or developed theory (Maslow's book on his Needs Hierarchy) Usually journal sources Definitive determination: locate article If theorist cited in text of reference of lit, then reference list should contain theorist's name Ex: Maslow's theory discussed, should see Malsoe as author in references list

Primary and secondary sources

Primary: firsthand reports of facts/findings; in research, original report prepared by investigator who conducted the study Secondary: secondhand accounts of events/facts; in research, a description of a study prepared by someone other than the original researcher

Percentages

Proportion of subgroup to total group IMPORTANT TO REMEMBER → ≥20 values needed for statistics to be valid (20 is minimum) Always report underlying frequencies w/ percentages; if not, can be misleading Round to one or two places (will not always add up to 100% because of rounding) Ex. "60% of students interviewed said scrubs should be required in the classroom as well as in clinical." How many interviewed?

Triangulation or mixed methods

Qualitative research type The use of multiple methods to collect and interpret data about a phenomenon, as to converge on an accurate representation of reality Requires sequencing and prioritization (qualitative and quantitative are both collected and decisions are made on which to emphasize) Gaining different perspectives Data: use multiple data sources to validate conclusions (time, space, person triangulation) Investigator: not relevant to data collection Method triangulation: use of multiple methods of data collection to study the same phenomenon (self-report, observation) Theory: not relevant to data collection

Characteristics of probability sampling

Random selection of elements from a population Each element in the population has an equal, independent chance of being selected (*not the same as random assignment like in RCTs) Only viable method of obtaining representative samples Allows researchers to estimate the magnitude of sampling error, which is the diff. b/w population values (e.g. the average of the population) and sample values (e.g. the average of the sample) Can be: Simple Random: Researchers establish a sampling frame― a list of population elements Ex: Out of 8709 Brazilian T2DM patients, randomly sampled 368 of those patients; all in a hat and draw, random number generator Stratified Random: The population is first divided into two or more strata, from which elements are randomly selected Ex: Split the population of Harding students into classification, sample random number of student each class - enhances representativeness Systematic: Involves the selection of every kth (ex. 10th, 5th etc.) case from a list, such as every 10th person on a list starting at a randomly selected number. Ex: Out of 1858 patients in a list, start at 294 and select every sixth patient Cluster Random: Used for large scale studies with far or spread out geographic sites/clusters. ***Associated with larger sampling error, but is considered more efficient*** - clusters become sampling units Ex. all nursing schools in southern region, randomize from each state

Emic (inside view)

Refers to the way members of the culture regard their world Local language, concepts, or means of expression Ethnographic research (qualitative)

Relationship of reliability and validity, interrater reliability

Reliability: The extent to which scores for people who have not changed are the same for repeated measurements. Concerned with the absence of variation in measuring a stable attribute for an individual. Validity: a measurement context is the degree to which an instrument is measuring the construct it purports to measure. Close association Reliability is a condition for validity An instrument cannot be valid unless it is reliable Reliability tells nothing about degree of validity An instrument can be very reliable but w/ low validity Interrater reliability: The most typical approach to evaluate how reliable the measurements reflect attributes of the person being rated rather than the attributes of the raters. Involves having two or more observers independently applying the measure with the same people to see if the scores are consistent across raters.

Descriptive

Research that typically has its main objective as the accurate portrayal of people's characteristics or circumstances and/or frequency with which certain phenomena occur - can be qualitative or quantitative

Importance of replication of studies

Similar findings Allows researcher to draw conclusions similar to conclusions if one random sample were used

Types of hypothesis: Be prepared to read hypothesis (ONE OR THE OTHER): Simple or complex

Simple: bivariate - relationship between 1 independent variable and 1 dependent variable. Complex: multivariate - relationship between 2 or more independent variables and 2 or more dependent variables.

Rigor

Striving for excellence in a study - used in qualitative and quantitative - tried to control/limit bias in all aspects - controversy about quality: what should the key quality, related goals be, what terminology should be used - a major dispute has involved whether "validity" (only in quantitative) and "rigor" are appropriate for qualitative studies - question rigor in qualitative: not consistent with philosophical approach (Ex. said they used phenom but did not bracket), poor design, not collect/analyze data properly - some reject these terms and concepts totally, some think they are appropriate and others have searched for parallel goals - no common vocabulary exists in qualitative (goodness, truth value (believable), integrity, trustworthiness, validity, rigor)

Population: targeted and accessible

Target: entire population of interest; entire group of interest based on eligibility criteria Accessible: portion of the target population that is accessible to the researcher, from which a sample is drawn

Hawthorne effect

The effect on the dependent variable resulting from subjects' awareness that they are participants under study. - respond in certain ways because know being watched

Content analysis

The process of organizing and integrating narrative, qualitative information according to emerging themes and concepts

Inductive reasoning

The process of reasoning from specific observations to more general rules

Coding

The process of transforming raw data into standardized form for data processing and analysis in quantitative research: the process of attaching numbers to categories In qualitative research: the process of identifying recurring words, themes, or concepts from within the data. Substantive codes - open codes end when core category is identified - one type of core category is a basic social process (BSP): level 1 (in vivo), level 2, level 3 codes - Selective codes: codes relating to core category only Theoretical codes, axial coding, initial and focused coding Families of theoretical codes: process, strategy, cutting point; the 6 C's = causes, contexts, conditions, contingencies, consequence, and covariances

Research objective or aim

The specific accomplishments to be achieved by conducting the study **-more specific than purpose statement

Evidence-based practice

The use of the best clinical evidence in making patient care decisions - The basis for nursing decisions, influences many recent clinical practice changes - Produces decisions that are cost effective and result in positive client outcomes - Many recent clinical practice changes reflect the impact of research - Cochrane Collaboration started EBP movement - knowledge translation is a term associated with efforts to enhance systematic change in clinical practice - integration of the best available research evidence with clinical expertise & individual pt preference (personalized) - Does not necessarily imply practice changes, "best evidence" may confirm existing practices are effective already or cost-effective; may need to validate what is done is good and not change - Key Elements: making clinical decisions, best possible evidence, clinical expertise, patient values & needs (BROADER THAN RU)

Other use of lit reviews besides conducting research

To know what's out there: gain knowledge, EBP, practices/protocols, nursing curricula, critiquing, innovations, new theories

Purpose of literature review

To summarize what is known and not known from research evidence and state the significance of a new study The literature review supports the research proposal Guides all steps of research

Examples of ethical violations

Tuskegee study: 1932-1972 in Alabama. 600 black male farmers. 399 with syphilis and none of them received treatment when PCN became available in 1940s ("bad blood" approved by USDHHS; Clinton apology 1997, over 100 died) WWII Nuremberg Trials which led to the creation of the Nuremberg code: The standard for research guidelines protecting human right of subjects 1974 National research act led to the creation of the national commission for protection of human subjects 1979 Belmont report led to respect, beneficence, and justice (3 main ethical principles) = Essential in research funded by federal govt. - Declaration of Helsinki 1964: revised 7 times; therapeutic vs. non-therapeutic - protect life, health, dignity, privacy - increase care in non-therapeutic res - benefits > risks - placebo-tx afterwards History of ethics: IRB, ANA Code for Nurses, NIH Office of Research Integrity, HIPAA, 10 commandments

Data collection methods: Convenience sampling

Volunteer sampling Not preferred approach, but is economical Used a lot in nursing research Ex. posting a flyer in hospitals, participants call to join, position at Walmart, get in touch with anyone you can

Methodology

What, How, Who, Where, When [was the data collected]

Examples of Violation: Confidentiality

When anonymity is impossible, appropriate confidentiality procedures need to be implemented. A promise of confidentiality is a pledge that any information participants provide will not be publicly reported in a manner that identifies them and will not be made accessible to others Analyze and report information as a group: AGGREGATE (only one person sees individual data, pooled together) - individual identities of participants not linked to info they provide and not publicly divulged, data are coded, stored separately locked - do not allow unauthorized access to data - analyze and report as group "aggregate" - area of increased concern in qualitative research - delete identifiers

Homogenous

When only people who are similar with respect to confounding variables are included in the study. Ex. If age was considered a confounder, participation could be limited to a specified age range.

Theories

Why have one? Theory guides research process from beginning to end From problem ID to study conclusions It is an abstract generalization that explains how phenomena are interrelated. - systematic explanation (set of related statements) about how phenomena are interrelated - two concepts r/t one another, why one event associated with another or what causes event to occur - make scientific findings meaningful & generalizable - greek "theoria" beholding, spectacle - speculative never true or proven - always subject to revision or further development Elements of a theory: Concepts: building blocks of theories Group of concepts indirectly observable. Often deliberately invented or constructed Ex: Self-care, well-being, socioeconomic status, assertiveness. Identified only through certain measurable concepts. Ex: wellness inferred through lab data

Hypotheses

a statement of predicted relationships between variables - predicted relationship between 2 or more variables (making this change is predicted to cause this effect) - tests theoretical propositions in real world with real people Ex. Gate control theory

Cross-sectional design

a study design in which data are collected at one point in time; sometimes used to infer change over time when data are collected from different age or developmental groups

Models

a symbolic representation of concepts or variables and interrelationships among them

Construct

an abstraction or concept that is invented (constructed) by researchers based on inferences from human behaviors or human traits (e.g. health locus of control) - group of concepts indirectly observable - often deliberately invented or constructed Ex. self-concept, self-care, well being, socioeconomic status, assertiveness - ID only through certain measurable concepts - Ex. WELLNESS inferred through lab data - slightly more complex abstraction than a concept

Data collection in quantitative research

basic decision in use of : 1. new data, collected specifically for research purposes OR 2. existing data (won't be using this type with QUASI experimental) - records (patient charts, hospital records such as ns shift reports, school records student absenteeism, corporate records health insurance choices, letters, diaries, minutes or meetings, photographs), historical data, existing data set (secondary analysis) Major types: 1. self-report- *unless making observations it is self-report data*; structured, data are collected with a formal instrument - interview schedule: questions are prespecified but asked orally, either facetoface or telephone - questionnaire: questions prespecified in written form, to be self-administered by respondents - closed ended (fixed alternative) questions: for example, "were you ever? (yes/no)" - open-ended questions: "why?" 2. pt-reported outcome 3. observation- observe behavior/characteristics 3. biophysiologic measures- clinical info/BP Overview: structure, quantifiability, objectivity

Hypothesis should

be written in declarative sentence be written in present tense contain pop contain variables reflect prob statement, purpose statement, research question be empirically testable (objectivity, able to operationalize variables, operationally and conceptually defined variable)

Search strategy terms

bibliographic databases on the computer - ancestry approach (footnote chasing): use the bibliography of a recent relevant reference to find earlier related studies (ancestors) - descendancy approach: use a pivotal early study in citation indexes to find later studies (descendants) that cite the pivotal study - keywords: searching for substantive topics (most start here) - subject headings: keywords may be different than keywords due to database mapping capabilities - for quantitative studies, the keywords are typically the independent and dependent variables and often the population - for qualitative studies, the keywords are the central phenomenon of interest and the population - subject search: search for topics or keywords in the database - textword search: search for specific words (which can be keywords) in text fields of the database record (e.g. in the abstract or title) - author search: search for prominent researchers in a field - can extend a search to multiple words with the same root, by adding the database's wildcard character to a truncated word; A truncated symbol (often an asterisk, *) expands a seaerch term to include all forms of a root. Ex. nurs* would search for nurse, nurses, nursing - different databases use different wild cards - Boolean operators: combine, restrict, or broaden searches Ex. "and" two or more are present, "or" any of 2+ terms, "not" info for one term not the other - CINAHL (1982 to present), MEDLINE (uses MeSH or medical subject headings)

Research probs and questions

broad enough to include central concerns narrow enough to serve as guide to study design - research question and problem determine design of study - initial problem that expands

Research problem sources

clinical experience nursing lit (what studies suggest for the future) social issues theory- developed through qualitative, identifies further area to study suggestions from external sources (e.g. priority statements of national organizations or funders)- NIH [also the NLN, ANA, ACCN, etc.] - prior experiences and interests - from clinical experience/practice, nursing literature, social issues, theory (if developed they need to be tested because they show relationships among variables), suggestions from external sources (priority statements of national organizations or funders) such as NIH/NINR, presentations at conferences

Cross-Sectional Study

data collected at one point in time - Ex "snapshot" of levels of satisfaction with the HCCn students at midterm; random sample of small number from each level/track - phenomenological/qualitative

Grounded theory

data is typically collected before examining the literature; process, social, theoretical sampling, constant comparison, core variables, open coding

Preexisting data

data is used from previous research - existing info is re-analyzed for new research - pt charts, records from agencies and organizations, personal docs, almanacs, professional journals

Examples of Violation: Voluntariness

patients have the right to choose to be in a study or not. Review history of abuse by various nations in powerpoint slide/ class notes

In vitro measurements

performed outside the organism's body (e.g. urinalysis)

How to conduct a literature review - databases, time frames, search parameters

retrieve promising sources (obtain copies) screen references/articles discard irrelevant/inappropriate ones read relevant ones/take notes identify new sources through citations organize references; outline analyze/integrate materials write review write abstract of each source note all key ideas from reading of articles connect all similar ideas themes or key ideas or variables can become headings

Threats to internal validity

temporal ambiguity, selection bias threat, history threat, maturation threat, mortality/attrition threat - instrumentation, setting, testing, lab setting, representativeness of sample, tight controls - hawthorne effect, rosenthal effect <- threats to external/internal validity

Descriptive qualitative studies

tend to be eclectic in their designs and methods and are based on the general premises of constructivist inquiry - seek to holistically describe phenomena as they are perceived by the people who experienced them - the researchers may say that they did a content analysis of the narrative data with the intent of understanding important themes and patterns

*TEST Qs: key elements of EBP → DEEV B the key elements

Making clinical *d*ecisions Best possible *e*vidence Clinical *e*xpertise Patient *v*alues and needs *B*roader than research utilization

Purpose/meaning of standard deviation

Measures average deviation of scores from mean Is reported w/ mean Most frequent measure of validity Larger deviation from mean, larger the SD The larger the SD is the more variation in the population response

Construct validity

Most difficult to measure Concerned w/ what is this instrument really measuring & does it adequately measure the construct of interest Ways to measure → known-groups procedure tests relationships based on theoretical predictions, factor analysis

Examples of Violation: Anonymity

Most secure means of protecting confidentiality occurs when the researchers cannot link participants to their data. Ex) if questionnaires were distributed to a group of nursing home residents and were returned without any identifying information, response would be anonymous - allowing unauthorized person(s) access to raw data (family, other HCP) - participant's ID cannot be linked, EVEN BY RESEARCHER, with his or her individual responses - not publicly divulged - name, SSN, one-way mirrors without participants knowledge - longitudinal studies-anonymity? (difficulty to maintain anonymity because have to know over long time period, but still can maintain privacy/confidentiality)

Analyzing evidence from searches

NOT ON TEST - after identifying potentially relevant citations, the references must be: Screened: and gathered (best to work with a copy of the article) Documented: note search actions and results Abstracted and recorded: notes are made of key pieces of information (using a literature review protocol) Evaluating and analyzing: - integrating and synthesizing information across studies for a research literature review have much in common with a qualitative analysis - in both, the primary focus of analyzing the information in a literature review is on identification of important themes - a variety of themes (patterns) can be pursued - Substantive themes: are likely to be especially important: pattern of evidence? findings predominate? how much evidence is there? how consistent is the body of evidence? what are key gaps in the body of evidence? - Methodological themes: what methods have been used to address the question? what are major methodological deficiencies and strengths? - Generalizability themes: to what populations does the evidence apply? do the findings vary for different types of people? - Tips: organize material logically, write objectively, summarize in your own words, use appropriate language, conclude with a concise state-of-the-art summary of the existing evidence

Preparing a written review

NOT ON TEST - retrieve promising sources (obtain copies) - screen references/articles - discard irrelevant/inappropriate ones - *Read relevant ones/take notes* - identify new sources through citations; then retrieve - organize references; develop outline - analyze/integrate materials - write review - write abstract of each source, you must know what the lit says in order to argue what is known and not known - note all key idea form your reading of the articles - connect those ideas that are similar - themes or key ideas or variable can become your headings/subheadings

Literature review terms

NOT ON TEST Data-based lit: research reports based on evidence (empirical=observable/objective/hard data; scientific; research) Conceptual lit: theoretical; discussion of theories, concepts (hope, empathy, loss) or conceptual models - not study but expand on knowledge, can use in paper to explain overall concept, but not reports of actual study Refereed Journal: panel of experts review manuscripts Peer review: manuscript has been read and reviewed by two or more peers

Lit review: primary and secondary sources

NOT ON TEST Types of information for a research review 1. primary sources: principle reliance on these (the actual research reports written by researchers who conducted the study/research or developed the theory) - Ex. Maslow's book on his Needs hierarchy (know best about the study/theory) - historical research: eyewitness or original document - usually journal articles or definitive determination: locate the original article - *if theorist is cited in text of rev. of lit. then the references list should contain theorist's name* Ex. Maslow's theory discussed, should see Maslow as author in references list 2. secondary sources: less reliance on these (summaries of studies done by others) - written by persons other than the individual who conducted study/research or developed theory - discussion or critique of theory, summary of research study - Ex. Kozier's chapter o human needs lit review is secondary source, also systematic review - helpful if primary not available, another's viewpoint, can lead to primary sources - *this is another person's interpretation* (may misinterpret or omit valuable info) - Proper APA citing of secondary: give the secondary source in reference list, in text = name original work and give a citation for the secondary source Ex. Allport's diary (as cited in Nicholson, 2003). Search strategies: - ancestry approach: searching earlier studies cited - descendancy approach: using key study searching forward to studies citing it - related citations: searching for similar studies once find good example - search by authors (look at references list) - *decision rules for search strategy needs to be explicit; reproducible; unbiased; systematic (search parameters: date, setting, type of study, language, discipline)*; exhaustive study = far back as possible and all studies - peripheral use of clinical anecdotes, opinion articles, and case reports may broaden understanding of a problem or demonstrate a need for research

Writing a lit review

NOT ON TEST!!! introduction: purpose is to catch attention/interest - body of the review: data base sources - synthesize major findings (logical order, define first) - include purpose, sample size, design, specific findings - strengths/weaknesses of the evidence - summary of current knowledge (suggestions for further research) - structured analysis of answer you found (what ppl did the article use, sample size, qual or quant etc.) - introduce specific problem area - est. importance, uses specific from lit, include stats - define key terms, conceptual definitions - present lit from your point of view, summarize findings in conclusion - end with specific research questions, purposes, hypothesis Tips: - words are better than nothing, edit/delete, leave notes, organize articles oldest to newest, look for changes over time, define, changes in theories - be critical: warn of weak study or small sample sizes, critique studies as a group for weak/strengths, note GAPS: unstudied groups or variables, look for identifiers of unreliable sources - be selective: classics can be used but must state that info from last 5 years could not be used - AVOID overuse of direct quotes, not convey full meaning, disrupt flow, nonessential details given; used only if emotional impact is lost in paraphrasing - write in PRESENT TENSE - use passive voice sparingly - can include positive criticism - strong evidence terminology: strongly suggest, most studies, QOL clearly indicates the possibility, has led most researchers to conclude - moderate/weak evidence terminology: pilot study suggest, only limited evidence, indicates, is inconclusive, pointing towards Guidelines: - essay format - emphasize findings - point out trends, themes, gaps - % of people affected - express opinion about quality of research - logical transitions and critique (see pic)

Nursing theories/theorists from class

Nightingale: summary healing is linked to 5 environmental factors: pure/fresh air, pure water, efficient drainage, light/direct sunlight Opening blinds on window to allow infiltration of natural sunlight into the room of ICU pt Henderson: help pt gain independence through basic functions Intervention is routine care, basic care needs, bed bath, food/drink, clean Orem: theory about self-care and performance to maintain well-being, ID self-care deficit Teach pt and perform return demonstration of sizing and applying ostomy bag Leninger: cultural care, preserve, maintain, accomadate, restructure Thoroughly assess cultural preferences or needs to make it more comfortable for pt Watson: care is essential to practice of nursing, connection with pt, treat as real person, caring over curing Use therapeutic communication and touch to encourage expressed feelings and positive pt experience Roy: adaptation; humans are in constant interaction with environment and have to adapt to it

Protection from harm (levels of harm)

No anticipated effects (pt records; maintain HIPAA) Temporary discomfort (diabetic BS checks) Unusual levels of temporary discomfort (describing rape experience) Risk of permanent damage (drugs) Certainty of permanent damage (Nazis) DEGREE OF RISK SHOULD NEVER BE GREATER THAN POTENTIAL HUMANITARIAN BENEFIT (SHOULD HAVE POTENTIAL TO IMPROVE PT CARE)

Null hypothesis versus research hypothesis-which one is tested; language used r/t the null hypothesis to describe findings. Meaning of rejection of the null

Null hypothesis = no relationship between the variables; only used in statistics, not being tested - statistical, states "no difference", "no relationship" - test this one statistically - if small differences or low correlations found -> chance is reason -> null not being rejected - large diff/correlation not by chance, so null rejected - either accepted (likely due to chance), or rejected (indicate existence of relationship btw variables, unlikely due to chance) Research hypothesis = states the anticipated relationship between the variables; actual hypothesis that researcher is testing - scientific, based on theoretical framework - directional -predict results of study - never tested statistically, never say "proved", not say "rejected" because never actually tested Two explanations: 1. reflects researcher's scientific/research hypothesis 2. diff due to chance factors: reflects null hypothesis, no actual relationship, result of chance or sampling fluctuation Reject the null hypothesis = support the research hypothesis Fail to reject the null hypothesis = does not support the research hypothesis - hypothesis testing: process of disproving or rejection - it is possible to show that the null hypothesis has high probability of being incorrect - such evidence supports scientific hypothesis (research hypothesis) - goal of statistical test is to determine probability

Henderson

Nursing in relation with pt and their environment, even if pt's recovery is not feasible Assisting sick or healthy pts to gain independence in meeting their fundamental needs (lists 14 fundamentals needed) Intervention: collaborate with palliative care pt to establish that desired environment of comfort by adjusting room temp, moving pt in bed, and providing oral care

Descriptive research

Observe, describe, and document No attempt to infer causation Ex. percentage of teenagers engaging in risky behavior - do not intervene originally, but once know enough in that area develop into QUSI experimental study

Abstract

Often the only section read Should contain essentials: Hypothesis or Research Questions, methods, description of participants, major findings 100 - 200 words

Difference in parameter v. statistic

Parameter: characteristics of a population usually not known - inferential stats: info from sample used to make inferences concerning parameter - generalize findings from sample to population, mean sample stats, population parameter Statistic: characteristics of samples you usually are able to compute (descriptive stats for sample characteristics) You compute statistics to estimate parameters Must describe data in meaningful terms

Florence Nightingale as a nurse researcher

Pioneered nursing research in the 1850s first nurse researcher!!! Skillful analysis of factors affecting soldier mortality and morbidity during the crimean war She was successful in bringing about changes in nursing care and public health - History: first advanced degrees in 1950s, lots of research funding from the NINR (national institute of nursing research) in 1993

How do you determine significance of study?

Practical importance of research results in terms of whether they have genuine, palpable effects on the daily lives of patients or on the health care decisions made on their behalf 0.05 (5%); meaning 95 out 100 times the results came about due to the intervention and not due to random chance

Results

Present data Data, numbers, descriptive, and inferential statistics Analysis of data Problem, hypothesis - address each one Each test, results (summarization) Narrative and/or table, graphics Objectively presented Do not omit data, even if not significant

Hypothesis

Present tense; relationship between variables Consistent terminology Empirically testable Able to gather objective data Only one prediction

Dissemination of qualitative findings

Process of sharing research findings in many places

Literature review purpose

Purpose: - integrate research evidence to sum up what is known and not known; communicate the state of evidence to others, lay the foundation for new studies, help researchers interpret their findings - *written summary of the "state of the evidence" r/t a research problem* - KNOW: *determine what's known: (1) ID gaps, consistencies, inconsistencies in published lit; (2) refine hypothesis, (3) help develop theoretical framework, (4) help plan methodology (design, data collection method, groups)* - what we know and don't know - *guides all steps of the research process*: instruments, tools, successes/failures, research questions, replication of well-designed studies, clarify/narrow problem, determine what research can best contribute to knowledge - *must have lit review as support for research proposal* - WHY REVIEW LIT IF NOT CONDUCTING STUDY? add to knowledge, critique existing nsg practices, develop evidence-based protocols, develop/add to theory, revise nsg curricula, develop policy statements & practice guidelines, support recommendations for innovations Benefit: (So WHAT?) - develops lifelong skills (thinking and analyzing), helps YOU contribute to creating and sharing knowledge, learning process, validity, helps clarify for yourself It should: - give overview of what's known about the variables (ID in the purpose) - show how these variables have been studied in the past - show with whom those variables studied - synthesize approaches taken to develop knowledge in this area (method)

Purpose of inferential statistics; based on what assumption?

Purpose: use data from sample to draw conclusion(s) about population - test hypotheses: how much results fro chance? how stronly are variables associated? Help ID systematic variations btw or among groups within sample? - Based on the assumption that chance is the only explanation for relationships discovered in research - Based on the assumption that researcher used a random sample - assumption that chance is the only explanation for relationships discovered in research - researcher wants to demonstrate that chance is not the reason for relationships found in research - used to determine the likelihood that the sample chosen actually represents the population - helps researcher determine if difference between 2 groups (exp/control) is real difference or only a chance difference that occurred because an unrepresentative sample was chosen from population - larger the difference found, lower probability difference occurred by chance - make an educated guess about a population parameter based on a statistic computed from a sample randomly drawn from that population - take raw data -> understandable - used to test our prediction or hypothesis useful in nursing: - using nonrandom samples decrease ability to generalize results - replication of studies: similar findings; allows conclusions that are similar to conclusions as if one random sample were used

Action participatory research

Qualitative Closely allies to both critical research (key is transformation) and feminist reserach - feminist research (focuses on how gender domination and discrimination shape women's lives and their consciousness, similar to critical theory research on initiating change) Based on a recognition that the production of knowledge can be potential and used to exert power Collaboration of participants and researchers Raises conscious awareness, increases action and empowerment Research methods are designed to facilitate processes of collaboration and dialogue that can motivate, increase self esteem, and generate community solidarity - participatory action research (PAR): produces knowledge through close collaboration with groups or communities that are vulnerable to control or oppression (come together with oppressed to solve problems and make change such as homeless)

Focus groups

Qualitative research type Involve 5-10 people whose opinions and experiences are solicited simultaneously Interviewer/moderator uses topic guide Often used in qualitative research studies Not everyone may be comfortable sharing in front of a group

Historical (history based)

Qualitative research type Looks at past practices and changes over time (look back and compare, past, old documents, minutes from past meetings) - systemic collection and critical evaluation of data relating to past occurrences - relies primarily on qualitative (narrative) data but can sometimes involve statistical analysis of quantitative data (GOAL: gain new knowledge) - nurses have used historical research methods to examine a wide range of phenomena in both the recent and more distant past Written records and non written materials It is usually interpretive Often involves reading back over documents or minutes from meetings, talking with someone present for a historical event, etc Time consuming Use external and internal criticism 1. Internal criticism: accuracy of a record, valid/reliable/accurate (how accurate is the account of the event? is the document accurate?) 2. External criticism/record: authenticity/genuineness of the data/document (did the document reflect the time period? written by the person? is it their signature?) - primary and secondary source: first hand account or written by someone else? - Must be evaluated for all documents researched to know if it's valid/reliable

Patterns

Qualitative researchers seek patterns of association as a way of illuminating the underlying meaning and dimensionality of phenomena of interest Patterns of interconnected concepts are identified as a means of understanding the whole

Gathering Qualitative Self-Report Data

Qualitative studies: unstructured observation in naturalistic settings, includes participant observation - gather narrative self-report data to develop a construction of a phenomenon that is consistent with that of participants - this goal requires researchers to overcome communication barriers and to enhance the flow of information - gathering participant observation data (these people are TRAINED): physical setting, participants, activities, frequency and duration, process, outcomes - recording observations: logs/field diaries, field notes (DETAILED: descriptive observational notes, reflective notes such as methodological notes, theoretical notes or analytical notes, personal notes) - evaluation of unstructured observational methods: excellent method for capturing many clinical phenomena and behaviors, potential problem of reactivity when people are aware that they are being observed; risk of observational biases: factors that can interfere with objective observation

Types of variables

Qualities, properties, or characteristics of people, things, or situations that are manipulated or measured in research. KNOW THESE VERY WELL AND KNOW HOW TO PICK THEM OUT OF A STATEMENT. Dr. Lee really emphasized this when I went to meet with her.

Validity of instrument

Quantity of variable of interest can be calculated w/ use of instrument Greater validity, more confidence in instrument Ways to measure validity → panel of experts, examination of literature Measurement may be w/ correlations - MUST HAVE reliability to have validity - face, content, construct, criterion

Experimental, Quasi-experimental

Quasi-experimental: trials without randomization in medical literature. May also lack a control group. The signature is an intervention in the absence of randomization Experimental: Contain an experimental and control group, along with randomization. Sometimes called posttest design

Symbolic presentation of research designs

R: random assignment of participants to groups X: experimental tx or intervention O: observation or measurement of DV If subscript, numbers indicate first treatment, second treatment, first observation, second observation etc. R O1 x O2 (experimental group) R O1 O2 (comparison group)

Experimental research

RCTs (gold standard for inferring causal relationships) Intervention, control group, randomization Control group: no intervention, "usual care" with standard protocol and procedures, alternative treatment, or placebo Ex. testing the effectiveness of a home based walking intervention in improving symptom and mood distress in women following surgery for breast cancer. Some received treatment, while some did not. These things must be present with true experimental design: 1. manipulation (IV-intervene) 2. control (decr. extraneous variables-no drug to some group; no intervention, usual care/standard protocol/procedure, alternative tx, placebo) 3. randomization 4. researcher actively introduces/implements an intervention 5. "clinical trial" with intervention protocol (RCTS, Intervention, Control group: routine care, randomization)

RU vs EBP

RU: begins with new evidence or research based innovation EBP: begins with a clinical question (how can I do better, what bothers me?)

Types of journals (refereed, peer-reviewed),

Refereed- Panel of experts review manuscripts for possible publication Peer-reviewed- manuscript that has been read and reviewed by two or more peers before acceptance for publication

selection bias

Reflects biases stemming from preexisting differences between groups. When people are not assigned randomly to groups, the groups being compared may not be equivalent

Know basic information about each step of the research process: quantitative

Research process: orderly series of phases/steps, allowing researcher to move from question to answer Circular process (more for qualitative): answer may suggest new questions/further research areas Main phases: select/define problem, select design, collect data, analyze data, use findings 1) conceptualize the study: ID problem-WHAT - problem statement: focus, intent; justifies study, makes the case, background info - must be researchable by collecting and analyzing data and feasibility (time? resources? funding? number of participants? does PI have time and expertise to lead effort?) - Purpose: WHY being studied, expand on goals of study, significance? (large % of pop, a vulnerable pop, affect process or outcomes of pt care, incidence, # affected 2) Review of literature: search for relevant information/data - what is known/not known (gaps) - helps develop theoretical framework, may help identify data collection instruments - comprehensive, supporting/nonsupporting evidence, prevents unknowingly repeating prior work - built on previous knowledge, profit from successes/failures of previous researchers - occasionally initial lit rev may precede problem identification- ID problem from suggestions/recommendations of previous researchers (clinical fieldwork) 3) Theoretical framework: foundation for the study, rationale for researcher's prediction, helps explain study outcomes and link to existing body of knowledge, made up of concepts/constructs 4) Develop hypothesis: researcher's prediction, researcher's educated guess based on the theoretical framework 5) Formulate variables: concept/trait that varies among individuals or in environment; IV (cause) and DV (effect) & extraneous variables seek to control them because they can influence results 6) Design the study: overall plan and guides everything about study, designates whether doing intervention, comparison, blinding; strategy for data collection *cannot deviate once approved* - how to conduct study, Cause & Effect or describe existing conditions, answer question or test hypotheses, in quantitative it can be non-experimental or experimental 7) data collection techniques: develop an instrument (device, piece of equipment that measures concept/variable of interest) - evaluate instrument quality on reliability (consistency) & validity (does it measure what it is supposed to measure) 8) conduct study/collect data: approval- institutional review board, ethical concerns- protection of participants (any risk of harm emotional, money, time), recruit participants, conduct pilot study, collect data, consumes largest % of time 9) Analyze data: describe sample (demographics, descriptive stats); summarize quantitative data in meaningful way (use inferential stats), hypothesis (support or reject) 10) Interpret results: - conclusions: offer support for a position, implications for nursing practice, nursing research, and nursing education (even if not statistically significant) - generalization: extent to which finding can be applied beyond study setting to other settings/participants -> further study 11) Recommend further study: nursing implications, even if hypothesis not supported 12) disseminate results: journal articles, research conferences, inservice presentations, responsibility to share with colleagues, if not disseminated, little value to anyone

Types of hypothesis: Be prepared to read hypothesis (ONE OR THE OTHER): Research or null

Research: States the actual prediction of a relationship Null: expresses the absence of a relationship (used only in statistical testing) Statistical Analysis: evaluates the null hypothesis. Significance level in nursing at or below .05 which means that 95/100 time the outcome occurred because of our intervention.

Purpose and goal of research specific to nursing profession

Research: systematic inquiry using disciplined methods to answer questions or solve problems (similarities to nsg process) Nursing research: systematic inquiry to develop trustworthy evidence about issues of importance to nurses and their clients (EBP) - EBP: use of best clinical evidence to make patient care decisions, basis for nsg decisions, influence changes, clinically appropriate, cost effective, and result in positive client outcomes - clinical practice changes that reflect research: chlorhexidine, flushes, catheters, CPR etc. Clinical nursing research: nursing research designed to guide nursing practice - experimental trials involving real people Identification and description (count, delineate, and classify: qualitative) Exploration and explanation (nature, manner, or cause) Prediction and control (quantitative) Therapy, treatment, or intervention Diagnosis and assessment Prognosis, etiology (causation), and harm Meaning and process - our studies are interventions and so are quantitative studies - involves measurement

Nonexperimental research

Researchers are bystanders - they collect data without introducing treatments or making changes Usually done to address etiology, prognosis, or diagnosis questions Ex. comparison of sleep quality and daytime sleepiness in women with breast cancer vs. those without cancer. The two groups differed in regard to several sleep outcomes, such as sleep latency and insomnia - not use treatments or attempt to manipulate IV, study what is already occurring or has already occurred; no introduction of a treatment - descriptive or exploratory: observational - observational, researchers do not intervene; do not control the IV; quantitative - still have IV and DV - correlational: examine relationships between variables - IV may have already occurred, do not imply causation Ex. Surveys, polls, opinions, phone/mail

Data collection methods: Purposive sampling

Researchers deliberately choose the cases that will best contribute to the study and meet criteria - most collection is this way because it is purposeful - At the end of data collection, confirming and disconfirming cases occurs to help strengthen credibility of analysis or they realize that the data does not fit and it needs revision 1) maximum variation sampling: covers a wide range of cases with maximal range (one month to 10 years of recovery) 2) extreme/deviant case sampling: pick the most unusual or extreme sample (on each end of the criteria) 3) typical case sampling: just your average case/experience nbd 4) criterion sampling: specific criteria for the participant to meet 5) confirming and disconfirming cases: develop theory from case and take back to grounded theory, strengthen credibility or disconfirm original theory

Where in a research article would you find purpose statement, problem statement, goals or aims of study

Researchers often communicate information about their approach through their choice of verb. Problem statement First sentence is often the starting point Presented early and often begins with first sentence after abstract Interwoven with findings from the research lit. Others found later in the introduction Purpose Statement Establishes the general direction of the inquiry and captures the study's substance Usually has purpose, aim, goal or objective in sentence Identifies the key study variables and their possible interrelationships as well as population of interest (usually in intro)

Limitations & threats to internal and external validity

Restrictions: may influence validity/credibility of study and generalizability of population findings Weaknesses; extraneous variables (things you can't control) Uncontrolled variables: may affect results and limit generalizability Ex: drop outs, equipment malfunction, timing - threats to internal/external validity (experimental studies); Ex. dropouts, equip malfunction, timing - internal validity: IV causes DV not extraneous variables Threats: - selection bias not randomly assigning to groups, results could be from differences in participants before intervention - history occurrence of events concurrent with study (happens during study and effects results) - maturation result of time, growing taller, gaining weight etc. - mortality/attrition participants dropping out or dying in unequal numbers between groups - testing (pretest): or participants have knowledge of baseline data - Instrumentation changes: observers may become more adept; digital BP machine needs recalibration - External validity: being able to generalize results Threats: - hawthorne effect: respond in certain ways because know being watched - experimenter effect: researcher's behaviors/characteristics influence respondents' behaviors (way I ask questions) - Rosenthal effect: interviewer's influence on respondents' answers

APA

Review content specific to formatting the paper: margins (1 inch) type font/size (Times New Roman, 12 point font) paragraph length At least 3-5 sentences In proportion to the length of the paper cover page Title, Name, Affiliation Centered, double spaced Running head and page number in heading running head title Cannot exceed 50 characters including spacing and punctuation "Running head: TITLE OF PAPER/shortened title" on cover page, "TITLE OF PAPER" or shortened title on all pages after that. the phrase "running head" the reference list Alphabetical by author last name Hanging indent Syllabus pg. 4-13 section 3 - indent first line of each paragraph 5-7 spaces, no hyphenation, no contractions or abbreviations - italicize titles of books and periodicals; Bible not included in reference page (in text cite), page number in text cite only with quotes - indent when quote is over 40 words or 3 lines long - paragraphs are to be less than a page, no "widow sentences" carried over to the next page by itself - in text citations include up to 5 authors, otherwise use et al. - past tense, active voice; do NOT use introduction as a heading!!! - A running head is a short title that appears at the top of every page of your paper in the page header. The running head identifies the pages for the reader in case they get separated, and if you submit your paper for publication, it does this while preserving your anonymity during the review process (that is why the running head is a short title and not your name). In published articles the running head also identifies the article for the reader at a glance - The running head appears in the header of every page along with the page number. (The header by nature is situated within the top margin of your paper; all the margins themselves should be set to 1 inch.) On the first page of the paper only, the running head is preceded by the words "Running head" and a colon (SENTENCE CASE). On all other pages, just the running head itself and the page number appear, without the label Running head:

Planning a qualitative study

Review pages 53-54 See outline above - Question, not much lit, determine who will collect data, who will be participants 1. conceptualize and plan study: ID research problem, doing a lit review (only after collecting data to prevent bias), select sites and gaining entree (where to get info and people you need to know in organization to get close to participants), developing an overall approach, addressing ethical issues: vulnerability, honesty, privacy label with no names, confidentiality and anonymity, informed consent, permission to record person, plan of treatment if it causes harm: counseling/social worker if flashbacks; must get permission through IRB: institutionalized review board) 2. Conducting the study: undertaking iterative activities through emergent design (making sampling decisions, deciding what questions to ask, collecting data, evaluating integrity & quality, analyzing and interpreting data, making new decisions) - someone with dementia may not be a good participant due to cognitive impairments, need people who can communicate - continuously collecting, analyzing, and changing throughout, adjustments (different from quantitative that sticks to the same plan/steps throughout) 3. sampling: still concerned with quality of sample but use different considerations in selecting, selection of sample members guided by desire for information rich data sources - "representatives" not a key issue, random selection not considered productive - sample size: no explicit formal criteria, determined by informational needs, decisions to stop sampling guided by ***data saturation (start hearing repetitive information, no additional data with the next interview, collect until you hear repetition), data quality can affect sample size (may need to get more and new participants)

Criterion validity

Scores are correlated w/ external criterion Degree to which the instrument is r/t an external criterion Validity coefficient → calculated by analyzing the relationship between 2 scores on the instrument and the criterion 1) Concurrent validity: instrument's ability to distinguish individuals who differ on a present criterion 2) Predictive validity: instrument's ability to distinguish people whose performance differs on a future criterion Prediction of future behaviors Correlation coefficient closer to 1.00

Critiquing research

See syllabus examples: 28-32 (quant), 26-27 (qual) p. 66 in textbook for quant, p. 67 in textbook for qual

Respect (#1)

Self-determination (ANA) - would this person participate if money/other inducement not there? if not, voluntariness does not exist (coercion), implicit or explicit Autonomy (decision-making capacity, full disclosure) - free to participate or not; withdraws without penalty Ex. informed consent

ANA human rights

Self-determination (respect for persons) Privacy, dignity Anonymity, confidentiality Fair treatment Protection from discomfort and harm - these rights apply to all involved in research project (researcher, data collector, statistician, ns, participants) - as a research consumer, look for these being addressed & resolved

Review types of instruments, scales, etc.

Self-report: a data collection method that involves a direct verbal report by participants (e.g. questionnaires, face-to-face interview, telephone interview) Evaluation: strong on directness, allows access to info otherwise not available to researchers; but can but can we be sure participants actually feel or act the way they say they do? - elicits socially acceptable answers, elicits answers desired by researcher, may not reflect true feelings or attitudes of subjects Interviews: a data collection method in which an interviewer ask questions of a respondent, either face-to-face, by telephone, or over the internet (e.g. Skype or FaceTime) Scale: a device that assigns a numeric score to people along a continuum; used to make fine quantitative discriminations among people with different attitudes, perceptions, & traits - Summated rating scales (composite scales): 5-7 choices and rate agreement/disagreement with subscales within that scale never/always - Attitude scales (Self report data collection instruments, respondents report attitudes or feelings, score given for the item responses, total may be obtained for individual subject or a group) - Likert Scale and Semantic Differential Scale Observational methods *excellent for capturing many clinical phenomena and behaviors* Time Sampling: sampling of time intervals for observation (random sample/systematic sample) Event Sampling: observation of integral events; requires researchers to either know when events will occur or wait for their occurrence to observe the response - Problem = Reactivity: behavioral distortions due to the known presence of an observer - Problem = observational bias: factors that can interfere with objective observation (cannot be eliminated, but can be minimized through careful observer training and assessment) The Flesch reading ease The Fog scale level The Flesch- Kincaid Grade Level Sources for research instruments: Mental measurement yearbooks Instruments for clinical health - care research The measurement of nursing outcomes health and psychosocial instruments

Statistical significance v. statistical non-significance

Significance Means results not likely due to chance at some specified level of probability Does not reflect importance or meaningfulness Non-significance Probability high that observed difference or relationship could be result of chance (not reproducible) Does not mean the research hypothesis is not correct Could mean that sample size is too small

Implications

Specific for: Nursing practice, nursing education, nursing research Possible to replicate Further development of instrument Large sample Author should consider limitations and findings of previous studies

Assumptions- what they are and why is it important to identify them

Statements considered true by large percentage of society though not scientifically tested; taken for granted Ex: stress should be avoided, people have a need to feel loved, people respond honestly when interviewed, health is a priority for most people It can influence the rigor of the study

Research Hypothesis

States an expectation, a predicted answer to the research question should almost always involve two or more variables (*must have IV and DV to have hypothesis*) suggests predicted relationship between independent variable and dependent variable - theories are also sources for hypothesis development - more important than ever, EBP, practices based on research studies for nsg practice

Semantic differential scale (Attitude Scale)

Subjects give their position or attitude about concept Continuum exists between 2 adjectives or phrases presented that are always opposites (e.g. happy to sad) Positions on continuum vary from 5-9 Scores then calculated for all the subjects - easier for subjects to use, adjectives used may be a problem

Correlation coefficient (pg. 235)

Summarizes the degree of relationship between variables ranging from -1 to +1 Higher the absolute value of the coefficient value of the coefficient (no matter that the sign), the stronger the relationship +1.00 means perfect positive relationship; both values go in the same direction Ex: as height increases, weight increases 0 means no relationships -1.00 means perfect negative relationship; variables inversely related Ex: higher levels of self-esteem have lower levels of depression

Tables, graphs, figures

Supplement the text Economize/ condense the text Not repeat the text Precise titles, headings Understandable Located with related text Not leave random/ sporadic blank areas within data unless explained

Types of errors

Systematic Error: consistently measures wrong (i.e. measures everyone's wt 2 pounds heavy) Random Error: measuring some samples differently without pattern - randomization is more effective as # of objects/people incr, but is always possibility that incomplete randomization results in the DV rather than the cause (IV) -> DV - statistical inferences tells res. if random error can be ___ as possible explanation for results

Hierarchy of research evidence

Systematic review (synthesis of multiple studies) Single RCT (effects of interventions/meds) Single non randomized trial (weaker sample) Single prospective cohort study Single case control cohort study Single cross sectional study Single in depth qualitative Expert opinion, case reports

Saturation

The collection of qualitative data to the point where a sense of closure is attained because new data yields redundant information

Trustworthiness

The degree of confidence qualitative researchers have in their data and analysis, assessed using the criteria of credibility, transferability, dependability, confirmability, and authenticity *OVERALL GOAL IN QUALITATIVE*

Replication

The deliberate repetition of research procedures in a second investigation for the purpose of determining if earlier results can be confirmed

Population

The entire set of individuals or objects having some common characteristics Ex. all RNs in New York. sometimes called universe - target population: participants of interest; entire set; generalize to this population - Accessible population: readily available to researcher; closely resembles target

Generalizability

The extension to which research findings can be applied to settings other than that in which they were originally tested

Internal validity

The extent to which it can be inferred that the independent variable is causing the outcome.

History threat

The occurrence of events concurrent with independent variable that can affect the outcome. Ex. studying the effectiveness of a senior center program to encourage flu shots among the elderly. Suppose a flu epidemic was aired in the national media at about the same time. The outcome variable, is now influenced by at least two forces and would be hard to disentangle the two effects.

Deductive reasoning

The process of going from general principles to specific predictions Quantitative emphasizes deductive reasoning

Sample

The subset of a population selected to participate in a study - portion of pop closely resembling target pop - sampling plan: not always referring to people-pt records or lab samples

Research utilization (RU)

The use of some aspect of a study in a practical application unrelated to the original research - the need to reduce the gap between research and practice led to formal RU projects, including groundbreaking CURN project - *systematic* process to incorporate research knowledge into practice (applied) - RU applies knowledge to clinical practice, translation into real world - *Purpose*: improve pt outcomes - began in 1980s, starts with research based innovation - Ex. improve: satisfaction, cost, prevent rehospitalization, improve ns efficiency, prevent errors - Direct use of findings in patient care: tympanic thermometer, CPR (revisions at least q 5yrs) - implementing new practice, policy, procedure, protocol (ACH: foley care protocol)

Propositional statements

Theoretical statements presenting/reflecting relationships between concepts Connected logically May assert two concepts vary together (pulse rate and resp rate are related) Or may assert that one concept causes another (bacteria cause dz) - part of theory that discuss theorists belief about how concepts are related

Framework

Theoretical: based on theory Conceptual: based on conceptual model A study's framework is often implicit Quantitative researchers are less likely to identify their frameworks than qualitative researchers

Sources or rationale for hypothesis

Theories (Isolate propositional statements and test) Personal experience (observation, empirical generalization, literature) Previous research (Test assumptions, hypotheses based on findings, WHY REVIEW OF LIT IS SO IMPORTANT) Review of literature

Role of theory to research process

Theory guides research process from beginning to end. From problem identification to study conclusions Abstract generalization Systematic explanation about how phenomena are interrelated Two concepts r/t one another Why one event assoc. With another or what causes event to occur Make scientific findings meaningful and generalizable Greek "theoria" - beholding spectacle Speculative - never true or proven Always subject to revision or further developments

Therapeutic vs. non-therapeutic research

Ther: participant has opportunity to receive experimental treatment that might have benefit (skin care; ROM; touch) Non-ther: generate knowledge for discipline, might benefit future pts but probably not participant

Van Manen's Phenomenological Method: Six Activities

Three broad schools of phenomenology: Duquesne school (descriptive phenomenology): have to validate findings with participants, Gorgi is inappropriate Utrecht school (descriptive and interpretive phenomenology) Heideggerian hermeneutics (interpretive) 1. turning to the nature of the lived experience 2. exploring the experience as we live it 3. reflecting on essential themes 4. describing the phenomenon through the art of writing and rewriting 5. maintaining a strong relation to the phenomenon 6. balancing the research context by considering parts and whole

Examples of Violation: fair treatment

Treat people who decline to participate in a study or who withdraw from it in a non prejudicial manner; They must honor all agreements made with participants; They must treat participants; They must show respect for the beliefs & lifestyle of people from different background; & They must treat participants courteously & tactfully at all times

Quasi experimental research

Trials have intervention but lack either randomization or control group Use existing groups for experimental and control groups Using naturally occurring groups more closely approximates the real world - *no inferences on cause/effect because no randomization* Manipulation, control, NOT randomization (trials without randomization)

Research design

Type If experimental - 3 criteria met? (control, randomization, intervention) Tx described Method of Assigning participants Setting described in general terms

Lit review: primary and secondary sources

Types of information for a research review 1. primary sources: principle reliance on these (the actual research reports written by researchers who conducted the study/research or developed the theory) - Ex. Maslow's book on his Needs hierarchy (know best about the study/theory) - historical research: eyewitness or original document - usually journal articles or definitive determination: locate the original article - *if theorist is cited in text of rev. of lit. then the references list should contain theorist's name* Ex. Maslow's theory discussed, should see Maslow as author in references list 2. secondary sources: less reliance on these (summaries of studies done by others) - written by persons other than the individual who conducted study/research or developed theory - discussion or critique of theory, summary of research study - Ex. Kozier's chapter o human needs lit review is secondary source, also systematic review - helpful if primary not available, another's viewpoint, can lead to primary sources - *this is another person's interpretation* (may misinterpret or omit valuable info) - Proper APA citing of secondary: give the secondary source in reference list, in text = name original work and give a citation for the secondary source Ex. Allport's diary (as cited in Nicholson, 2003). Search strategies: - ancestry approach: searching earlier studies cited - descendancy approach: using key study searching forward to studies citing it - related citations: searching for similar studies once find good example - search by authors (look at references list) - *decision rules for search strategy needs to be explicit; reproducible; unbiased; systematic (search parameters: date, setting, type of study, language, discipline)*; exhaustive study = far back as possible and all studies - peripheral use of clinical anecdotes, opinion articles, and case reports may broaden understanding of a problem or demonstrate a need for research

Approaches to both types of research

Ultimate goals (build evidence for nsg practice) External evidence Reliance on human cooperation Ethical constraints (for both qual and quant) Fallibility (tendency to make mistakes or to be wrong, can fail because we are human) Paradigm: world view or perspective of world's complexities with certain assumptions about reality - affected by a lot, belief or theory, system of belief, value, view, habits about real world, guides how researchers make decisions (plan, carry out) 1. positivist paradigm: quantitative 2. constructivist paradigm: qualitative (sometimes researchers will do both: see examples of titles for both in notes) Research method: techniques used to structure a study and to gather, analyze, and interpret information

Limitations

Uncontrolled variables Research should clearly identify aspects of study over which no control has been exercised Inappropriate tool, weather, small sample

Purpose of studying research for a BSN student

Understand research process Read/Evaluate research reports: credibility of studies Be a patient advocate for research participants; judge before apply/discarding Promote pt advocacy Value research ***Be a knowledgeable consumer of research!!!*** - future direction: EBP, confirmatory strategies, systematic reviews (take studies and combo and reorganize data, integrate all together about one topic), local, collaboration, expanded due to internet, cultural issues and disparities (access and health literacy), clinical significance & patient input - systematic review vs. meta analysis: a meta-analysis is one type of systematic review where many become one - #1 patients have taken center stage in efforts to define clinical significance, challenge ahead incorporating research evidence and patient preferences into clinical - best way to get strong evidence = repetition (we can replicate a study = confirmatory strategy) - interprofessionals: PT (can do wound care), OT, Dr, nurse, dietician, nutritionist, pharmacy - may not have statistical significance but has clinical significance with patient - professional organizations set priorities for research (AHA, ACS etc.)

Examples of Measures of Outcomes Used in Outcomes Research

Unruh and Zhang used 9 years of data from 124 hospitals in Florida to examine the relationship between changes in RN staffing and patient safety events Safety, effectiveness, equity, efficiency, timeliness, system responsiveness, pt-centeredness - minority veterans, examine drug Rx, health insurance competition, value of measuring quality and ID barriers of care - John Wennberg = study on geographic variations in medical tech - AHRQ (for national and state statistics) Designs: RCT, cross-sectional, cohort, meta-analysis, systematic reviews Mortality, morbidity, disparity

Biophysiologic methods:

Used for creating independent variables and for measuring dependent variables. Ex. Explores the ways in which nursing actions and interventions affect physiologic outcomes, product assessments. In vivo measurements: performed directly within or on living organisms BP, body temp, HR, RR In vitro measurements: Data is gathered from participants by extracting biophysiologic material from them and subjecting it to analysis by laboratory technicians chemical measures, microbiologic measures, and cytologic or histologic measures. UA, BMP, ABG

Uniqueness of qualitative methodology

Uses emergent design: evolves as researchers make ongoing decisions about their data needs It's flexible and capable of adjusting to what is learned during data collection Often involves triangulating various data collection strategies Tends to be holistic, striving for an understanding of the whole Researchers get intensely involved and reflexive and can require a lot of time

Secondary analysis

Uses previously gathered data to address new questions Can be Qn or Ql Cost-effective May not be aware of data quality problems and typically face "if only" issues of inadequate data

Review conceptual definition and operational definition, would you be able to pick out which is which when reading about a study.

Variables have to be defined conceptually and operationally. Operational definitions related to how they are measured. Conceptual definition: the abstract or theoretical meaning of a concept being studied Operational definition: the definition of a concept or variable in terms of the procedures by which it is to be measured

Purposes of hypothesis

[Let's Take A Goat Down South] - lend objectivity to investigation - test theoretical proposition - advance scientific knowledge of nursing - guide research design - dictate statistical analysis used (the more variables you have, the more extensive the stat analysis has to be, hypothesis determines the analysis to use; inferential to describe hypothesis) - show researcher's expectations

Credibility

a criterion for evaluating integrity and quality in qualitative studies, referring to confidence in the truth of the data; analogous to internal validity in quantitative research

Dependability

a criterion for evaluating integrity in qualitative studies, referring to the stability of data over time and over conditions; analogous to reliability in quantitative studies

Confirmability

a criterion for integrity in a qualitative inquiry, referring to the objectivity or neutrality of the data and interpretations

Conceptual map

a schematic representation of a theory or conceptual model that graphically represents key concepts and linkages among them

Longitudinal design

a study design in which data are collected at more than one point in time, in contrast to a cross-sectional design

Prospective design

a study design that begins with an examination of a presumed cause (e.g. cigaretter smoking) and then goes forward in time to observe presumed effects (e.g. lung cancer); also called a cohort design

Retrospective design

a study design that begins with the manifestation of the outcome variable in the present (e.g. lung cancer), and a search for a presumed cause occuring in the past (e.g. cigarette smoking)

Experimenter effect

a threat to internal validity in which the experimenter, consciously or unconsciously, affects the results of the study researcher's behaviors/characteristics influence respondents' behaviors (way I ask questions)

Extraneous variables

a variable that confounds the relationship between the independent and dependent variables and that needs to be controlled either in the research design on through statistical procedures; often called confounding variables

Sources of error

all research contains some error - human beings - environmental or setting types of sources of error: - instrument inadequacies, instrument administration biases, environment variations during collection of data, temporary subject characteristics during the collection of data

Theory

an abstract generalization that presents a systematic explanation about relationships among phenomena. Deduction: from theory (reasoning) -> to facts - theory, propositional statement, hypothesis, empirical data - hypothesis deduced from theory, hypothesis tested in real life, "if theory valid/true what should I expect", Ex. safety needs over self-esteem needs Inductive: from facts (reasoning) -> to theory - empirical data, empirical generalization, propositional statements, theory - data gathered from real life situation; researcher tries to derive general explanation, "how can i explain what I have been observing?", Ex. pts occupied watching TV seem less anxious Building a theory: stage 1 concepts, stage 2 constructs, stage 3 propositions, stage 4 theory - rigorous "clean" study, clear and defensible conceptualization made explicit, clear explanation of rationale for how the IV is expected to affect the DV (internal validity) Discussion of theory in your proposal: name of theory/theories, central propositions (theory says?), past use of theory and its application, statements reflecting how the theory relates to the study/proposed intervention (how variables fit into theory) - inappropriate use of theory if infants not adults, male CEOs vs. female CEOs, one discipline applied (psych) to another (nsg) - review/select theory, review lit on theory, develop hypothesis based on propositional statement from theory, define variables based on theory, choose instrument congruent with theory, describe findings in light of theory, nsg implications based on theory, future research recommended

Concept

an abstraction based on observations of behaviors or characteristics (e.g. fatigue, pain) - building blocks of theories, word picture or mental idea of phenomenon - symbolize some aspect of reality Ex. concrete human heart, abstract love

Discussion

author interprets, more subjective (more opinionated) Compare findings with those in lit review No new lit review source introduces In light of theoretical framework - findings supportive or not Statistical significance/ clinical significance How limitations may have affected

Nurse's role in research

be a knowledgable consumer of research - understand research process - read/evaluate research reports: credibility of studies - promote pt advocacy - VALUE RESEARCH

APA

be sure to review in-text citations, referencing first time and there after, using direct quotes and formatting, reference page journal volume and issue guidelines. (5 questions) P. 177 Website quote citation (paragraph #) Journal quote citation (page #) When to use volume and issue # Continuous pageation, no issue # ALWAYS use volume # If each issue begins with page 1, use issue # - italicize titles of books and periodicals; Bible not included in reference page (in text cite), page number in text cite only with quotes - indent when quote is over 40 words or 3 lines long - paragraphs are to be less than a page, no "widow sentences" carried over to the next page by itself - in text citations include up to 5 authors, otherwise use et al., up to two authors use both each time, more than two on consecutive time use et al. - past tense, active voice; do NOT use introduction as a heading!!! - citing research author use "Herbert & James OR et al. (2018) found that..." and then you do not recite the author at the end of the sentence, just the p. # if quote.

Response set bias

biases reflecting the tendency of some people to respond to items in characteristic ways, independently of item content - Social desirability: a bias in self-report instruments created when participants have a (tendency to misrepresent attitudes/traits by the participant giving answers that are socially acceptable) their opinions in the direction of answers consistent with prevailing social norms - Extreme: a bias in psychosocial scales created when participants select extreme response option (e.g. "strongly agree"), independent of the item's content (tendency to express extreme attitudes or extreme answers even if they don't have the extreme view) - Acquiescence: a bias in self-report instruments, especially in psychosocial scales, that occurs when participants characteristically agree with statements ("yea-sayers"), independent of content; (answer with ALL strongly agrees) Prevent: keep short and clear questions, avoid leading questions, avoid difficult or break up difficult concepts, good size sample

Search strategy terms

bibliographic databases on the computer - ancestry approach (footnote chasing): use the bibliography of a recent relevant reference to find earlier related studies (ancestors) - descendancy approach: use a pivotal early study in citation indexes to find later studies (descendants) that cite the pivotal study - keywords: searching for substantive topics (most start here) - subject headings: keywords may be different than keywords due to database mapping capabilities - for quantitative studies, the keywords are typically the independent and dependent variables and often the population - for qualitative studies, the keywords are the central phenomenon of interest and the population - subject search: search for topics or keywords in the database - textword search: search for specific words (which can be keywords) in text fields of the database record (e.g. in the abstract or title) - author search: search for prominent researchers in a field - can extend a search to multiple words with the same root, by adding the database's wildcard character to a truncated word; A truncated symbol (often an asterisk, *) expands a seaerch term to include all forms of a root. Ex. nurs* would search for nurse, nurses, nursing - different databases use different wild cards - Boolean operators: combine, restrict, or broaden searches Ex. "and" two or more are present, "or" any of 2+ terms, "not" info for one term not the other - CINAHL (1982 to present), MEDLINE (uses MeSH or medical subject headings)

chi-square (x^2)

compare frequencies (counts, not means) obtained or observed in categories w/ frequencies expected to occur by chance/if null is true (no relationship) - Assess whether relationship exists between two nominal-level variables (differences in proportions) Nonparametric, nominal data (frequencies or percentages) Ex: Study the relationship of gender & source of HIV Pearson correlation → correlation coefficient designating the magnitude of relationship between two interval- or ratio-level variables Correlation coefficient → Summarizes the degree of relationship between variables ranging from -1 to +1 - if obtained freq. quite diff from expected freq. at specified p-value, null is rejected

purpose of descriptive statistics

condense objective observations into usable data

Measures of central tendency

describe average member of sample Answer question "what does the average...?" - summarize the sample, describe average, typical, or most common value for a group of data Mean (average of all scores; interval or ratio; M,X) Most stable & most used measurement of central tendency Larger the sample, less the mean is affected by a single score Very sensitive to outliers or extreme values; pulled in direction of outliers (median and mode not affected by outliers) Most tests of significance use means - all things being equal; choose mean; more powerful statistical tests can be applied to it than to median and mode - exceptions: highly skewed distributions, nominal and ordinal data Mode/modality (most frequent score or value) Only measure appropriate for nominal data; report as % or frequency Crude estimate of average value Sometimes designated 'Mo' Median = the value that falls in the middle - 50% above and below it - best used when data are skewed (less affected by extreme scores) - always somewhere btw mean and mode, arrange in numerical order - designated 'Md, Mdn' Ex: 4 4 5 5 7 8 8 8 9 → median = 7

Guidelines for writing a literature review

essay format emphasize findings of previous studies, not just methodologies and variables point out trends, themes, gaps in lit note percentage of people affected by prob you're studying express opinions about quality of research cited

Critiquing research probs, questions, hypothesis

evaluate whether researchers have adequately communicated their research prob consider whether prob has significance for nursing and evidence- based practice determine whether the research prob is compatible with chosen research paradigm and its associated methods evaluate whether statement of purpose or research questions lend themselves to research inquiry

Correlational/Predictive

examine relationship between/among variables to look at predictability Ex. NCLEX

Null hypothesis

expresses absence of a relationship (used only in statistical testing, there is "absence" of relationship) something assumed H0 predicts no relationship between variables statistically analyzed *** null hypothesis expect no correlations between variables or no difference between groups being compared - the one we do statistical testing on - support/accept null hypothesis tells us the intervention had no effect - reject the null tells us the research has support, correlation without causation, hypothesis is not proved or disproved just shows support - statistical analysis: evaluates null hypothesis, significance level in nursing at or below 0.05, what does level of 0.05 mean? - we are willing to accept that 95 out of 100 times the outcome occurred because of the intervention, willing to accept that 5 out of 100 times it occurred by chance and not by our intervention - there are some where researcher expects no correlation between variables (just test theory) - OR expects no difference between groups being compared (H1 and H0 are same)

Develop demographic questionnaires

helps describe sample characteristics edu level, mean age Qual- age level, percentage of gender; more limited- don't want to give info away- sample sizes lot smaller

Qualitative research

helps with less written topic (less emphasis on qualitative lit review in general) helps researchers focus on what isn't known more conceptual articles Scholarly opinion of concept- no research done discussion/explanation/ideas about certain topic helps provide framework not report of research study compare researcher's findings with literature avoid bias

Hypothesis and proof

hypothesis are never proved or disproved - statistical hypothesis testing cannot provide absolute proof-only probabilistic info to support an interference that hypothesis is probably correct (or not) - hypotheses are supported or rejected, by study area (based on statistical analysis of the null) d/t possibilities of error ***can only say "strongly supports" or "suggests" null hypothesis rejected -> research hypothesis supported research hypothesis supported -> theory supported research hypothesis not supported -> theory not supported

Operational definitions

indicates what the researchers specifically must do to measure the concept and collect needed info How will the variable be measured? Ex: clinical anxiety rating scale, v/s, quiz, etc - defining these helps with replication of studies

Writing lit review

intro purpose catch attention/interest synthesize major findings include purpose, sample size, design, specific findings strength/weaknesses of evidence summary of current knowledge

Introduction

introduce specific prob area est importance; use specifics from lit; include stats define key terms; conceptual definition present lit from your point of view; summarize findings in conclusion end with specific research questions, purposes, hypotheses Avoid overuse of direct quotes does not convey full meaning when out of context direct quotes appropriate when emotional impact would be lost in paraphrasing Write in past tense for studies Write in present tense for theory or conceptual articles Use passive voice sparingly

Writing a lit review

introduction: purpose is to catch attention/interest - body of the review: data base sources - synthesize major findings (logical order, define first) - include purpose, sample size, design, specific findings - strengths/weaknesses of the evidence - summary of current knowledge (suggestions for further research) - structured analysis of answer you found (what ppl did the article use, sample size, qual or quant etc.) - introduce specific problem area - est. importance, uses specific from lit, include stats - define key terms, conceptual definitions - present lit from your point of view, summarize findings in conclusion - end with specific research questions, purposes, hypothesis Tips: - words are better than nothing, edit/delete, leave notes, organize articles oldest to newest, look for changes over time, define, changes in theories - be critical: warn of weak study or small sample sizes, critique studies as a group for weak/strengths, note GAPS: unstudied groups or variables, look for identifiers of unreliable sources - be selective: classics can be used but must state that info from last 5 years could not be used - AVOID overuse of direct quotes, not convey full meaning, disrupt flow, nonessential details given; used only if emotional impact is lost in paraphrasing - write in PRESENT TENSE - use passive voice sparingly - can include positive criticism - strong evidence terminology: strongly suggest, most studies, QOL clearly indicates the possibility, has led most researchers to conclude - moderate/weak evidence terminology: pilot study suggest, only limited evidence, indicates, is inconclusive, pointing towards Guidelines: - essay format - emphasize findings - point out trends, themes, gaps - % of people affected - express opinion about quality of research - logical transitions and critique (see pic)

probability sampling

involves random selection of elements (each element has an equal, independent chance of being selected) - allows researchers to estimate the magnitude of sampling error (difference between population values & sample values), works to decrease sampling bias - stronger evidence, more for quantitative QUASI experimental studies

Bias

is any influence that distorts the results of a study and undermines validity Ex: age, gender, race, income

Multi-causality in nursing

is the portrayal of causality wherein several individual community and environmental factors may interact to cause a particular disease or condition or outcome.

Examples of Violation: protection from harm and levels of harm

knowledge of risks/harm prior to performing study risks > benefits Risks > humanitarian benefit - permanent damage

Principle Investigator (PI)

lead person in research group (doctor or masters)

Descriptive/exploratory

observational (look at people that has already smoked as IV, do not implement directly); systematically describe particular situation/event already existing, usually less known about situation/variables, no attempt to predict how variables might be changed in the future (stressors affect on family) - observe, describe, document - no attempt to infer causation

Representatives of sample

one whose key characteristics closely approximate those of the population

Theoretical framework

organizes study - provides context for interpretation of findings - broad general explanations of relationships - based on one existing theory Theory of learning: - will contracting for grades motivate students to earn higher grades? - Rogers theory: learning is facilitated when the student participates responsibly - Concept: learning- earn higher grades - Concept: participates responsibly- contracting for grades Development: - select concepts/variables - ID interrealtionships, IV and DV - formulate definitions, conceptual and operational - select theory: descriptive studies, *predictive/experimental studies*, explanatory/correlational studies

Dependent variables

outcome or response the researcher wants to predict or explain; change in this variable caused by the independent variable (MEASURED) effect, outcome, response

T test

parametric examines difference between means of 2 groups of values Useful w/ small (<30) sample Two forms: 1. Independent/Pooled → no association between scores of groups; experimental & control group Ex: compare research course grade (mean score of 92) of SPRING students w/ research course grade (mean score of 88) of FALL students completing research course - *differences between groups, compare group means or averages, if sample means are far enough apart then t-test shows significant diff or statistical significance* 2. Dependent/Correlated/Paired → scores/values are associated Ex: anxiety scores of mothers & daughters compared; each subject in one group matched w/ subject in another group on some variable like age, wt Same group measured pre & post intervention (BP measured pre-exercise & post-exercise) - If calculated t-value (your data) >/= to critical value (table/computer), null is rejected (means that the mean scores are significantly different) *PRIMARY REASON for LACK OF STATISTICAL SIGNIFICANCE IS NOT HAVING LARGE ENOUGH SAMPLE*

Nondirectional hypothesis

predicts existence of relationship, not its direction Ex: walking 30 min/day "affects/effects" BS levels (use when don't have enough lit to report, so no direction) Advantages: no theoretical basis for prediction previous research findings contradictory (without theoretical basis for prediction) not enough research to support findings

Directional hypothesis

predicts the direction of relationship "lower", "inc", "dec" Ex: walking 30 min/day will dec BS levels Advantages: researcher's expectations are clear more precise testing of theoretical propositions one-tailed statistical tests vs 2- tail - we know direction of effect, it will increase or decrease

Examples of Violation: Self-determination

prospective participants have the right to decide voluntarily whether to participate in a study, without risking penalty or prejudicial treatment right to ask questions, to refuse to give information, and to withdraw from the study Freedom from coercion - involves explicit & implicit threats of penalty from failing to participate in a study or excessive reward from agreeing to participate (believe care negative affected if not participate) Freedom from covert data collection - participants unaware of data being collected; if done then must inform at end; unacceptable with illegal conduct, sex behaviors, drug use, and obtaining information over the internet (i.e. chatrooms) Freedom from deception - actual misinforming of participants and those with diminished autonomy, especially vulnerable (dementia, children, non-English speaking, etc.) - may be justifiable if not giving explicit description: essential to obtain important info, no other substantial risk, other ethical principles not violated, participants informed deception is part of study before consent; *may need to give general description before*

Rules for treatment of participants

protect confidentiality no pressure painless/free from discomfort or harm ID sponsors of research disclose basis for participant's selection no hidden ID codes on questionnaires honor promise to give participants reports after study right to resources to address any concerns informed consent adhere to research protocols debrief participants (afterwards) When doing non-experimental study & determine need for treatment, it MUST NOT be withheld, as that would harm the participant

Data analysis & Normal distributions

provides concrete view of more abstract concepts/propositions of the conceptual model or theoretical framework - inappropriate analysis -> inappropriate conclusion - level of measurement: great precision interval or ratio, rank things = ordinal scale, contrast things choose nominal scale - higher level of measurement/greater flexibility Normal distributions: - theoretical concept-data from repeated measures (interval/ratio) will group around a midpoint in a manner close to a normal curve - normal curve, mean, median, mode are equal = Bell curve - Skewness - samples not symmetrical; peak is off center - Positive skew: tail points to right (ex. personal income) - Negative skew: tail points to left (age of people with chronic illness)

Variables

qualities, properties, or characteristics of people, things, or situations that manipulated or measured in research - changeable - age/state of health could be independent or dependent depending on hypothesis

Basic (pure)

quantitative Establish fundamental concepts/theories, it's just knowledge for knowledge's sake Empirical data (how blood cells function; examine structure/function of brain) May be no immediate practical application

Prospective design

quantitative cohort design: start with presumed cause (IV), look forward to presumed effect (DV) - Ex. smokers/nonsmokers (IV) look at incidence of lung CA (DV) - cohort means stay with group for specific time, look into future so its prospective - could also be experimental: treat pts with med to lower cholesterol levels (IV) and follow over time to measure development of CAD (DV)

RCT

randomized controlled trial (randomized clinical trial) - experimental design - determine effects of: healthcare interventions, often drug studies Ex. nsg: testing new wound care procedure Gold standard for inferring causal relationships (CAUSE AND EFFECT)

Goal of sampling

represent the population

Demographic variables

sample characteristics of subjects age, edu, gender, ethnic origin, income, medical diagnosis, etc analyzed to develop sample characteristics - used to describe sample population, percentage of male/female in sample

Ancestry approach

searching earlier studies cited earlier than last 5 yrs using the bibliography

sensitivity and specificity

sensitivity: the instrument's ability to correctly ID a "case" i.e. to dx a condition specificity: the instrument's ability to correctly ID noncases, that, is to screen out those without the condition

Problem statement

statement articulating the research prob and making an ARGUMENT to conduct new study

Research hypothesis

states actual prediction of relationship between the independent and dependent variables H1 or H2 or H3- depends on # of variables or hypothesis they had alternative, scientific, substantive, theoretical states expected relationship between variables can be directional or non-directional clarify study's framework (describe variables of framework) demonstrate researcher's critical thinking based on theoretical framework

Univariate study

statistical analysis of a single variable for descriptive purposes (e.g. computing a mean)

Bivariate statistics

statistical analysis of two variables to assess the empirical relationship between them

Meta-analysis

statistical integration of results used to compute common effect size - statistical integration of results used to compute common effect size advantages: objectivity- statistical integration eliminates bias in drawing conclusions when results in different studies are at odds, increased power- reduces the risk of a type II error compared to a single study - despite these advantages, it is not always appropriate; indiscriminate use has led critics to warn against potential abuses steps: 1. problem formulation-delineate research question or hypothesis to be tested 2. design of meta-analysis- identify sampling criteria for studies to be included 3. search for evidence in literature- develop and implement a search strategy (database, unpublished?, avoid publication bias, key words) 4. evaluation of study quality- locate and screen sample of studies meeting criteria (omit low-quality, more high-quality, use of scale/component approach, analyze low and high to see if effects differ = sensitivity analyses) 5. extraction and encoding data for analysis 6. calculation of effects 7. data analysis - Criteria: must decide whether statistical integration is suitable, research question or hypothesis should be essentially identical across studies (avoid apples/oranges), must have a sufficient knowledge base = must be enough studies of acceptable quality, results can be varied by not totally at odds - analytic decisions: effect size index, effect size d, fixed effects model, model, subgroups, quality, publication bias - a key component of meta-analysis is the calculation of an effect size index QUANTITATIVE

Multivariate statistics

statistical procedures designed to analyze the relationship among three or more variables.

Independent variables

stimulus or activity manipulated by researcher to cause an effect on dependent variable (what is being done to produce a change?) treatment, intervention, experimental

Barriers to research utilization

study flaws random error difficulty obtaining random samples complex language (research jargon) implications not clear for practice institutional support (ie, if your hospital doesn't support it)

Likert Scale (Attitude Scale)

summated rating scales - consist of several declarative statements (items) expressing viewpoints - responses are on an agree/disagree continuum (5-7 response options) - responses to items are summed to compute a total scale score Usually contains 5-7 responses for each item Responses range from strongly agree to strongly disagree Equal # of + or - worded items important Scores assigned to each response: Positive items scored in positive direction Negative items scored in negative/reverse direction Total scores are obtained

Evidence summary

systematic summarization of research studies, looking at trends and variations - state of science: conclusion - implications for practice Appraise the evidence: quality (findings valid), magnitude of effects (clinically important), precision of estimates (stats), peripheral effects (benefits, adverse effects), cost (apply/not apply), clinical relevance (for your pt), action (usual care is best) Integration: integrate with nurse's expertise, agency factors, pt preferences, cost, and feasibility; implement and evaluate, pilot test (helps detect glitch in question or unable to gather enough for sample before doing actual big study)

Measurement

the assignment of numbers to represent the amount of an attribute present in an object or person, using specific rules Advantages: removes guesswork, provides precise info, less vague than words Direct: BP, concrete Indirect: coping, self-care (use scale) - process of assigning numbers to variables - ways to assign numbers: count, rank, compare objects/events - quantification is the GOAL - numbers are assigned to data, concept applied with quantitative research designs - FOUR LEVELS (*NOIR*): nominal, ordinal, interval, ratio - a variable's level of measurement determines what mathematic operations can be performed in the statistical analysis (inferential is more precise) - errors of measurement: obtained score = true score +/- error - obtained score: an actual data values for a participant (anxiety scale score) - true score: the score that would be obtained with an infallible measure - error: the error of measurement caused by factors that distort measurement Two types of error: 1. systematic: variation/diff of score is consistently in the same direction; Ex. measuring wt, scale always weighs 2lb less than normal 2. random: difference in the pattern, not consistent; Ex. some it wt 2lb less or 3lb more Factors contribute to errors: situational contaminants (environment, hot/cold/loud), transitory personal factors, response set biases, item sampling

Operational definitions

the definition of a concept or variable in terms of the procedures by which it is to be measured

Transferability

the extent to which qualitative findings can be transferred to other settings or groups; analogous to generalizability.

Authenticity

the extent to which qualitative researcher fairly and faithfully show a range of different realities in the collection, analysis, and interpretation of their data.

Reliability

the extent to which scores are free from measurement error. Test-retest reliability: replication takes the form of administering a measure to the same people on two occasions. The assumption is that for traits that have not changed, any differences in people's scores on the two testings are the result of measurement error. Internal consistency: In responding to a self-report item, people are influenced not only by the underlying construct but also by idiosyncratic reactions to words. By combining multiple items with various wordings, item irrelevancies to the extent that its items measure the same trait. For internal consistency, replication involves people's responses to multiple items during a single administrations. This captures the consistency across items.

Manipulation

the introduction of an intervention or treatment in an experimental or quasi-experimental study to assess its impact on the dependent (outcome) variable

Sample size

the number of study participants in the final sample - sample size adequacy is a key determinant of sample quality in quantitative research - sample size needs can and should be estimated through power analysis - the risk of "getting it wrong" (Statistical conclusion validity) increases when samples are too small

Setting

the physical location and conditions in which data collection takes place in a study.

Inductive reasoning

the process of reasoning from specific observations to more general rules

Sampling

the process of selecting a portion of the population to represent the entire population - *sample*

Probability sampling

the selection of sampling units (e.g. participants) from a population using random procedures (e.g. simple random sampling) Means of predicting Ex: 50% chance of rain Likelihood an event will occur Probability of getting heads with single flip of coin is 1 out of 2, or ½ or 0.5 Expressed as 50% or p=0.5

Conceptual definition

the theoretical meaning of a concept Dictionary; specific meaning in THIS study Ex: Anxiety - uneasiness about the impending event

Conceptual framework vs. theoretical framework

the underpinnings of a study- e.g. a theoretical framework in theory- based studies or conceptual framework in studies based on a specific conceptual model. - no existing theory fits concepts to be studied - links concepts from several theories, previous research, or researcher's own experiences - less well-developed - Ex. ns job satisfaction and level of empathy with pts - empathy theory and job satisfaction theory - empathy requires begin satisfied with self; if happy with job will be satisfied with self; therefore, job satisfaction and empathy are positively related

Sources of EBP

tradition and authority, clinical experience (functional source of knowledge) and trial and error (haphazard), logical reasoning (inductive and deductive), assembled information (benchmarking data and quality improvement and risk data), disciplined research, best method of acquiring reliable knowledge, evidence based findings

Lincoln and Guba

two quality frameworks for qualitative research - often considered "gold standard" and widely cited - key goal: trustworthiness ("truth value" of qualitative data, analysis, interpretation) parallels reliability and validity - parallel perspective, with analogs to quantitative criteria - encompasses four criteria: credibility, dependability, confirmability, transferability (must have all four to have trustworthiness) Credibility: involves (1) carrying out the study in a way that enhances the believability of the findings and (2) taking steps to demonstrate credibility to external readers (so someone else can repeat study and identify patterns of association) - refers to confidence in the truth of the data and interpretations of them - the analog/equivalent of internal validity in quantitative research, arguably the most important criterion for assessing the quality and integrity of a qualitative inquiry Dependability: refers to stability/reliability of data over time and over conditions - the analog/equivalent of reliability in quantitative research - if we repeated would we get same results? Confirmability: refers to objectivity: the potential for congruence between two or more independent people about data accuracy, relevance, or meaning - the analog/equivalence of objectivity in quantitative research - needs to represent the voice of the participant, no bias - the criterion is concerned with establishing that the data represent the information participants provided and that the interpretations of those data are not imagined by the inquirer Transferability: the extent to which qualitative findings can be transferred to other settings or groups, the analog/equivalent of generalizability or external validity in quantitative research Authenticity: the extent to which the researcher fairly and faithfully show a range of different realities and convey the feeling/tone of participants lives as they are lived, no analog in quantitative research, added to the Lincoln and Guba's framework at a later date - may include those extreme cases Ex. smoking cessation like losing a friend

Consecutive sampling

type of nonprobability; recruiting all people from an accessible population over a specific time interval

Convenience sampling

type of nonprobability; selecting the most conveniently available people as participants - MOST WIDELY USED APPROACH FOR QUANTITATIVE RESEARCHERS, IT IS THE MOST VULNERABLE TO SAMPLING BIAS - people who are readily available might be atypical of the population

Random sampling

type of probability; selection of a sample such that each member of a population has an equal probability of being included

Lab setting

used when the researcher needs to have a great deal of control over the research situation, which often gives greater internal validity to the study

Descendancy approach

using key study searching forward to studies citing it

Analysis of Variance (ANOVA)

→ compares differences among >2 means, simultaneously - parametric Examines variance between means, within groups Value you get is an "f" value - 3 or more groups - could use with two groups but results same as with t-test, good to eliminate bias between groups - three or more groups means ANOVA tests significance of variance btw group means, group means of three or more groups - can be used when > one independent variable - Repeated measures (RM-ANOVA)→ 3 or more measures of the same DV for each subject (same indiv. Exposed to intervention A, B, C) OR multiple measures of same DV collected longitudinally at several points in time Ex: effect of humorous distraction on pre-op anxiety...1)20 min recorded comedy routine, 2) 20 mins instrumental music, 3) control/comparison group Ex: Pt BP before, during and after dx exam - prevents from having to do 6 different t-tests between groups so the answer is more accurate

Top of evidence hierarchy?

→ systematic review (synthesis of multiple studies) Evaluating evidence: determine best evidence, based on strength of evidence, different types of evidence for different types of questions, systematic reviews (top of all evidence hierarchies, highest level of evidence) 1. Systematic review (synthesis of multiple studies on same topic) 2. single RCT (effects of interventions/meds) 3. single non-randomized trial 4. single prospective cohort study - follow group over period of time 5. single case control study 6. single cross-sectional study - each group or level 7. single in depth qualitative study 8. expert opinion, case reports