Research Exam 1

Generalizability

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

Bracketing

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

Retrospective design

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

PICOT/PICO/PIO

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

Deductive reasoning

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

Inductive reasoning

The process of reasoning from specific observations to more general rules

Coding

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

Sample

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

Barriers to research utilization

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

Sources of Evidence for Nursing Practice

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

Purpose of review of literature in qualitative and when done

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

Difficulty with reading research articles and tips

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

Role of nurses in research

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

Time-series design

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

clinical practice guidelines

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

Replication of studies

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

One-shot case study (also called preexperimental)

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

Cochrane Collection NINR Research Priorities

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

Limitations to EBP

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

Pilot study

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

Meta analysis research

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

Coding for qualitative studies

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

Critical theory research

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

Theory

An abstract generalization that presents systematic explanation about relationships among phenomena

Descriptive phenomenology

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

Causality

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

Posttest only

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

Longitudinal

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

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

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

Research utilization

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

Examples of research utilization by the nurse

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

Research proposal

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

Evidence based medicine

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

Empiricism

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

Correlational research

Examines relationship between or among variables Looks for predictability

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

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

Action participatory research

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

Theoretical framework

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

Content of Research Journal Articles

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

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

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

3 things involved with experimental design?

Manipulation (intervention), randomization of groups, control

Preparing a written review

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

Literature review terms

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

Literature Review

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

Descriptive research

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

Etic (outsiders view)

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

PICO/PICOT

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

Florence Nightingale as a nurse researcher

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

Quantitative research

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

Experimental research

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

RU vs EBP

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

Emic (inside view)

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

Descriptive

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

Purpose and goal of research specific to nursing profession

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

Hypothesis

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

Nonexperimental research

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

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

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

Limitations & threats to internal and external validity

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

Assumptions

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

Rigor

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

Hierarchy of research evidence

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

Saturation

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

Replication

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

Population

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

Research utilization (RU)

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

Evidence-based practice

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

Quasi experimental research

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

Approaches to both types of research

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

Uniqueness of qualitative methodology

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

Top of evidence hierarchy?

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

Content analysis

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

Thick descriptions

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

Ethnographic

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

Phenomenology

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

Applied

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

Grounded theory

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

interpretive phenomenology

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

descriptive phenomenology

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

Data collection methods: Qualitative research sampling

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

Case studies

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

Strategies to enhance quality in qualitative inquiry

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

Qualitative Analysis Challenges & Management/Organization & analysis

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

Benner's hermeneutic analysis

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

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

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

CURN project

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

Themes

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

Research problem

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

Member checks

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

Constant comparison

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

Basic (pure)

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

Data collection methods: Snowball sampling

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

Internal criticism in historical research

Concerned with the accuracy of a record

External criticism in historical research

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

Ethics in qualitative

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

Qualitative research

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

pretest-posttest

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

Thematic analysis

Cultural themes uncovered in ethnographic research analysis (qualitative research)

Focus groups

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

Generalization

General statement or concept obtained by inference from specific case studies

Independent/Dependent variables

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

Systematic reviews

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

Content analysis

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

Data collection methods: Theoretical sampling

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

Analyzing evidence from searches

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

Lit review: primary and secondary sources

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

Writing a lit review

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

Primary and secondary sources

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

Dissemination of qualitative findings

Process of sharing research findings in many places

Triangulation or mixed methods

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

Trustworthiness

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

Historical (history based)

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

Patterns

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

Gathering Qualitative Self-Report Data

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

Symbolic presentation of research designs

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

Data collection methods: Purposive sampling

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

APA

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

Planning a qualitative study

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

Researcher credibility

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

Van Manen's Phenomenological Method: Six Activities

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

Purpose of studying research for a BSN student

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

Data collection methods: Convenience sampling

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

Credibility

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

Dependability

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

Confirmability

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

Nurse's role in research

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

Search strategy terms

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

Cross-Sectional Study

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

Control

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

Correlational/Predictive

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

Operational definitions

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

Principle Investigator (PI)

lead person in research group (doctor or masters)

Descriptive/exploratory

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

Prospective design

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

RCT

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

Evidence summary

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

Descriptive qualitative studies

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

Transferability

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

Authenticity

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

Conceptual definition

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

Sources of EBP

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

Lincoln and Guba

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