CNUR 209

How is ethics defined in nursing research?

Comes up in research anytime it deals with human subjects 1. protect the participants 2. ensure research is conducted that is in the interest of the groups 3. examine research activities and projects for their ethical soundness

Barriers to Research Utilization - EBP

Communication Difficulty in locating relevant studies Poorly presented studies with few implications for practical use Research jargon Cost and time restraints; limited resources for change Negative attitudes towards research Research not valued Lack of education about research process Organizational and workplace limitations Expected, yet not in job description = lack of support or recognition Lag in use of internet for sources of knowledge (considered non-productive or unprofessional) Typically do bedside nursing care, not research on shift

What are the steps in writing a review of the literature?

Purposes - Document current knowledge of selected topic Indicate findings ready for use in practice Outline - Introduction - Empirical literature - Summary

What are the four types of descriptive analysis?

Reflective thought Bracketing Data reduction Coding

Types of Outcomes Measured - Clinical endpoint

Symptoms and signs Laboratory values Death

Sources for EBP

Systematic reviews Meta-analyses Integrative reviews Meta-summaries Meta-syntheses

Further Research: stats

To improve the next study. Suggestions emerge from the present study. Strategies to further test framework in use

What is nursing research?

To search again To examine carefully Diligent and systematic inquiry Discovery Goal is to develop an empirical body of knowledge for a discipline

Quasi-experimental - QN

examines casual relationships or determine the effect of one variable on another. i.e .using carbon sponge vacs for controlling the healing and infection rates of ulcers.

Correlational - QN

involves the systematic investigation of relationships between or among variables. i.e. research shows that the more people smoke the more lung damage they experience.

The risk ratio meta-anaylsis

is also called the relative risk (RR) which is the ratio of the risk of subjects in the intervention group to the risk of subjects in the control group for having a particular outcome. The health outcome is usually adverse, such as the risk of a disease (cancer) or the risk of complications or death.

Statistical significance:

results not random

What ethical principles are addressed in the National Commission for the Protection of Human Subjects guidelines?

Ethical principles: Principle of respect for persons Principle of beneficence - to do no harm Principle of justice

How does sample size differ from quantitative studies?

Decisions regarding sample size differ - Based on needs related to study purpose - Number of subjects is usually smaller - Case studies with only one subject may be used - Six to 10 subjects not unusual

Why is research important for evidence-based practice?

Develops empirical knowledge base Identifies best practice that are based on clinical practices Improves outcomes for: - Pt and family - Nurse - healthcare system

What is included in the introduction

Indicates focus or purpose of review Describes organization of sources Indicates basis for ordering: - Most important to least - Earliest to most recent - Categories

Levels of Measurement - statistics

Interval data Ratio data Ordinal Nominal Discrete data Continuous

Research Objectives or Aims, and Research Questions - QN

Narrow focus Description of variables, examination of relationships among variables, differences between groups re: variables

What types of settings are used in quantitative research?

Natural or field settings Partially controlled settings Highly controlled or laboratory settings

Setting in QL Research

Natural setting: "field setting" Uncontrolled Real-life situation or environment (no manipulation or change in environment)

How is nursing knowledge acquired?

Non structured: - Traditions - Authority - Borrowing - Trial and Error - Personal Experience - Role Modeling - Intuition Structured: - Reasoning - Problem Solving - Scientific Research

What is sampling, and what methods are use to select a sample? - QN

Process of selecting subjects who are representative of the population Random sampling - Each member has an equal chance of being selected. - Has the most control Convenience sampling - Whoever is available

Iowa Model of EBP

Provides direction for development of evidence-based practice in an agency Looks at triggers for change, such as: - Risk management data - Financial data - Organizational standards - Philosophy of care

Statistical Analysis - How can statistics be used in nursing practice?

Publications Outcomes Reports Identifying

Performing Post Hoc Analyses

Purpose: to determine which groups are significantly different without which multivariate hypothesis testing would greatly suffer.

Nonprobability Sampling Methods: types - QL

Purposeful or Purposive sampling Network sampling Theoretical sampling

Goals for Conducting Nursing Research

(a) promote evidence-based nursing practice (b) ensure credibility of the nursing profession (c) provide accountability for nursing practice (d) document the cost effectiveness of nursing care

How is data reduction accomplished?

- Analysis focuses on reducing the large volume of acquired data to facilitate examination. - Researcher begins to attach meaning to elements of data. - Researcher discovers classes of things, persons, events, and properties.

Case study method: Data Analysis

- Analyzed by researcher as time is spent on site - Reflecting on and revising meanings of what is happening - Searching for patterns or themes

Decision-Driven Evidence

- Application of scientific knowledge as part of a new practice, policy, procedure, or intervention - Decision is based on review and critique of studies applicable to the practice Example: Iowa Model of Evidence-Based Practice to Promote Quality Care

Ethnography

- method to study cultures through immersion in the culture over time - portrait of people - Culture is focus - the uniqueness of the individual

What questions are important when critically appraising literature reviews?

- Are primary sources cited in the review? - Are the references current? - Are relevant studies identified and described? - Are relevant theories identified and described? - Are relevant landmark studies described? - Are the studies critiqued? - Are sources paraphrased to promote the flow of content? - Is the current knowledge about the research problem described? - Does literature review identify gap(s) in the knowledge base that provides a basis for study? - Is the literature review clearly organized, logically developed, and concise?

What is applied research? - QN

- Attempts to solve real problems in clinical practice - Studies the effects the intervention may have on patients - Applies findings in the real world on real patients

Meta-analysis attempts to answer clinical effectiveness questions:

- "What is the effectiveness of a selected intervention?" - By asking: Does the new treatment confirm significant benefits compared with the conventional treatments? - It's benefits offer rational and helpful ways of dealing with a number of practical difficulties that help anyone trying to make sense of effectiveness research. - When meta-analysis is carried out on a rigorous systematic review it can overcome these dangers offering an unbiased synthesis of the data. - Combine the results from many trials, have more power to detect small but clinically significant effects. They give more precision estimates of the size of any effects. - Their advantage lies in the openness with which good meta-analyses reveal all the decisions that have been taken throughout the process of achieving the final aggregate effect sizes. ***The main requirement for a worthwhile meta-analysis is well-executed systematic reviews.

What are inferences?

- A conclusion or judgment based on evidence - Judgments are made based on statistical results. - Statistical inferences must be made cautiously and with great care. - Decision theory rules were designed to increase the probability that inferences are accurate.

What is the difference between frameworks and theories?

- A framework is a brief explanation of a theory or portions of a theory to be tested in a study. - A theory is abstract rather than concrete. - It focuses on the general. - The framework may be implicit.

Meta-synthesis includes:

- A meta-synthesis involves the breaking down of findings from different studies to discover essential features and then combining these ideas into a unique, transformed whole. Meta-summary is a step in conducting meta-synthesis. - Qualitative research synthesis is the process and product of systematically reviewing formally integrating the findings from qualitative studies. The process for conducting a synthesis of qualitative research is still evolving. - Qualitative researchers recognize the importance of summarizing qualitative findings to determine the knowledge that might be used in practice and for policy development.

Systematic Review - EBP

- A narrowly focused synthesis of research findings from quantitative studies - Looks at studies of similar methodology - Has same standards of clarity, rigor, and replication as primary research studies

Critically appraising mixed-methods systematic reviews

- A process of combining findings from quantitative and qualitative studies as mixed- methods synthesis. - May include various study designs, such as qualitative research and quasi-experimental , correlational, and descriptive quantitative studies. - Reviews include syntheses of various quantitative and qualitative study designs are referred to as mixed methods-systematic reviews. - Involves complex synthesis processes that includes expertise in synthesizing knowledge from quantitative, qualitative, and mixed-methods studies.

What are the requirements for decision trails?

- A record is kept of all decision rules used in data analysis to support the study's conclusions and emerging theory. - All raw data are stored and available for review, if requested.

Systematic Review means:

- A structured, comprehensive synthesis of the research literature to determine the best research evidence available to address a healthcare question. - A systematic review involves identifying, locating, appraising, and synthesizing quality research evidence for expert clinicians to use to promote a evidenced based practice (EBP). - Teams of expert researchers, clinicians, and sometimes students conduct these reviews to determine the current best knowledge for use in practice. - For example: SR are used in development of national and international standardized guidelines for managing health problems such as acute pain, hypertension, and depression

How does qualitative research differ from quantitative research?

- A systematic, subjective approach used to describe life experiences and give them meaning - Useful in understanding human experiences such as pain, caring, powerlessness, and comfort - Focuses on understanding the whole - Consistent with holistic philosophy of nursing

Research Objectives, Questions, and Hypotheses - QN

- All identify relationships between variables and indicate population to be studied - Narrower in focus than the purpose and often specify only one or two research variables

What are potential causes of bias in designs?

- Attitudes or motivations of the researcher (conscious or unconscious) - Components of the environment in which the study is conducted - selection of the subjects - composition of the sample - groups formed - measurement methods - data collection process - data and statistical analyses

Demographic Variables

- Attributes of subjects collected to describe sample - May include age, education, gender, ethnic origin, marital status, income, medical diagnosis, geographic location, etc. - Demographic data are analyzed to develop sample characteristics.

What does research design mean?

- Blueprint for conducting a study - Descriptive and correlational (natural setting) qausi-experimental and experimental design (examine causality)

Research Design - QN

- Blueprint for conducting the study - Maximizes control over factors that could interfere with the study's desired outcome - Directs the selection of the population, sampling, methods of measure, plans for data collection, and analysis. - The choice of the research design depends on what is known and not known about the research problem.

What is storytelling?

- Can be instructive in understanding a phenomenon of interest - Includes a sequence of events with a beginning, middle, and end - Stories have their own logic and are temporal.

Case study method - QL

- Capturing unique stories - What are the details and complexities of the story of...?

Case study method: Sample Selection

- Case may involve single person or group, institution (ex. hospital), or community - People who are experiencing the circumstance - Seek best case for learning - May use network sampling and/or snowballing

Research Purpose

- Clear, concise statement of focus of study QN: describe, examine or determine r/ships or effectiveness of an intervention QL: explore perceptions of a phenomenon, describe elements of a culture, develop a theory (grounded theory) Includes: variables (QN) or concepts (QL), population, setting

What is meant by a testable hypothesis?

- Clearly predicts relationship between variables. without stating "no significant difference" - Variables are measurable or able to be manipulated: Independent variable (IV): clearly defined, implemented precisely & consistently as an intervention, Dependent variable (DV): clearly defined, how it will be precisely & accurately measured

Literature Review - QN

- Collecting pertinent literature to give in-depth knowledge about the problem - Understanding what knowledge exists to make changes in practice

How does the qualitative nurse researcher utilize and conduct a literature review?

- Compare and combine study findings with literature - To explain, support, and extend research theory - As a background for research - As a way to formulate research questions - As a source of data

What is the difference between ethical and unethical research?

- Ethical research would follow IRB and get ethical approval - Unethical research includes fraud, violating research protocols, plagiarisms, putting subjects at risk, not getting the proper consent, falsifying or forging data

Critically Appraising a Study Framework

- Concepts are linked with variables that are measured. - Concepts are represented in hypotheses, research questions, or objectives. - The hypotheses, research questions, or objectives are tested statistically. - The hypotheses, research questions, or objectives emerge from framework propositions - Look for comments connecting findings to specific elements of the framework. - Search for comments discussing the implications of findings in terms of truth or falsity of framework propositions - Are the findings for each hypothesis, question, or objective consistent with those proposed by the framework? - If the findings are not consistent with the framework, was the methodology adequate to test the hypothesis, question, or objective? - Are the findings consistent with those of other studies using the same framework (or testing the same propositions)?

What is included in the summary section?

- Concise presentation of research knowledge about selected topic—what is known and not known - Judgment stating whether there is adequate knowledge to direct change in clinical practice - Brief statement of proposed change in practice

Ethical Research Practices with Aboriginal Communities

- Continued attention needs to be paid to issues of diversity in research involving diverse First Nations, Inuit and Métis peoples. - Health Canada (2014) stated researchers must involve Aboriginal communities in their research involving Aboriginal people. - Flicker and Worthington (2012) key steps to ethical research practices with Aboriginal communities

Assumptions & Characteristics - QN research

- Control, manipulation - Predetermined elements - recipe, consistency - Comparison between groups - Objectivity - Context free - Planned representative sample - Deductive approach - Researcher as neutral - Theory/hypothesis testing - Numerical - empirical

What are the main characteristics of experimental research? - QN

- Controlled manipulation of at least one independent variable - Uses experimental and control groups - Random assignment of the sample to the experimental and control groups - Objective, systematic, highly controlled investigation conducted for the purpose of predicting and controlling events in nursing practice i.e. medication administration schedules.

What is probability theory?

- Deductive - Used to explain or predict - Expressed as p with values and percentages

What frameworks might be used for physiological studies?

- Derived from physics, physiology, and pathophysiology - Theoretical relationships may be considered facts rather than theories. - Propositions can be developed and tested using these laws and principles.

What are the components of the results section? - QN

- Descriptions of findings after data were analyzed - Usually organized by research objectives, questions, or hypotheses. - The results section of a study describes the study outcomes and presents the results in figure, tables, and narrative.

What is the purpose of the literature review in quantitative studies?

- Direct the development and implementation of a study - Cite relevant and current sources - Document background and significance of study - Identify theoretical ideas to guide a study

Consent in Research - What does consent in research mean?

- Disclosure of essential study info to the subject - Comprehension of this info for the subject - Competence of the subject to give consent - Voluntary consent of the participant to take part in the study: have the right to leave whenever

How and why do researchers utilize empirical knowledge?

- Empirical knowledge is gained by employing research - Empirical knowledge is essential for the delivery of high-quality, safe patient and family nursing care.

Historical

- Events from the past

How about quasi-experimental research? - QN

- Examines cause-and-effect relationships - Less control by researcher than true experimental designs - Samples are not randomly selected. - All variables in the study cannot be controlled by the researcher. - Determines the effect of one variable on another i.e. these studies lack a certain amount of control over the treatment, management of the setting and the selections of subjects. When studying human behavior researchers are not able to select the subjects or control certain treatments.

Extraneous Variables

- Exist in all studies. - Can interfere with obtaining clear understanding of relational or causal dynamics in the study. - Can be recognized or unrecognized and controlled or uncontrolled.

What sources are commonly used for conceptual definitions?

- Existing theoretical works - Must be used if proposition from theory being tested - Always desirable when available - Should be directly quoted (if possible) and cited - Published concept analyses

Typical quantitative data gathering strategies include

- Experiments/clinical trials. - Observing and recording well-defined events - Obtaining relevant data from management information systems. - Administering surveys/questionnaires with closed-ended questions

How would you define descriptive research? - QN

- Exploration and description of phenomena in real-life situations - New meaning is discovered and the description of concepts is accomplished - Helps to identify relationships - Through descriptive studies , researchers discover new meaning, describe what exists, determine the frequency with which something occurs, and categorize information in real-world settings (determine weather changes and earthquakes).

What frameworks are included in conceptual nursing models?

- Few conceptual models come from a research tradition. - Researchers are working to develop research studies to test conceptual models in nursing.

What should a quantitative research literature contain?

- Finding from empirical research reports - Articles that evaluate or purpose theory - Literature reviews that summarize an expansion of the literature on a topic - How many articles?

Case study method: Important Concepts

- Focus on an individual, family, community, organization, or some other complex phenomenon - NB especially in areas where exceptions are being studied - In-depth study of a situation of event (the case): by detailing its context & ordinary activities, tries to understand issues r/t history, development, or circumstances of case - Usually incident "bounded" or limited rather than something that lacks specificity. Ex. the closure of a clinical unit

What is quantitative research?

- Formal, objective, rigorous, systematic process for generating information - Describes new situations, events, or concepts - Examines relationships among variables - i.e. temperatures, body weight or parcel weight and blood pressure. - Determines the effectiveness of treatments - based on concepts at various levels of abstraction that are measured, manipulated or controlled in a study i.e. blood pressure changes between genders, weight of patients ages.

What are frameworks?

- Frameworks explain the theory. - Frameworks give relationships of variables. - This results in the hypothesis, which is testable.

Facilitating Research Utilization - EBP

- Fund key research initiatives - Create institutional infrastructures - Provide workshops, CE courses, reward systems, incentives - Provide easy to access research resources, databases, reports, papers - Make it a role expectation Promote collaborative efforts

Outcome research - Why?

- Health care reform - National concerns r/t quality of pt care - Justify interventions - Costs of care - Systems of care that demonstrate improved pt outcomes - key to develop better ways to monitor and improve quality of care

Summary of Ethical Principals that Various Codes Address

- Honesty - Objectivity - Integrity - Carefulness - Openness - Respect for Intellectual Property - Confidentiality - Responsible Publication - Responsible Mentoring - Respect for colleagues - Social Responsibility - Non-Discrimination - Competence - Legality - Animal Care - Human Subjects Protection

Outcome Based Research - Role

- How nurses make decisions - Nurse case management - Advanced practitioner interventions - Community health - Health promotion - Nursing outcomes in hospitals

What is a theory?

- Ideas and knowledge of science - Research is based on theory. - Theory is the initial inspiration for research study. - Research helps answer the question "Was my theory correct?"

What Is the purpose of a literature review?

- Identifies theoretical and scientific knowledge - Identifies what is known and unknown about the topic - Identifies available evidence for use in practice - Identifies contribution of present study to knowledge base

Exploratory-descriptive-qualitative

- naturalistic inquiry, descriptive or just QL - when some researchers don't identify a particular approach

Integrative Reviews - EBP

- Identify, analyze, and synthesize results from independent quantitative and qualitative studies to determine current knowledge - Include multiple types of research designs and literature types - Complicated review, but give breadth and depth to conclusions - Annual Review of Nursing Research publishes integrative reviews.

What does observation entail? QL

- In a naturally occurring situation - What is going on here? - Look and listen carefully. - Note routine activities - what do they do for their daily routine - Focus on details. - Note processes as well as discrete events - detailed lab values etc. - Note unexpected events.

What are examples of problems with frameworks?

- Inappropriate framework - Disconnected framework - Multiple frameworks - Unidentified framework

What is included in the data-based literature?

- Includes quality studies relevant to topic - For each study, purpose, sample, sample size, design, and specific findings are presented, using paraphrasing rather than direct quotes. - Scholarly, but brief, critique of study's strengths and weaknesses

What are the causes for lack of rigor?

- Inconsistency in adhering to philosophy of approach being used - Failure to get away from older ideas - Poorly developed methods - Insufficient time spent collecting data - Poor observations - Failure to give careful consideration to all data

Types of Variables

- Independent variables - Dependent variables - Research variables or concepts - Extraneous variables - Demographic variables

Conceptually Driven Evidence

- Influences nurse's thinking but not the action - Read and incorporate research into critical thinking - May lead to an integrative review of the literature, formulation of a new theory, or generation of new hypotheses - Use of knowledge in this way = knowledge creep or cognitive application

What research outcomes are usually reported? - QN

- Interprets data findings in meaningful manner - Involves forming conclusions and considering implications for nursing - Suggests future studies - Generalizes the findings

Independent Variable (IV)

- Intervention manipulated or varied by researcher to cause an effect on DV. - AKA intervention, treatment or experimental variable. - IV causes the DV variable to change. - IV does not change, controlled by researcher

Meta-analysis means:

- Is conducted to combine or pool the results from previous qualitative studies into a single statistical analysis that provides one of the highest levels of evidence about an interventions effectiveness. - Qualitative studies do not produce statistical findings and cannot be included in a meta-analysis. - Meta-analysis can be performed on correlational (two or more randomized control trials) studies to determine the type (positive or negative) or strength of relationships among selected variables because meta-analysis involve statistical analysis to combine study results, it is possible to be objective rather than subjective when synthesizing research results and determining clinical interventions - This approach has objectivity because it concludes analysis techniques to determine the effect of an intervention while examining the influences of variations in the studies included in the meta-analysis.

What guidelines can be used for appraising interventions? QN

- Is the intervention in fact effective? - Was the experimental intervention described in detail? - Was justification from the literature provided for development of the intervention? - Was a protocol developed to consistently implement the treatment? - Was any control group intervention described? - Was an intervention theory provided to explain conclusions?

Non-parametric tests

- Isn't normal distribution; therefore, it is not mathematically easily explained (Can't ever draw conclusions like cause and effect) Measured at nominal and ordinal levels - Mann-whitney U test

What are middle-range theories?

- Less abstract and narrower in scope than conceptual models - Emerge from review of studies to build evidence-based practice related to a clinical problem

What frameworks are used in middle- range theories?

- Limited scope - Particular substantive focus - Contain limited number of concepts - Focus on limited aspect of relationship - Sufficiently general to be interesting - Empirically testable - Consolidated into wide-range theories

Sampling or Eligibility Criteria

- List of characteristics essential for eligibility in target population - Sample selected from accessible population that meets sampling criteria - Inclusion or exclusion criteria For example: researchers may choose to study the effect of pre-op teaching about early ambulation on the outcome of length of hospital stay for adults having knee joint replacement surgery. Sampling criteria: 1) age of at least 18 yrs of age or older 2) able to speak and read English 3) Surgical replacement of one knee joint 4) no history of previous joint replacement surgery 5) No diagnosis of dementia 6) No debilitating chronic muscle diseases

What is the aim of experimental research? - QN

- Looks at cause-and-effect relationships - Highly controlled, objective, systematic studies - Involves the measurement of independent and dependent variables - Predict and control nursing events, practices and treatments in nursing practice

How would you describe correlational research? - QN

- Looks at the relationship between two or more variables - Determines the strength and type of relationship - Explains what is seen - No cause and effect - A positive relationship indicates that the variables vary together while a negative relationship indicates that the variables vary in opposite directions i.e. the number of cigarette pkgs smoked per week determines the rapidity of ones declining health, disease processes and life span.

How is text collected?

- May be written by participants on a particular topic at request of researcher - Narratives may be solicited by mail rather than in person. - Text developed for other purposes, such as patient records or procedure manuals, can be accessed for qualitative analysis. - Published text (books, newspapers, etc.)

What frameworks are derived from qualitative studies?

- Middle-range theories are developed in some qualitative studies as outcomes of the study. - These become the basis for clinical practice and/or the framework for other qualitative or quantitative studies.

Mixed method systematic reviews

- Mixed methods reviews may include various study designs, such as qualitative research and quasi-experimental, studies, correlational, and descriptive quantitative studies. Reviews that include synthesis of various quantitative and qualitative study designs are referred to as mixed methods systematic reviews. - Mixed-methods systematic reviews involve a complex synthesis process that includes expertise in synthesizing knowledge from quantitative, qualitative and mixed methods.

4. Systematic Sampling

- Used when ordered list of all members of population is avaliable. - Select every kth individual on list (starting point is randomly selected). - Need to know desired sample size

Who serves on the institutional review board?

- Must have five members - Must have different backgrounds (cultural, economic, educational, gender, racial) - One must come from the professional that the researcher is from - Vulnerable subjects (mentally disabled, children etc.) will need one or more members on the board that have knowledge about and experience with working with these subjects - to promote complete, scholarly and fair review of research commonly conducted at an institute

Assumptions & Characteristics - QL research

- Naturalistic, phenomenon - Emergent design flexibility - No planned comparisons - Subjectivity - Context rich - Experiential small sample - Inductive approach - Researcher as "research instrument" - Theory generating - Non-numerical - data is text

Nonprobability Sampling Methods

- Not every element of population has an opportunity to be selected

What does interviewing entail?

- Open-ended format - Researcher defines focus. - No fixed sequence of questions - Questions tend to change as researcher gains insights from previous interviews and/or observations. - Respondents are encouraged to raise issues not addressed by researcher.

How is rigor obtained in qualitative research?

- Openness - Scrupulous (consciousness) adherence to a philosophical perspective - Thoroughness in collecting data - Consideration of all data in subjective theory development phase

Sampling plan:

- Outlines strategies used to obtain a sample for a study - Probability (random) or nonprobability (nonrandom) sampling plans: Probability is used to increase representatives and decrease systemic variation or bias in QN. Subjects are selected from sampling frame using sampling plan

What are the characteristics of researcher-participant relationships?

- Participants are treated as colleagues rather than subjects. - The researcher must have the support and confidence of participants to complete the study. - Maintaining relationships is of utmost importance

How do nurses utilize practice and intervention theories?

- Practice theory is prescriptive theory. - Intervention theory is a form of practice theory. - These theories direct nursing interventions. - Practice theory research develops into evidence-based practice.

Data Collection - QN

- Precise, systematic gathering of information for the study - Consent must be obtained from the sample. - Researchers use observation, interviews, questionnaires, or scales to gather information. - Described under the "procedures" section of a research article

What are the stages in data analysis? QN

- Prepare data for analysis. - Describe the sample. - Test reliability of measurement methods. - Conduct exploratory analysis. - Conduct confirmatory analysis guided by hypotheses, questions, or objectives. - Conduct posthoc analyses.

Sources of Conceptual Definitions

- Previous studies using the concept - Publications describing instrument development - General literature - Performing a concept analysis

Importance of Ethics in Nursing Research

- Promote the aims of research - Promote the values that are essential to collaborative work - get a ton of views - Promote accountability to the public - duty to provide a certain level of care - Promote build public support for research. - Promote a variety of moral and social values

What are the main elements of ethical research?

- Protecting human rights - Understanding informed consent - Understanding institutional review of research - Examining the balance of benefits and risks of the study

Primary Nursing Values in Ethical Practice

- Providing safe, compassionate, competent and ethical care - Promoting health and well-being - Promoting and respecting informed decision-making - Preserving dignity - Maintaining privacy and confidentiality - Promoting justice - Being accountable

What to assess in a quantitative study abstract?

- Purpose - Highlights design - Sample - Intervention

What characteristics are unique to qualitative research?

- Qualitative data analysis occurs concurrently with data collection rather than sequentially, as in quantitative research. - The researcher is simultaneously gathering data, managing a growing bulk of collected data, and interpreting the meaning of data - learning as you go

Outcomes Studies - Research strategies

- Quasi-experimental or Observational - suitable for addressing questions of effectiveness and efficiency - Prospective Cohort Studies - epidemiological study in which the researcher identifies a group of people who are at risk for experiencing a particular event and then follows them over time to observe whether or not the event occurs (must be very large sample sizes) - Retrospective Cohort Studies - epidemiology study in which the researcher identifies a group of people who have experienced a particular event (procedure, episode of care, nursing interventions or diagnosis) - Population-Based Studies - conducted within the context of the pt. community rather than the medical system. - Economical or Ethical - cost and benefits of alternative treatment or ways to identify efficient means of care

Key Principles for Conducting Intellectual Critical Appraises of QN and QL Studies

- Read and critique the entire study. - Examine the organization and presentation of the research report (is it clear with headings) - Examine the significance of the problem being studied and determine the relevance for nursing practice. - Identify the type of study (qualitative and quantitative) conducted and the steps or elements of the study. - Identify strengths and weaknesses of the study. - Be objective and realistic. - Provide specific examples. - Provide a rationale for your critique. - Evaluate the quality of the study. - Discuss usefulness of the findings for practice.

Data Analysis - QN

- Reduce, organize, and give meaning to data - Describe and examine relationship analysis of data in order to make predictions and determine common areas and differences in data. - Determines the study outcome and results clearly expressed in figures, tables or narratives.

Phenomenological

- Refers to both a philosophy and a group of research methods congruent with the philosophy that guide the study of experiences or phenomena - Phenomenologists view the person as integrated with the environment - "What is the meaning of one's lived experiences"

QL Rigour: Trustworthiness

- Refers to degree to which rigour has been established - Steps taken to ensure study procedures meet high standards & can trust results - Study is trustworthy when it accurately represents or portrays the participants' experience

Analyzing and Reporting Results: Explained Variances

- Regression Analysis: The R2 is the variation between two variables expressed as a percentage. - Cronbach's Alpha Coefficient: Tests internal consistency of measurement scale Factor Analysis: - Aids in development of theoretical constructs - Aids in development of measurement scales

PAR - Data Gathering

- Research team and participants collaborate to conduct research project - Use a variety of sources: interviews, observation, photo-voice - Seeks to engage stakeholders in discovering the solutions to the community problems

What is reflective thought?

- Researcher explores personal feelings and experiences that may influence study and integrates this understanding into study. - Requires conscious awareness of self

2. Stratified Random Sampling

- Researcher knows some variables in population critical for achieving representativeness - Ensures all levels of identified variables adequately represented - Must define categories (strata) Ex. types of nurses: Target population has 48% RNs, 40% LPNs, 12% NPs... sample for each stratum same as target population Variables include: age, gender, race, and ethnicity etc. A large population must be available

PAR - Sample Selection

- Sample of community members purposively selected - After problematic situation identified, further individuals from community identified to participate in the research - become researchers - Divided into groups of committees based on experiences, knowledge, skills, & abilities to perform assigned tasks - Vary in size: From small teams to projects encompassing entire communities

Representativeness

- Sample, accessible population, & target population are alike in as many ways as possible. - Random variation - the expected diff in values that occurs when diff subjects from the same sample are examined - Systematic variation (bias) - consequence of selecting subjects whose measurement values differ in some specific way to the population QN - evaluate in terms of setting, characteristics of the subjects and distribution of values on variables measured in the study. - The setting identified does influence the representatives

Assumptions - QN

- Statements are taken for granted or are considered true. - Assumptions are often unrecognized in thinking and behavior. - Sources of assumptions are universally accepted truths. - They are often embedded in the philosophical base of the study's framework.

Why is rigor so important in quantitative research? - QN

- Striving for excellence in research and adherence to detail - Precise measurement tools, a representative sample, and a tightly controlled study design - Logical reasoning is essential. - Precision, accuracy, detail, and order required

Parametric

- Stronger to draw conclusions form because they can mathematically describe the data that they see (draw more conclusive conclusions from it) - interval or ratio level of measurement - Values of the subject for the variables are normally distributed - Student t-test, t-test, ANOVA, pearson correlation co-efficient

How are subjects selected?

- Subjects are referred to as participants. - May volunteer to be involved in study - May be selected by researcher because of their particular knowledge, experience, or views related to study

Outliers

- Subjects or data points with extreme values that seem unlike the rest of the sample

Participatory Action Research (PAR) - Important concepts

- Systematic study or assessment of a community to plan context-appropriate action - A focus on change; to solve practical problems - Context-specific - Emphasis on collaboration: between researchers and those with a problem and perceived need for change - Participants engaged throughout entire research process - Knowledge and solution to problem generated through researcher and participants' collective efforts & actions - Empowerment is a goal

EBP Process Steps

- Team approach is best with a leader - Selection of a topic - Problem-focused triggers, Knowledge-focused triggers - Form a team Formulate EBP question using PICO - Evidence retrieval (literature review) - Evidence rating and critique - Synthesis of findings - Recommendations for EBP - Decision to change practice - Development of EBP - Implementation of practice change - Evaluation

T-Test: compares two sample means

- The "One Sample T-Test" or "Independent Samples T-Test"-compare one group's average value to a single number - The "paired t-test"-observations in one group is paired with a related observation in the other group.

Results of meta-analysis for continuous outcomes

- The effect of an intervention on a continuous outcome in a meta-analysis is determined by the mean difference between two groups. The mean difference is a standard statistic that identifies the absolute difference between two groups. It is the estimated change caused by the intervention (i.e. physical activity affects on depression). The mean difference is reported in a meta-analysis to identify the effect of an intervention but is appropriate only if the outcome is measured by the same scale in all the studies.

Framing for the meta-synthesis

- The frame identifies the focus and scope of the meta-synthesis. The focus of the meta-synthesis is usually an important area of interest for the individuals conducting it and is a topic with an adequate body of qualitative studies. The scope of a meta-synthesis is an area of debate, with some qualitative researchers recommending a narrow, precise approach and others recommending a broader, more inclusive approach. - Framing is essential for making the synthesis process manageable and the findings meaningful and potentially transferable to practice. Usually the research question used to direct the meta-synthesis process is identified in the synthesis report.

What are the frameworks for qualitative studies?

- The goal of qualitative research is not hypothesis testing. - Frameworks are used in a different sense in qualitative research. - Each type of qualitative research is guided by a particular philosophical stance.

Translation Science - EBP

- The investigation of methods, interventions, and variables that influence the adoption of EBPs by individuals and organizations to improve clinical practice. - Includes testing the effect of interventions in promoting and sustaining adoption of EBPs.

Search criteria and strategies for meta-analysis

- The methods for identifying search criteria and selecting search strategies are similar for meta-analysis and systematic reviews. - The search criteria are usually narrowly focused for a meta-analysis to identify the specific studies examining the effect of a particular intervention (i.e. examining the effects of restraints in LTC facilities over the last 5 years) - The search needs to be rigorous and should include published sources identified through varied databases and unpublished studies identified through other types of searches like ancestry searches .

What are decision trails?

- Using the same data, can follow logic of original researcher and arrive at same conclusions - Requires researcher to establish rules for categorizing data, arriving at ratings, or making judgments

Biases for meta-analysis and systematic reviews

- The nature of published studies limitations sources lead to biases and flawed or inaccurate conclusions in the research syntheses. The common biases that can occur in conducting and reporting research syntheses includes published bias, time lag biases, location bias of studies, citation biases, language biases methodological biases and outcome reporting biases - Remember when researchers assign people into experimental and various controlled groups it increases their biases. The cause for the biases are preconceived biases, life experiences and assumptions).

Descriptive Stats: Degrees of Freedom

- The number of scores that can vary is your degree of freedom. - Generally refers to the number of independent observations in a sample minus the number of population parameters that must be estimated from sample data.

Dependent Variable (DV)

- The outcome or response the researcher wants to predict or explain. - Changes in DV are presumed to be caused by the IV.

How is coding accomplished?

- The process of reading data, breaking text down, into subparts, and giving a label to that part of the text - Provide a way for the researcher to identify patterns in the data because sections of that text that were coded in the same way can be compared for similarities and differences - Way of indexing or identifying categories in data - Codes may be placed in data at time of data collection, when entering data into computer, and during later examination of data. - Data segments can then be retrieved by coding category.

How does the researcher interpret qualitative results?

- The researcher offers his or her interpretation of what is going on. - The focus is on understanding and explaining beyond that which can be stated with certainty. - May focus on usefulness of findings for clinical practice - Researcher develops hunches about relationships that can be used to formulate tentative propositions.

Searching the literature and selecting sources (meta-synthesis)

- The search criteria needs to be detailed in the synthesis report, and the years of the search, keywords searched and language of sources need to be discussed. - Meta-synthesis are usually limited to qualitative studies only and do not include mixed-methods. - Note that qualitative findings that have not been interpreted and are not analyzed quotes, field notes, case histories, stories, or poems are usually excluded .

Meta-anaylsis needs to examined for:

- The studies included in a meta-analysis need to be examined for variations or heterogeneity in areas such as sample characteristics, sample size, design, types of interventions, and outcome variables and measurement methods

Strategies used to synthesize research evidence:

- The synthesis of study findings is a complex, highly structured process that is best conducted by at least two or even a team of expert researchers. Synthesis - clustering and interrelating ideas from several sources to form a gestalt or a new, complete picture of what is known and not known in an area. Research evidence in nursing and health care is synthesized by using the following processes: 1). Systematic review 2). Meta-analysis 3). Meta-synthesis 4). Mixed-methods systematic review -

Meta-synthesis means:

- The systematic compilation and integration of qualitative study results expand understanding and develop a unique interpretation of study findings in a selected area. The focus is on interpretation rather than on combining study results, as with quantitative research synthesis. - Uses original qualitative studies and summaries from qualitative studies to produce the synthesis - Uses Narrative method for analysis to achieve synthesis.

Why are conceptual models important?

- These are more abstract than theories. - They explain phenomena of interest and reflect a philosophical stance. - They cannot be tested via research. - They may guide further qualitative studies. - Operational definitions are often found in these models.

What is meant by extraneous variables?

- These occur in all research studies. - They may interfere with the hypothesized relationships between variables. - The influence of extraneous variables can be decreased through sample selection and the use of defined research settings. - Variables that can affect the measurement of study variables and the relationships among these variables.

Mixed Method means:

- This mixed method approach has the potential to provide more comprehensive answers to health problems. Combining qualitative and quantitative methods requires research teams to include individuals that are in multidisciplinary teams for solving complex health care problems. - Mixed methods approaches offer investigators the ability to use the strengths of qualitative and quantitative research designs. Mixed-methods research is characterized as research that contains elements of both qualitative and quantitative approaches * Mixed methods studies may be published as separate qualitative and quantitative articles, or they may be published combining both phases. *The conclusion must match the results and link directly to the research question; check it out carefully. *As research methodologies continue to evolve, mixed-methods approaches offer investigators the ability to use the strengths of qualitative and quantitative research designs.

Case study method: Data Gathering

- Use of interviews, observations, document reviews, and other methods - To gain a sense of case environment and relationships as context

What is bracketing?

- Used in some phenomenological research to help researcher avoid misinterpreting phenomenon as it is being experienced by participants - Bracketing is suspending or laying aside what researcher knows about experience being studied.

How are memos helpful?

- Used to record insights or ideas related to notes, transcripts, or codes - Move researcher toward theorizing and are conceptual rather than factual - May link data or use specific piece of data as an example of conceptual idea

Critiquing the Ethics of a Study

- Was study approved by the appropriate IRB? - Was informed consent obtained from subjects? If subject is incompetent, did legally authorized representative give consent? - Were rights protected during sampling and data collection and analyses? - was participation voluntary, were their rights violated - Was privacy protected during study and in final report? shutting the door for ex - Was benefit/risk ratio of the study acceptable? - was it made clear to participants

What components might the nurse research include in the literature review?

- What is known and not known about the topic - The focus of the study - Sources must be current—published within the past 5 years - Landmark studies may be included if essential to the background of the problem

Explanatory research designs means?

- When you need to explain the concept - to understand cause and effect, meaning the researcher wants to explain what is going on - looks at how things come together and interact

Results of meta-analysis for dichotomous outcomes

- With dichotomous data (risk ratios, odds ratios and risk differences)every participant fits into one of two categories, such as clinically improved or no clinical improvement, effective screening device or ineffective screening device, or alive or dead. - The risk ratio - The odds ratio (OR) - The risk difference (RD)

Participatory action method - QL

- Working with people to improve the present - What community practices can improve the health of this group of people?

Sample

- defines the selected grp of ppl or elements from which data are collected for a study - should represent an identified population of ppl - Members of the sample can be called the subjects (QN) or participants (QL) ex. Might be all people with diabetes for ex. Most cases it is hard to research an entire population. Sampling theory was developed to determine the most effective way to acquire a sample that accurately the population under study. Key concepts of sampling theory include populations, target populations, sampling, eligibility criteria, accessible population, elements, representatives, sampling frames, and sampling methods or plans

When are critical appraisals of studies implemented in nursing?

- determine the research evidence ready for use in practice - after verbal presentations of studies - after a published research report - selection of abstracts when studies are presented at conferences - article selection for publication - evaluation of research proposals for implementation or funding

Grounded theory

- grounded from social interaction theory - tries to understand the interaction between self and group from the perspective of those involved

Standardized mean difference (SDM)

- or d, is a summary statistic that is reported in a meta-analysis when the same outcome is measured by difference scales or methods. SDM is also sometimes referred to as the standardized mean effect for example: depression is measured by 3 different scales - Profile of Mood, Beck Depression Inventory and Medical Diagnosis diseases. The difference in the means and standard deviations in the studies are assumed to be the result of the measurement scales and not variability in the outcome

Phenomena

- the experiences that comprise the lives of humans - an experience is considered unique to the individual, time, and context - why QL researchers describe a phenomenon from the perspective of the persons who are experiencing the phenomenon

Research Ethic Boards (REB) - Factors assessing the adequacy of the researchers' proposed measures for safeguarding information include:

- the type of information to be collected - the purpose and way the information will be used - risks to participants - appropriate security safeguards of information - looks at how you store the data - any anticipated linkage of data gathered in the research with other data about participants

Control - There are different types of "control" in statistics: a member of the control group:

1. Controlled experiment. An experiment with a control group 2. Controlled, randomized experiment. A controlled experiment with control group is done at randomly 3. Control for a variable. to separate its effect from the treatment effect 4. Control group. do not receive the treatment.

Hypothesis testing:

1. Define the research hypothesis 2. Explain how you are going to operationalize 3. Set out the null and alternative hypothesis 4. Set the significance level. 5. Make a one- or two-tailed prediction. 6. Determine whether the distribution that you are studying is normal 7. Select an appropriate statistical test 8. Run the statistical tests 9. Reject or fail to reject the null hypothesis.

Use the following checklist to critically appraise the published systematic reviews and meta-analyses processes

1. Did the title indicate if a systematic review or meta-analysis was conducted? 2. Was an abstract included? 3. Was the clinical question clearly expressed and significant using PICOS? 4. Were the purpose and objectives or aims of the research synthesis clearly expressed and used to direct it? 5. Were the search criteria clearly identified? Was the PICOS format used to identify the search criteria? 6. Were a comprehensive, systematic search of the literature conducted using explicit criteria identified in step 3? 7. Was publication bias addressed, including any time lag bias, location bias, duplicate publication bias, citation bias, and language bias? 8. Was the process for the selection of studies for the review clearly identified and consistently implemented? 9. Were key elements (population, sampling process, design, intervention, outcomes, and results) of each study clearly identified and presented in a table? 10 Was quality critical appraisal of the studies conducted? 11. Was a meta-analysis conducted as part of the systematic review? 12. Were the results of the systematic review or meta-analysis clearly described? 13. Did the report conclude with a clear discussion section? 14. Did the authors of the review develop a clear, concise, quality report for publication? Refer to the PRISMA diagram on page 426 - 427).

Guidelines for critically appraising meta-syntheses are:

1. Did the title of the report indicate that it was a meta-synthesis? 2. Did the report include an abstract of the purpose, clinical question addressed, meta-synthesis process implemented, key findings, and implications for practice? 3. Did the authors clearly identify the purpose or focus of their meta-synthesis? 4. Was the meta-synthesis framed, and was a research question developed to direct the synthesis? 5. Did the authors conduct a systematic and comprehensive search and retrieve the qualitative studies in the target area of inquiry? 6. Was the process for selecting studies for the meta-synthesis detailed? 7. Was the process for critically appraising the studies described? 8. Was a qualitative meta summary conducted as part of the meta-synthesis? 9. Did the authors discuss the analysis and interpretation of the findings from the qualitative studies? 10. Were the findings from the meta-synthesis clearly presented, including the themes identified and/or a model or map of the overall findings? 11. Was the meta-synthesis report complete and concise?

Critically appraising meta-syntheses includes:

1. Framing for the Meta-Synthesis. 2. Searching the Literature and selection sources . 3. Appraisal of studies and analysis of data . 4. Discussion of Meta-synthesis findings

Steps to Implementing Evidence-based practice:

1. Identify a problem from practice and turn it into a specific question. 2. Find the best available evidence that relates to the specific question. 3. Critically appraise the evidence for its validity, usefulness, and rigour. 4. Identify and use the current best evidence, and apply it to the situation. 5. Evaluate the effect

Meta-analysis overview

1. Is a statistical technique for combining the findings from independent studies. 2. Is most often used to assess the clinical effectiveness of healthcare interventions; it does this by combining data from two or more randomized control trials. 3. It's trails provides a precise estimate of treatment effect, giving due weight to the size of the different studies included. 4. It's validity of the meta-analysis depends on the quality of the systematic review, structured and available analysis and synthesis of the entire body of knowledge in a field on which it is based. 5. The good meta-analysis aim for complete coverage of all relevant studies, look for the presence of heterogeneity, and explore the robustness (strong and sound evidence)of the main findings using sensitivity (true positive - patients have a disease with positive lab results) analysis. (EBM 2nd edition Crombie and Davies. April 2009). 6. It pools results from previous studies into a single quantitative analysis

How Would you Critically Appraise Observational Measurements?

1. Is the object of observation clearly identified and defined? 2. Is interrater reliability described? 3. Are the techniques for recording observations described?

two types of approaches to integrate the findings from quantitative, qualitative, and mixed methods studies

1. Multilevel synthesis - involves synthesizing the findings from quantitative studies separately from qualitative studies and integrating the findings from these two syntheses in the final report. 2. Parallel synthesis - involves the separate synthesis of quantitative and qualitative studies, but the findings from the qualitative synthesis are used in interpreting the synthesized quantitative studies

Setting in QN Research

1. Partially Controlled: Environment manipulated or modified in some way 2. Highly Controlled: Artificially constructed environment for study Labs, research centre, test unit in hospitals ↓ influence of extraneous variables, accurately examine effects of IV on DV

Using research evidence in practice involves examining:

1. Potential risks - what are the risks associated with the change in practice. What are the risks if we do not change the practice? 2. Resources needed - How many people, funds and resources are available to make the changes. What resources are we lacking? How can we get these resources? What is required to get them? 3. Readiness of those involved - who is involved in the processes of change? Who needs to be involved? And who is ready to implement the changes?

What are the essential elements of experiments? QN

1. Random assignment of subjects to groups 2. Researcher-controlled manipulation of independent variable 3. Researcher control of experimental situation and setting, including control/comparison group 4. Control of variance

Mixed methods design have four important characteristics

1. Timing (the order of collecting the data for qualitative and quantitative phases). 2. Weighting (the priority given to the qualitative and quantitative phases). 3. Integration (how the qualitative and quantitative phases are mixed during the research process). 4. Theory (orientating and guiding the study).

What is an institutional review board (IRB)?

1974 National Research Act Functions - Protection of rights and welfare - Voluntary informed consent - Benefits exceed risks Who serves on the board

Reading a Study Prior to Critically Appraising

1st read - review abstract & read entire study Think about title, abstract, find major headings, research process, the report structure 2nd read - highlight, underline, jot notes Comprehend the content of the study Now ready to write initial critical appraisal of the study

Construct Validity -

A test measuring the constructs it claims to measure. Do they actually reflect the overall phenomenon they were wanting to measure?

Why is it important to perform an intellectual research critique?

A careful examination of all aspects of a study to judge: Merits (values) Limitations Meaning Significance

What is narrative analysis?

A qualitative means of formally analyzing stories Researcher unpacks story structure. Can be used to determine how people tell stories - How they shape the events - How they make a point - How they "package" events and react to them - How they communicate their stories to audiences

Sample - QN

A subset of the population that is selected for study Example: women students in three state universities in the Southwest

Compare means between three or more distinct/independent groups

Analysis of variance (ANOVA) Kruskal-Wallis test

Outcomes Studies - Statistical Approaches

Analyzing change Analysis of Improvement - how many pt have improved

What components are contained in most research reports? - QN

Abstract— clear concise summary of study a study in 100 to 250 words. Includes the study reason, design, setting, sample size, major results, and conclusions. Introduction—problem, purpose, literature, framework, and hypothesis Methods—design, sample, setting, tool Results—data analysis procedures Discussion—findings, conclusions, implications Reference list—all sources cited

Types of Outcomes Measured - Satisfaction with Care

Access Convenience Financial coverage Quality General

What are the advantages and disadvantages of obtaining information on the Internet?

Advantage: information is more current than that found in books. Disadvantage: information is uneven in terms of accuracy. - There is no screening process for information put on the Web. - It is important to check the source of any information obtained on the Web to judge its validity.

EBP Models include:

All EBP models include: - Synthesis of the evidence - Implementation of the evidence - Evaluation of the impact on client care - Consideration of the context or setting where evidence is implemented

1. Convenience Sampling

Also called accidental sampling Weak approach, does not control bias Subjects are in right place at right time - Ex.) patients who attend a clinic on a specific day Inexpensive, accessible, less time-consuming

3. Purposeful or Purposive Sampling

Also called judgmental or selective sampling Efforts are made to include typical or atypical subjects. Sampling is based on the researcher's judgment. Ex.) Participants from various age categories are included

4. Network Sampling

Also called snowball sampling Takes advantage of social networks to get the sample One person in the sample asks another to join the sample, and so on. Good to use when subjects are difficult to find. ex.) women who have not had a Pap test; ppl addicted to drugs

The Quality and Safety Education for Nurses (QSEN)

An initiative focused on developing the requisite knowledge, skills, and attitude (KSA) statements for each of the competencies for prelicensure and graduate education.

QL Rigour: Trustworthiness - Credibility

Are the conclusions believable? Do they reflect the truth/reality? Enhanced through: - Prolonged engagement - researcher is "immersed" Peer debriefing (experts) - Member checking - return findings to participants to determine if they reflect their experiences - Triangulation - use of multiple sources of data

QL Rigour: Trustworthiness - Transferability

Are the findings applicable, NB, or useful to similar group or practice setting? Do the results "ring true" or "fit" for others? Assessed by: - Review of examples of data gathered - quotations by participants or detailed thick descriptions

Critiquing The Discussion Section - QN

Are the findings linked back to the literature review? Was practical significance addressed along with statistical significance? Was a recommendation for future research made?

QL Rigour: Trustworthiness - 4 components of trustworthiness critiqued:

Are the findings worth paying attention to? Do the findings have meaning? 4 components of trustworthiness critiqued: - Credibility - Dependability - Confirmability - Transferability

Outcomes Studies - Critical Appraisal

Are the results valid? What are the results? How can I apply the results to patient care?

Research Problem

Area of concern - gap in knowledge needed for nursing practice Research report: 1. Significance: importance of problem to nursing 2. Background: what is already known about problem area 3. Problem statement: identifies specific gap in knowledge needed for practice Research problem may not always be clear find in the first page in the report

Homogeneous sample:

As similar as possible so as to control for extraneous variables - researchers may narrowly define the sampling criteria to make the sample as similar as possible to control extraneous variables

Research Questions and Hypotheses: assess

Assess: Placement Research questions clarity (PICOS) Appropriateness

Methods of Measurement - QN

Assigning numbers to objects Application of rules to development of a measurement device or instrument Data are gathered at the nominal, ordinal, interval, or ratio level of measurement. Must examine reliability and validity of measurement tool - Reliability: consistency of the tool - Validity: does it measure what it is supposed to measure?

1. Associative vs. Casual Hypotheses

Associative - relationship between variables Causal - independent and dependent variable - cause-and-effect relationship between variables

Types of Hypotheses

Associative vs. Causal Simple vs. Complex Nondirectional vs. Directional Statistical vs. Research

What concepts are relevant to the quantitative research process? - QN

Basic research Applied research Rigor Control Extraneous variables Sampling

What are the goals for describing qualitative research?

Become familiar with data. - Read and reread notes and transcripts. - Recall observations and experiences. - Listen to audiotapes. - View videotapes. Become immersed in data.

Research Objectives or Aims, and Research Questions - QL

Broad focus More complex/abstract concepts, gain understanding of a phenomenon

QL Rigour: Trustworthiness - Confirmability

Can the results can be corroborated by others? Is there neutrality or the reduction of bias? Enhanced through: - Researcher reviews own attitudes or preconceptions so not imposed on participants - Reflective journaling

QL Rigour: Trustworthiness - Dependability

Can you account for the changing context of the study? Would the data patterns be consistent, or stable, over time and for similar conditions? Enhanced through: - Audit trail - of research process and findings - Field notes, memos, transcripts, and researcher's reflexivity journal allow reader to follow the researcher's decision making

Inclusion Criteria

Characteristics subject or element must possess to be part of target population Examples: - Between the ages of 18 and 45 - Ability to speak English - Admitted for gallbladder surgery - Diagnosed with diabetes within past month

Exclusion Criteria

Characteristics that can cause a person or element to be excluded from target population Examples: - Diagnosis of mental illness - Less than 18 years of age - Diagnosis of cognitive dysfunction - Unable to read or speak English

What are the four types of data analysis?

Coding Memos Storytelling Narrative analysis

What is coding?

Coding, used earlier for description, also can be used to expand, transform, and reconceptualize data, providing opportunities for more diverse analyses.

Research Topic

Concept or broad issue NB to nursing ex.) chronic pain management, health promotion Each research topic has numerous research problems ex.) "What is it like to live with chronic pain?" (QL study) "What interventions are effective in managing chronic pain?" (QN study)

What are the elements of a theory?

Concepts: Abstractly describe and name an object, idea, or phenomenon, thus providing it with a separate identity or meaning Conceptual definition: More comprehensive than a dictionary definition; includes associated meanings a word may have Relational statement: Clarifies the type of relationship that exists between or among concepts Map or model: Graphically shows the interrelationships of the concepts and relational statements

Conceptual & Operational Definitions of Variables (QN)

Conceptual definition - something you'd look up - Abstract meaning of a variable that usually is based on theory Operational definition (specific and concrete) - Way of defining a variable so that it can be measured or manipulated

Common mixed methods: Concurrent

Concurrent - both sets of data are combined during the analysis phase. a. Triangulation (comparing)- is value-based and action-orientated such as a critical theory or feminist theory. The integration of the two data sets allows them to be compared, in order to look for similarities differences, or other patterns. This triangulation strategy offsets some of limitations present with each qualitative and quantitative approach and increases validation of results. Ideally, equal weight is given to both the qualitative and quantitative portions. For example, qualitatively determine the frequency of using physical restraints on patients , while concurrently conducting in-depth interviews with nurses and family members. b. Embedded (given more weight) - is similar to the triangulation strategy, but one portion, either qualitative or quantitative, is given more weight. The lower priority portion is embedded within the dominant data set. For example: a large experiment on the treatment of diabetic foot ulcers done at the same time as a smaller qualitative phase to examine patients comfort with the new procedures.

Factor Analysis: two types

Confirmatory: know the dimensions Exploratory: do not have a pre-defined idea of how many dimensions

2. Quota Sampling

Convenience plus ensuring inclusion of subjects likely to be underrepresented - Ex.) females, minority groups Similar to stratified + convenience

Nonprobability Sampling Methods: types - QN

Convenience sampling Quota sampling

Problem-Solving Process - QN

Data collection Problem definition Plan - Setting goals - Identifying solutions Implementation Evaluation and revision

How does data differ in qualitative studies?

Data is subjective - insight, experiences with the participant, demonstrate empathy Data incorporate perceptions and beliefs of researcher and participants

What role does research have in implementing an evidenced-based nursing practice?

Description Explanation (finding risk factors that lead to colon cancer. Why do things happen more to other people) Prediction (what are the chances of it happening to a person) Control (manipulate a situation to produce a desired outcome) (giving insulin)

The Methods Section: How was the research study executed? - QN

Description of participants - Demographic information - Sampling techniques and sample size Description of the research procedure - What did the researcher do to collect data? Ethics and consent - Was ethical approval obtain? - Informed consent? - Voluntary - Confidentiality Description of variables - Operationalizations

What are the types of quantitative research?

Descriptive Correlational Quasi-experimental Experimental

Probability Sampling Methods (QN)

Each person/element has an opportunity to be selected Random sampling (↑ representativeness) 4 types: - Simple random sampling - Stratified random sampling - Cluster sampling - Systematic sampling

What to critique in the results section: QN

Explain the data collected Use tables to provide exact values Presented in the order of the research questions and hypotheses Unbiased results For each RQ or H - Statistical test used - Results of the test - Significance level of the test - Description connecting statistical results to support for or rejection of H or to answer RQ Limitations Generalization

Generalization

Extending the findings from the sample to the larger population - The extent is influenced by the quality of the study and consistency of the study's findings. - obtained from the accessible population with the goal of generalizing the findings from the sample to the accessible population and more abstractly, to the target population.

Judging Statistical Suitability

Factors that must be considered include: - Study purpose - Hypotheses, questions, or objectives - Design - Level of measurement Are there dependent or independent groups? Was performed appropriately and the results were interpreted correctly? Was the data for analysis were treated as nominal, ordinal, or interval?

Outcomes research

Focus of outcomes - Patients and families - Providers - Health care systems - Practice changes - Policy development

Outcome research - What is it?

Focuses on: how pt's health status changes as result of nrsg care received or nrsg services delivered Seeks to: understand end results of particular health care practices & interventions - Concerned about the effectiveness of healthcare interventions and health services

Manipulation

Form of control. generally in quasi-experimental and experimental studies

Hypotheses

Formulated statement of expected relationship(s) between 2+ variables Includes: - variables to be manipulated or measured - identifies population to be examined - indicates proposed outcomes QN: Quasi-experimental & experimental studies

Study Framework and theory - QN

Framework is the abstract, theoretical basis for a study that enables the researcher to link the findings to nursing's body of knowledge. Theory is an integrated set of defined concepts and relational statements that present a view of a phenomenon and can be used to describe, explain, predict, or control phenomena.

two major types statistics used to analyze quantitative data? - Descriptive

Frequency distributions - Ungrouped frequency distributions (discrete data) - Grouped frequency distributions (continuous data, Data are pregrouped into categories) - Percentage distributions Measures of central tendency - midpoint Measures of dispersion - measures of individual differences of the members Measure of shape

Evidence-based practice (EBP) - goal

Goal: implementation of high-quality cost-effective care to promote positive outcomes - Integration of best research evidence with clinical expertise and patient values and needs to facilitate clinical decision making

Types of Outcomes Measured - General Well-being

Health perception Energy/fatigue Pain Life satisfaction

Heterogeneity: meta-analysis Homogeneous

Heterogeneity (different in kind/variations) in the studies included in a meta-analysis can lead to different types of biases. Meta-analyses that include more homogeneous (similar, limited, or narrow distribution or spread of scores p.505) studies have less bias and usually provide more valid findings

2 Ways to Define Sampling Criteria

Homogenous Heterogenous QN - the findings are often generalized from the sample to the target population that meets sampling criteria

Content validity -

Includes validity strategies that focuses on the content of the test

Examples of EBP Models

Iowa Model of EBP to Promote Quality Care (p.451) Stetler Model of Research Utilization to Facilitate EBP (p.447) Grove Model for Implementing EB Guidelines in Practice (p.459) Ottawa Model of Research Use (OMRU)

What other questions might be important when critically appraising a research report? - QN

Is there depth for accuracy, completeness, uniqueness of information, and organization? Was the research process logically presented? Are there critical arguments in the discussion section?

Conclusions and Implications - QN

It is different than the conclusion of a paper Conclusion is a synthesis of the findings using Implications differ from conclusions

Standard Deviation

Its symbol is σ The formula is easy: it is the square root of the Variance. Variance in this formula is - The average of the squared differences from the Mean.

Surveys/ Questionnaires Methods to Collect Data

Likert scale - designed to figure out opinions or attitudes of subjects Semantic differential scale Ranking scale Visual analog scale - used to measure strength, magnitude or intensity of individuals' subjective feelings, sensations, or attitudes about symptoms or situations

Sampling frame:

List of every member of population, using sampling criteria to define eligibility (not always possible... HIPA can make this difficult)

3 Research Phases of PAR:

Look: build the picture with stakeholders, so problem is defined on their terms and problem definition reflects community context Think: interpret and analyze what is learned in look phase Act: the planning, implementing and evaluating based on information collected and interpreted

Criterion Related Validity -

Looking at the correlation of the test being valid to actually reflect that phenomenon

Sample Size in QL Research

Looking for adequate depth or richness of data Adequate when saturation & verification met Saturation: - of data when additional sampling provides no new info, only redundancy of previously collected data Verification: - of data when researcher confirms hunches, relationships, or theoretical models further

What is purposive sampling?

May select individuals typical in relation to the phenomenon under study May seek out individuals different in some way from other participants to get diverse perspectives Snowballing technique is commonly used.

Meta-synthesis & Meta-summary - EBP

Meta-synthesis: systematic compilation and integration of qualitative study results to expand understanding and develop a unique interpretation of study findings in a selected area. - Focus is on interpretation rather than on combining study results. Meta-summary: summarizing of findings across qualitative reports to identify knowledge in a selected area. - Meta-summary identified as a step in conducting meta-synthesis

Expedited institutional review procedures -

Minimal risk - the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or tests. - can be used to review minor changes in previously approved research - Review may be carried out by the IRB chairperson or one or more experienced reviewers designated by the chairperson from among members of the IRV. - The reviewer may exercise all authority of the IRB except disapproved - has to be a complete review

3. Nondirectional vs. Directional Hypotheses

Nondirectional - States relationship exists between variables, but does not predict nature of relationship Directional - States nature (+ or -) of interaction between 2+ variables - Developed from theoretical framework, literature, or clinical practice - All causal hypotheses are directional - states if the relationship is positive and negative (increase hours will increase med errors)

Type I error

Null hypothesis is rejected when its true

Sample retention:

Number of subjects who remain in and complete a study

Who is involved in the critical appraisal of studies in nursing?

Nursing Students Practicing Nurses Nurse Educators Nurse Researchers

What is the history of nursing research?

Nursing research has evolved slowly over the years. Nursing research began in the 19th century with Florence Nightingale. Clinical research is the current major focus of nursing research and will continue to be so throughout the 21st century.

Outcome Based Research - How it Differs

Outcomes - Clinical endpoints - Functional status - General well-being - Satisfaction with care - Researchers are from a mix of disciplines (economics, public health and nursing) - Uses unique theoretical framework to focus on health outcomes

Compare two quantitative measurements taken from the same individual

Paired t test Wilcoxon signedrank test

Population

Particular grp of individuals or elements who are the focus of the research Target population: Entire set of individuals or elements who meet the sampling criteria - ex. female, 18 yrs of ages or older Accessible population: Portion of the target population the researcher has reasonable access to - country, state, hospital, nursing unit etc.-> researchers obtain the sample from the accessible population by using a particular sampling method or plan, such as, sample random sampling Elements: Individual units of the population and sample - Person, event, object

Estimate the degree of association between two quantitative variables

Pearson coefficient of correlation Spearman's rank correlation

Acceptance rate:

Percentage of subjects meeting criteria and consented to participate 80 subjects approached and 76 accepted 76 / 80 = 0.95 = 95% acceptance rate

Refusal rate:

Percentage of subjects who declined to participate 80 subjects approached and 4 refused 4 / 80 = 0.05 = 5% refusal rate

What are the typical sources included in a literature review?

Periodicals and journals - Internet publications - Monographs - Encyclopedias - Conference papers - Theses and dissertations - Books and textbooks

Evidence based practice principles:

Phase 1 - Preparation - involves determining the purpose, focus and potential outcomes of making an evidence-based change in a clinical agency. Phase 2 - Validation - the research reports are critically appraised to determine their scientific soundness. Phase 3 - Comparative Evaluations/Decision Making - includes: 1. Substantiation of the evidence 2. Fit the evidence with the healthcare setting. 3. Feasibility of using research findings. 4. Concerns with current practice. Phase 4 - Translation and application - involves planning for the research evidence in practice. Phase 5 - Evaluation - is to evaluate the impact of the research-based change on the healthcare agency, personnel, and patients.

What are the five approaches to qualitative research?

Phenomenological Grounded theory Ethnography Exploratory-descriptive-qualitative Historical

Types of Outcomes Measured - Functional status

Physical Mental Social Role

Population - QN

Population All elements that meet certain criteria for inclusion in study Example: all women students in higher education

3. Cluster Sampling

Population is divided into groups or clusters and a simple random sample of the groups is selected. Ex.) list of provinces, cities, hospitals, units - Multiple stages - Geography dispersed sample, the researcher cant identify the individual elements making up the population and therefore cannot make a sampling frame

What are the two types of sources?

Primary sources - In research, written by the person(s) who conducted the research - In theory, written by the theorist(s) who developed the theory Secondary sources - Paraphrase the works of researchers and theorists.

What is Qualitative Research?

Qualitative (QL) research involves the study of "things in their natural settings, attempting to make sense of or interpret phenomena in terms of the meanings people bring to them - By nature QL research is exploratory.

Face Validity -

Quick look. Does it look like it makes sense? Reliable? Valid?

What is the best way to skim a research report? - QN

Quickly review source for broad overview. Read title, author's name, abstract, introduction, and discussion. Examine conclusions and implications. Give preliminary judgment of study. Requires the use of a variety of critical thinking skills, such as skimming, comprehending, and analyzing, to facilitate an understanding of the study.

1. Simple Random Sampling

Randomly selected from sampling frame Ex.) Using a computer program, "draw from hat", table of random #s

What is an interval scale?

Ranking data. Zero is arbitrary, which means it does not mean there is none of it.

What is a ratio scale?

Ranking order, and zero has a value. Ex. Height, weight

Heterogeneous sample:

Represents a broad range of values - Used when a narrow focus is not desirable (ex. If too narrow, hard to find adequate sample size and can limit generalizability) - may broadly define the criteria

Research ethics provides guidelines for the responsible conduct of research, including

Research data Research methods Relationships involved in the research

Why are critical appraisals of studies implemented in nursing?

Research is critically appraised to: - broaden understanding, - improve practice, and - provide a knowledge base for future research (adding on new information)

Research Problem and Purpose - QN

Research problem is an area of concern needing research for nursing practice. - The problem identifies, describes, or predicts the research situation. Research purpose comes from the problem and identifies the specific goal or aim of the study. - The purpose includes variables, population, and setting for the study.

How is feasibility of problem and purpose identified?

Researcher expertise - area of study Money commitment/funding source - to complete Time commitment Availability of subjects (QN), participants (QL), facilities, equipment Ethical considerations - approval from an ethics board

Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans - The guidelines in this Policy are based on the following three core principles:

Respect for Persons - self determination (participant is able to voluntarily participate - able to withdraw to a certain point, full disclosure (benefits and risks) Concern for Welfare - Justice - confidentiality, how you are keeping the results and presenting, fair treatment

Limitations - QN

Restrictions in a study that may decrease the credibility and generalizability of the findings Theoretical limitations - Restrict the generalization of the findings - Reflected in the framework and definitions Methodological limitations - Restrict the population to which the findings can be generalized - May result from an unrepresentative sample or weak design

Informed Consent rights

Right to Anonymity and Confidentiality Right to Fair Selection and Treatment Right to Protection from Discomfort and Harm Right to Privacy (HIPAA) Right to Self-Determination

What measures of control can be utilized in quantitative research?

Rules that are followed to decrease the possibility of error in part determine the design of the study. Different levels of control depending on study - Quasi-experimental studies partially controlled regarding selection of subjects - Experimental studies highly controlled because of precision of sample selection

3 STEPS FOR CRITICAL APPRAISAL - QL Research Study

STEP 1: Identifying the Components of the Research Process STEP 2: Determining the Strengths & Weaknesses STEP 3: Evaluating the Trustworthiness & Meaning of Study Findings

3 STEPS FOR CRITICAL APPRAISAL - QN Research Study

STEP 1: Identifying the Steps of the Research Process STEP 2: Determining the Strengths & Weaknesses STEP 3: Evaluating the Credibility & Meaning of Study Findings

Outcomes Studies - Methodologies

Sample methods - random sampling is not used Heterogeneous - Varied types of patients Unrestricted sampling criteria Larger samples Large databases

assessing the quantitative research design - Sample

Samples are drawn from populations.

How is the process similar for qualitative and quantitative research?

Select topic. State problem or question. Justify significance of study. Design study. Identify and gain access to data sources. Select study subjects.

Which methods are unique to qualitative research?

Selection of subjects Researcher-participant relationship Data collection methods - interview Data management Data analysis - analyze the information Interpretation

Common mixed methods designs: Sequential

Sequential a. Exploratory - begins with the qualitative phase of the mixed methods study followed by the quantitative phase (this is the timing). The qualitative phase explores the topic so that the second part (quantitative) can build on the results found in the first phase. Usually more weight would be given to the first phase interviews. b. Explanatory - involves collection and analysis of quantitative data in the first part of the study followed by collection and analysis of qualitative data to further explain and build on the first set of results.

2. Simple vs. Complex Hypotheses

Simple - states relationship (associative or causal) between 2 variables Complex - states relationship (associative or causal) between 3+ variables - independent variable and 2 or more dependent

Research Setting

Site or location where study was conducted Natural Partially Controlled Highly Controlled

Bias

Slant or deviation from the true or expected

two major types statistics used to analyze quantitative data? - Inferential

Some examples are: linear regression analyses, logistic regression analyses, ANOVA, correlation analyses, structural equation modeling, T-test, Chi square

4. Statistical vs. Research Hypotheses

Statistical - Null hypothesis (Ho) - rejecting that there's no relationship - States there is no difference or relationship between variables - Can be simple or complex, associative or causal Research - Alternative hypothesis (H1 or HA) to Ho - States relationship exists between 2+ variables - Can be simple or complex, associative or causal, nondirectional or directional

Meta-analysis - EBP

Statistically pools results from previous studies into single quantitative analysis Allows for application of scientific criteria For example, sample size, level of significance, variables

Complete institutional review procedures -

Study has greater risks than minimal - traumatic triggers Researchers must ensure these things in order for approval 1) minimized risk 2) Risks are reasonable in relation to anticipated benefits 3) Selection of subjects is fair 4) Informed consent from participants 5) Consent will be documented 6) Research plan makes adequate provision for monitoring data collection for pt. safety 7) adequate provisions are made to protect the privacy of subjects and maintain confidentiality

How would you communicate findings? - QN

Summarize major elements of a study and identify contributions of study to nursing knowledge Present at professional meetings and conferences Publish in journals and books

Chi-Square Test of Independence

Tests for differences between expected frequencies if groups are alike and frequencies actually observed in the data Ex of how to report results: 2 = 4.98, df = 2, p = 0.05

Analysis of Variance (ANOVA)

Tests for differences between means More flexible Multiple versions of ANOVA are available. Reported as F = 9.75 (2, 95) (p = 0.002) Post hoc tests are used to determine the location of differences.

Analyzing and Reporting Results Parametric Statistical test Pearson Correlation:

Tests for the presence of a relationship between two variables

PAR Data Analysis

The "think" phase, where what has been learned is interpreted or analyzed. Researchers and community members reflect on data: - Coding and categorizing to reveal patterns and themes - Evidence for specific ways to address problem Findings presented to and discussed by participants, then shared in reports.

Probability

The likelihood of accurately predicting an event Therefore, what is the likelihood that a specific cause will result in a specific effect?

Treatment:

The stimulus given to a dependent variable.

assessing the quantitative research design - Population

The target group under investigation, The population is the entire set under consideration.

Goal of meta-analysis

The ultimate goal of a meta-analysis is to determine if an intervention: 1. Significantly improves outcomes. 2. Has minimal or no effect on outcomes. 3. Increases the risk of adverse events

Consent in Research Vulnerable Participants and what the researcher must do

The vulnerable individuals' capability to protect one-self from risks is decreased, and they are unable to make informed choices. Research must: - pay attention when designing studies - have unique recruitment considerations - have quality scrutiny measurements of overall safety and efficacy

What do mixed methods do:

They merge two data sets by actually bringing them together, connecting the two datasets by having one build on the other and are embedding one dataset within the other.

Causality and multi causality

Things have causes and causes leads to effects - examine relationships The presence of multiple causes for an effect

Compare means between two distinct/independent groups

Two-sample t-test (Parametric) Wilcoxon ranksum test (nonparametric)

Homegeneity

Type of reliability testing used with paper and pencil or scales to address the correlation of each question to the other question within the scale ➢ Looks at the variances ➢ Collect data and the variances between the mean. Those variances around the mean, when compared with another sample, would be similar. ➢ Should have a middle --> Some people fall above and some fall below ➢ Allows you to generalize it

What factors are important in comprehending a research report?

Type of study conducted—highlight key points Knowledge available on topic Expertise of researcher - Replication versus original research Funding resources of researcher - Amount of funding - Sources of funding

What are three types of descriptive designs would you look for in quantitative research studies?

Typical descriptive design - used to examine variables in a single sample, identifying the variables within the phenomenon of interest, measuring the variables, and describing them Comparative descriptive design - used to describe variables and examine differences in variables in two or more groups that occur in a natural setting Case study design

History of Ethics in Research

Unethical research studies Creation of ethical codes and regulations Ethical reviews Consent

5. Theoretical Sampling

Used to develop selected theory through research process Used in grounded theory research

Regression Analysis

Used to predict the value of one variable when the value of one or more other variables is known - predict the value of one variable based on the value of one or more variables - The outcome of analysis is the regression coefficient R. - The R2 is also called the coefficient of multiple determination. Reported as R2 = 0.63

Research Utilization -EBP

Using research findings to improve client care - Dissemination - publications, conferences, consultations, training programs - Critique studies - Synthesis of findings - Determine applicability for practice - Development of evidence based standard/guideline - Implementation standard - Evaluation of practice with respect to staff, clients, cost, resource utilization

Sample Size in QN Studies

Usually larger Power analysis: - ability to detect differences or relationships that exist in the population (or to correctly reject Ho) - Standard power of 0.8 (or 80%) 20% chance of type II error (fail to detect existing differences/relationships)

Assessing the quantitative research design: Variables

Variable: can vary Independent Variable: manipulated Dependent Variable: measured Hypothesis: predicting statement

Variables & Research Concepts

Variables: (QN) - qualities, properties, or characteristics of people, things, or situations that are manipulated or measured in research - measurable with instruments and/or intensity scales. (pain scale) Research concepts: (QL) - ideas, experiences, situations, or events investigated - Often focus of study is to define or describe concept(s) being studies

Determining Significance of a Study Problem and Purpose

Was knowledge that affects nursing practice generated or refined: - Influences nursing practice - Build on previous research - Promotes theory testing or development - Addresses current nursing concerns or priorities Fulfills 1 or more, relevant to us/significance

What is involved in critically appraising a study design? QN

Was the type of design identified? Was the study design linked to the purpose and/or objectives, questions, or hypotheses? Were all variables manipulated or measured? If the study included a treatment, was it clearly described and consistently implemented? Were extraneous variables identified and controlled? What were threats to design validity in the study? Was a pilot study performed? How adequate was the manipulation? What elements should have been manipulated? How valid are the findings? Is there another reasonable (valid) explanation for the study findings? Identify elements controlled in the study. Identify possible sources of bias. Are there elements that could have been controlled to improve the study design? What elements of the design were manipulated, and how?

Statistical Conclusion Validity -

Were there conclusions appropriate and accurate on the phenomenon?

Questions that would apply to the Iowa Model

What are effective strategies for implementation? What are outcomes from using the research findings? Do the data support the change? Is the proposed change an agency priority?

Case study method: Research Question

What are the details and complexities of the story of...? Questions about issues that serve as a foundation to uncover complexity and pursue most common cases, or instead select most unusual cases.

PAR: research Q

What community practices can improve the health of this group of people? Frame question with community members by asking who, what, how, where, when - Researcher is consultant - Look phase Aim - to improve situation by proposing tentative changes

What questions are important when critically appraising statistics in a study?

What statistics were used to describe the characteristics of the sample? Are the data analysis procedures clearly described? Did statistics address the purpose of the study? Did the statistics address the objectives, questions, or hypotheses of the study? Were the statistics appropriate for the level of measurement of each variable?

What questions are important in an initial research critique? - QN

What type of study was conducted? What was the setting for the study? Were the steps for the research process clearly identified? Were any steps missing? Did the steps logically link together?

Type II error

When the null hypothesis is regarded as true but is in fact false - often caused by flaws in the research method

Sample attrition:

Withdrawal or loss of subjects from study Attrition rate = # of subjects withdrawing ÷ # of study subjects × 100

Randomization:

allocating subjects to experimental and control groups

One- and Two-sided hypotheses:

alternative hypothesis

Deductive:

conclusions are formulated about facts from general or universal premises

Sampling method or plan:

defines selection process

A Conceptual Definition

defining a specific concept (variable), so it can be systematically measured.

Experimental - QN

is an objective, systematic, highly controlled investigation conducted for the purpose of predicting and controlling the phenomena in nursing practice i.e. controlling the time of day when blood pressures are recorded.

The risk difference (RD) meta-analysis

is called the absolute risk reduction. Ask is the risk of an event in the experimental group minus the risk of the event in the controlled or standard care group.

The odds ratio (OR) (meta-analysis)

is defined as the ratio of the odds of an event occurring in one group, such as the treatment group, to the odds of it occurring in another group, such as the standard care group. The OR is the way of comparing.

Correlation

measures the degree of relationship between pairs of interval variables in a sample

Levels of review: Exempt from review procedures

pose no apparent risks for the research subjects

Descriptive - QN

provides an accurate account of characteristics of a particular individual, group or situation. i.e. conducted with large numbers of subjects or groups in natural settings with no manipulation of the settings.

Sampling:

selecting a grp of ppl, events, objects, or other elements to conduct a study

Statistical Hypothesis:

statistical inference- Was the intervention being implemented and di not happen by chance. Ex. Null, direction

An Operational Definition-

the actual method, indicating how the concept will be measured

Analyzing and Reporting Results: Generalizations

the application of information that has been acquired from specific to a general making careful inferences.

Reliability: Internal Consistency

• Are the questions matching the concepts? They should correlate • Internal consistency reliability ➢ Average inter-item correlation - More reliable ➢ Split-half reliability • Example: • If Cronbach Alpha is 0.3, and • Cronbach's Alpha scales are: ➢ .00 to .69 = Poor ➢ .70 to .79 = Fair ➢ .80 to .89 = Good ➢ .90 to .99 = Excellent/Strong • What should you do? Poor, go back and make sure it's testing the concepts right

Reference of Measurement - Criterion-referenced testing

• Comparison of a subject's score with a criterion of achievement that includes the definition of target behaviors • When behaviors are mastered, the subject is considered proficient in the behaviors. • Criteria to cut off. Comparing the subject group to the criteria

What is a Measurement Error?

• Difference between the true measure and what is actually measured ➢ Systematic Error: The variation in measurement is in the same direction, has a pattern (Ex. Instrument was wrong) ➢ Random Error: The difference is without pattern (Ex. Irregular changes in heat)

Threats to Validity - Internal Validity Selection:

• A Selection-History - Event occurring between the pre/post test effects the groups differently • A Selection-Maturation - When there is different rates of growth between the groups (pre/post) • A Selection-Testing • A Selection-Instrumentation - Instrument in pre/post test might have fit better • A Selection-Mortality - Drop out • A Selection-Regression - Move towards two means at different rates. Why did that regression occur?

What Factors are Associated with Physiological Measures?

• Accuracy - The deviation of a measurement from a standard or true value being measured. • Precision - How close a group measures are to one another --> Reliability • Specificity - "True Negative" Ex. Percentage of healthy people who are correctly identified as not having the condition • Sensitivity - "True Positive" Ex. The percentage of sick people who are correctly identified as having the condition

What are the concepts of measurement theory? - QN

• Directness of Measurement: Direct or indirect ➢ Direct: Determining the values of concrete things (Weight, height) ➢ Indirect: Trying to measure things like pain • Measurement Error • Levels of Measurement - Nominal, ordinal, interval, ratio • Reliability - Ability to reproduce • Validity - Looking to see if you're measuring what you're supposed to be

Assessing Reliability

• How is the reliability of raters tested? ➢ Inter-Rater - Different people with the same test ➢ Test-Retest - The same people do the test, but at different times ➢ Parallel Forms - Both, different people same time, but different test

How Would you Critically Appraise Reliability in a Study?

• How well the tool was tested --> How? • Did the analyze if the tool was appropriate?

How Would you Critically Appraise Methods of Measurement?

• Look if they're clearly identified, are they described, levels of measurement, appropriate methods for reliability and validity • Is there any other reason why these results could occur?

Mulitvariate Bivariate Univariate

• Multivariate - Looking at multiple variables and trying to predict the relationships, and maybe trying to predict if one variable effects another • Bivariate - Comparing a bit more complex. Comparing different variable being • Univariate - Simplest form of analysis

How would you describe nominal scale?

• Nominal - Putting things into categories (QN - Numbers)

What is an ordinal scale?

• Ordinal - Rank things in order. Ex. Low, medium, high

What is the Difference Between Reliability and Validity?

• Reliability refers to reproducing measures. Ex. How well an instrument can be used in one person, to the next... • Reliability = precision • Validity refers to the similarities for the experiments values compared to the value in the real world • Validity = Accuracy

Types of Results for statistics - QN

• Significant and Predicted Results - Formed from a research question, a framework, quite formulated • Non-Significant Results - Results might not be significant, but they still make a difference because we then know that intervention may not be good • Mixed Results - Result that was supposed to show a change in two variables, but results are only shown for one. Ex. See changes physically in anxiety, but not emotionally. • Unexpected Results - See the relationship between variables that are not hypothesized. You would then usually explore those results more to see how true they are

What are the Types of Reliability?

• Stability: Focuses on consistency of repeated measures. Tested for stability • Equivalence: Focuses on comparing two versions of the same instrument. Should get equivalent • Homogeneity: Addresses the correlation of various items. Range consistent with first and second test

What is Reference Measurement? - Norm-referenced testing

• Tests performance standards that have been carefully developed over years with large, representative samples using a standardized test with extensive reliability and validity • Take data and compare it to the norm • Want to make sure the data you're comparing to is valid

Reliability - how it is estimated

• There are two ways that reliability is usually estimated: 1. Test/Retest - More conservative. Put out a test, should get the same score on the test 2. Internal consistency - Questionnaires measuring the concepts, questions match what they're supposed to

Test-Retest

• Want a shorter gap between • Longer the gap between --> Things can come into play and may cause a difference

Threats to Validity - internal

➢ History - Historical event that effects your study, impacts results ➢ Maturation - Occurs when an event occurs over the course of time ➢ Testing - Pre/post test --> Someone will have seen the questions previously. Can influence your results ➢ Instrument - Instrument might not have been the best for testing ➢ Mortality - When people drop out of the study, impacts results. Has to be noted ➢ Selection

What is validity? - internal and external

➢ How sound your research is overall • What is internal validity? ➢ Internal: Flaws within the study itself (Design, interpretation) • What is external validity? ➢ External: Talking about how much you can generalize he study to the population

Looking for Normal Distribution Violations:

➢ Looking at the distribution to see if it's normal Shape, skewness, hysteresis

Threats to Validity - External:

➢ Selection - Bias (Select a sample specifically) ➢ Reactive - Effects the experimental arrangements ➢ Measurement - Multiple variables come into play, and affect the results. Researcher should talk about them