Nursing Research 1
■ Documentation of nursing care is essential for risk management and quality improvement. Documentation must include the patient assessment, the nursing care plan, the child's responses to medical therapies and nursing care, and the regular evaluation of the child's progress toward nursing goals.
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b. Predictive Correlational Design
-Predicts value of one variable based on values obtained for other variables -Independent and dependent variables are defined. -Independent variables most effective in prediction are highly correlated with dependent variables -Required development of theory-based mathematical hypothesis proposing variables expected to effectively predict dependent variable
The AHRQ funds research studies focused on the following topics:
-Quality improvement and patient safety -Outcomes and effectiveness of care -Clinical practice and technology assessment -Health care organization and delivery systems -Primary care (including preventive services) -Health care costs and sources of payment
Barriers to EBP
-Lacks research evidence in many areas -May create a "cookbook" approach to care -Guidelines are based on population data then applied in practice to individual patients -Lack of resources to support implementation of EBP
■ Efforts to increase the number of children with access to health care include the State Children's Health Insurance Program (SCHIP) currently being implemented nationwide.
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■ Families are always disrupted by a child's hospitalization, and various approaches can help them to understand the process and cope more successfully with this challenge.
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■ Family-centered care is a method designed to meet the emotional, social, and developmental needs of children and families needing health care.
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What is Cronbach's alpha?
-The most common measure of internal consistency is called Cronbach's alpha. Generally, alphas in the .60-.70 range are considered acceptable, though of course the higher the better.
Results
-findings. -description of participants. -names of statistical tests used. -values of calculated stats. -the significance
Discussion
-interpretation of results. -clinical and research implications. - study limitations and ramifications for the belivievability of results
■ Federal regulations require a formalized ethical decision making process to assist healthcare providers and families in making important decisions about witholding, withdrawing, or limiting a child's therapy.
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■ Grief is individualized. Not everyone dealing with a loss will experience all of the stages (denial, anger, bargaining, depression, and acceptance), and individuals who do experience all stages may not experience them in the sequence listed.
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■ Hospitalization is a stressful event for all children and their families, especially when the hospitalization is unplanned and sudden.
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■ In an effort to cope and feel a sense of control over the family's life, the parents may use normalization, a process of focusing on those aspects of family life and routine that are similar to other families while integrating the needs of the child with a chronic condition.
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■ Infancy spans the time from 1 month to 1 year, and is marked by rapid physical growth, mastery of basic fine and gross motor skills, and beginning cognitive and language skills.
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■ Influences on the developmental process include one's genetic potential and a series of environmental influences unique to each family and individual.
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Agency for Healthcare Research and Quality (AHRQ)
An agency of the U.S. Department of Health and Human Services that aims to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services
Confidentiality
An agreement between a patient and a provider that information discussed during the healthcare encounter will not be shared without the permission of the patient.
palliative care
An approach which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment, and treatment of pain and other physical, psychosocial, and spiritual problems.
research problem
An area of concern in which there is a gap in the knowledge base needed for nursing practice. research is conducted to generate essential knowledge to address the practice concern, with the ultimate goal of providing evidence-based practice.
In published research literature, a primary source refers to
An article written by the people who did the study
compassion fatigue
An emotion that comes from knowing about the traumatizing events experienced by families and the stress from helping or wanting to help that family.
3. The healthcare setting where Drew receives care has an evidence-based clinical pathway for the management of children with seizures. Identify a clinical pathway that has been developed for a pediatric healthcare condition in your healthcare setting. How is the clinical pathway used and how does this process differ from implementation of a nursing care plan?
An example of a clinical pathway would be for children with asthma in the hospital setting. The pathway is utilized by all care providers from the emergency department and the inpatient units. It dictates all aspects of care from an interdisciplinary standpoint. The plan includes medical interventions, diagnostic tests, comfort measures, family centered care, goals and outcomes, and discharge parameters. It differs form a nursing care plan because it is developed and implemented by ALL health care team members. The nursing care plan is specifically individualized for the child and family, whereas the clinical pathway is a general population guideline.
4. Depends on the type of study
At what point is the literature review conducted in a qualitative investigation? 1. Prior to study implementation 2. During study implementation 3. After study completion (otherwise it will influence the researchers openness) 4. Depends on the type of study
A patient states that he does not believe in the existence of God. This patient most likely is an: A) Academic. B) Atheist. C) Agnostic. D) Anarchist.
Atheist.
Data collection and data analysis occur simultaneously in qualitative research. One technique that is used to help the research to not misinterpret the phenomenon as the subject experiences it is to set aside what is known about the experiences. This technique is called
Bracketing
Scope of the Study
Broad studies require larger samples than narrow studies. The sample size must be adequate for the scope.
Charting by exception
Charting methodology in which data are entered only when there is an exception from that which is normal or expected; reduces time spent documenting in charting. It is a shorthand method for documenting normal findings and routine care.
Which of the following statements about obtaining permission to study children is true?
Children aged 7 or older, with normal cognitive development, may be asked to assent to participating in research
After Zach's death, Joey exhibits out-of-control, aggressive behavior. The preschool teacher sends Joey to the school nurse for timeout. How does the school nurse interpret Joey's behavior, and what interventions are appropriate?
Children experience stages of grief after a significant loss. Joey is in the anger stage. Although aggressive behavior cannot continue in the classroom, Joey needs someone to understand his feelings. The nurse could initiate play therapy sessions to encourage expression of anger in a safe environment. Joey's parents should be informed, participate in the play sessions, and help him come to the acceptance stage.
children with special healthcare needs (CSHCN)
Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require services beyond that usually required by children.
medically fragile
Children who need skilled nursing care with or without medical equipment to support vital functions.
Which of the following potential research subjects have diminished autonomy and are considered incompetent to give informed consent?
Children, Mentally ill, cognitively impaired elderly
A researcher can undertake random sampling by which of the following strategies?
Choosing the participants out of a hat, Using a computer program, Assigning each volunteer a number and then choosing the participants using a random numbers tabe
Hypnotics
Class of drug that causes insensibility to pain and induces sleep.
After entering data into a database, the researcher prints a copy of the data and cross-checks all of the data for accuracy. This process is referred to as
Cleaning the data
Purpose Statement
Clear, concise statement Goal, aim, focus, or objective of study Includes variables, population, and setting
When a full-text article is found in a bibliographic citation database, how does the researcher obtain the article?
Clicking on the link
The process of describing clinical problems, identifying possible courses action, assessing the probability of outcomes, and calculating a optimal course of action is referred to as
Clinical decision analysis
Where do we get research ideas from?
Clinical experience Nursing literature Social issues Theory Suggestions from external sources (e.g., priority statements of national organizations or founders)
What is clinical importance?
Clinical importance is the practical relevance of the findings. There is no common agreement about how to evaluate the clinical importance of a finding.
Nurse Researcher Roles
Clinical nurse specialist (CNS) Clinical nurse researcher (CNR)
What type of interview techniques does the nurse use when asking these questions, "Do you have pain or cramping?" "Does the pain get worse when you walk?" (Select all that apply.) A) Active listening B) Open-ended questioning C) Closed-ended questioning D) Problem-oriented questioning
Closed-ended questioning Problem-oriented questioning
Factor
Closely related variables that are grouped together.
individualized family service plan (IFSP)]
Developed for the early intervention process for infants with special healthcare needs and their families, the IFSP contains information about the services required to support a child's development and enhance the family's capacity to facilitate the child's development.
Sampling Error
Difference between the population mean and the mean of the sample
Measurement Error
Difference between the true measure and what is actually measured
Measurement Error
Difference between the true measure and what is actually measured.
In studies, the intervention is expected to have a small effect size. Which of the following statements about effect size is true?
Differences between groups will be more difficult to detect
Evidence of Validity from Convergence
Determined when a relatively new instrument is compared with an existing instrument(s) that measure the same construct.
Chi-Square Test of Independence
Determines whether two variables are independent or related; the test can be used with nominal or ordinal data.
Potential Funding Areas
Determining disease risk and treatment through utilizing genetic information Determining effective health-promotion strategies for individuals, families, and communities Discovering approaches that encourage people to effectively take responsibility for symptom management and health promotion Assisting in identification and effective management of symptoms related to acute and chronic disease Improving clinical settings in which care is provided Improving quality of caregiving in long-term care facilities, the home, and the community Understanding predisposition to disease, socioeconomic factors that influence health, and cultural health practices that protect from or expose to risk for health problems Improving symptom management for those at end of life
Institutional review boards (IRBs) I universities, clinical agencies, and managed care centers are responsible for reviewing studies involving human subjects for the express purpose of
Determining if potential benefits of the investigation outweigh any risk that may be present to the subject
Evidence of validity of measurement can be obtained by examining
Different groups
What are direct measures?
Direct measures involve determining the value of concrete things, such as height, weight, temperature, (accuracy and precision are important) and of demographic variables such as age gender, and income.
When action is taken on one's prejudices: A) Discrimination occurs. B) Delivery of culturally congruent care is ensured. C) Effective intercultural communication develops. D) Sufficient comparative knowledge of diverse groups is obtained.
Discrimination occurs.
In which section of the research study are the results of the study made clear with language the reader can understand?
Discussion
Which section of a quantitative research report includes the implications of the findings for nursing practice and theory and the recommendation for further research?
Discussion
Which section of a research article provides an interpretation of the study's results?
Discussion
A woman experiences the loss of a very early-term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing? A) Delayed B) Anticipated C) Exaggerated D) Disenfranchised
Disenfranchised
Transcultural nursing
Distinct discipline developed by Leininger that focuses on the comparative study of cultures to understand similarities and differences among groups of people.
Which statement is correct? Disturbed body image related to Bell's Palsy or Disturbed body image related to unilateral facial paralysis or Disturbed body image related to unilateral facial paralysis secondary to Bell's Palsy
Disturbed body image related to unilateral facial paralysis & Disturbed body image related to unilateral facial paralysis secondary to Bell's Palsy
The school nurse is teaching health-promoting behaviors that improve sleep to a group of high school students. Which points should be included in the education? (Select all that apply.) A) Do not study in your bed. B) Go to sleep each night whenever you feel tired. C) Turn off your cell phone at bedtime. D) Avoid drinking coffee or soda before bedtime. E) Turn on the television to help you fall asleep.
Do not study in your bed. Turn off your cell phone at bedtime. Avoid drinking coffee or soda before bedtime.
Measurements
Do the instruments adequately measure the study variables? Are the instruments sufficiently sensitive to detect small differences? Does the instrument have adequate validity and reliability?
Variables
Do the variables reflect the concepts identified in the framework? Are the variables clearly defined? Is the conceptual definition of a variable consistent with the operational definition?
When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? (Select all that apply.) A) Do you use any folk remedies? B) Do you have a family physician? C) Do you use a Shaman? D) Does your family have a history of alcohol abuse?
Do you use any folk remedies? Do you have a family physician? Do you use a Shaman?
Flow sheets
Documents on which frequent observations or specific measurements are recorded.
Literature review
Does it demonstrate progressive development of ideas through previous research? Is a theoretical knowledge base developed for the problem and purpose? Does the literature review provide rationale and direction for the study? Is a clear, concise summary presented of the current empirical and theoretical knowledge in the area of study?
In which type of designs do neither subjects nor individuals administering the treatments know if subjects are receiving experimental interventions or the standard of care?
Double-blind experimental
Three broad schools of phenomenology:
Duquesne school (descriptive phenomenology) Utrecht school (descriptive and interpretive phenomenology) Heideggerian hermeneutics (interpretive)
2. Data collection and analysis
Florence Nightingale is most noted for which of the following contributions to nursing research? 1. Case study approach to research 2. Data collection and analysis 3. Framework and model development 4. Quasi-experimental study design
centration
Focus on only one particular aspect of a situation; common in thoughts of preschoolers.
Equivalence
Focused on comparing two versions of the same instrument (alternate forms reliability) or two observers (interrater reliability) measuring the same event
Integrative review
Focused review and synthesis of the literature on a specific area that follows specific steps of literature integration and synthesis without statistical analysis.
phenomenology
Focuses on the description and interpretation of people's lived experience Asks: What is the essence of a phenomenon as it is experienced by people, and what does it mean? Acknowledges people's physical ties to their world: "being in the world" Four key aspects of experience: lived space, lived body, lived time, lived human relation Main data source: in-depth conversations with a small number of participants who have experienced the phenomenon
Readability Level
Focuses on the study participants.
When preparing a preschooler for a procedure, do you think it would help to have someone who has had the procedure before come and talk with the child? Will the child be interested in hearing the perspective of another?
Probably not. A more effective approach is to teach the child what it will feel like to her. Show her pictures, take her on tours, and let her touch and use stethoscopes and other materials to increase her understanding.
The following set of statements is an example of what type of reasoning? An altered level of comfort is experienced with facial surgery. Therefore, all surgeries result in an altered level of comfort
Inductive reasoning
Which type of reasoning moves from the specific to the general
Inductive reasoning
Describe appropriate methods for preparing children for procedures. Identify techniques appropriate for each developmental level.
Infants will not receive an explanation because parents are given the information. Toddlers should be given a brief explanation just prior to the procedure. A story read to them, or pictures, might be helpful. Preschool-age children also need simple explanations with the opportunity to touch or play with equipment. Toddlers learn well through therapeutic play with safe medical equipment. Simple drawings and stories may be helpful. School-age children will need clear, thorough explanations and the chance to ask questions and have fears acknowledged. Drawings, pictures, books, and videos and handling equipment that will be used are also appropriate. Adolescents should receive clear explanations both orally and in writing. Videos and talking to someone of the same age range who has had a similar experience also are appropriate.
Problem-orientated medical record
Method of recording data about the health status of a patient that fosters a collaborative problem-solving approach by all members of the health care team.
A small urepresentative sample s an example of which of the following?
Methodologcal limitation
Median
Midpoint or the score at the exact center of the ungrouped frequency distribution - the 50th percentile.
In the Iglesias et al. (2012) study, the study participants. . . (Choose all that apply.).
Might have been more likely to participate to please their professor Could be defined as a vulnerable population
Standard of care
Minimum level of care accepted to ensure high-quality care to patients. It define the types of therapies typically administered to patients with defined problems or needs.
Three factors are evident when a healing relationship develops between nurse and patient:
Mobilizing hope for the nurse and patient Finding an interpretation or understanding of the illness, pain, anxiety, or other stressful emotion that is acceptable to the patient Helping the patient use social, emotional, and spiritual resources
Advantages of Quasi-experimental Design
More practical: ease of implementation More feasible: resources, subjects, time, setting More readily generalized: comparable to practice
Multiple Regression
More than one independent variable.
Gold Standard
Most accurate means of currently diagnosing a particular disease and serves as a basis for comparison with newly developed diagnostic or screening tests.
a) Typical Descriptive Design
Most commonly used design Examines characteristics of a single sample Identifies phenomenon, variables, conceptual and operational definitions, and describes definitions
ANOVA (cont'd
Multiple versions of ANOVA are available that can be used in studies examining multiple outcome variables, or repeated measures of outcome variables across several time periods. Can look at between-group variance, within-group variance, and total variance
In conducting a keyword search of a literature database, including the Boolean operator "AND" to connect two words has what effect on the search results?
Narrows the search to include only articles that contain both words
What is the NINR? Where is it? What is its mission? What are some categories for research opportunities / funding from the NINR?
National Institute of Nursing Research. -Bethesda , MD -...
Research focus, 1980s
Naturalistic paradigm More qualified researchers Widespread availability of computers for data collection and analysis Qualitative studies
directional hypothesis
Nature (positive or negative) of interaction between two or more variables is stated These are developed from theoretical framework, literature, or clinical practice example: Attitudes of pediatric nurses toward mentally retarded clients are more favorable than those of medical surgical nurses
Historical examples of unethical research
Nazi experiments Tuskegee syphilis study Jewish Chronic Disease Hospital in New York
Another name for snowball sampling is
Network sampling
allnurses.com
Networking site for students especially in distance learning programs; exchange information, advice, find resources
American Nurses Association smartbriefs.com
News for the nursing profession. Free email of important news.
How do diuretics effect sleep?
Nighttime awakenings caused by nocturia
Is a p-value of 0.35 significant?
No
The following ethnicity data is an example of which level of measurement?
Nominal
Levels of measurement (nominal ordinal, ratio)
Nominal: the lowest level measurement involving the assignment of characteristics into categories. *example* males-category 1, female category 2. Ordinal: a measurement level that rank orders phenomena along some dimension. Ratio: A measurement ratio with equal distances between scores and a true meaningful zero point. *example: weight.
Fictive
Nonblood kin; considered family in some collective cultures.
Two-Tailed Test of Significance
Nondirectional hypothesis.
Using decision theory, if the alpha level of significance for determining differences between groups is set at .05, which of the following probability levels calculated during data analysis has the most significant difference?
None of the Above
What is a normal curve? Bimodal curve?
Normal curve: bell shaped and symmetrical. unimodal: has one peak multimodal: has two or more peaks (2 or more values of high frequency) bimodal: has 2 peaks
What are null, directional, non-directional hypotheses? Give an example of each.
Null: used as the hypothesis to be rejected or accepted. nondirectional: does not stipulate the expected direction of the relationship between variables. directional: hypothesis that can make a specific prediction about the relationship between variables
Based on Gossec's 2012 paper, what type of questions comprised the Qualisex questionnaire?
Numeric rating scale questions
Interval-Scale Measurement
Numerical distances between intervals Absence of a zero point Likert scale scores 1 = Strongly disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly agree
Mode
Numerical value or score that occurs with the greatest frequency; it does not necessarily indicate the center of the data set.
Which of the following was developed in the late 1940s to address ethical conduct of biomedical research?
Nuremberg Code
Utilization of research findings in clinical areas is slow because:
Nurses are not usually rewarded for using research findings in practice.
Preventative Nursing actions
Nursing actions directed toward preventing illness and promoting health to avoid the need for primary, secondary, or tertiary health care.
-The conduct of clinical research and obtaining increased funding for nursing research.
One major focus of nursing research during the 1980s was:
Disorganized and despair
One of Bowlby's four phases of mourning in which an individual endlessly examines how and why the loss occurred.
Numbing
One of Bowlby's four phases of mourning. It is characterized by the lack of feeling or feeling stunned by the loss; may last a few days or many weeks.
Scientific rigor in qualitative studies requires
Openness in collecting data
Which of the following statements about operational definitions is true?
Operational definitions are developed so that variables can be measured in research
■ Informed consent is the formal preauthorization for an invasive procedure or participation in research. Parents typically give informed consent for children under 18 years of age unless the child is an emancipated minor, a self-supporting adolescent not subject to parental control.
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■ It is essential to work closely with the family when a child's death is imminent, helping to provide the support and services most important to them in the last moments or hours of their child's life.
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■ Major theories of development encompass the psychosexual (Freud), psychosocial (Erikson), cognitive (Piaget), moral (Kohlberg), social learning (Bandura), and behavioral (Skinner and Watson) components of individuals.
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■ Moving the chronically ill child or technology-dependent child to the home setting is a life-changing decision for the family, and it must be done with collaboration between the family and the healthcare team.
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■ Nurses assess the impact of the child's illness or hospitalization on the family unit and provide individualized family-centered care.
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■ Nurses care for children in many different settings: various units within the hospital and outpatient clinics, schools, childcare centers, physician offices, community health centers, rehabilitation centers, and the home.
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■ Nurses must identify culturally relevant facts about their patients to provide appropriate and competent care to an increasingly diverse population.
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■ Nurses who specialize in caring for children with complex chronic conditions may experience compassion fatigue as they continue their efforts to meet the ongoing needs of these families.
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■ One commonly accepted definition of death in the United States is brain death, or the irreversible cessation of all functions of the brain, including the cerebral cortex and brainstem.
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■ Palliative care combines therapies to comfort and support persons with a short life expectancy, by providing therapies to improve the quality of remaining life.
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What are the possible results that you could have with a Pearson's product-moment correlation?
A negative (inverse) relationship (the result will be close to -1) A positive relationship (the result will be close to +1) No relationship. (the result will be close to 0)
Survey
A nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants.
1. Consumer
A nurse who reads research articles and incorporates research findings into nursing practice would demonstrate which of the following research roles? 1. Consumer 2. Primary investigator 3. Collaborator 4. Producer
Significant and Unpredicted Results
Opposite of those predicted by the researcher and indicate that flaws are present in the logic of both the researcher and the theory being tested.
Indirect Measures
Or Indicators. Researchers cannot directly measure an abstract idea, but they can capture some elements of it in their measurements.
True Measure
Or Score. Ideal, perfect measure.
Ordinal-Scale Measurement
Order/ranking imposed on categories Numbers must preserve order 1 = Tallest 2 = Second tallest 3 = Third tallest
What level of measurement is provided by questions 35, 27, 28, and 29 on the EPIC-50 Questionnaire (see the Steinsvik 2011 article).
Ordinal
Which of the following best describes a primary source
Original information Journal Article
-The result of care or in determining the changes in health status of patient.
Outcomes research in health care is oriented toward establishing:
Which of the following research methodologies is (are) being used to generate nursing knowledge?
Outcomes research, qualitative research, and quantitative research
Etic worldview
Outsider's perspective.
The nurse identified that the patient has pain on a scale of 7, he winces during movement, and he expresses discomfort over the incisional area. He guards the area by resisting movement. The incision appears to be healing, but there is natural swelling. Write a three-part nursing diagnostic statement using the PES format.
P, acute pain; E, related to incisional trauma; S, evidenced by pain reported at 7, with guarding, and restricted turning and positioning. The PES format stands for: P (problem), E (etiology or related factor), and S (symptoms or defining characteristics).
What are the elements of a PICO question?
P: population or participants of interest I: intervention needed for practice C: comparisons of interventions to determine the best for practice O: outcomes needed for practice
PICO(T) question
P: population or patients I: the intervention, influence, or exposure C: comparative or alternate intervention O: outcome T: time
A widely used EBP model consisting of four components for identifying clinical questions for specific patient problems is known as the ____________ model.
PICO
The nurse in a geriatric clinic collects the following information from an 82-year-old patient and her daughter, the family caregiver. The daughter explains that the patient is "always getting lost." The patient sits in the chair but gets up frequently and paces back and forth in the examination room. The daughter says, "I just don't know what to do because I worry she will fall or hurt herself." The daughter states that, when she took her mother to the store, they became separated, and the mother couldn't find the front entrance. The daughter works part time and has no one to help watch her mother. Which of the data form a cluster, showing a relevant pattern? (Select all that apply.) A) Daughter's concern of mother's risk for injury B) Pacing C) Patient getting lost easily D) Daughter working part time E) Getting up frequently
Pacing Patient getting lost easily Getting up frequently
The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now "in hospice." What does the nurse tell the family member about palliative care? (Select all that apply.) A) Hospice and palliative care are the same thing. B) Palliative care is for any patient, any time, any disease, in any setting. C) Palliative care strategies are primarily designed to treat the patient's illness. D) Palliative care interventions relieve the symptoms of illness and treatment.
Palliative care is for any patient, any time, any disease, in any setting. Palliative care interventions relieve the symptoms of illness and treatment.
Pearson Product-Moment Correlation
Parametric test used to determine relationships among variables.
4. Nursing diagnosis
Problem identification in the research process would be equivalent to which step in the nursing process? 1. Goal identification 2. Data interpretation 3. Identifying solutions 4. Nursing diagnosis
Skills required of nurses
Problem solving Communication Teaching Caring Management
These skills are most effectively learned through activities such as:
Problem-based learning Case studies Diverse projects in many community agencies
2. control.
A researcher designs a study that uses a random sampling method to decrease the likelihood of bias in the study sample. This strategy was used to implement: 1. manipulation. 2. control. 3. data collection. 4. experimental research.
1. applied research.
A researcher investigates the effect of frequency of position change on healing of decubitus ulcers. The study would be described as: 1. applied research. 2. basic research. 3. descriptive research. 4. phenomenological research.
What is a likert scale?
A type of rating scale that typically has four, five or seven categories that address agreement, evaluation, or frequency. Ex. strongly agree, agree, uncertain, disagree, strongly disagree.
What is stability?
A type of reliability testing that focuses on the consistency of results when a test is repeated. It is also called test-retest reliability. It is expressed as an "r" value with higher numbers = greater test-retest reliability.
what is the agency funded mostly nursing research?
ANA
In performing a complex literature search using a computerized database, what term should be between each of the keywords?
AND
Private Foundations
Private foundations are an important source of funding for health care projects and research. Two of the largest private foundations are the Robert Wood Johnson Foundation and the W.K. Kellogg Foundation.
Which sampling design is the most representative?
Probability Methods
Level of Statistical Significance
Probability level at which the results of statistical analysis are judged to indicate a statistically significant difference between the groups.
The power of a statistical procedure is the
Probability that a statistical test will detect a significant difference if one exists
Power
Probability that a statistical test will detect a significant difference that exists.
If you are conducting a study to examine relationships or predict an event, your study is based on which of the following theories?
Probability theory
What does regression analysis do?
Regression analysis can be used to predict the value of one variable when the value of one or more other variables is already known. Example: can we predict the length of a hospital stay of a patient with a certain diagnosis?
defining characteristics
Related signs and symptoms or clusters of data that support the nursing diagnosis.
What technique(s) best encourage(s) a patient to tell his or her full story? (Select all that apply.) A) Active listening B) Back channeling C) Validating D) Use of open-ended questions E) Use of closed-ended questions
Active listening Back channeling Use of open-ended questions
A team of nursing students on the University of Michigan campus is concerned that the men's basketball team will engage in binge drinking after they win the NCAA tournament. They implement a plan based on the results of the Giske and Cone (2012) article. The plan involves inviting the team members to attend church each week. They communicate the plan to the basketball coach but the coach says, "No way. I've thought about this carefully, and I have decided that they have no time for that." The coach's response is an example of . . . .
Active rejection
Instrumental activities of daily living
Activities necessary for independence in society beyond eating, grooming, transferring, and toileting; include such skills as shopping, preparing meals, banking, and taking medications.
Activities of Daily Living
Activities usually performed in the course of a normal day in the patient's life such as eating, dressing, bathing, brushing the teeth, or grooming.
Review the following list of nursing diagnoses and identify those stated incorrectly. (Select all that apply.) A) Acute pain related to lumbar disk repair B) Sleep deprivation related to difficulty falling asleep C) Constipation related to inadequate intake of liquids D) Potential nausea related to nasogastric tube insertion
Acute pain related to lumbar disk repair Sleep deprivation related to difficulty falling asleep Potential nausea related to nasogastric tube insertion
Non directional hypothesis
Relationship exists between variables, but hypothesis does not predict nature of relationship Ex. Early nursing home residents self appraisal are r/t their conditioning factors between the elder nsg home residents and self appraisal. But no direction.
The most common purpose for Pearson correlational is to examine
Relationships between two variables
Associative hypothesis
Relationships between variables examples: An increase in variable X is associated with an increase in variable Y in a specified population An increase in variable X is associated with a decrease in variable Y in a specified population
What is reliability?
Reliability is defined as the consistency of the measurement method.
Bereavement
Response to loss through death; a subjective experience that a person suffers after losing a person with whom there has been a significant relationship.
Which of the following is a concept?
Restlessness
Data analyses are conducted to reduce, organize, and give meaning to the data. Data analyses are used to produce which of the following?
Results
Correlation (cont'd)
Results Nature of the relationship (positive or negative) Magnitude of the relationship (-1 to +1) Testing the significance of a correlation coefficient Does not identify direction of a relationship (one variable does not cause the other) Are symmetrical
Ethnicity
Shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics.
A community health nurse is making a healthy baby visit to a new mother who recently emigrated to the United States from Ghana. When discussing contraceptives with the new mom, the mother states that she won't have to worry about getting pregnant for the time being. The nurse understands that the mom most likely made this statement because: A) She won't resume sexual relations until her baby is weaned. B) She is taking the medroxyprogesterone (Depo-Provera) shot. C) Her husband was recently deployed to Afghanistan. D) She has access to free condoms from the clinic.
She won't resume sexual relations until her baby is weaned.
Education trends
Shifts in conditions and concerns that emerge from and influence various aspects of society; broad changes in the United States and the world that influence the education and practice of nurses and other providers.
Significance of a study problem and purpose
Should build on previous research Should influence nursing practice Promotes theory testing or development Addresses nursing research priorities
National Institute of Nursing Research (NINR)
The National Institute of Nursing Research (NINR), a section of the National Institutes of Health (NIH), is recognized as the premier organization for funding nursing research. NINR's mission is to promote and improve the health of individuals, families, communities, and populations.
Stage 3 NREM
Stage lasts 15 to 30 minutes. It involves initial stages of deep sleep. Muscles are completely relaxed. Vital signs decline but remain regular. Sleeper is difficult to arouse and rarely moves.
Stage 1 NREM
Stage lasts a few minutes. It includes lightest level of sleep. Decreased physiological activity begins with gradual fall in vital signs and metabolism. Sensory stimuli such as noise easily arouses person. Awakened, person feels as though daydreaming has occurred.
Stage 4 NREM
Stage lasts approximately 15 to 30 minutes. It is the deepest stage of sleep. If sleep loss has occurred, sleeper spends considerable portion of night in this stage. Vital signs are significantly lower than during waking hours. Sleepwalking and enuresis (bed-wetting) sometimes occur. It is very difficult to arouse sleeper.
REM
Stage of sleep in which dreaming and rapid eye movements are prominent; important for mental restoration.
REM Sleep Stage
Stage usually begins about 90 minutes after sleep has begun. Duration increases with each sleep cycle and averages 20 minutes. Vivid, full-color dreaming occurs; less vivid dreaming occurs in other stages. Stage is typified by rapidly moving eyes, fluctuating heart and respiratory rates, increased or fluctuating blood pressure, loss of skeletal muscle tone, and increase of gastric secretions. It is very difficult to arouse sleeper.
Cultural desire
The motivation and commitment to caring that moves an individual to learn from others, accept the role as learner, be open and accepting of cultural differences, and build on cultural similarities
The directional hypothesis for a study is
Substantive theory and/or previous research
Which of the following can be achieved using a correlational design?
Testing of relationships proposed in a theoretical proposition
c) Model Testing Design
Tests accuracy of hypothesized causal model (middle-range theory) All variables are relevant to the model being measured. A large, heterogeneous sample is required. All paths expressing relationships between concepts are identified.
Analysis of Variance (ANOVA)
Tests for differences between means More flexible than other analyses in that it can examine data from two or more groups
Analysis of Variance (ANOVA)
Tests for differences between means of dependent variables.
Agency for Healthcare Research and Quality (AHRQ)
The Agency for Healthcare Research and Quality (AHRQ) is the health services research arm of the U.S. Department of Health and Human Services. Its mission—to improve the quality, safety, efficiency, and effectiveness of health care for all Americans—complements the biomedical research mission of the NIH.
What is a Likert scale?
The Likert Scale is an ordered, one-dimensional scale from which respondents choose one option that best aligns with their view. EXAMPLE: strongly disagree, somewhat disagree,neutral,somewhat agree, strongly agree.
Research studies include both a research hypothesis, which states what the researcher thinks will be found, and a null hypothesis is true?
The null hypothesis states that no interaction occurs between variables or that no relationship exists among the variables being studied
Which of the following statements about a one-tailed test of significance is True?
The researcher is interested in extreme scores in only one tail of the distribution
Written informed consent may be waived in some circumstances that present no more than minimal risk to the potential subject-for example, completion of questionnaires not asking for sensitive data. What is the researcher's responsibility in this case?
The researcher is obliged to inform the potential subject of all of the usual elements of consent (e.g., disclosure of the purpose of the study, obligations of the participant, and voluntary nature of participation) in a cover letter or in some other identified fashion
In searching databases, it is important that the researcher identify keywords to enter into the search process. Which of the following statements about these keywords is true?
The researcher may need to find synonyms of alternate terms to describe the concepts
Which of the following is an example of random measurement error?
The researcher presses the wrong key when entering data into the computer
In nursing research, which of the following researcher factors is most important in relation to statistical analysis?
The researcher should understand the meaning underlying the choice and interpretation of statistics
- abstracts
The researcher uses which portion of the research report to capture the reader's attention?
A type I error occurs when
The results indicate a statistically significant difference when in reality no significant difference exist
Competency outcomes
The results, or end products, of planned study and experience that are focused on specific abilities required for practice.
Justice
The right to fair treatment, the right to privacy.
Respect for Human Dignity
The right to self determination, the right to full disclosure
Triangulation
The use of multiple methods to collect and interpret data about a phenomenon, so as to converge on an accurate representation of reality. Combining qualitative and quantitative methods in a single study.
Which of the following is the best definition of evidence-based practice (EBP)?
Use of theory-derived, research-based information in making decisions about health care delivery, with consideration of individual needs and preferences and the clinical expertise of the provider.
expressive jargon
Use of unintelligible words with normal speech intonations as if truly communicating in words; common in toddlerhood.
How can a nurse manager advance EBP as part of evaluating his or her staff
Use performance criteria related to EBP.
Which nursing measure best promotes sleep in a school-age child? A) Encourage evening exercise B) Offer a glass of hot chocolate before bedtime C) Make sure that the room is dark and quiet D) Use quiet activities consistently before bedtime
Use quiet activities consistently before bedtime
Possible choices for the variables "Education" are given as
did not graduate from high school; high school graduate; college degree; graduate degree. This set of choices is an example of which of the following levels of measurement?: Ordinal
pepsia
digestion
(o)rrhea
discharge
Essential elements of informed consent include which of the following
disclosure of essential information regarding the study, comprehension of essential study information, and competency to give consent
pathy
disease
In a quantitative study , what does sample bias refer to?
distortions that arise when a sample is not representative of the population from which it was drawn.
Clinical nurse researcher (CNR)
doctorally prepared with clinical and research experience Focuses on the conduct or facilitation of research Works with staff to identify research questions Designs studies Disseminates findings to staff, administrators, and legislators Emerging roles DNP and CNL
qualitative
dynamic design context-bound holistichumanas as instruments qualitative info seeks patterns
tympan(o)
eardrum
phagia
eating, swallowing
Quantitative (planning)
entails 6) selecting a research design 7) developing intervention protocols if the study is experimental 8) specifying the population 9) developing a plan to select a sampl 10) specifying a data collection plan and methods to measure the research variables 11) developing strategies to safeguard subjects right and 12) finalizing research plan.
Type II
error occurs when the researcher regards the null hypothesis as true but it is false. The results indicate there is no significant difference, when in reality there is a difference.
Interpersonal skills
essential for effective nursing action. Develop a trusting relationship, express a level of caring, and communicate clearly with a patient and his or her family
types of qualitative designs
ethnography, grounded, phenomenology
Research focus of 21st century
evidence base for practice
A theory has credence until
evidence comes forward to refute it.
Ethical research involves citation of previous researchers and their findings to assist in the
evolution of nursing knowledge and practice.
Concomitant symptoms
experience other symptoms along with the primary symptom
The researcher actively manipulates the independent (causal) variable to determine its effect on the dependent (outcome) variable when using a(n)
experimental design
The three major categories of quantitative research designs are
experimental, quasi-experimental, nonexperimental
Experimental vs non-experimental vs quasi experiemental
experimental: Randomization, Manipulation, Control non-experimental: NONE Quasi- No randomization!
In searching database subject headings, you would use the ____________ technique to broaden the search by locating all records indexed to your search term plus any that include the term in a related, narrower category
exploding
Variables that confuse the effect of the independent variable on the dependent variable, so that the research results do not really reflect a true relationship between the independent and dependent variables are
extraneous variables
Five important characteristics of quality documentation and reporting
factual, accurate, complete, current, and organized.
According to Sandelowski and Barroso, a metasummary lays the foundation for meta-analysis.
false
Major controversy involving qualitative research is that a relatively small amount of terminilogy is used
false
Persistent observation is a quality-enhancement strategy useful for coding and analysis.
false
There are five broad schools of phenomenological analysis.
false
an experimental research design involves a nonrandomized controlled trial
false
clinical trials are an example of observaitional research in medicine
false
in qualitative studies, observation is structured
false
quantitative research tries to identify a phenomenon
false
researchers involved in quantitative research commonly engage in fieldwork
false
statistical results provide the most meaningfull means of comunication about a study's results
false
stratified random sampling is associated with a larger sampling error but is more efficient
false
strongest level of evidence is obtained from individual correlational studies
false
true score is data obtained from the acual research study
false
cross-sectional research designs are helpful in showing patterns of change
false Rationale: Longitudinal studies, in which data are collected two or more times over an extended period, are better at showing patterns of change than cross-sectional studies, which collect data at a single point in time.
reed's self-transcendance theory is an example of a nonnursing model used by nurse researchers
false Reed's Self-Transcendence Theory is an example of a middle-range theory developed by nurses.
An advantage of meta-analysis is that it reduces the risk of a type I error as compared to a single study.
false (reduces risk of type II error)
tachy
fast
primary resource? which journal has mostly primary resources?
first hand reports of facts or findings; in research, the original report prepared by the investigator who conducted the study.
When making a consultation?
first identify the general problem, direct the consultation to the right professional, and provide the consultant with relevant information about the problem.
Research focus, 1950s to 1970s
foci on nurses Teaching Administration Curriculum issues 1970's-improvement of pt. care
Locating published research
focus on the usefulness of computerized databases such as CINAHL and MEDLINE and the Annual Review of Nursing Research
Methodologic:
focuses on development and testing instruments to improve their reliability and validity
Secondary prevention
focuses on people who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions
Qualitative (phenomenology)
focuses on the lived experiences of humans and is an approach to gaining insight into what the life experiences of people are like and what they mean.
If a topic is a priority for the organization, what is the next step in the Iowa Model?
form a team and assemble the relevant research and related literature
poiesis
formation of
done first when designing and planning a quantitative study
formulating a research design
which of the following would be done first when designing and planning a quantitative study
formulating a research design
Common symptoms of sleep cycle disturbances
frequent yawing, restlessness, irritability, moodiness, impaired judgement, inability to concentrate, confusion, increase in traffic, home, and work related accidents
As an undergraduate student, which of the following should be the focus of your literature review?
gathering information
Informed consent requires that a study subject has free power of choice regarding participation and:
general knowledge and comprehension of the study
syn
going together
A non- significant p-value is ______ 0.05? Therefore, you would ______ the null hypothesis.
greater than; accept
plasm
growth
Hand-off reports
happen any time one health care provider transfers care of a patient to another health care provider. The purpose is to provide better continuity and individualized care for patients.
(o)sclerosis
hardening
vital organs
heart, liver, lungs, kidneys, pancreas, intestine
A model of research utilization such as the Rogers model has been designed to:
help nurses and organizations to implement research evidence into practice.
validity
high ______ = high reliability and relevance
> 0.8
high reliability:
Researchers perform a literature review for the purpose of
highlighting areas of needed change. helping to sharpen and focus a research question. identifying gaps in current research.
What are the threats to internal validity?
history, maturation, selection, testing
concepts central to models of nursing care
human beings, environment, health, nursing
A ____________ is a special type of proposition that has a theoretical basis and can be tested empirically.
hypothesis
purposes of research
identification and description. exploration. explanation. prediction and control.
In developing a questionnaire, the researcher should
identify the essential content to be covered
What are the benefits of implementing EBP?
improved outcomes for patients, providers, and healthcare agencies. the evidence has been synthesized by teams of researchers and clinicians to develop strong evidence-based guidelines for practice. it helps agencies meets accreditation requirements and assists with obtaining magnet status
In qualitative research, when are decisions made about data collection and sampling?
in the field
Case management
organized system for delivering health care to an individual patient or group of patients across an episode of illness and/or a continuum of care; includes assessment and development of a plan of care, coordination of all services, referral, and follow-up; usually assigned to one professional.
SIDS
is thought to be related to apnea, hypoxia, and cardiac arrhythmias caused by abnormalities in the autonomic nervous system that are manifested during sleep
Trial and error is not a preferred approach for delivering nursing care because
it is not based on systematic scientific approaches.
what is basic research?
knowledge for knowledge base. background questions. "what is COPD?"
Quasi-experimental:
lacks one of the components of experimental design, i.e., randomization, control group, or manipulation of one or more variables
pleur(o)
lining of lung
which of the following would be an advantage of using a questionnaire
lower cost
sarcoma
malignant tumor
poly
many
Clinical nurse specialist (CNS)
master's degree-prepared nurse who is an expert clinician with additional responsibility for education and research: assesses agency's readiness for research utilization; works with staff to identify clinical problems; helps staff find, implement, and evaluate findings relevant to current practice
Patient adherence
means that patients and families invest time in carrying out required treatments
The difference between the observed score and what exists in reality (true score) is called:
measurement error.
interclass equivalency
measures equaility of two types of methods
interclass stability
measures take place over two or more days
Subjects or participants
members of the sample
Are men or women more affected by obstructive sleep apnea?
men
A type of quantitative study is the ____________, which examines outcomes across a number of studies.
meta-analysis
The concepts that are core to nursing are person, environment, health, and nurse; these are known as the nursing
metaparadigm
Phenomenology:
method used to study intangible experiences such as grief, hope, or risk taking. It is designed to provide an understanding of the patient's "lived experience."
Complex Hypothesis
more than 2 variables example: Both men and women who participated in the CHIP (Cardiac Home Information Program) intervention would have lower levels of psychological distress, higher levels of physical functioning, and fewer adverse symptoms than would women and men who did not participate in such a program
intraclass reliability
more than two variables
stomat(o)
mouth
When outcomes have many causes, the situation is known as
multicausality
What are some typical knowledge-focused triggers in the Iowa Model of Evidence-Based Practice?
new research or other literature national agencies or organizational standards and guidelines philosophies of care observation from institutional standards committee
If an instrument is not reliable can it be valid?
no
If it is not statistically significant is it not realistically significant?
no
What are the four levels of measurement?
nominal (data is a category only - gender) ordinal (data is in categories that can be ranked - pain) interval (data is in categories with equal ranks - temperature) ratio (data has equal ranks and absolute zero - weight)
Intermediate priority nursing diagnosis involve:
nonemergent, nonlife-threatening needs of patients
rhin(o)
nose
What is the problem with the following example? Age: under 18 18 to 25 25 to 40 40 to 65 over 65
not mutually exclusive. response options are not specific enough.
x̄
notation for the mean of the sample
The following statement: "There will be no difference in practice of nurses after completion of an EBP program as compared to before the mentorship program," is an example of a
null hypothesis.
Bowlby's four stages of mourning
numbing, yearning and searching, disorganization and despair, and reorganization
What are some barriers to evidence-based practice?
nursing lacks research / evidence for certain nursing interventions. guidelines may encourage cookbook practice rather than encourage the use of clinical expertise and patient needs / and values. evidence is based on population data and may be difficult to apply to people as individuals. agencies / administrators may not always provide resources to support the implementation of EBP
In the United States during the 1970s, nursing practice included the use of granulated sugar to pack stage III and IV wounds based on the rationale that bacteria would be less invasive of new tissue formation. Over time, this method did not result in statistically significant increase in wound healing time as compared to use of normal saline wet packing. Research was begun to determine what packing method led to best wound healing. The 1970s practices provides an example of
nursing practice based on untested theory
clinical criterion
objective or subjective sign, symptom, or risk factor that, when analyzed with other criteria, leads to a diagnostic conclusion
What is the most common form of sleep apnea?
obstructive
positive evaluation
occur when the patient meets desired outcomes, which leads you to conclude that the nursing intervention(s) were effective
Biculturalism
occurs when an individual identifies equally with two or more cultures
Obstructive sleep apnea
occurs when muscles or structures of the oral cavity or throat relax during sleep. The upper airway becomes partially or completely blocked, diminishing nasal airflow (hypopnea) or stopping it (apnea) for as long as 30 seconds (The person still attempts to breathe because chest and abdominal movement continue, which often results in loud snoring and snorting sounds.
Type I error
occurs when the researcher rejects the null hypothesis when it is true. The results indicate that there is a significant difference, when in reality there is not.
When to consult?
occurs when you identify a problem that you are unable to solve using personal knowledge, skills, and resources.
Exaggerated grief
often exhibits self-destructive or maladaptive behavior, obsessions, or psychiatric disorders. Suicide is a risk for these people.
interclass reliability
only two variables
Give examples of types of questions a qualitative researcher would ask?
open ended, close ended, descriptive
Explicit statements of how a variable will be measured, such as using a rating scale to collect quantitative data regarding pain, are called
operational definitions
quantitative
orderly procedures prespecified plan control over context formal measurement quantitative information seeks generalizations
Creating an EBP culture is an example of contribution at the
organizational level.
In searching a literature database, you would use the ____________ technique to designate which fields (e.g., author, title, subject, publication date) are to be included in the search.
qualification
Credibility is to ________ as internal validity is to________
qualitative :quantitative
research is associated wiht constructivist tradition that involves a dynamic design, holism and is context bound is known as
qualitative research study
metaanalysis use statistics to integrate the findings across ______ studies
quantitative
What are the two types of measurement error?
random error and systematic error
A method of sampling in which all people in the population of interest have an equal chance of being selected to be included in the study is
random sampling.
3 requirements of a true experiment
randomization, manipulation, control
researcher subtracts lowest value of data from highest value of data to obtain
range
Sleep requirements for school age
range from 9-12 hours of sleep nightly, can resist sleeping because of unawareness of fatigue or need to be independent
0-1
range of reliability:
statiscally significant
real and replication good chance
constructivist
reality is multiple and subjective, constructed by indivduals
positivist
realuty exists there is a real world driven by natural causes
Five preparatory activities for the implementation process:
reassessing the patient, reviewing and revising the existing nursing care plan, organizing resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
Rando' R process model
recognizing the loss, reacting to the pain of separation, reminiscing, relinquishing old attachments, and readjusting to life after loss
penia
reduced number
Algor mortis
reduction in body temperature with loss of skin elasticity
patient-centered goal
reflects a patient's highest possible level of wellness and independence in function. It is realistic and based on patient needs and resources.
Rogers indicates that the process by which adopters of research modify innovations to best meet their own needs is:
reinvention.
Causality is the ____________ that exists between a cause and its effect.
relationship
*random* error
reliability measures:
Psychomotor skills
require the integration of cognitive and motor activities. For example, when giving an injection you need to understand anatomy and pharmacology (cognitive) and use good coordination and precision to administer the injection correctly (motor).
An area of concern due to a gap in knowledge that requires a solution that can be described, explained, or predicted to improve practice is a
research problem.
The major difference between experimental and nonexperimental designs is the role of the
researchers
Delayed grief
response is unusually delayed or postponed, often because the loss is so overwhelming that the person must avoid the full realization of the loss.
The ____________ section of a research article outlines the methods used to analyze the data and notes the findings
results
Federal regulations mandate the establishment of institutional review boards whose purpose is to
review and approve research studies
What are some typical problem-focused triggers in the Iowa Model of Evidence-Based Practice?
risk management data process improvement data internal / external benchmarking data financial data identification of a clinical problem
In which situation does the use of key words provide better results than a controlled vocabulary search
searching full text or citation records
Qualitative (grounded theory)
seeks to describe and understand key social and psychological processes that occur in a social setting.
Theoretical Sampling
Used in grounded theory research Data are gathered from any individual or group that can provide relevant data for theory generation. The sample is saturated when the data collection is complete based on the researchers' expectations. Diversity in the sample is encouraged.
Member checking
Used in qualitative data as a method to validate credibility
Exploratory Analysis
Used to examine all of the data descriptively.
T-Test
Used to examine group differences when the variables are measured at the interval or ratio level of measurement.
Regression Analysis
Used to predict the value of one variable when the value of one or more other variables is known.
Grouped Frequency Distribution
Used when continuous variable are being examined.
Nominal-Scale Measurement
Used when data can be organized into categories of a defined property but the categories cannot be rank ordered.
Quota Sampling
Uses convenience sampling, but with a strategy to ensure inclusion of subject types who are likely to be underrepresented in the convenience sample Goal is to replicate the proportions of subgroups present in the population Works better than convenience sampling to reduce bias
The advanced practice nurse can work to implement EBP by
Uses evidence to writes and modify practice standards. Locates relevant evidence and synthesizes evidence for practice. Serving as a coach and mentor in EBP.
Systematic error can be diminished by
Using a valid measurement tool
Cultural imposition
Using one's own values and customs as an absolute guide in interpreting behaviors.
Therapeutic recreation
Using recreational therapy interventions to improve functioning of individuals with illness or disabling conditions.
Sleep requirements for infants
Usually develop a nighttime pattern of sleep by 3 months, several naps during the day, sleeps 8-10 hours during night, 15 total hours of sleep per day
Christianity
Usually in favor of organ donation. Health is important to maintain. Allow time for patients to pray by themselves, with family or friends.
Nursing research is a scientific process that
Validates existing knowledge, refines existing knowledge, and generates new knowledge
Which of the following states the primary characteristic(s) of variables that separate them from concepts?
Values of variables must be able to be measured or manipulated, and the values must vary among the objects, people, or situations in the study
Which of the following are measured in research?
Variables
How does a researcher describe a sample?
Variables relevant to the sample are called demographic variables (age, gender, educational levels). Demographic variables are usually described with descriptive statistics.
Systematic Measurement Error
Variation in measurement values from the calculated average is primarily in the same direction.
Subcultures
Various ethnic, religious, and other groups with distinct characteristics from the dominant culture.
How was the data collected in the Sanders 2008 paper about heart failure? (Choose all that apply.)
Via clinician interviews
What should you document at the time of occurrence?
Vital signs Pain assessment Administration of medications and treatments Preparation for diagnostic tests or surgery, including preoperative checklist Change in patient's status and who was notified (e.g., physician, manager, patient's family) Admission, transfer, discharge, or death of a patient Treatment for sudden change in patient's status Patient's response to treatment or intervention
Which of the following variables can be directly measured?
Vital signs (temperature, pulse, respiratory rate, blood pressure)
As the nurse cares for a patient in an outpatient clinic, the patient states that he recently lost his position as a volunteer coordinator at a local community center. He expresses that he is angry with his former boss and with God. The nurse knows that the priority at this time is to assess the patient's spirituality in relation to his: A) Vocation. B) Life satisfaction. C) Fellowship and community. D) Connectedness with his family and co-workers.
Vocation.
Assent
Voluntary agreement to participate in a research project or to accept treatment.
Stranger anxiety
Wariness of strange people and places, often shown by infants between six and 18 months of age.
Measurement Sensitivity
Was the tool used a reliable and valid measure of the variable? As the variance in the instrument scores increases, the sample size needed to obtain significance increases.
Operational definition
Way of defining a variable that makes it measurable or manipulable in real world example: Smoking rates that were monitored through use of self-report data and validated by corroborating reports from friends and family members. Participants who varied in their answers from their significant contacts or could not be reached by telephone were considered ongoing smokers and were included in the resulting relapse rates.
What are the steps to piloting the change in practice?
select the outcomes to be achieved collect baseline data design and implement EBP guidelines pilot the new guidelines on the unit(s) evaluate the process and outcomes modify the new practice guideline as needed
What are the tasks of data collection?
selecting subjects collecting data in a consistent way maintaining research controls as indicated in the study design protecting the integrity (or validity) of the study solving problems that threaten to disrupt the study
The semantic differential scale consists of:
sets of bipolar adjectives measuring degree of feeling about a concept.
Which of the following statements about clarifying and refining a research problem is true?
several alternative problems should be evaluated before one is selected for study
1. Applied research
What category of research is suggested by the following research question? "Does telephone follow-up by nurses improve patients' compliance with their medication regimens?" 1. Applied research 2. Basic research 3. Practice-related problem solving 4. Quality assurance
The research question of a phenomenological study of the birth of a first child might be
What is the meaning of a woman's lived experience of having a first child
What is the initial question the researcher should ask when selecting a research design for a particular study?
What is the primary reason for the study?
Critiquing Reliability and Validity
What reliability information is provided? Does the author include reports of the validity of the instrument from previous studies? Did the author perform pilot studies to examine the validity of the instrument? Did the researcher report use of data from the present study to examine instrument validity in the discussion section of the report?
1. Complex, directional hypothesis
What type of hypothesis is the following? "Cancer patients who receive music therapy complain less frequently of pain and require less pain medication than cancer patients not receiving music therapy." 1. Complex, directional hypothesis 2. Simple, associative hypothesis 3. Simple, nondirectional hypothesis 4. Complex, null hypothesis
In searching a database, a controlled vocabulary is
a standardized, hierarchical list of terms that represent major subjects and conditions
What is a metasummary?
a synthesis of multiple primary qualitative studies to produce a narrative about a selected phenomenon
Clinical practice guideline
a systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations
an example of systematic error is
a thermometer measurement indicating a body temperature as 0.1 higher than the accurate temperature
Ambiguous loss
a type of disenfranchised grief, occurs when the lost person is physically present but not psychologically available, as in cases of severe dementia or severe brain injury.
what is a continuous variable?
a variable that can take on an infinite range of values along a specified continuum. (height)
what is an extraneous variable?
a variable that confounds the relationship between the independent and dependent variables and that needs to be controlled in either the research design or through statistical procedures; often called confounding variable.
supra
above
independent nursing interventions
actions that a nurse initiates. These do not require an order from another health care professional.
dependent nursing interventions
actions that require an order from a physician or another health care professional
The focus of significant research problems and purposes are
addressing research priorities in nursing, building on previous research, potential impact on clinical practice
post
after
Primary prevention
aimed at health promotion includes health education programs, immunizations, and physical and nutritional fitness activities
Which principles were violated in the Tuskegee Syphilis Study?
all three. nonmalificince, beneficence,and justice
pan
all, total
Naturalistic paradigm
alternative to the positivist paradigm that holds that there are multiple interpretations of reality, and that the goal of research is to understand ho individuals construct reality within their natural context. *qualitative
What is a construct? Give an example
an abstraction on concept that is deliberately invented by researchers for a scientific purpose. *health locus of control
construct
an abstraction or concept that is deliberately invented (constructed) by researchers for a scientific purpose. (health locus of control ex)
Meta-analysis:
an advanced process by which research on a specific topic is reviewed and findings of multiple studies are statistically analyzed and expressed quantitatively
Parasomnia
sleep problems that are more common in children than adults, which include somnambulism (sleepwalking), night terrors, nightmares, nocturnal enuresis (bed-wetting), body rocking, and bruxism (teeth grinding).
Sleep requirements for toddlers
sleeps 12 hours a day, usually sleeps through the night and might take daily naps that decrease with age
Sleep requirements for preschoolers
sleeps 12 hours a night, with no naps during the day, has difficulty relaxing after long, active days
paresis
slight paralysis
stasis
slow, controlled
Pilot studies:
small-scale studies referred to as feasibility studies; purpose is to identify strengths and limitations of a larger planned study
Research outcomes should focus on
specific recommendations for implementation (or not) of the findings in practice, what the findings contribute to building knowledge, and specific recommendations for future research
phasia
speech
What are the three aspects of reliability testing?
stability, equivalence, and homogeneity
Rigor mortis
stiffening of the body, developing 2-4 hours after death
What are some treatments for narcolepsy?
stimulants, antidepressants, brief 20 minute daytime naps, Modafinil, eat light meals high in protein, and chewing gum
Experimental:
studies that include the manipulation of one or more independent variables, random assignment to a control or a treatment group, and observation of the outcome or effect that is presumably the result of the independent variable
people in quantitative studies
subject
One limitation of observation as a data collection technique is that observation is:
subjective.
peri
surrounding (outer)
Review of systems
systematic approach for collecting the patient's self-reported data on all body systems
nursing research is
systematic inquiry to develop knowledge about issues of importance to nursing
ten(o)
tendon
Intervention Mode
test existing relationship between modes when looking at that theory.
t-test is used to
test for a significant difference between the means of two samples
Study validity refers to
the ability to accept that the research results are logical, reasonable, and justifiable based on the evidence presented.
What is serendipity?
the accidental discovery of something useful or valuable.
purposes of research hypothesis
the actual hypthesis a researcher wishes to test (as opposed to the null hypothesis) stating the anicipated relationship between two or more variables.
What is a primary resource?
the actual research reports written by researchers who conducted the study
A sample should be homogenous because
the ample with common characteristics more clearly indicates the impact of a treatment
What is generalization?
the application of information that has been acquired from a specific instance to a general situation. Generalization extends the implications of the findings from the sample studied to a larger population.
Purpose and Research Question for qualitative critical appraisal
the author may clearly state the purpose of the study or may describe the purpose as goals, objectives or aims.
what does it mean to operationalize a definition?
the definition of a concept or variable in terms of the procedure by which it is to be measured.
trustworthiness
the degree of confidence QUALITATIVE researchers have in their data and analyses, assessed using the criteria of credibility, transferability, dependability, confirmability, and authenticity
External validity refers to
the degree to which the findings can be generalized to other subjects, settings, and times
External validity refers to
the degree to which the findings can be generalized to other subjects, settings, and times.
The advantage of using a quasi-experimental design in nursing is
the design is more adaptable to real-world settings.
The reliability and validity of historical research are based on which of the following concerns?
the reliability of the primary data source
Introduction (IMRAD)
the research problem and its context
blind review
the review of a manuscript or a research proposal such that neither author or reviewer is identified to the other party.
Beneficence
the right to freedom from harm and discomfort, the right to proctection rom exploitation
The term representativeness means that
the sample must be like the population in as many ways as possible
Independent variable
the stimulus or activity manipulated or varied by the research to cause an effect on dependent variables It is also called the treatment or experimental variables
Methods (IMRAD)
the strategies used to answer research questions.
Religion
the system of organized beliefs and worship that a person practices to outwardly express spirituality
According to sampling theory, findings can be generalized to
the target population
Narrative documentation
the traditional method for recording nursing care. It is simply the use of a story-like format to document information specific to patient conditions and nursing care.
dependent variable
the variable hypothesized to depend on or be caused by another variable (the independent variable); the outcome of interest
independent variable
the variable that is believed to cause or influence the dependent variable; in experimental research, the manipulated (treatment) variable.
Systematic error
the variation in measurement is in the same direction
What is systematic measurement error?
the variation in measurement value from the calculated average is always in the same direction. For example: most of the variation may be higher or lower than the average that was calculated. Example: Why does my scale at home routinely weigh me at 150lbs in the morning....but the scale at the MD's office weigh me at 157lbs for an 0830 appointment?!?!
Sampling that helps to develop theory is called
theoretical sampling
Setting
typically take place in naturalistic settings by researchers who engage in fieldwork. Sometimes there is no set time.
Not a type of qualitative sampling
untheoretical
The best definition of outliers is that they are
unusual scores that should be examined
uria
urine
what is applied research?
use knowledge to solve/educate/help. foreground questions. What is best treatment used for nausea?
evidence based pratice includes
use of best clinical evidence in making pt care decisions nursing decisions need to be based on evidence many recent clinical practice changes reflect the impact of research
research utilization
use of study findings in a practical application unrelated to the original research
evidence based practice
use of the best clinical evidence in making patient care decisions
Triangulation:
use of various research methods or data collection techniques in the same study
Survey:
used to collect large amounts of information with little expenditure of time and money
Practice-based competence
uses terms like interactive learning, collaborative learning, and competency-based learning.
Research utilization is characterized by:
using research knowledge in practice to achieve the desired outcomes.
*systematic* error {internal/external validity}
validity measures:
Mode
value that appears most often
In research, a(n) ____________ is an observation that can be measured by assigning a number to each dimension.
variable
quantitative studies use
variables
phleb(o)
vein
ven(o)
vein
vas(o)
vessel
Emergent fit Mode
we can extend or refine a certain theory. Find other ways to extend theory in this mode. Build on theory.
Disenfranchised grief
when their relationship to the deceased person is not socially sanctioned, cannot be openly shared, or seems of lesser significance. The person's loss and grief do not meet the norms of grief acknowledged by his or her culture, cutting the grieving person off from social support and the sympathy given to persons with "legitimate" losses. The grieving person often wonders if he or she should call the experience a loss.
Restless leg syndrome (RLS)
which occurs before sleep onset. More common in women, older people, and those with iron deficiency anemia, symptoms include recurrent, rhythmical movements of the feet and legs. Patients feel an itching sensation deep in the muscles. Relief comes only from moving the legs, which prevents relaxation and subsequent sleep.
which of following represents a quasi-experimental design
within subjects design
paradigm
world view; general perspective on the complexities of the real world
content-related validity
{aka face validity} degree to which sample represents question
interclass internal consistency
{split halves reliability} compares two halves of a written test
Masked grief
behaves in ways that interfere with normal functioning but is unaware that the disruptive behavior is a result of the loss and ineffective grief resolution
Personalistic practitioners
believe that an external agent, which can be human (i.e., sorcerer) or nonhuman (e.g., ghosts, evil, or deity), causes health and illness. Emphasize the importance of humans' relationships with others, both living and deceased, and with their deities.
The Belmont Report, issued in 1979, identified the following three ethical principles
beneficence, respect for persons, and justice
para
beside
When extraneous variables influence and distort the relationship between the independent variable (IV) and the dependent variable (DV) so that the findings do not reflect a true relationship between the IV and the DV, the result is
bias
soma
body
would be classified as an in vivo biophysiologic measure
body temperature
associated with descriptive phenomenology
bracketing
(o)rrhage
burst forth
When subjects are selected because they happen to be in the right place at the right time, the sampling method is referred to as
convenience sampling
which type of sampling is most vulnerable to bias
convenience sampling
types of nonprobability sampling in quantitative research
convenience, quota, consecutive, purposive
Non vital tissues
corneas, skin, long bones, middle ear bones, ligaments, tendons, heart valves
Which type of design would be used by researchers interested in establishing relationships between two or more variables, for example, the type of coping used by caregivers of older adults having cognitive changes and the occurrence of elder abuse?
correlational
cross-sectional vs longitudinal
cross-sectional:data are collected at one point in time. longitudinal: data collected over a period of time
rigor
demanding strict attention to rules and procedures
Kubler-Ross's five stages of dying
denial, anger, bargaining, depression, and acceptance.
There will be a change in nursing practice after completion of an EBP mentorship program as compared to before the mentorship program." In the preceding statement, "completion of an EBP mentorship program" represents the
dependent variable
In research studies using nonexperimental designs, the purpose is to
describe a phenomenon in detail. predict relationships and differences among variables. explain relationships and differences among variables
Compassion fatigue
described as physical, emotional, and spiritual exhaustion resulting from seeing patients suffer, leads to a decreased capacity to show compassion or empathize with suffering people
Simple Hypothesis
describes the associative or causal relationship between two variables
Dual process model
describes the everyday life experiences of grief as moving back and forth between loss-oriented and restoration-oriented activities
Factual record contains
descriptive, objective information about what a nurse sees, hears, feels, and smells. An objective description is the result of direct observation and measurement.
Needs assessment:
determines what is most beneficial to an aggregate group
Demographic variables are attributes of subjects that are collected to allow the researcher to
develop a description or profile of the sample
Clinical practice guidelines
developed by AHCPR (Agency for Health Care Policy and Research) in 1992 -Acute pain care management in infants, children, and adolescents -Prediction and prevention of pressure ulcers in adults -Identification and treatment of urinary incontinence in adults
Bivariate Correlation
Measures the extent of relationship between two variables.
What type of study was conducted by Wye (2009) and colleagues?
Qualitative
What are the 3 requirements of a true experiment?
Randomization, Manipulation, Control
The sampling method most desired for outcome studies is
Convenience sampling using large heterogeneous samples
Which of the following is not a descriptive statistic?
Correlation
What type of research involves the systematic investigation of relationships among variables?
Correlational research
For nursing as a discipline to be effective in research, which of the following should be the focus of research-directed activity?
Creating a culture within nursing that value, uses, and supports research
Rating Scales
Crudest form of measure involving scaling techniques.
During their clinical post-conference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that her patient was homeless. This is an example of caring for a patient from a different: A) Ethnicity. B) Culture. C) Heritage. D) Religion.
Culture.
Which of the following indexes(indices) is the most helpful in locating sources for a nursing research proposal?
Cumulative Index to Nursing & Allied Health Literature (CINAHL)
Biological Clock
Cyclical nature of body function. Functions controlled from within the body are synchronized with environmental factors; same meaning as biorhythm.
Simple Random Sampling
Randomly choosing the sample Can use a table of random numbers Can draw names out of a hat
What is range and what does it look at?
Range is a measure of central tendency for nominal data
Which are examples of scales
Rating, Likert, Semantic differential
A blood hemoglobin measurement of 13.5 g/100 mL would be which level of measurement?
Ratio
As a staff nurse, how can you further educate yourself about EBP?
Read evidence related to your area of practice on a regular basis.
Which of the following strategies for utilization is most amenable to adoption by baccalaureate nursing students and new graduates?
Reading professional journals critically and reporting the findings at staff meetings
Scientific rationale
Reason why a specific nursing action was chosen based on supporting literature.
During the implementation step of the nursing process, a nurse reviews and revises the nursing plan of care. Place the following steps of review and revision in the correct order: A) Review the care plan. B) Decide if the nursing interventions remain appropriate. C) Reassess the patient. D) Compare assessment findings to validate existing nursing diagnoses.
Reassess the patient. Review the care plan. Compare assessment findings to validate existing nursing diagnoses. Decide if the nursing interventions remain appropriate.
Reminiscence
Recalling the past to assign new meaning to past experiences.
A patient signals the nurse by turning on the call light. The nurse enters the room and finds the patient's drainage tube disconnected, 100 mL of fluid in the intravenous (IV) line, and the patient asking to be turned. Which of the following does the nurse perform first? A) Reconnect the drainage tubing B) Inspect the condition of the IV dressing C) Improve the patient's comfort and turn onto her side. D) Obtain the next IV fluid bag from the medication room
Reconnect the drainage tubing
Unmet and partially met goals require the nurse to do which of the following? (Select all that apply.) A) Redefine priorities B) Continue intervention C) Discontinue care plan D) Gather assessment data on a different nursing diagnosis E) Compare the patient's response with that of another patient
Redefine priorities Continue intervention
credibility
Refers to confidence in the truth of the data and interpretations of them The analog of internal validity in quantitative research Arguably the most important criterion for assessing the quality and integrity of a qualitative inquiry
confirmability
Refers to neutrality—the potential for congruence between two or more people about data accuracy, relevance, or meaning The analog of objectivity in quantitative research
dependability
Refers to stability of data over time and over conditions The analog of reliability in quantitative research
Types of descritive analysis
Reflexive thought Bracketing- May have preconceived ideas about things, but must get away from that by bracketing. May write their feelings about a certain phenomenon but keep it to themselves. Helps them become more objective about the data they are collecting. Data reduction- Classifying the data Coding-categorize data
Variance
Scores in the study is calculated with a mathematical equation and indicates the spread or dispersion of the scores.
4. Develop a family-centered nursing care plan for Zachary's end-of-life care.
See #5
In which of the following examples is a nurse applying critical thinking attitudes when preparing to insert an intravenous (IV) catheter? (Select all that apply.) A) Following the procedural guideline for IV insertion B) Seeking necessary knowledge about the steps of the procedure from a more experienced nurse C) Showing confidence in performing the correct IV insertion technique D) Being sure that the IV dressing covers the IV site completely
Seeking necessary knowledge about the steps of the procedure from a more experienced nurse Showing confidence in performing the correct IV insertion technique
Which steps does the nurse follow when he or she is asked to perform an unfamiliar procedure? (Select all that apply.) A) Seeks necessary knowledge B) Reassesses the patient's condition C) Collects all necessary equipment D) Delegates the procedure to a more experienced staff member E) Considers all possible consequences of the procedure
Seeks necessary knowledge Collects all necessary equipment Considers all possible consequences of the procedure
A patient expresses the desire to learn how to meditate. What does the nurse need to do first? A) Answer the patient's questions B) Help the patient get into a comfortable position C) Select a teaching environment that is free from distractions D) Encourage the patient to meditate for 10 to 20 minutes 2 times a day
Select a teaching environment that is free from distractions
Sampling
Selecting a group of people, events, behaviors, or other elements with which to conduct a study
Extraneous variables may be controlled by
Selecting a homogeneous sample
Independent Groups
Selection of one subject is totally unrelated to the selection of other subjects.
If a researcher unobtrusively observes interactions among patients in a psychiatric hospital for the purposes of data collection, which human right may be violated?
Self-determination
Physiologic measures may be obtained in which of the following ways?
Self-report, Observation, Electronic Monitoring
Which of the following is an advantage of self-reports over interviews?
Self-reports allow respondents to easily writ down measurements and perceptions soon after the event
emancipated minors
Self-supporting adolescents under 18 years of age not subject to parental control.
Self-transcendence
Sense of authentically connecting to one's inner self.
the amount of change in a physiologic measure that can be detected reflects an instrument is
Sensitivity
2. Calculate Sergio's height and weight percentiles. Consult the growth grids in Appendix Aand the Skills Manual for correct analysis. Since he is steadily growing, what summary can you provide for Sergio's parents? What nutritional advice should you provide for them?
Sergio is just below the 3rd percentile for length and at the 10th percentile for weight. It can be expected that Sergio will be small for his age, but since his growth remains steady, he is fine. The nurse should encourage Sergio's mother to continue to breast feed him, although he should be on supplemental iron. If they haven't already, the parents should begin solid foods, offering one food at a time. Traditionally babies start on rice cereals and progress to vegetables and fruits.
accommodations
Services or special assistance provided in the school setting to ensure that a student with a physical or mental impairment has access to an appropriate education.
Faith
Set of beliefs and a way of relating to self, others, and a Supreme Being.
data cluster
Set of signs or symptoms that are grouped together in logical order.
Organizations
Several nursing organizations fund research studies. The focus of the organization determines the type of funding available. Some organizations are more general in scope (such as Sigma Theta Tau International and the American Nurses Foundation) and some are specialized (such as the Oncology Nursing Society, the Association of Women's Health, Obstetric and Neonatal Nurses, or any other specialty organization). Most nursing organizations provide limited funding for a project, often $10,000 or less. These organizations, therefore, are most appropriate for funding small, targeted, and/or pilot studies.
What are the characteristics that describe a data set?
Shape, measure of central tendency, measure of variability
accommodation
The process of changing an individual's cognitive structures to include data from recent experiences.
normalization
The process of family management that involves acknowledging that the child has a chronic health problem but encouraging the family members to make an effort to lead normal lives.
Evidence-based practice
The process of systematically finding, appraising, and using research findings as the basis for clinical practice.
Educational mobility
The progressive movement from one type or level of education to another, often based on flexible, self-directed, or advanced placement options. Examples are progression from diploma preparation to an academic degree, such as RN to BSN or MSN; BSN to doctoral degree; or non-nursing degree to BSN, MSN, or doctoral degree.
If a diagnostic / screening test is very sensitive, what does that mean?
The proportion of patients with the disease who have a positive test result. A highly sensitive test is good at identifying a patient with the disease / disorder and has a low percentage of false negatives.
If a diagnostic / screening test is very specific, what does that mean?
The proportion of patients without the disease who have a negative test result. A highly specific test is good at identifying a patient without the disease / disorder and has a low percentage of false positives.
What is the purpose of a literature review?
The purpose of a literature review is to: establish a theoretical framework for your topic / subject area. define key terms, definitions and terminology. identify studies, models, case studies etc supporting your topic. define / establish your area of study, ie your research topic.
Purpose and Results of Nursing Research
The purpose of nursing research is to generate knowledge that may support current practice or lead to refinement of practice. Historically, nurses did not question many activities that were taken for granted, such as the following: Schedules for changing IV sites or wound dressings End-of-shift report procedures Handwashing procedures More recently, nurses have started to question these kinds of activities through research that leads to evidence-based practice changes that benefit nurses and patients.
3. Population (and setting)
The purpose statement should identify the study variable(s) and what other key aspect of the study? 1. Design 2. Measurement tools 3. Population (and setting) 4. Statistics
-Correlational
The question "Is there a relationship between caffeine intake and intraocular pressure in patients with glaucoma?" is an example of:
ego
The realistic part of the person, which develops during infancy and searches for acceptable methods of meeting impulses.
Read the first paragraph on page e151 of the Iglesias et al. (2012) article about student stress. What ethical concerns might be relevant regarding how participants were recruited? (Choose all that apply.)
The relationship of the researcher and the students was not described. If the researcher was also the students' professor, students may have felt pressured to participate in the study (Principle of Respect for Persons). The right to privacy may have been violated if the students did not give permission to distribute their email addresses to the research (Principle of Justice)
3. Has a broader focus
The research process differs from the nursing process on which of the following? 1. Identifies new information 2. Involves abstract, critical thinking 3. Has a broader focus 4. Utilizes complex thinking
In health sciences it is unlikely that researchers will be able to establish absolute causality. Therefore, most nursing research studies must deal with relative cause and probabilities of a cause leading to an effect. Which of the following statements about probability is true?
The researcher investigates the likelihood that an effect will occur under specific circumstances
In quantitative research what is the function of the research design?
control extraneous variables
In health-related experimental designs, the group of subjects receiving the standard of care but not the intervention is the
control group.
Polysomnogram
involves the use of EEG, EMG, and EOG to monitor stages of sleep and wakefulness during nighttime sleep.
causality
the relationship between cause and effect
Which of the following are the four major parts most often included in a research report?
Introduction, methods, results, discussion
Symmetrical
Means that the analysis gives no indication of the direction of the relationship.
Reliability Testing
Measure of the amount of random error in the measurement technique.
Sedatives
Medications that produce a calming effect by decreasing functional activity, diminishing irritability, and allaying excitement.
■ Development unfolds in a predictable pattern, but at different rates dependent on the particular characteristics and experiences of each child.
...
Which of the following statements describes a heterogeneous study?
Members of a sample have different values on study variables
American Association for History of Nursing aahn.org
Membership, contacts, publications regarding nursing history
What are strata? Which sampling approach includes strata ?
1. Strata are sub-populations, that are mutually exclusive segments based on specific characteristics. 2. quota
10. A child who weighed 8 pounds at birth should weigh __________ pounds at 12 months of age.
24 A child should double his birth weight by 5-6 months and triple it by one year.
What is the typical response rate for a mailed questionnaire?
25 to 40%
how many broad schools of phenomological analysis are there?
3
ANOVA can be used with
3 or more groups
Ecologic theory
A theory of development that emphasizes the importance of interactions between the developing child and the settings in which the child lives.
Dramatic play
A type of play in which a child acts out the drama of daily life.
dramatic play
A type of play in which a child acts out the drama of daily life.
associative play
A type of play that emerges in preschool years when children interact with one another, engaging in similar activities and participating in groups.
cooperative play
A type of play that emerges in school years when children join into groups to achieve a goal or play a game.
parallel play
A type of play that emerges in toddlerhood when children play side by side but demonstrate little or no social interaction.
Advocacy
Acting to safeguard and advance the interests of another.
functional health patterns
Method for organizing assessment data based on the level of patient function in specific areas (e.g., mobility).
competence
An ability to be involved in healthcare decisions requiring a certain degree of intellect, an ability to communicate, and an ability to remember.
Questionnaire
Printed self-report form designed to elicit information through written or verbal reposes of the subject.
Clinical nurse researcher (CNR)
An advanced practice nurse who is doctorally prepared and directs and participates in clinical research.
Clinical nurse specialist (CNS)
An advanced practice nurse who provides direct care to clients and participates in health education and research.
Verify that all material has been subjected to the peer-review process.
Appraise the materials to ensure their integrity and applicability
Characteristics of variables
Are at a more concrete level than concepts Represent only a portion of the concept Several variables may be used to represent one concept
The statement "People want control of their own health problems" is an example of which of the following?
Assumption
Several problems can occur during data collection. Which f the following is a researcher-related problem?
Bias
Critical Appraisal of Nursing Research
Blind review Abstract and findings
Critical appraisal of nursing research
Blind review Abstract and findings may be the easiest sections of a research report for the novice to understand
risk factors
Characteristics of a child or family that promote or contribute to health system challenges.
Types of Quantitative Research Designs
Descriptive study designs Correlational study designs Quasi-experimental study designs Experimental study designs
Likert Scale
Designed to determine the opinions or attitudes of study subjects.
Evaluation
Determination of the extent to which established patient goals have been achieved.
Who is identified as the first nursing research?
Florence Nightingale
Focus charting
Charting methodology for structuring progress notes according to the focus of the note (e.g., symptoms and nursing diagnosis). Each note includes data, actions, and patient response.
Stability
Concerned with the consistency of repeated measures of the same attribute with the use of the same scale or instrument.
Stability
Concerned with the consistency of repeated measures or test-retest reliability
Reliability
Concerned with the consistency of the measurement method.
Inference
Conclusion or judgment based on evidence.
2. dependent variable.
"Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." "Perception of pain" is the: 1. independent variable. 2. dependent variable. 3. attribute variable. 4. extraneous variable.
2. not well-defined and general.
"Abstract" is defined in research as: 1. particular and realistic. 2. not well-defined and general. 3. well-defined and precise. 4. concrete and specific.
A registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient? A) "What are your dietary preferences?" B) "What time do you typically go to bed?" C) "Do you bathe and use deodorant more than one time a week?" D) "Do you have any health issues that we should know about?"
"Do you bathe and use deodorant more than one time a week?"
Which of the following statements made by an older adult whose husband recently died most indicates the need for follow-up by the nurse? A) "I planted a tree at church in my husband's honor." B) "I have been unable to talk with my children lately." C) "My friends think that I need to go to a grief support group." D) "I believe that someday I'll meet my husband in heaven."
"I have been unable to talk with my children lately."
A 62-year-old male patient has just been told he has a terminal illness. Which of the following statements supports a nursing diagnosis of spiritual distress related to diagnosis of terminal illness? A) "I have nothing to live for now." B) "What will happen to my wife when I die?" C) "How much longer do I have to live?" D) "I need to go to church and pray for a miracle."
"I have nothing to live for now."
Which statement made by a mother being discharged to home with her newborn infant indicates a need for further teaching? A) "I won't put the baby to bed with a bottle." B) "For the first few weeks we're putting the cradle in our room." C) "My grandmother told me that babies sleep better on their stomachs." D) "I know I'll have to get up during the night to feed the baby when he wakes up."
"My grandmother told me that babies sleep better on their stomachs."
A nurse is conducting a patient-centered interview. Place the statements from the interview in the correct order. 1. "You say you've lost weight. Tell me how much weight you have lost in the last month." 2. "My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history." 3. "I have no further questions. Thank you for your patience." 4. "Tell me what brought you to the hospital." 5. "So, to summarize, you've lost about 6 pounds in the last month, and your appetite has been poor—correct?"
"My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history." "Tell me what brought you to the hospital." "You say you've lost weight. Tell me how much weight you have lost in the last month." "So, to summarize, you've lost about 6 pounds in the last month, and your appetite has been poor—correct?" "I have no further questions. Thank you for your patience."
Which type of reliability is examined by Cronbach's alpha?: homogeneity
...
1. independent variable.
"Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." "Type of support" is the: 1. independent variable. 2. dependent variable. 3. attribute variable. 4. extraneous variable.
2. dependent variable.
"Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." 15. "Request for analgesics" is the: 1. independent variable. 2. dependent variable. 3. attribute variable. 4. extraneous variable.
3. complex, directional, research.
"Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." This hypothesis is: 1. simple, directional, research. 2. complex, nondirectional, null. 3. complex, directional, research. 4. simple, nondirectional, statistical.
A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which of the following nursing responses reflect a helpful understanding of patient self-care at the end of life? A) "Learning to accept that you can't perform some activities anymore will bring you more acceptance and peace." B) "Which activities are most important to you, and how can you continue to do them?" C) "People in your life want to help you with things; allow them to do what they want for you." D) "Spending more of your time resting or reading will conserve your energy."
"Which activities are most important to you, and how can you continue to do them?"
inference
(1) Judgment or interpretation of informational cues. (2) Taking one proposition as a given and guessing that another proposition follows.
Indirect measures
(abstract concepts such as pain, depression, coping, self-care, and self-esteem)
Direct measures
(concrete things such as oxygen saturation, temperature, weight)
Define the nonprobability sampling methods and give examples of each.
*not everyone has a chance to be chosen to be part of the study. Convenience Sampling: selecting most convenient people, most bias. (using 33 available women to represent entire hospital unit) quota: use strata to figure out how many people are needed. (using a convenient number of 100 out of 500 to get 20% of sample) consecutive: recruiting all people over specific time, or a specified sample. (study of patients in ICU with pneumonia over 6mos) purposive sampling:hand picks members. (researchers choosing to interview 22 nurses)
inferential statistics
*stats that permit inferences about whether results obsereved n sample are likely to occur in the larger population test null hypothesis, t-test, ANOVA, pi2
descriptive statistics
*stats used to describe and summarize statistics tables, measures of central tendency, frequency, range
interclass methods of calculation
-- Pearson Product Moment (PPM) - reliability coefficient - percentage -- Spearman-Brown Prophecy Formual - predicts reliability when questions are added
factors affecting reliability
-- fatigue -- practice -- timing -- homogeneity -- level of difficulty -- precision -- environment
correlation coefficient
-- outcome of the calculation of the relationship between two or more *observed* scores (true scores cannot be known) -- observed score variance
relevance
-- representative of question being studied -- measurement of question being studied
reliability
-- the degree to which the *observed* score relects the *true* score -- *consistency* & *repeatability* of test results
validity
-- truthfully measures what is *supposed* to be measured -- it is possible to have reliability and relevance, and still not have validity
Inclusion
-Characteristics that the subject or element must possess to be part of the target population -Examples: Between the ages of 18 and 45 Ability to speak English Admitted for gallbladder surgery Diagnosed with diabetes within past month
Summary
-Educators must prepare students to appreciate and conduct research and evaluation at their level of preparation -Health care administrators must foster research -Consumers must be educated about the value of nursing research -Policymakers must be informed about findings, so results can be translated
b) Comparative Descriptive Design
-Examines differences in variables in two or more groups that occur naturally in a setting -Results obtained from these analyses are frequently not generalizable to a population
Benefits to EBP
-Improved patient outcomes for patients, providers, and agencies -Leads to best treatment (Gold Standard) plan -Meets accreditation requirements -An integral part of the Magnet Status process (documents excellence of nursing in an agency)
A line 100mm long with right-angle stops at each end indicating bipolar describing sensations is referred to as: Visual analogue scale
...
Analyses performed in studies with more than two groups often indicate that the groups are significantly different but do not identify which groups are different. In such instances, a second analysis is then performed to identity significant differences between groups. These analyses are referred to as: Post hoc analyses
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CRITICAL THINKING IN ACTION Haley Leftwich is an 8-year-old girl with cerebral palsy. She had an intraventricular hemorrhage during her neonatal intensive care unit (NICU) hospitalization for prematurity. Haley lives with her mother and two older siblings, ages 10 and 13. Her parents divorced when Haley was 3 years old. She has frequent contact with her father, who she visits on weekends. Her father is supportive emotionally, physically, and financially in the care of Haley and her siblings. Haley's mother is the full-time primary care provider. Routine care includes hygiene, supplemental enteral tube feedings to promote adequate nutrition in between oral feedings, range of motion (ROM) exercises, and home-schooling. Haley uses her motorized wheelchair without difficulty, and her mother has decided that she would benefit from social interaction and a structured educational environment at the local public school. Her family asks the clinic nurse and case manager at the cerebral palsy clinic for assistance in helping with planning Haley's entry into school. How can the clinic nurse and case manager assist Haley and her family in this transition? What special arrangements are needed to permit a child to receive care for a chronic condition while at school? What measures can be taken to ensure an effective transition between home and school?
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CRITICAL THINKING IN ACTION Zachary Conway is a 3 1⁄2-year-old who began experiencing motor difficulties and demonstrating bizarre emotional behavior a few months ago. After a series of diagnostic studies, he was diagnosed with an inoperable, rapidly progressing brain tumor. Zachary underwent radiation and chemotherapy to reduce the size of the tumor. He is currently hospitalized after experiencing grand mal seizures and dehydration from poor oral nutritional intake. Zachary's condition has deteriorated and his death is imminent. Emphasis is now on promoting his comfort and supporting his family during the death vigil. Zachary is awake but appears lethargic. He now receives enteral feedings, fluids, and pain medication via a nasogastric tube. He interacts very little with anyone other than his mother. Zachary's mother remains with him at all times during hospitalization while other family members visit. His father spends several hours each day at the hospital. Zachary's sister, Marilee, attends school in the second grade. She is being cared for by grandparents after school when her mother and father are with Zachary. What is the role of the nurse in caring for Zachary and his family? What nursing interventions address the physiologic and psychological needs of the child who is dying? How can you provide family-centered care?
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CRITICAL THINKING IN ACTION: Drew Santo is a 3-year-old boy who has a seizure disorder that until a week ago was fairly well controlled by medication. He and his family receive health care at the center serviced by their health plan. A pediatric nurse and pediatrician collaborate in providing Drew's health care and monitoring his developmental progress. Drew had a seizure in the last week. His phenytoin blood level, taken the day of the seizure, was slightly lower than the therapeutic range. This likely indicates that his parents have given Drew his medication fairly regularly, but perhaps he needs a higher dosage or a different medication. Because of the recent seizure, an electroencephalogram (EEG) is ordered to identify any change in the electrical pattern in the brain. Other laboratory tests are also ordered, following the guidelines of the health center's clinical pathway for children with seizure disorders. Over the past 2 years, Drew's family and the pediatric nurse have worked in partnership to ensure that Drew is treated as a healthy child with a chronic condition. The nurse has helped his parents to obtain information about his condition, to understand the action of his medication, and to take appropriate measures when he has a seizure. Drew's parents are upset that he has again had a seizure, especially when they have done everything they could to keep the seizures under control. They have been able to think of him as a normal boy because he had not had a seizure for a long time. Now they wonder if they will be able to keep treating him that way. In how many different settings could you find nurses providing care to children with this condition? Does the type of nursing care provided to children differ among these settings?
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Chapter 16: Nursing Care of the Hospitalized Child
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Chapter 1: Nurse's Role in Care of the Child: Hospital, Community Settings, and Home
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Chapter 20: Nursing Care of the Child with a Chronic Condition
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Chapter 22: End-of-Life Care and Bereavement
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Chapter 5: Concepts of Growth and Development
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Insomnia
Condition characterized by chronic inability to sleep or remain asleep through the night.
DESCRIPTION Because of her history of sleep apnea, Tiona was scheduled to spend the night in the hospital to monitor her for any poten- tial respiratory complications. Following the operation, Tiona refused to drink liquids because she was afraid it would hurt when she swallowed. After receiving intravenous pain medica- tion, Tiona realized that she could swallow without too much pain and began to eat Popsicles and drink liquids. She was then switched to oral pain medication. The next morning Tiona is drinking liquids well enough that she is to be dis- charged home.
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DESCRIPTION Despite aggressive therapy, Zachary's condition has continued to deteriorate. After consulting with Zachary's healthcare team, the parents agree to discontinue the radiation and aggressive treatment. He will continue to receive antiseizure medications, pain medication, and nutrition. They have requested a DNR order and the family wishes to have time with Zachary to say good-bye. The parents want guidance to help Zachary's 7-year-old sister Marilee say good-bye.
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DESCRIPTION Since they have no other children and have limited experience with children, Pepe and Yolanda, Sergio's parents, have all the needs of new parents. Due to prematurity, Sergio has additional needs for developmental surveillance and parental education. Sergio is 24.5 inches (62 cm) long and weighs 1 5 lb (6.8 kg). Some developmental milestones that the nurse observes include: ■ Personal social—smiles, watches his own hand ■ Fine motor—hands meet at midline, regards and watches small objects, and has begun to grasp a rattle ■ Language—turns to sounds and voices, squeals and makes a variety of other sounds ■ Gross motor—holds head steady when in sitting position; holds head and chest up using arms when prone
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DESCRIPTION The case manager coordinates a multidisciplinary meeting of the clinic nurse, physical therapist, physician, and Haley's family to review her health status and to discuss the transition to school. They also discuss potential accommodations needed for Haley's mobility limitations. A full educational evaluation has not yet been performed, and the family is encouraged to talk with the school system to initiate that process. The multidisciplinary team assists the parents in developing a plan for Haley's transition to school. Once her mother has signed consent, the case worker will ensure that needed medical records are transferred to the school for development of the IEP and IHP.
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DESCRIPTION: The pediatric nurse has worked closely with the family to ensure that all of Drew's healthcare needs are addressed during health promotion and health maintenance visits. Prior to the seizure, the nurse had been helping the parents to ensure that all healthcare requirements were met for Drew to attend a new childcare center. The pediatric nurse will now modify the nursing care plan to integrate the needed diagnostic procedures and treatment for Drew's seizure disorder, and to help the parents manage their increased concerns about his seizure disorder.
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Emma, a 3-year-old, has had asthma since she was 12 months old. She knows how to use her flowmeter, and her asthma is well controlled with an inhaler.
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Ethical Issues Related to Research
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How do you determine a sample size?
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INTRODUCTION Consider Sergio, who was introduced in the chapter-opening scenario. He is now 6 months of age and growing well. His mother has altered her work schedule to stay with him each day; she works for a few hours in the evening when her husband is home. One pair of grandparents live about 30 miles away and visit frequently. The family has medical insurance but has had to budget carefully to pay household bills since Yolanda is working less and they have expenses connected with Sergio's care.
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INTRODUCTION Recall Haley, the child with cerebral palsy who will be attending school for the first time. Her mother had initially preferred homeschooling for Haley, and now wants to support her social development with other children. Haley's sister is in the local elementary school and, if possible, her mother would like Haley to attend the same school. A case manager is asked to assist with facilitating Haley's entry into school.
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INTRODUCTION Recall Tiona, the child described in the chapter beginning. She is a 5-year-old who was admitted to the hospital for a tonsillec- tomy and adenoidectomy.
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INTRODUCTION Recall Zachary, the 3-year-old child with an inoperable brain tumor hospitalized and near death. His seizures and dehydration are being treated. He is also receiving morphine for pain. His mother remains at his bedside while his father and other family members visit.
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INTRODUCTION: Return to the scenario about Drew at the beginning of the chapter. Despite his seizure disorder Drew has been developing normally, meeting expected developmental milestones as evaluated by the Denver II (see Chapter 11).
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Ian, a 14-year-old boy, has Hodgkin's lymphoma, and has missed a year of school due to chemotherapy treatments. He will start school again in September, but he now is in a new class one grade behind his peers. As side effects of chemotherapy, Ian has lost his hair, and his puberty has been delayed.
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Many decisions need to be made in selecting the appropriate statistical procedure for a study. Which of the following statements about selection of statistical procedures is true?: Specifying the purpose of the study and stating the hypotheses or research questions will narrow the options of statistical procedures considerably
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Refer to Haley, the 8-year-old girl with cerebral palsy, discussed at the beginning and the end of the textbook chapter to answer the following questions:
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School-age children play cooperatively with other children and participate in various school and community activities.
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What are some ways to measure research variables i.e., instruments, tools, measures
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What types of studies would be investigated by qualitative designs? quantitative designs?
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Zach attended preschool before his illness, and his classmates are asking when he will return. At preschool, Zach made a best friend, Joey, who is especially troubled about Zach. Joey is 4 years old and attends preschool. He is refusing to join in play groups and sits by himself during outdoor play. When the preschool teacher visits Zach and his family in the hospital, she finds that Zach's death is imminent. The teacher asks the nurse for assistance in talking with Joey and the preschool class about Zach. Refer to the case scenario at the beginning and end of the textbook chapter.
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dissemination research examples
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thematic analysis
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what is the NINR?
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what is the most important goal of nursing research?
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which of the following I not an example of a Scale? Questionnaire
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which of the following will provide the most sensitive measurement of a concept such as pain intensity? A visual analogue scale
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■ A chronic condition is a long-term, ongoing condition that is expected to last 3 months or more and may involve any of the following alone or in combination: functional limitations, disfigurement, dependence on technology, medications, special diet for management of the condition, and requiring more healthcare services than a healthy child.
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■ A developmental delay results when there is failure to achieve anticipated developmental milestones during specific developmental stages.
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■ A teaching plan includes goals and expected outcomes, interventions needed to achieve the specified goals, and a method and time for evaluation of the expected outcomes. How the teaching plan is implemented depends on the unique characteristics of the child/family to be taught.
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■ Adolescence occurs from about 1 2 years of age through the teen years. Adolescents establish their own identities distinct from parents and other adults. They are mature physically and cognitively. The peer group exerts the major influence at this age.
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■ Adolescents at a higher risk of death due to a serious acute or chronic condition should be encouraged to talk with their parents and jointly prepare advance directives.
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■ An individualized education plan (IEP) is developed for a child with cognitive, motor, social, or communication impairments who needs special education services in the school setting. An individualized health plan (IHP) is developed for the child with medical conditions that need to be managed within the school setting.
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■ An individualized transition plan (ITP) is developed for adolescents with a chronic condition in collaboration with the family to assist in identifying appropriate support programs, living arrangements, and employment for adult life.
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■ Approximately 10 million children in the United States have a chronic condition.
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■ Because adolescents fear disclosure of confidential information, they may avoid seeking health care. When adolescents have a reportable disease, it is important to inform them that confidentiality cannot be maintained, as a report must be made to a public health agency.
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■ Bereavement support must be provided to the family, making sure that siblings are not overlooked. Allow siblings to participate in planning the memorial service. Encourage parents to allow siblings to express their emotions.
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■ Caregiver burden, the ongoing pressure of caring for children with special healthcare needs, causes fatigue and makes it difficult for the parents to meet other family obligations.
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■ Caring for a dying child is difficult, and nurses need special preparation to meet the needs of the child and family while managing their own personal stress.
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■ Children may experience loss through death of a parent, sibling, grandparent, pet, or friend, and through losses associated with relocation, trauma, and loss of an object.
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■ Children need to become more actively involved in decisions about their care as their decision-making abilities develop. Even though they cannot provide informed consent, federal guidelines mandate that children as young as 7 years of age receive information about treatment procedures and research project participation and give their assent.
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■ Children who are medically fragile are those dependent on a medical device for survival or prevention of further disability.
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■ Children who are medically fragile or dependent on technology are entitled to a free and appropriate education and education services in the school setting. The school administration is obligated to plan for and ensure that the personnel resources and equipment needed to provide care are consistently available.
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■ Children with chronic health conditions require regular health promotion, health screening, and health maintenance care, as well as specialized health services to assist the child and family in the management of the condition.
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■ Children with life-threatening illnesses often learn about death and their own illness through exposure to other ill and dying children. Even if they have not been told they are dying, they will know their condition is worsening with extra treatments, feeling ill, and cues from their parents.
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■ Children with special healthcare needs represent 15.6% of children in the United States, but they use 33.6% of total healthcare expenditures for children.
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■ Chronic conditions can occur as a result of a genetic condition, congenital anomaly, injury during fetal development or at birth, complication of care after birth, serious infection, or significant injury.
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■ Parents may experience many of the same responses to the diagnosis of a child's chronic condition as if they had experienced the child's death, including shock, disbelief, anger, denial, and despair. Siblings of the child with a chronic illness may have feelings of jealousy, resentment, anger, depression, and guilt.
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■ Preschool years range from 3 to 6 and are marked by increasing social skills. Most preschool children attend childcare programs and learn to play with other children. Continued mastery of physical coordination and language occurs.
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■ Resiliency theory examines risk and protective factors that hinder or help children and families when dealing with developmental and life crises.
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■ Roles of nurses in caring for children include providing direct care (health promotion, health maintenance, and nursing care for health conditions), patient education, patient advocacy, and case management, and minimizing the psychological and physical distress experienced by children and their families.
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■ School age spans the years from 6 to 1 2, when children mature in many areas. They show slow, steady growth until reaching puberty between 9 and 12 years, when a growth spurt marks increased height and weight, as well as sexual maturation.
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■ Sending the child to school has several benefits for the child and family, including socialization for the child beyond the immediate family, respite for parents, and promotion of a sense of normalization in the family.
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■ Strategies such as child life programs, rooming in, therapeutic play, and therapeutic recreation help meet the psychosocial needs of the hospitalized child.
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■ The child is prepared for procedures using a variety of techniques taking into consideration the child's developmental age, coping abilities, and previous experience.
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■ The child with a chronic condition is more likely to be hospitalized than the child without a chronic condition. Sudden hospitalization resulting from exacerbation of the child's disorder places increased demands and stressors on the child and family.
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■ The child's developmental level, culture, spirituality, and parental support directly affect the child's response to loss, death, and grief.
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■ The ecologic theory of Bronfenbrenner and the temperament theory of Chess and Thomas emphasize the interactions of the individual within the environment.
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■ The families of dying children face many decision-making issues such as palliative and/or hospice care, advance care planning, the withholding or withdrawal of treatments, and DNR requests.
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■ The financial burden of caring for a child with special healthcare needs is significant even when the family has health insurance.
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■ The newborn period begins at birth and ends at about 1 month, and is characterized by adaptation to extrauterine life, establishing periods of varying alertness, and specific physical findings.
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■ The nurse assists the family to plan for the child's long-term healthcare needs and home care issues. Culturally competent care is integrated throughout all provisions of care.
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■ The nurse caring for the dying child and family offers physiologic and psychosocial support during end-of-life care.
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■ The nurse is involved in assessing development at each stage, and in providing anticipatory guidance to families to foster optimal development.
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■ The role of the nurse in caring for the child with a chronic condition includes providing health supervision from infancy to transition into adulthood, collaborating with the multidisciplinary healthcare team, and partnering with the family to manage the child's care at home.
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■ The time of diagnosis is one of the most stressful times for families of children with chronic conditions as the parents wait anxiously for the outcome of diagnostic procedures. Other times associated with significant stressors for the family include developmental milestones, school entry, adolescence, planning for the transition to adult health and vocational services, and planning for long-term guardianship.
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■ The understanding of children about their illnesses and hospitalizations is based on cognitive and psychosocial stage/level, and upon previous healthcare experiences.
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■ Toddlers range in age from 1 to 3 years, and become increasingly mobile and communicative. They master control over excretion and are known for exerting their own opinions and wishes to parents. Injury prevention and toilet training are specific parental teaching needs.
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■ Unintentional injury is the leading cause of death for children between 1 and 1 9 years of age.
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■ When hospitalization is planned, both the child and parents can prepare for the experience. Nurses assist this process by teaching about what to expect.
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What is the minimum acceptable power in a study?
.80
Levels of Acceptable Significance
0.05 0.01 0.005 0.001
reliability of a measurement tool- closer to
1
State-of-the-science summary
A merging of findings from several studies concerning the same topic. Examples include meta-analysis with a quantitative approach and integrative review with a descriptive approach.
What is a meta-analysis?
A meta-analysis statistically pools the results from previous studies into a single quantitative analysis that provides the highest level of evidence for an intervention's efficacy.
2. In which situations are children at risk of injury? Choose all that apply. 1 . An infant is crawling on the floor while older children are playing nearby. 2. An adolescent is learning how to become a safe babysitter. 3. A toddler is playing on the playground while at preschool. 4. A school-age child likes to imitate her older sibling's movements while on her bike. 5. An adolescent is attending a gathering of school friends after a dance.
1 . An infant is crawling on the floor while older children are playing nearby. 3. A toddler is playing on the playground while at preschool. 4. A school-age child likes to imitate her older sibling's movements while on her bike. 5. An adolescent is attending a gathering of school friends after a dance. Rationale: In all but one ofthese situations, there is the possibility of the child getting hurt. The infant may put small parts ofthe toys in his/her mouth; the toddler may fall while on the playground; the school-age child may not physically be capable ofsafely doing the same movements as her older sibling; and adolescents are more likely to do activities as a result ofpeer pressure, when other adolescents are around. The safe babysitter class poses no immediate threat to the adolescent's safety. Cognitive Level: Comprehension; Client Need: Physiologic Integrity; Nursing Process: Assessment; Learning Outcome: Analyze the current causes of child morbidity and mortality and identify opportunities for nurses to intervene.
Match the activity on the left with the source of diagnostic error on the right: Activity a. Nurse listens to lungs for first time and is not sure if abnormal lung sounds are present. b. After reviewing objective data, nurse selects diagnosis of fear before asking patient to discuss feelings. c. Nurse identifies incorrect diagnostic label. d. Nurse does not consider patient's cultural background when reviewing cues. e. Nurse prepares to complete decision on diagnosis and realizes that clinical criteria are grouped incorrectly to form a pattern. Source of Diagnostic Error __ 1. Collecting data __ 2. Interpreting __ 3. Clustering __ 4. Labeling
1 a, 2 b and d, 3 e, 4 c.
EBP steps
1 ask questions 2 searchfor evidence 3 appraise and synthesize evidence 4 integrate evidence with other sources 5 assess effectiveness of decision or advice
Levels of evidence:
1-7 (greatest to least)
3. A mother is watching her school-age child learn self-care techniques after being recently diagnosed with type 1 diabetes. Which is a correct statement? 1 . "Bandura's theory states children learn new behaviors best when imitating others." 2. "Erikson's stages describe school-age children learning by attaining goals." 3. "Piaget believes learning will take place more quickly when abstract thinking develops." 4. "Freud's description of personality development affects learning ability."
1. "Bandura's theory states children learn new behaviors best when imitating others." Rationale: Goal attainment, developing abstract thinking, and personality development are not as closely related to learning self-care as is Bandura's social learning theory, which is described in option 1. Cognitive Level: Application; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation; Learning Outcome: Plan nursing interventions for children that are appropriate for the child's developmental state and that apply developmental theories and frameworks.
4. The nurse is about to approach the family of a child who was killed in a bomb explosion about organ donation. The nurse first expresses her empathy for the family concerning their loss. What is the nurse's best opening question to the family? 1. "Have you thought about giving life to other children by donating your child's organs?" 2. "Has any family member ever donated his or her organs?" 3. "Would you consider donating your child's organs?" 4. "Do your religious beliefs allow organ donation?"
1. "Have you thought about giving life to other children by donating your child's organs?" Rationale: Framing organ donation in terms of the hope it can bring to other children makes a difficult decision more acceptable to parents. The faith of Jehovah's Witnesses forbids organ donation, and organ donation might be a complex issue for people of the Jewish faith. The nurse should refrain from asking about specific religious beliefs and should rely on the parents' wishes.
1 . The siblings of an injured child are coming to visit their sister who is recovering in the hospital. They ask the nurse, "Is my sister going to die?" What is the nurse's most effective response? 1 . "No, and soon she will be able to go home with you." 2. "Why do you think that your sister is going to die?" 3. "Do you know what it means to die?" 4. "I think you should be asking your parents that question."
1. "No, and soon she will be able to go home with you." Rationale: It is important for the nurse to be honest and base the answer on age and developmental level of the siblings."Why" questions are confrontational and nontherapeutic and should never be asked offamily members. It is more appropriate to prepare them for what they might see in their sister's room and allow them to ask questions. Answering their question with a question will make them think the nurse is hiding something. It would be better to answer their question honestly on a level developmentally appropriate. Putting this question off will worsen fears about seeing their sister. Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Implementation; Learning Outcome: Apply family-centered care principles to the hospital setting.
superego
A moral and ethical system that develops in childhood and contains a set of values and conscience.
Systematic Review of Research
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
Cataplexy
Condition characterized by sudden muscular weakness and loss of muscle tone.
1. Which role would the nurse be serving when helping parents understand and respond to the needs of an ill child's siblings? 1. Advocate 2. Researcher 3. Educator 4. Case manager
1. Advocate Rationale: The nurse acts to safeguard the child's interests by educating and supporting his parents; therefore, advocate is correct. A team effort is not being coordinated as it relates to the child's needs, so case manager is incorrect. The nurse is, in fact, educating the child's parents. The education is focused specifically on advocacy in relation to the child's needs, so educator also is incorrect. Though the nurse would certainly want to provide evidence-based care to the family, the role in this instance is that of an advocate for the child, not a researcher.
8. Which nursing intervention is most developmentally appropriate for a hospitalized 10-year-old? 1. Allow the child to assist with dressing changes. 2. Encourage the child to play with safe medical equipment. 3. Encourage dependency on parents while the child is hospitalized. 4. Obtain a complete health history from the child.
1. Allow the child to assist with dressing changes. Rationale: Allowing the child to participate in care and assist with procedures such as dressing changes promotes the development of industry, characteristic of school-age children. Playing with safe medical equipment is more appropriate with preschool- and young school-age children. Encouraging dependency does not promote the development of industry and could lead to a sense of inferiority. The 10-year-old probably will not be able to give a complete health history.
7. The nurse is preparing a 4-year-old for surgery. Which technique is most appropriate? 1. Allow the child to handle safe medical equipment. 2. Limit the teaching to one 1-hour session. 3. Use an anatomically correct doll to explain the procedure. 4. Explain to the child that she will be put to sleep for the procedure.
1. Allow the child to handle safe medical equipment. Rationale: The preschool-age child learns well by participating in therapeutic play, such as handling safe medical equipment. Terms such as "put to sleep" might be misinterpreted by the child. Anatomically correct dolls are not appropriate for preschool-age children. The preschool-age child benefits from several short teaching sessions.
6. The healthcare team and the family are considering a do not resuscitate order (DNR) for a child with a severe brain injury. Issues they must discuss include: (Select all that apply.) 1. Allowing the child to die with dignity. 2. Potential to cause more suffering if resuscitative measures are implemented. 3. The family's feeling that they are giving up on their child. 4. Keeping the child free of pain. 5. Violating state or federal child neglect laws.
1. Allowing the child to die with dignity. 2. Potential to cause more suffering if resuscitative measures 3. The family's feeling that they are giving up on their child. 4. Keeping the child free of pain.
1. A parent tells the nurse, "I just don't think my child will make it this time. We have had so many hospitalizations, but this time is different." This statement is consistent with which nursing diagnosis? 1. Anticipatory Grieving related to child's deteriorating health status 2. Knowledge Deficit related to complex condition management plan 3. Compromised Family Coping related to prolonged condition management 4. Risk for Impaired Parenting related to stress with many hospitalizations
1. Anticipatory Grieving related to child's deteriorating health status Rationale: The parent is preparing for the worst outcome and expresses an intuition. There is no behavioral evidence of problems with family coping, deficient knowledge, or impaired parenting.
4. Which is the most appropriate nursing diagnosis for the family of a dying child? 1. Anticipatory Grieving related to terminal illness 2. Parental Role Conflict related to child's hospitalization 3. Interrupted Family Processes related to child with terminal illness 4. Activity Intolerance related to functional changes accompanying the dying process
1. Anticipatory Grieving related to terminal illness Rationale: Families need to be prepared for the impending death, and nurses should provide this support by discussing the events forthcoming. In a situation involving a dying child, preparing the family for death is the priority. Preparing the family for the impending death takes precedence over the change in family processes. This is not a concern as the child is dying. It is more important to prepare the family for the death. Cognitive Level: Analysis; Client Need: Psychosocial Integrity; Nursing Process: Diagnosis Learning Outcome: Develop a nursing care plan to provide family-centered care for the dying child and his or her family.
8. The family of a hospitalized child with leukemia believes that the child will be cured by prayer alone and plans to take the child home. Which of the following nursing interventions will address this barrier to care? 1. Assess the family's understanding of leukemia. 2. Demonstrate respect for the family's wishes. 3. Evaluate the home for wheelchair accessibility. 4. Communicate the parents' request to the child's physician.
1. Assess the family's understanding of leukemia. Rationale: A child with leukemia has a life-threatening chronic condition that requires ongoing nursing and medical care. The nurse first must assess if the family understands the gravity of the child's condition and required treatment. Demonstrating respect for the family's wishes does not protect the child's life.
3. The parents of a terminally ill child tell the nurse that they believe their child will not die because they asked God to spare the child if they gave enough money to build a new church. The nurse recognizes that the parents are in which stage of grieving? 1. Bargaining 2. Acceptance 3. Anger 4. Denial
1. Bargaining Rationale: The parents are bargaining or trying to exchange something for the life of their child. They are not expressing anger or acceptance. They still might be denying the situation, because the stages of grieving are not linear. Bargaining is the best and more complete description of the parents' thinking and behavior.
Components of the Research Process There are four steps in the research process:
1. Conceptualization—Identify what needs to be done 2.Planning—Decide how to proceed 3. Implementation—Put your plan into action 4. Communication—Make sure others know about it
5. An adolescent waiting for a heart transplant asks the nurse for assistance in planning his funeral in case the heart does not become available. The best nursing intervention is replying: 1. "You are not dying yet." 2. "Why? Do you think you are dying?" 3. "Your parents should help you, not me." 3. "What do you want me to do?"
3. "What do you want me to do?" Rationale: An adolescent has a true understanding of death and knows the reality of his situation. The nurse must not deny that death is inevitable, or the adolescent's trust in the nurse might be lost. The nurse should be honored to assist the adolescent, support his choices as a way of maintaining control, and refrain from giving the adolescent advice about who should help him.
7. The nurse is caring for a pediatric patient not covered by insurance. Which statement to the child's parents regarding the State Child Health Insurance Program is accurate? 1. Eligibility for coverage is determined based on household income and the number of children. 2. Eligibility for the program is determined based on the child's medical diagnosis. 3. Early application is recommended due to the large number of applications received annually. 4. Families are only eligible if the parents are unemployed.
1. Eligibility for coverage is determined based on household income and the number of children. Rationale: The State Child Health Insurance Program is designed to provide the patient with health insurance comparable to federal/state employee benefit programs. This program is undersubscribed, with lack of knowledge of its eligibility requirements being one of the barriers to subscription.
1 . Which nursing intervention is directed towards the school-age child's independent management of asthma symptoms? 1 . Encourage the child to use the flow meter and record results every day. 2. Assess the child and family's level of understanding about asthma. 3. Discuss with the child how to tell friends about asthma. 4. Teach the parents proper use of inhalers.
1. Encourage the child to use a peak flow meter and record results every day. Rationale: Only encouraging the child to use the flow meter and record results every day is directed toward independent self-care. The other nursing interventions are all important, but they do not address the child's independent management of symptoms. Cognitive Level: Application; Client Need: Physiological Integrity; Nursing Process: Implementation; Learning Outcome: Assess the child with a chronic condition and identify specific nursing interventions for the child at different ages.
9. Which nursing intervention is directed to the school-age child's independent management of asthma symptoms? 1. Encourage the child to use his flowmeter and record the results every day. 2. Discuss with the child how to tell friends about asthma. 3. Assess the child and family's level of understanding of asthma. 4. Teach the parents the proper use of inhalers.
1. Encourage the child to use his flowmeter and record the results every day. Rationale: Only encouraging the child to use his flowmeter and recording results every day is directed toward independent self-care. The other nursing interventions are all important, but they do not address the child's independent management of symptoms.
10. The nurse is caring for a 12-year-old child with cystic fibrosis in the final hours of life. What can the nurse expect to observe when death is imminent? (Select all that apply.) 1. Incontinence of bowel and bladder 2. Cool and mottled skin 3. Increased hunger and thirst 4. Mental confusion, visions 5. Irregular and shallow respirations
1. Incontinence of bowel and bladder 2. Cool and mottled skin 4. Mental confusion, visions 5. Irregular and shallow respirations
9. An adolescent client states that he would rather die than undergo a prescribed treatment. Which of the following ethical principles should direct the nurse in planning care for this client? (Select all that apply.) 1. Nonmaleficence 2. Compassion 3. Justice 4. Beneficence 5. Autonomy
1. Nonmaleficence 4. Beneficence 5. Autonomy Rationale: Autonomy, the right to self-determination, and involvement in decision making should be respected in all individuals to the extent of their capacities. Adolescents are able to think abstractly and should have this right respected. Often it is compromised. Beneficence - an obligation to act or to make a decision to benefit the client, promoting the child's well-being in addition to working with parents and other family members - and nonmaleficence, preventing harm, also are appropriate. Justice, or fairness in the use of scarce resources, is another ethical principle important to consider in decision making but is not central to this situation. Compassion is considered a virtue, not an ethical principle.
4. A child and his grandfather arrive in the emergency department after a car collision. The grandfather does not have custody of the child. What should be the nurse's next action? 1 . Obtain the custodial parent's telephone number for permission. 2. Provide emergency care to both under implied consent. 3. Register and provide care to the grandfather but transfer the child. 4. Ensure permission to treat is obtained prior to registering them.
1. Obtain the custodial parent's telephone number for permission. Rationale: No indication is given regarding the nature of the injuries for either the grandfather or the child. Therefore, permission to treat should be obtained from the custodial parent. Implied consent only applies in life or death situations and there is no indication ofthis in the stem. Registration can occur while permission to treat is obtained, and transferring cannot occur until the child has a medical screening exam. Cognitive Level: Application; Client Need: Physiological Integrity; Nursing Process: Implementation; Learning Outcome: Contrast the policies for obtaining informed consent of minors with policies for adults.
4 strategies for critical reading:
1. Preliminary 2. Comprehensive 3. Analysis 4. Synthesis
10.In order to administer a medication safely to a pediatric client, what drug information must the nurse be aware of that is not always essential when administering a medication to an adult client? 1. Recommended dose per kilogram of body weight 2. Indicators of drug toxicity 3. Incompatibilities with other medications 4. Commonly expected side effects
1. Recommended dose per kilogram of body weight Rationale: Children require medication doses based on weight or body surface area. Consequently, nurses must determine the appropriateness of the ordered dose and be able to calculate its preparation. Drug calculations are very complex and consequently pose a greater risk for error. Rationale: Children require medication doses based on weight or body surface area. Consequently, nurses must determine the appropriateness of the ordered dose and be able to calculate its preparation. Drug calculations are very complex and consequently pose a greater risk for error.
2. An adolescent who lost both her parents and her younger brother in a plane crash survived the crash but now is hospitalized after an attempted suicide. She lives with her older brother and his family. The older brother asks the nurse why she attempted suicide. The nurse's best reply is: 1. She is experiencing survivor guilt. 2. She has no understanding of the true concept of death. 3. She has a fear of being abandoned. 4. She might have inherited a tendency for severe depression.
1. She is experiencing survivor guilt. Rationale: The adolescent feels guilty about surviving the crash that killed her family members. No data support an inherited tendency for depression or a fear of abandonment by her older brother. Adolescents have a true concept of death as permanent and irreversible, whereas younger children do not.
Sleep deprivation
Condition resulting from a decrease in the amount, quality, and consistency of sleep.
4. Which of the following indicates that a 10-year-old girl with diabetes has achieved an expected outcome for the nursing diagnosis of Knowledge Deficit (child) related to learning self-care skills? 1. The child demonstrates correct technique of withdrawing insulin from the vial. 2. The child verbalizes fear in giving injections to herself. 3. The child asks her parents to check her blood sugar. 4. The child participates in a diabetes support group.
1. The child demonstrates correct technique of withdrawing insulin from the vial. Rationale: Correct technique of insulin withdrawal is an observable behavior that shows that the child has learned a self-care skill for her diabetes. The other answers are behaviors but are not related to a knowledge deficit of self-care skills.
8. Which behavior by a client's parent is the best indicator that he understands how to administer medication to his child at home following surgery? 1. The parent gives the medication to the child using appropriate technique. 2. The parents state that he understands how to administer the medication. 3. The parent signs the written discharge instruction, verifying understanding of the instructions. 4. The parent describes to the nurse how he will give the medication.
1. The parent gives the medication to the child using appropriate technique. Rationale: Although all of the answers indicate some degree of understanding, the best way to determine understanding is to actually have the parent demonstrate by administering the medication as the nurse observes technique.
3. In planning an educational session for parents of toddlers concentrating on primary prevention, which indicates the most appropriate topic on which the nurse should concentrate? 1 . Unintentional injury prevention 2. Seizure management 3. Child abuse prevention 4. Sudden infant death prevention
1. Unintentional injury prevention Rationale: Toddlers ages 1 to 4 are most likely to be hospitalized or killed from unintentional injury. Therefore, the nurse should concentrate on this topic for these parents. Seizure management is not primary prevention, and although child abuse can occur in this age group, injuries occur more frequently. SIDS does not occur in this age group. Cognitive Level: Analysis; Client Need: Physiological Integrity; Nursing Process: Planning; Learning Outcome: Analyze the current causes ofchild morbidity and mortality and identify opportunities for nurses to intervene.
What are the five possible results you may find as a result of your statistical analysis?
1. significant results that agree with those predicted by the researcher. 2. nonsignificant results 3. significant and unpredicted results (results are the opposite of those that were predicted by the researcher) 4. mixed results 5. unexpected or serendipitous results
What are some ways that agencies / administrators do not provide support for the implementation of EBP?
1.) not providing access to research journals, sources of synthesized research findings, or evidence-based guidelines 2.) limiting time to make research-based changes in practice 3.) limiting RN's authority to change patient care based on research findings 4.) providing minimal funds to support research-based changes for practice 5.) providing few rewards for RNs delivering evidence-based care to patients and families.
2. When planning nursing care for a hospitalized 9-year-old child, which intervention is most developmentally appropriate? 1 . Encourage the child to continue schoolwork. 2. Provide a separate recreation room for activities. 3. Encourage the child to brush teeth twice a day. 4. Offer medical equipment for play.
1.; Encourage the child to continue schoolwork. Rationale: The developmental task ofa 9-year-old is industry according to Erikson; thus, the nurse should encourage the continuation of schoolwork. The separate recreation room is appropriate for adolescents, toddlers need reminders to brush, and playing with medical toys is appropriate for preschool-age children. Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Planning; Learning Outcome: Plan nursing interventions for children that are appropriate for the child's developmental state and that apply developmental theories and frameworks.
Quantitative (empirical)
13) collecting data and 14) preparing data for analysis
Sleep requirements for neonates to 3 months
16 hours of sleep a day, with sleep cycles being 40-50 minutes long and awakening after 1 or 2 sleep cycles. 50% of this sleep is REM.
Quantitative (dissemination)
17) communicating the findings and 18) efforts to promote the use of the study evidence in nursing practice.
What was the sample size in the Wye (2009) study?
18
Simple Hypothesis
2 variables (one independent and the other dependent examples: Higher levels of perceived control would be associated with less emotional distress in spouses of patients recovering from cardiac disease Perceived control could be enhanced in spouses of cardiac patients by cardiopulmonary resuscitation (CPR) training
4. During a developmental assessment, a parent complains that she has a "difficult" toddler. What advice would the nurse offer to the parent? 1 . "Toddlers are flexible. Accepting new rules will occur quickly." 2. "Do not expect the child to adapt quickly to new situations." 3. "Encourage associative play and this will get better." 4. "Spanking your child will make the difficult behavior improve."
2. "Do not expect the child to adapt quickly to new situations." Rationale: Toddlers are not flexible and do not adapt to anything quickly. Associative play does not occur until preschool age, and spanking should not be encouraged. Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Planning; Learning Outcome: Use data collected during developmental assessments to plan appropriate nursing interventions that promote development ofchildren and adolescents.
2. Following a diagnosis of cancer, a child is close to dying. The child asks the nurse what she can do to make sure her family will be okay after her death. Which is the most appropriate response? 1 . "Don't worry about your family, they will be just fine." 2. "I think you should talk to them and tell them what you want for them." 3. "Why are you worried about something you can't control?" 4. "Can I get your family in here for you to let them know your worries?"
2. "I think you should talk to them and tell them what you want for them." Rationale: The nurse should talk to the child as long as she wants. It is not therapeutic for the nurse to put offthe child by telling her not to worry or asking her why she's worried. Cognitive Level: Analysis; Client Need: Psychosocial Integrity; Nursing Process: Implementation; Learning Outcome: Intervene with the child's responses to his or her impending death.
5. A 4-year-old has been hospitalized for several days, and his parents have decided to return to work during the day and then spend the evening and night with him. They have informed the nurse that they will return around 5:30 or 6:00 p.m. During lunch, the child asks the nurse when his parents will return. What is the most appropriate response by the nurse? 1. "Your parents will return between 5:30 and 6:00 p.m." 2. "Your parents will return around suppertime." 3. "Your parents will return when they get off work" 3. "I do not know when your parents are going to return."
2. "Your parents will return around suppertime." Rationale: Preschoolers need to know when their parents will return as much as that is possible. Relating the response to an activity that the child will understand is appropriate. Being as specific as possible will help as well. The child cannot relate a time frame to "when they get off work." This child also will not understand 5:30 to 6:00 p.m. due to limited understanding of time concepts but will understand "suppertime." Giving the child no information will only increase anxiety. In a situation where the nurse does not know, phoning the parents might be beneficial.
7. Well child care for a child with sickle cell anemia will include which of the following? 1. No immunizations, because the child is immunocompromised. 2. Additional immunizations, because of the child's higher-risk status for infection. 3. Refer the child for genetic testing. 4. Daily dietary supplemental folate and vitamin B12.
2. Additional immunizations, because of the child's higher-risk status for infection. Rationale: All children with chronic conditions should receive additional immunizations appropriate for their higher risk status for infection. Genetic testing of the child is not needed at this time; parents should be tested for sickle cell and sickle cell trait. Daily dietary supplements of folate and B12 are not necessary for sickle cell anemia.
5. A home health nurse needs to make a visit to the home of a child who recently died to close the case. How might the nurse best support this family? 1 . Keep the visit short and business-like to keep it as painless as possible. 2. Allow the family to ask questions about the recent events and future expectations. 3. Ask the family what they have been doing since the child died. 4. Send another nurse with whom the family is not familiar to keep it impersonal.
2. Allow the family to ask questions about the recent events and future expectations. Rationale: Making the visit personal is important to share memories ofthe child as a way to help provide support. The priority support would be for the nurse to let the family lead the conversation, not to ask them questions. Cognitive Level: Analysis; Client Need: Psychosocial Integrity; Nursing Process: Implementation; Learning Outcome: Implement strategies for bereavement support of the parents and siblings after the death of a child.
6. A 2-month-old infant is hospitalized for surgical repair of a cleft lip and palate. Priority nursing interventions include: 1. Refer the family for enteral nutrition equipment. 2. Assess the parents for parental-infant bonding. 3. Teach parents to provide a safe home environment. 4. Provide information about the recommended immunization schedule.
2. Assess the parents for parental-infant bonding. Rationale: Parental bonding might be impaired in an infant with a facial defect. Teaching about safety and about recommended immunization schedules is done during well child care visits; these are not priority nursing interventions at this time. Enteral nutrition equipment is not required for this infant.
4. Which intervention is most appropriate in order to facilitate the development of trust in an infant who is hospitalized? 1. Place pictures of the child's family at the bedside. 2. Encourage the parents to room in and participate in care. 3. Offer the infant a pacifier. 4. Play tapes of the mother's voice.
2. Encourage the parents to room in and participate in care. Rationale: Encouraging parents to stay at the bedside and participate in care promotes a sense of trust in the infant. Placing pictures at the bedside and playing tapes of the mother's voice are more appropriate to decrease the feeling of separation in an older infant and toddler; however, they do not promote the development of trust. A pacifier satisfies the oral needs that an infant has, not the development of trust.
8. An adolescent with metastasized cancer is experiencing chronic pain and asks the nurse for an overdose of morphine to end his life. The nurse is legally and ethically obligated to perform which nursing intervention? 1. Comply with the adolescent's request. 2. Focus on effectively relieving the adolescent's pain. 3. Inform the adolescent's parents. 4. Report the adolescent's request to the physician.
2. Focus on effectively relieving the adolescent's pain. Rationale: Neither the American Nurses Association or the American Academy of Pediatrics supports active euthanasia. If the child's pain is relieved, then requests for euthanasia usually cease. Thus, the nurse is bound legally and ethically to focus on relieving the adolescent's pain and suffering. The nurse is not required to report the adolescent's request to the parents or physician.
4. A preschooler's response to hospitalization includes the fear of bodily injury or mutilation. How can the nurse best reduce this fear? 1. Give thorough explanations of procedures to the child. 2. Use Band-Aids or bandages after invasive procedures to reassure the child that his body will not leak and that body parts will not fall out. 3. Avoid any discussion of impending procedures with the child. 4. Ask parents to restrain the child for procedures because the child trusts them.
2. Use Band-Aids or bandages after invasive procedures to reassure the child that his body will not leak and that body parts will not fall out. Rationale: Preschool-age children fear bodily injury and mutilation and are concerned that they will leak or that body parts will fall out when they have had an operation or when they have had a procedure involving a needle stick. Band-Aids and bandages help reassure them that their body will remain intact. Parents should be allowed to be present for the procedure, but they should be there for support, not restraint. Preparation for procedures is essential to decrease the preschooler's anxiety.
8. A 15-year-old is hospitalized following her second relapse of acute myelogenous leukemia and is scheduled for a bone marrow transplant. She tells the nurse that she doesn't want to go through with it and that she would rather die. The nurse should: 1. Ensure that her parents sign the informed consent form. 2. Inform the physician and nursing supervisor. 3. Cancel the procedure. 4. Inform the patient's teacher.
2. Inform the physician and nursing supervisor. Rationale: The child is of an age where issues of consent need to be considered seriously; therefore, informing the physician and nursing supervisor is the best answer. Telling her teacher of her decision violates patient confidentiality. Canceling the procedure is not under the nursing scope of practice. Ensuring that her parents sign the informed consent form does not address the moral conflict in this situation. Rationale: The child is of an age where issues of consent need to be considered seriously; therefore, informing the physician and nursing supervisor is the best answer. Telling her teacher of her decision violates patient confidentiality. Canceling the procedure is not under the nursing scope of practice. Ensuring that her parents sign the informed consent form does not address the moral conflict in this situation.
2. A 14-year-old has been diagnosed with insulin-dependent diabetes. Which technique is most appropriate in order to facilitate coping with this diagnosis? 1. Give the adolescent specific instructions. 2. Introduce the adolescent to another teenager who is successfully managing his diabetes. 3. Warn the teen of the consequences of noncompliance. 4. Encourage increased dependence on parents for several weeks.
2. Introduce the adolescent to another teenager who is successfully managing his diabetes. Rationale: The adolescent benefits from meeting teens who are successfully managing a similar diagnosis. The adolescent might not respond well to being instructed what to do. Although the teen needs information related to consequences of noncompliance, this should never be in the form of a warning. In addition, this information would not facilitate coping with the diagnosis. The teen needs to remain as independent as possible. Although parents must learn the information as well, the teen still is encouraged to be very involved in his care and to be as independent as possible.
6. The parent of a hospitalized infant expresses the desire to hold her infant who has been hospitalized with a bacterial infection. What is the most appropriate action by the nurse? 1. Inform the mother that holding the infant may cause the intravenous line to become dislodged. 2. Show the mother how to hold the infant so that intravenous lines are not jeopardized. 3. Ask the mother why she wants to hold the infant. 4. Tell the mother that the infant should rest.
2. Show the mother how to hold the infant so that intravenous lines are not jeopardized. Rationale: Parent-infant attachment is critical to the infant's development; therefore, the nurse should assist the mother to hold the infant in a way that does not jeopardize intravenous lines or equipment. Giving the mother messages that imply that she should not hold her child increases parental anxiety and jeopardizes appropriate development for the infant. The nurse already should understand why the mother wants to hold the infant.
2. The nurse is planning a checkup visit for an adolescent with a chronic condition. The nurse should include which topic of anticipatory guidance? 1 . The adolescent will perform many self-care activities. 2. The adolescent with a chronic condition may be more likely to withdraw from social activities and relationships. 3. The parents should begin to describe the long-term needs in terms the child can understand. 4. The parents should always allow the adolescent choices to promote autonomy.
2. The adolescent with a chronic condition may be more likely to withdraw from social activities and relationships. Rationale: Adolescents do not want to stand out from their peers so those with obvious differences are more prone to withdraw. Adolescents may be physically capable of performing them but are likely to ignore those self-care activities to fit in with their peers. It is appropriate anticipatory guidance for parents to use terms the child can understand for school-age children, not adolescents. Having the parents allow choices to promote autonomy is appropriate anticipatory guidance for toddlers, not adolescents. Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Planning; Learning Outcome: Assess the child with a chronic condition and identify specific nursing interventions for the child at different ages.
9. The nurse is providing care for a hospitalized 10 year-old. Which assessment datum collected by the nurse validates that the child is in the appropriate stage of development? 1. The child does not participate in his care. 2. The child states that he wants to help remove the bandage from his abdomen. 3. The child cries whenever his parents leave. 4. The child kicks and screams when venipuncture is performed.
2. The child states that he wants to help remove the bandage from his abdomen. Rationale: The school-age child is developing independence. The child who asks to help remove his dressing is demonstrating the development of industry. A child who will not participate is showing signs of regression. School-age children might want parents to stay, but they should not be demonstrating signs of separation anxiety at this age. A 10-year-old who kicks and screams with procedures is not demonstrating coping mechanisms characteristic of most school-age children.
9. The nurse notes that a 6-month-old infant who weighed 7 pounds at birth now weighs 15 pounds. What is the nurse's evaluation of the infant's current weight? 1. The infant should be hospitalized for failure to thrive. 2. The infant's weight is appropriate for his age. 3. The infant needs weekly follow-up to assess weight. 4. The infant has been consuming more calories than needed.
2. The infant's weight is appropriate for his age. Rationale: The infant should double his birth weight by 5 to 6 months; therefore, the weight of 15 pounds is appropriate. There is no need for weekly weights in an infant who is thriving. There is no indication of failure to thrive, nor is there any indication that the child has been consuming too many calories.
3. Which behavior by a child's parents is the best indicator that they understand how to administer medication to the child at home following surgery? 1 . The parents sign the written discharge instruction verifying understanding of the instructions. 2. The parents give the medication to the child using the appropriate technique in the nurse's presence. 3. The parents state they understand how to administer the medication and deny questions. 4. The parents state they can give the medication to the child using appropriate technique.
2. The parents give the medication to the child using the appropriate technique in the nurse's presence. Rationale: While all four options indicate understanding, watching the parents correctly administer the medication provides the most information about their understanding. Cognitive Level: Analysis; Client Need: Physiological Integrity; Nursing Process: Evaluation; Learning Outcome: Evaluate the effectiveness of teaching strategies used with the hospitalized child and the family.
1 . The nurse notes that a 6-month-old infant boy who weighed 7 pounds at birth now weighs 15 pounds. Based on the evaluation of the infant's current weight, what is the nurse's next action? 1 . Ask the parent why the child does not eat enough. 2. Immediately inform the physician. 3. Chart the assessment. 4. Teach how not to overfeed the baby.
3. Chart the assessment. Rationale: The baby's weight should be just about double the birth weight by 6 months. The other options treat the weight as if it is either too high or too low. Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Evaluation; Learning Outcome: Synthesize information from several theoretical approaches to plan assessments of the child's growth and developmental milestones.
4. The nurse assigned to care for a 3-year-old child with seizure disorder is unsure of protocols for nursing management of children with seizure disorders. To identify the best evidence to use to provide care, the nurse should consult: 1. Internet search engines. 2. Critical pathways for 3-year-old children. 3. Clinical practice guidelines. 4. Research studies.
3. Clinical practice guidelines. Rationale: Clinical practice guidelines are most valuable in promoting uniformity and excellence in care. The wealth of both credible and incorrect information on the Internet precludes the use of Internet search engines for best care. A synthesis of the best research is provided in clinical practice guidelines. Individual articles are not sufficient as guides to practice. Because the child is 3 years old, the nurse would need to consult only critical pathways that have as their focus protocols for managing seizures in children. These are found in clinical practice guidelines.
6. The nurse notes that a 5-month-old has significant head lag when she attempts to pull the infant to a sitting position. Based on this assessment, the nurse recognizes that the infant: 1. Has some degree of mental retardation. 2. Is developing normally. 3. Needs further assessment and evaluation. 4. Has been neglected by the parents.
3. Needs further assessment and evaluation. Rationale: Head lag should not be present in a 5-month-old. The nurse cannot conclude that the child has been neglected or has some degree of mental retardation based on head lag alone. The child needs further assessment and evaluation.
2. A mother confides to the nurse that she gets so frustrated at times that she is afraid that she will hurt her child, who is mentally and physically challenged. The nurse makes which nursing diagnosis? 1. Compromised Family Coping related to caregiver burnout. 2. Caregiver Role Strain related to child's chronic condition. 3. Risk for Impaired Parenting related to feelings of anxiety. 4. Fatigue related to excessive role demands in caring for child.
3. Risk for Impaired Parenting related to feelings of anxiety. Rationale: The mother states that she fears she will harm her child because she is frustrated, which is subjective data. She has not actually harmed the child; thus, she is at risk for harming the child. There are no subjective or objective data to support the other nursing diagnoses.
5. A child with cerebral palsy might be at high risk for neglect and abuse. Which of the following nursing diagnoses address this risk? (Select all that apply.) 1. Caregiver Role Strain related to continuous responsibilities for caring for child. 2. Increased Parental Stress related to inadequate social support. 3. Risk of Impaired Parenting related to child's care requirements. 4. Ineffective Family Coping related to inadequate financial resources. 5. Risk of Parental Anxiety related to concerns of child's future.
3. Risk of Impaired Parenting related to child's care requirements. 5. Risk of Parental Anxiety related to concerns of child's future. Rationale: "Risk of/for" nursing diagnoses are those that might happen given the client's condition, medical diagnosis, and family circumstances. The other answers are actual nursing diagnoses that must be supported by objective or subjective data from a specific family situation.
1 . Which is the correct developmental stage at which a child begins to have a more realistic understanding of death? 1 . Preschooler 2. Adolescent 3. School age 4. Preteen
3. School age Rationale: Cognitively after age 6 or so, children are able to understand that death is permanent and occurs from varied causes. Preschoolers have magical thinking and believe death is temporary. Many preschoolers believe that bad thoughts and/or behavior cause death. The understanding occurs during the school-age years. The adolescent understands death much like an adult. There is no developmental stage by the name ofpreteen. Cognitive Level: Application; Client Need: Psychosocial Integrity; Nursing Process: Assessment; Learning Outcome: Apply the child's concept of death and loss to each of these age groups: infant, toddler, preschool, school age, and adolescent.
3. Prior to identifying a nursing diagnosis for a 3-year-old child with seizure disorder, it is important that the nurse: 1. Define nursing intervention classifications (NICs) relevant to his care. 2. Carry out interventions specified in the nursing care plan for him. 3. Synthesize data to make a judgment about the child's problems. 4. Use both objective and subjective measures to assess progress in meeting goals for the child.
3. Synthesize data to make a judgment about the child's problems. Rationale: It is important to assess prior to making decisions; therefore, synthesizing data to make a judgment about the child's problems is the best answer. Carrying out interventions specified in the nursing care plan for him would be premature; remember that the nurse should assess before any intervention. Defining nursing intervention classifications (NICs) relevant to his care would not be done yet; after assessing, the nurse would examine the NIC database. Using both objective and subjective measures to assess progress in meeting goals for the child also is incorrect. First the nurse would have to define those goals, following a comprehensive assessment.
2. In planning care for a student with a seizure disorder, the school nurse considers that this child's educational rights are protected by which most recent federal legislation? 1. Title V 2. Healthy Start 3. The Individual with Disabilities Education Act 4. Sheppard-Towner Act
3. The Individual with Disabilities Education Act Rationale: The Individual with Disabilities Education Act was designed to ensure that all children have access to appropriate education in the least restrictive environment. The other choices are not the most recent. Review IDEA 1997.
the definition of a set of sampling criteria is
A list of the characteristics essential to be a member of the target population
Sampling frame
A listing of every member of the population, using the sampling criteria to define membership in the population Subjects are selected from this
4. Which outcome indicates a successful transition from hospital to home for the family of a 2-year-old child with a tracheostomy due to bronchopulmonary dysplasia? 1 . The parents demonstrate proper technique of suctioning the tracheostomy in the hospital. 2. The child demonstrates self-care skills prior to discharge. 3. The family provides appropriate home care for the child while maintaining family routines. 4. The parents demonstrate how to take the child's vital signs at home.
3. The family provides appropriate home care for the child while maintaining family routines. Rationale: Maintenance of family routines while successfully caring for the ill child is the only answer that addresses the hospital-to-home transition. The child is too young to do self-care. Suctioning the child's tracheostomy and taking vital signs are skills required ofthe parents before discharge, but performance ofskills does not indicate that the parents will successfully navigate the transition to home care. Cognitive Level: Analysis; Client Need: Psychosocial Integrity; Nursing Process: Evaluation; Learning Outcome: Assess the family of a child with a chronic condition and discuss the impact ofthe child's condition on the family.
5. The nurse is planning educational interventions to reduce the incidence of the number one cause of mortality in children ages 1 to 4. Recognizing the developmental needs of this age group, the nurse would focus the session on which topic? 1. Child abuse prevention 2. Seizure disorder management 3. Unintentional injury awareness 4. Sudden infant death syndrome (SIDS) recognition
3. Unintentional injury awareness Rationale: Unintentional injury awareness includes motor vehicle accidents, so teaching should include prevention factors. Although all the other choices are a significant cause of mortality, they are not the number one problem for children ages 1 to 4.
9. A hospice nurse makes an initial visit to the home of a terminally ill child to meet the family members and explore the parents' wishes. Which question should the nurse ask first? 1. "Do you want lifesaving interventions withheld?" 2. "Will you consider a do not resuscitate (DNR) or allow natural death (AND) order?" 3. "How do you feel about interventions that will prolong your child's life?" 4. "What can I do for you and your family?"
4. "What can I do for you and your family?" Rationale: The nurse first must develop trust and ask an open-ended question to assess the parents' stage of grieving and understanding of the child's condition. All the other questions can be asked at a later time. At the present time, they are too specific and might be too threatening for the parents' stage of grieving or understanding.
3. A 4-year-old tells the nurse that she is bad and that's why she is in the hospital. What is the nurse's most appropriate response? 1. "Don't be silly." 2. "Let's call your mom and see what she has to say about it." 3. "What did you do that makes you feel like you are bad?" 4. "You are here so we can help you feel better, not because of anything you might have done."
4. "You are here so we can help you feel better, not because of anything you might have done." Rationale: Preschoolers do not fully understand cause and effect and what causes illness. They also frequently view illness as punishment. The nurse needs to be clear about why the child is in the hospital without giving any physiological information that the child cannot understand. The nurse should not discount the statement by saying "Don't be silly." It also does not show the child that whatever behavior made her feel like she was bad has no relationship to her hospitalization. Children of this age may feel two unrelated events have a cause-and-effect relationship. Open-ended statements focus the child on behavior she thinks is bad instead of assuring her that her behavior is unrelated to the reason for hospitalization. Calling the mom to get her input about the child's behavior is not related to the hospitalization and does not focus on helping the child to understand why she is hospitalized.
3. The family of a hospitalized child with leukemia believes the child will be cured by prayer alone, and plans to take the child home. Which nursing intervention will address this barrier to care? 1 . Demonstrate respect for the family's wishes. 2. Evaluate the home for wheelchair accessibility. 3. Communicate the parents' request to the child's physician. 4. Assess the family's understanding of leukemia.
4. Assess the family's understanding of leukemia. Rationale: A child with leukemia has a life-threatening chronic condition that requires ongoing nursing and medical care. The nurse first must assess if the family understands the gravity of the child's condition and required treatment.Assessment ofthe situation must take precedence over evaluation of wheelchair accessibility. Although the physician needs to know ofthis request, it is more important to assess the situation first so the physician can be aware of the family's exact situation. Demonstrating respect is important, but the nurse must first ensure the family understands their child's diagnosis and possible outcomes. Cognitive Level: Analysis; Client Need: Psychosocial Integrity; Nursing Process: Implementation; Learning Outcome: Assess the family of a child with a chronic condition and discuss the impact ofthe child's condition on the family.
1. A toddler's grandmother, who cared for him while the parents worked, has died. The nurse recognizes which behavior to be consistent with the toddler's expected response to death? 1. Resists cuddling and cries excessively 2. States belief that the dead person will awaken 3. Complains of a stomachache 4. Complains of trouble falling asleep
4. Complains of trouble falling asleep Rationale: The toddler might manifest a sense of loss or separation anxiety by having sleep disturbances. Infants resist cuddling, might cry excessively, and might sleep more than usual. Preschoolers believe death is reversible and might think that the dead person will awaken. Older children might have psychosomatic complaints.
1. A 4-year-old who has been toilet-trained becomes incontinent when hospitalized for surgery. The most appropriate nursing diagnosis based on this assessment finding is: 1. Growth and Development Altered related to incontinence. 2. Ineffective Individual Coping related to hospitalization. 3. Urinary Elimination, Altered related to incontinence. 4. Coping, Defensive related to stress of hospitalization.
4. Coping, Defensive related to stress of hospitalization. Rationale: A toilet-trained 4-year-old who becomes incontinent during hospitalization is coping with the stress of this experience through the defense mechanism of regression. This is an effective means of coping for a child this age.
-Communication of research findings
A major focus of nursing science during the 1970s was:
reliability
A measure of the consistency of test or research results
Hope
Confident but uncertain expectation of achieving a future goal.
1. Separation anxiety is one of the major stressors of hospitalization for a toddler. How can the nurse best limit the amount of separation anxiety that the hospitalized toddler will experience? 1. Reduce the amount of time spent with the child when the parents are not present. 2. Encourage the parents to leave the child's room when care is being provided. 3. Encourage the parents to limit the time they hold their child. 4. Encourage parental involvement in the child's care and suggest rooming in if possible.
4. Encourage parental involvement in the child's care and suggest rooming in if possible. Rationale: Parents should be encouraged to room in with their child and to participate in their child's care as much as possible. Asking the parents to leave the room will cause anxiety in the child. Parents should be encouraged to remain with and participate in the care of their hospitalized child. Parents should be encouraged to hold their child as much as the child's condition allows. The nurse should spend as much time as possible with the child when the parents are not present to decrease the amount of anxiety the child experiences.
2. How can the nurse best limit the amount of separation anxiety that the hospitalized toddler will experience? 1 . Reduce the amount of time spent with the child when the parents are not present. 2. Discourage the amount of time the parents hold their child while hospitalized. 3. Encourage the parents to leave the child's room when care is being provided. 4. Encourage parental involvement in the child's care and suggest rooming-in if possible.
4. Encourage parental involvement in the child's care and suggest rooming-in if possible. Rationale: Parents should be encouraged to room-in with and hold their child and to participate in the child's care as much as possible. The child's anxiety will increase when the parent leaves or the child is left alone. Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Assessment; Learning Outcome: Apply family-centered care principles to the hospital setting.
7. A hospitalized 9-year-old states that he does not understand why he needs to have an operation. Based on this statement, the most appropriate nursing diagnosis for this child is: 1. Social Isolation related to hospitalization. 2. Fear of Mutilation related to surgical procedure. 3. Anxiety related to surgery. 4. Knowledge Deficit: Need for Surgery related to lack of previous teaching.
4. Knowledge Deficit: Need for Surgery related to lack of previous teaching. Rationale: Although all of the diagnoses might be appropriate, the one that corresponds directly to the child's statement is Knowledge Deficit related to need for surgery.
2. A 16-year-old female has been admitted to the hospital because of a serious respiratory infection with a diagnosis of possible tuberculosis. She has been placed on respiratory isolation in a private room. Knowing that peers are important, what should the nurse suggest? 1. Drawing pictures of her feelings to give to her peers 2. Placing the child in a room with a roommate of the same age 3. Having friends visit her often 4. Maintaining contact with her friends by telephone
4. Maintaining contact with her friends by telephone Rationale: Telephone contact with friends should be encouraged for the hospitalized adolescent. Disposable equipment is contaminated and should be discarded. In this situation, peer visitation would not be encouraged, because the client is in respiratory isolation for possible tuberculosis. She would not want to expose her friends to the disease. Drawing pictures symbolizing her feelings to give to her friends is not age appropriate.
1 . Which is an important difference between general and advanced practice roles in child health nursing? 1 . Only the general practice nurse can act as a patient advocate. 2. Only the general practice nurse can educate patients and families. 3. Only the advanced practice nurse can act as a case manager. 4. Only the advanced practice nurse can manage medications.
4. Only the advanced practice nurse can manage medications. Rationale: Both the advanced and general practice nurse are responsible for functioning as a client advocate, can act as a case manager, and can educate clients and families. However, only an advanced practice nurse can manage client medications. Cognitive Level: Application; Client Need: Safe, Effective Care Environment; Nursing Process: Implementation; Learning Outcome: Describe and differentiate between the general and advanced practice nurse roles in child health nursing.
6. The nurse recognizes the need to update knowledge related to the most common cause of hospitalization in children. On which body system should continuing education focus? 1. Cardiac 2. Musculoskeletal 3. Gastrointestinal 4. Respiratory
4. Respiratory Rationale: Respiratory diseases are the most common admission to hospitals in children from 1 to 14 years old. They account for 33% of hospital discharges in the 1- to 14-year-old age group.
3. Which nursing intervention is most important for the family of a premature infant of 16 weeks' gestational age with Down syndrome who is not expected to survive? 1. Orient the parents to the high-tech environment of the neonatal intensive care unit. 2. Refer the family to social services to receive assistance for respite care. 3. Encourage the parents to join the hospital's support group for children with Down syndrome. 4. Support the family in anticipatory grieving.
4. Support the family in anticipatory grieving. Rationale: A family with a child who is not expected to live will experience anticipatory grieving. Referral to social services and a support group assume that the child will be discharged. Orientation to the unit is not a priority nursing intervention over supporting the family in anticipatory grieving.
10. Which outcome indicates a successful transition from hospital to home for the family of a 2-year-old child with a tracheostomy due to bronchopulmonary dysplasia? 1. The parents demonstrate how to take the child's vital signs at home. 2. The child demonstrates self-care skills prior to discharge. 3. The parents demonstrate proper technique of suctioning tracheostomy in the hospital. 4. The family provides appropriate home care for the child while maintaining family routines.
4. The family provides appropriate home care for the child while maintaining family routines. Rationale: Maintenance of family routines while successfully caring for the ill child is the only answer that addresses the hospital-to-home transition. The child is too young to do self-care. Suctioning the child's tracheostomy and taking the child's vital signs are skills required of the parents before discharge, but performance of skills does not indicate that the parents will successfully navigate the transition to home care.
The parents of a 10-year-old girl who is diagnosed and hospitalized with a terminal brain tumor ask that she not be told she is dying. How can the nurse communicate with this family?
A meeting of the girl's healthcare team and family will assist the family in facing their fears of being truthful with their daughter. Trust is not built on silence. Children of this age will pick up cues that they are seriously ill.
4. Which is the most critical factor used in evaluation of readiness to learn? 1 . Family expectations 2. Developmental level 3. Education level 4. Timing
4. Timing Rationale: Parents and children who are stressed or preoccupied will not be successful in learning. Choosing the correct time is critical to the child's and parent's learning. Developmental level and education level have little to do with readiness to learn and more to do with choosing appropriate teaching strategies. Family expectations are an important factor in readiness to learn. However, timing is the better answer as appropriate timing sets the stage for effective teaching chosen with family expectations in mind. Cognitive Level: Analysis; Client Need: Safe, Effective Care Environment; Nursing Process: Evaluation; Learning Outcome: Evaluate the effectiveness ofteaching strategies used with the hospitalized child and the family.
3. Which toy is most age appropriate for a 2-year-old? 1. Playhouse 2. Nesting cups 3. Mobile 4. Toy vacuum cleaner
4. Toy vacuum cleaner Rationale: A 2-year-old benefits from having push-pull toys that encourage movement and autonomy. Nesting cups are appropriate for older infants. Mobiles are appropriate for young infants. Playhouses are appropriate for preschool-age children.
5. Which observation is most representative of the type of play usually seen in toddlers? 1. Two children putting a puzzle together 2. A child who sits on the floor by himself playing with blocks 3. The child who dresses up like a fireman 4. Two children sitting side by side, each playing with a toy truck
4. Two children sitting side by side, each playing with a toy truck Rationale: Two children sitting side by side playing with similar toys is an example of parallel play, which dominates in toddlers. The child who sits on the floor by himself playing with blocks is demonstrating solitary play, seen in infants. The child who dresses up like a fireman is demonstrating dramatic play, seen in preschool-age children. Two children putting a puzzle together are demonstrating associative play, also characteristic of preschool-age children.
3. Which is an early indication of impending death? 1. Cheyne-Stokes breathing 2. Hearing loss 3. Increased fluid intake 4. Urine output of 5 mL/hr
4. Urine output of5 mL/hr Rationale: The kidneys are the first organs to respond with a decrease in function when death is imminent. Cheyne-Stokes breathing is a late sign ofimpending death. Hearing does deteriorate but is considered to be the last sense to diminish before death. Oral intake decreases, and anorexia is common. Cognitive Level: Analysis; Client Need: Physiological Integrity; Nursing Process: Assessment; Learning Outcome: Apply assessment skills to identify the physiologic changes that occur in the dying child.
7. Parents of a newborn with trisomy 18 have decided on palliative care for the newborn. The nurses understand that which of the following nursing interventions are applicable in this case? (Select all that apply.) 1. Administering intravenous hydration only 2. Withholding a DNR order 3. Withholding displays of affection for the newborn 4. Withholding nasogastric tube feeding 5. Withholding cuddling and rocking the newborn
4. Withholding nasogastric tube feeding Rationale: Trisomy 18 is a genetic mutation that is incompatible with life. The newborn with trisomy 18 who is given palliative care should be comforted by being admired, cuddled, and rocked. Intravenous fluids and nasogastric feedings are withheld. The newborn has a do not resuscitate (DNR) order or an allow natural death (AND) order.
10. For maintenance of normal body fluid requirements, a child undergoing surgery who weighs 9.6 kg will need __________ mL of fluid per hour in addition to any losses or deficits.
40 mL Rationale: The equation for calculating maintenance fluid is: 100 mL of fluid for the first 10 kg of body weight 50 mL of fluid for the second 10 kg of body weight 20 mL of fluid for the remaining body weight So for the child who weighs 9.6 kg: 9.6 kg × 100 mL = 960 mL per day or 40 mL per hour.
Quantitative data vs. Qualitative data
54 women ate the apple. Women described the apple as the best thing they have ever ate.
Sleep requirements for young adult
6-8 hours of sleep
A nurse has the responsibility of managing a deceased patient's post-mortem care. Arrange the steps for post-mortem care in the proper order. 1. Bathe the body of the deceased. 2. Collect any needed specimens. 3. Remove all tubes and indwelling lines. 4. Position the body for family visit/viewing. 5. Speak to the family members about their possible participation. 6. Confirm that request for organ/tissue donation and/or autopsy has been made. 7. Notify a support person (e.g., spiritual care provider, bereavement specialist) for the family. 8. Accurately tag the body, indicating the identity of the deceased and safety issues regarding infection control. 9. Elevate the head of the bed.
6-9-2-5-7-3-1-4-8
Sleep requirements for adolescents
7 1/2 hours of sleep, depends on the need of the individual
3. Natural
7. Applied research seeks to solve a clinical problem in which setting? 1. Controlled 2. Laboratory 3. Natural 4. Simulated
According to the theoretical normal curve, what percent of the scores un a data set are within 2 standard deviations (above and below) the mean?
95%
complex hypothesis
?
what are some current priorities for clinical nursing research?
?
what is positivism, empiricism, determination, naturalism? what are fundamental beliefs?
?
what types of studies would be investigated by qualitative designs? quantitative designs?
?
What statistical test is used to check a pencil and paper test for homogeneity or internal consistency?
A Cronbach's alpha or a Kuder-Richardson's 20. Both of these are expressed as an "r" value with values above .8 = high internal consistency. Note: internal consistency is checked every time a pencil and paper test is used. If your article for critique used a questionnaire of some sort, then they should report this number for both the questionnaire's development or past use AND the current sample.
What is a Type I Error?
A Type I error occurs when the null hypothesis is rejected when it is true. In plain terms...this means, that the researchers conclude that significant results exist in a study, when really, they don't.
What is a Type II Error?
A Type II error occurs when the null hypothesis is accepted when it is false. In plain terms...this means the researchers conclude that the study results are non-significant when in reality...the results were significant!
Describe a causal relationship between two variables. How would it be stated?
A cause-and-effect relationship. example: smoking causes lung cancer
The nurse is assessing the character of a patient's migraine headache and asks, "Do you feel nauseated when you have a headache?" The patient's response is "yes." In this case the finding of nausea is which of the following? A) An objective finding B) A clinical inference C) A validation D) A concomitant symptom
A concomitant symptom
What is the purpose of conducting a confirmatory analysis?
A confirmatory analysis is used to confirm expectations regarding data from objectives, questions, or hypotheses. Inferential statistics are used, and investigators can generalize the study findings to the appropriate accessible and target population.
moral dilemma
A conflict of social values and ethical principles that support different courses of action.
medical home
A continuous, comprehensive, family-centered, and compassionate source of health care. Also known as a healthcare home.
healthcare home
A continuous, comprehensive, family-centered, and compassionate source of health care. Also known as a medical home.
chronic sorrow
A coping mechanism of periodic grieving.
3. keywords.
A critical aspect of beginning a database search for relevant literature on a topic of interest involves identifying: 1. reference management software. 2. electronic journals. 3. keywords. 4. existing knowledge.
2. an academic library.
A crucial resource for researchers conducting a literature review would be: 1. a secondary source. 2. an academic library. 3. lay literature. 4. a research mentor.
Experimental design
A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena.
respite care
A family support service that provides periodic breaks from the constant stress of caring for the child.
death anxiety
A feeling of apprehension or fear of death.
individualized health plan (IHP)
A formal mechanism to ensure that the child's health needs are managed in the school setting.
Informed consent
A formal preauthorization for an invasive procedure or participation in research.
Managed care
A health delivery system that combines financing and delivery of specified healthcare services with the following elements in place: clinicians are contracted to provide services for a preset fee, clinicians are selected according to specific standards, formal programs of quality assurance and utilization review are in place, and members of the health program have incentives to use selected clinicians.
chronic condition
A health or medical condition that lasts or is expected to last three months or more.
What is the main difference between an integrative review versus a systematic review?
A integrative review considers all types of studies and a systematic review focuses on studies using a similar methodology.
Results of Meta-analysis
A large, diverse sample that is more representative of target population Determination of overall significance of probability of pooled data Indication of the efficacy of the intervention from the average effect size determined from several quality studies Strength of relationship between variables
disability
A limitation that interferes with a child's ability to fully participate in society.
the definition of target population is
A list of all members of the population
the definition of sampling frame is
A list of every member of the population
Family-centered care
A partnership between families, the nurse, and other health professionals in which the priorities and needs of the family are addressed when the family seeks health care; a dynamic, deliberate approach to building collaborative relationships between health professionals and families that are respectful of diversity and beliefs about the nature of the child's condition and ways to manage it.
advance directives
A patient's living will or appointed durable power of attorney for healthcare decisions.
A correlational design investigates relationships between or among variables in a single population. What is the parametric test most commonly used with this design?
A pearson product-moment correlation {sometimes this is just called a pearson's r or just an (r2)}. The results range from -1 to +1.
Self-efficacy
A person's belief that he or she can change behavior to produce a desired outcome.
Hospice
A philosophy of care for a terminally ill child that is focused exclusively on comfort and making sure the remaining time for the child is lived as comfortably and fully as possible.
individualized transition plan (ITP)
A plan that focuses on assisting the individual in moving successfully from school and home into other community settings.
What is a questionnaire (instrument / tool / survey / measurement)?
A printed self-report form designed to elicit information through written or verbal responses of the subject. It tends to have less depth than an interview. It may gather information about facts, beliefs, attitudes, opinions, knowledge, or intentions of the subject / participant. Some questionnaires may include open-ended questions.
A nurse working on a medicine nursing unit is assigned to a 78-year-old patient who just entered the hospital with symptoms of H1N1 flu. The nurse finds the patient to be short of breath with an increased respiratory rate of 30 breaths/min. He lost his wife just a month ago. The nurse's knowledge about this patient results in which of the following assessment approaches at this time? (Select all that apply.) A) A problem-focused approach B) A structured comprehensive approach C) Using multiple visits to gather a complete database D) Focusing on the functional health pattern of role-relationship
A problem-focused approach Using multiple visits to gather a complete database
Risk management
A process established by a healthcare institution to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors, and thereby reduce the institution's liability.
Case management
A process of coordinating the delivery of healthcare services in a manner that focuses on both quality and cost outcomes.
Grounded theory
A qualitative research design used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process.
Ethnography
A qualitative research method for the purpose of investigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior.
What is a rating scale?
A rating scale lists an ordered series of categories of a variable that are assumed to be based on an underlying continuum. Ex. Rate your pain on a 1 - 10 scale with 10 being the worst....
partnership
A relationship in which participants join together to ensure healthcare delivery in a way that recognizes the critical role and contribution of each partner in promoting health, preventing illness, and managing healthcare conditions.
Secondary analysis
A research design in which data previously collected in another study are analyzed.
1. predicts the expected results or outcomes of the study.
A research hypothesis: 1. predicts the expected results or outcomes of the study. 2. defines the theoretical framework for the study. 3. identifies the source of the problem under study. 4. clarifies the concepts used in the study.
-Area of concern in which there is a gap in the knowledge base needed for nursing practice. Research is conducted to generate essential knowledge to address the practice concern with the ultimate goal of providing evidence based practice.
A research problem is defined as a(n):
- description of variabless or concepts, examination of relationships among variables, and determination of differences between two or more groups regarding selected variables.
A research question focuses on:
-Description
A research study describing the benefits of ambulation following cesarean section would be an example of which type of research evidence?
-Control
A research study validates the positive effect that a nursing intervention, patient journaling, has on decreasing spiritual distress during cancer recovery. This would be an example of which type of research evidence?
1. Natural, field
A researcher is interested in studying stress and coping in caregivers of elderly stroke victims. The researcher designs a study where data collection takes place in the caregiver's home. This would be an example of which type of research setting? 1. Natural, field 2. Highly controlled, field 3. Partially controlled, laboratory 4. Highly controlled, laboratory
-Descriptive
A researcher is studying the relationship between age and involvement in social activities. This is what type of research?
3. Prediction
A researcher theorizes that walking three times per week will minimize the likelihood of premature labor in at-risk pregnant women. The researcher initiates a research program to test this theory. This research study is attempting to validate what aspect of theory? 1. Development 2. Explanation 3. Prediction 4. Strategies for controlling outcomes
Case study designs can involve in-depth study of
A single institution, Small groups of subjects, A family
Treatment room
A special room utilized for the pediatric population for procedures such as intravenous starts, lumbar punctures, and blood drawing. The treatment room is utilized rather than the child's own hospital room so that the child always has a "safe" environment and comfort zone by knowing that no unpleasant or painful procedures will occur in his or her room.
Of the situations listed, which is the best example of collaboration between the levels described in the model of EBP collaboration?
A staff nurse uses findings from the Joanna Briggs Institute to support an EBP project, evaluates outcomes, and reports the findings at an international conference
What is a hypothesis?
A statement of predicted relationships between variables or predicted outcomes.
Null hypothesis
A statement or idea that can be falsified, or proved wrong.
hypothesis
A statement predicted relationships between variables or predicted outcomes
Attachment
A strong emotional bond between people.
What is a systematic review?
A structureed, comprehensive synthesis of quantitative studies in a particular subject to determine the best research evidence available for expert clinicians to use to promote an EBP.
Concepts identified in a study may or may not be variables in that specific study. In which of the following studies would the concept "gender" also be a variable?
A study comparing men and women in their response to an intervention
4. researcher's "theory" or idea about the study.
A study framework reflects the: 1. blueprint for the study. 2. specific plan for data collection. 3. data analysis strategy. 4. researcher's "theory" or idea about the study.
What is a landmark study?
A study that changes the literature
Meta-Synthesis
A synthesis of a number of qualitative articles on a focused topic using specific qualitative methodology.
Qualitative research
A systematic, subjective approach used to describe life experiences and give them meaning Do not use questionaires (have to describe what it was like in your OWN words) in qualitative. The participants are very active. Ask what it was like to.. For example.. Be diagnosed with AIDS. Look for themes and patterns. Do interviews. Observations. May work one on one and ask open ended questions. May have a focus group. What was it like.. Etc. Be careful to not interject with our own thoughts and feelings in qualitative study.
What is a meta analysis?
A technique for QUANTitatively integrating the results of multiple studies addressing the same or a higher similar research question.
What does statistically significant mean?
A term indicating that the results from an analysis of a sample data are unlikely to have been caused by chance alone.
This chapter has summarized several theories that are important to consider when studying child developmental progression. What is a theory, and why do we study theories?
A theory is an explanation or construct that is formulated in a response to observations as a proposition to clarify those observations. Often, a person makes observations and seeks to understand them; formulating a theory makes this easier. For example, Freud observed certain commonalities in his psychiatric clients and formulated a theory of child development that explained the relationships between child experiences and adult psychiatric illness.
What is homogeneity?
A type of reliability testing that is used with pencil and paper testing. It addresses the correlation (or relationship) of each question on the test to other questions on the test. It basically asks...are the questions all asking about the same basic constructs? This is also known as internal consistency.
What is equivalence?
A type of reliability which involves the comparison of two versions of the same pencil and paper instrument or two observers who are observing (or grading) the same event. Two versions of the same test = alternate forms reliability Two judges rating the same person = inter-rater reliability It is expressed as an "r" value with values above .8 = greater IRR or alternate forms reliability.
What is a visual analog scale (VAS)?
A visual analog scale is typically used to measure the strength, magnitude, or intensity of individuals' subjective feelings, sensations, or attitudes about symptoms or situations. The VAS is usually 100mm long with right angle stops at either end and descriptive anchors for the phenomenon being measured. Subjects are asked to place a mark on the line to describe the intensity of the sensation or feeling.
Level 2
A well-designed RCT
Which type of theory systematically explains relationships among phenomena? A. Classical B. Descriptive C. Grand D. Middle-range
A. Classical Rationale: Classical theory is an abstract generalization that systematically explains relationships among phenomena. Descriptive theory thoroughly describes a phenomenon, based on rich observations of it. Grand theory attempts to explain large aspects of human experiences. Middle-range theory focuses on a specific aspect of human experience (e.g., stress).
Which type of sampling is most vulnerable to bias? A. Convenience sampling B. Snowball sampling C. Quota sampling D. Purposive sampling
A. Convenience sampling Rationale: Although it is the most widely used approach for quantitative researchers, convenience sampling is the most vulnerable to sampling biases. Snowball, quota, and purposive sampling are less subject to bias
In the Choi et al. (2012) systematic review, many of the included studies did not report adverse effects. This is potentially an unethical research practice because . . . (Choose all that apply.)
A. The adverse effects of acupuncture will be inaccurately represented in the literature. B. A researcher who fails to report treatment adverse effects is not conducting the research responsibly. This raises concerns regarding the researcher's skill and training per Nuremberg Code # 8. C. Adverse effects may have been very high and a biased researcher may have conducted research fraud by not reporting these data.
Confirmatory Analysis
Confirm expectations regarding data that are expressed as hypotheses, questions, or objectives.
A person is shopping in the mall and is approached by individuals who identify themselves as researchers for a local food chain. They ask the person to participate in their study by answering a few questions. As a subject for this survey, the person was selected by which method of sampling? a. Convenience sampling b. Purposive sampling c. Random sampling d. Systematic sampling
ANS: A
Which of the following samples is least likely to be representative of the overall population? a. Convenience b. Quota c. Random d. Stratified random
ANS: A
The Crohn's and Colitis Foundation of America referred the interested researcher to a local chapter of the organization. The local chapter agreed to send out letters on behalf of the researcher inviting potential subjects to contact the researcher if they are willing to participate in a study. Potential subjects in this situation would be described as the: a. accessible population. b. element. c. sample. d. target population.
ANS: A An accessible population is the portion of the target population to which the researcher has reasonable access.
The population from which the researcher selects the actual study sample is referred to as the: a. accessible population. b. scientific population. c. target population. d. theoretical population.
ANS: A An accessible population is the portion of the target population to which the researcher has reasonable access. The sample is obtained from the accessible population.
An advantage of convenience sampling is: a. ease in obtaining subjects. b. increased internal validity and control. c. low risk of sampling bias. d. representativeness of sample is ensured.
ANS: A Convenience samples are inexpensive, accessible, and usually require less time to acquire than other types of samples.
Which of the following study types would require the largest sample size? a. Correlational b. Experimental c. Grounded theory d. Phenomenology
ANS: A Descriptive studies and correlational studies often require very large samples. In these studies multiple variables may be examined, and extraneous variables are likely to affect subjects' responses to the variables under study.
Which of the following is true about sample size? a. An adequate sample size is particularly important to detect differences when they do in fact exist. b. Evaluating the possibility of a Type I error will help determine sample size. c. Finding a significant difference in study groups occurs most often with smaller samples. d. Sample size is especially important to support significant findings.
ANS: A Evaluating the adequacy of the sample size is very important when no differences have been found. Too small a sample can result in no difference being detected, even when there actually is one.
The term "comparison group" in research refers to the group of patients in a: a. nonrandom sample who do not receive a treatment. b. nonrandom sample who receive a treatment. c. random sample who do not receive a treatment. d. random sample who receive a treatment.
ANS: A If nonrandom methods are used for sample selection, the group not receiving a treatment is referred to as a comparison group.
Which of the following is true about probability sampling? Probability sampling: a. can take different forms, but random selection is always used. b. is the most economical way to get large numbers of subjects. c. guarantees that the sample is representative. d. subjects are handpicked because they have the expertise to provide information for the study.
ANS: A Random sampling allows each individual in the population an opportunity to be selected for the sample.
Which of the following statements is true about stratified random sampling? a. Allows the researcher to use a smaller sample size b. Ensures obtaining a larger sample at lower cost c. Internal validity is strengthened with this type of sampling d. Involves the selection of certain subjects from a convenience sample
ANS: A With stratification, the researcher can use a smaller sample size and achieve the same degree of representativeness in relation to the stratified variable as a large sample acquired through simple random sampling.
Which of the following types of sampling is considered to be the weakest? a. Cluster b. Convenience c. Quota d. Systematic
ANS: B
Which type of sampling will get the largest number of subjects in the shortest period of time? a. Cluster sampling b. Convenience sampling c. Network or snowball sampling d. Random sampling
ANS: B
The adequacy of a sample would be primarily based on which of the following criteria? a. Method chosen for sample selection b. Representativeness of the population c. Size of the total population d. Willingness of subjects to participate
ANS: B A sample needs to be representative in terms of characteristics, such as age, gender, ethnicity, income, and education
Which of the following statements is true about sampling plans? a. A probability sampling plan is a better plan than a nonprobability one. b. A sampling plan outlines strategies used to obtain a sample for a study. c. Each study has its own sampling method, unique to that project. d. Getting a sample that is the most representative is the ideal, not the goal, of the sampling plan.
ANS: B A sampling plan, or sampling method, defines the selection process for a study.
The sample size needed for a study increases when: a. the alpha level is increased from .01 to .05. b. the number of variables in the study increases. c. a one-tailed versus a two-tailed statistical test is used. d. the sensitivity of the instruments used is high.
ANS: B As the number of variables under study increases, the sample size needed may increase.
Which of the following is true about theoretical sampling? a. All studies use theoretical sampling as a background for creating the sample. b. Grounded theory research frequently uses theoretical sampling to develop a selected theory. c. Subjects are selected to participate in a research study to match certain theory characteristics. d. Theoretical sampling is a little-used, but powerful method of creating a sample for quantitative research.
ANS: B Because of the nature of grounded theory methodology, theoretical sampling is used.
Cluster sampling is: a. a form of nonprobability sampling used in small surveys. b. also known as multistage sampling. c. unlikely to result in sampling errors. d. useful when the target population is found in a small geographical area.
ANS: B Both terms, cluster sampling and multistage sampling, have the same meaning in sampling methods.
Which of the following types of studies would need the largest sample size? a. Case studies b. Descriptive studies c. Experimental studies d. Quasi-experimental studies
ANS: B Descriptive studies often require very large samples. Multiple variables may be examined, and extraneous variables are likely to affect subject response(s) to the variables under study.
Which of the following is the last stage in Rogers' research utilization process?
Confirmation
Which of the following is true about sample size in a qualitative study? a. "Adequate sample size" is of no concern to a qualitative researcher because there is no statistical analysis involved. b. Sample size is deemed to be adequate when the researcher is detecting no new knowledge from additional subjects. c. Subjects who have knowledge of a situation assist the researcher in determining whether the sample size is adequate. d. There is a test similar to the power analysis in a quantitative study that can be used to determine an adequate sample size for qualitative research.
ANS: B In qualitative research, the researcher looks for data saturation, which is reached when no new information is being discovered from additional subjects.
Which of the following is an example of purposive sampling? a. The names of all possible subjects are put into a hat, and an adequate number are drawn out. b. Volunteers are solicited from the entire population, and those who agree become subjects in the study. c. Sample members are determined by finding a designated number of subjects from each of several identified groups (men, women, high school graduates, etc.). d. Subjects who have knowledge about the study topic are asked to participate in the study; those who agree become the sample.
ANS: B Purposive sampling is when appropriate subjects are found by the researcher and asked to participate in the study.
Why do qualitative researchers need to be as concerned with sample size as quantitative researchers do? Qualitative researchers: a. are reaching the objectives of their study in a similar way. b. need subjects who are able and willing to share their knowledge, oftentimes in repeated and more in-depth interviews than subjects in quantitative studies. c. need to gain a narrow focus rather than a broad perspective as their research purpose. d. will be analyzing the data with statistical techniques that require certain numbers of subjects.
ANS: B Qualitative research oftentimes requires the subjects to share their knowledge of the topic being studied in an in-depth level in repeated interviews. Therefore the researcher needs to ensure that the sample size is adequate to provide the depth and rich data that are required.
Which of the following factors do not influence saturation of data and therefore sample size in a qualitative study? a. Quality of the data b. Randomization of the sample c. Scope of the study d. Study design
ANS: B Randomization of the data is a concern for quantitative research designs. All other choices are concerns for saturation of data in qualitative research.
In a study investigating nurses' attitudes toward taking care of respiratory disease patients who had a long history of smoking, the researcher randomly selected a sample from a list of all the registered nurses from a randomly selected list of four states in the Southeast. Because the sample was drawn randomly, to what population can the findings of the study be generalized? Registered nurses in the: a. Selected four states b. Southeast c. Southeast who are actively working d. United States
ANS: B This study used a cluster sampling technique that is one type of random sampling plan.
A researcher wants to obtain a sample of individuals who are HIV positive. Which of the following sampling methods would be the most effective way to obtain a sample? a. Accidental sampling b. Cluster sampling c. Network sampling d. Simple random sampling
ANS: C
The researcher is to select a set of five subjects using a random numbers table. The selected population is 50. The researcher's pencil was initially placed on the second column from the left and third row down. The decision is to move across the columns to the right. 06 84 10 22 56 72 25 70 69 43 07 63 10 34 66 39 54 02 33 85 03 19 63 93 72 52 13 30 44 40 77 32 69 58 25 15 55 38 19 62 20 01 94 54 66 88 43 91 34 28 The subject numbers will be: a. 13, 30, 44, 40, 32 b. 19, 38, 55, 15, 25 c. 19, 63, 93, 72, 52 d. 33, 02, 54, 39, 66
ANS: C
Subjects who participate in a study of patients with inflammatory bowel disease are described as the: a. accessible population. b. element. c. sample. d. target population.
ANS: C A sample is that group of people who are representing the entire population and participating in the study. Samples are expected to represent an entire population.
To detect a significant difference between two groups when the effect size is small, what should the researcher do? a. Conduct a pilot study. b. Obtain a different sample. c. Increase the sample size. d. Perform additional analysis.
ANS: C Increasing the sample size makes it easier to detect a difference.
A researcher was able to obtain a list of all lung cancer patients in the Southeast. If a table of random numbers was used to create a sample from that original list and then those individuals agreed to participate in a study, what kind of sample would have been created? a. Cluster b. Convenience c. Simple random d. Stratified random
ANS: C Simple random sampling is when every member of the population has an equal chance of selection for the sample.
Which of the following sets of terms represents an appropriate pairing of a probability sampling method and a corresponding nonprobability sampling one? a. Cluster sampling—snowball technique b. Simple random sampling—convenience sampling c. Stratified random sampling—quota sampling d. Theoretical sampling—quota sampling
ANS: C Stratified random sampling and quota sampling both attempt to balance the sample in terms of known characteristics in the population.
In a study investigating nurses' attitudes toward taking care of respiratory disease patients who had a long history of smoking, the researcher randomly selected a sample from a list of all the registered nurses from a randomly selected list of four states in the Southeast. If the researcher also selected the sample by randomly selecting nurses who smoke and those who do not, what sampling technique is being used? a. Cluster b. Quota c. Stratified random d. Systematic
ANS: C Stratified random sampling is used when certain characteristics of the group are identified and then proportionately included in the randomly chosen sample. Assuming the researcher first knew whether or not a nurse smoked, then this represents that sampling technique.
Apart from sample size, which of the following is typically not considered when determining the power of a study? a. Sensitivity of the instruments used b. Number of variables c. Skill of the researcher d. Data analysis techniques
ANS: C The skill of the researcher does not affect the statistical power of a study. All other answers are correct.
Nonprobability Sampling
Convenience (accidental) sampling Quota sampling
A researcher reports on a study conducted to determine if a new educational program has helped dialysis patients become more compliant with their fluid restrictions. The findings indicated that there was no difference. The report did include that a power analysis was performed to determine if the sample size (n = 100) was adequate. The power level was .5. What should the reader conclude? a. A sample of 100 is certainly adequate in a clinical study. The researcher should adjust the educational program. b. Chances are high that a Type I error has occurred. c. Findings of no difference are not surprising; it is difficult to make an impact on this population of patients. d. There is a high likelihood that the sample size was not adequate, and the study should be replicated using more subjects.
ANS: D A power level needs to reach .8 to be acceptable, and this one had only .5. There is a good chance that a Type II error occurred, and the study should be replicated.
Which of the following research settings is not correctly paired with the type of setting? a. Clinical research unit—highly controlled setting b. Indoor playroom—natural setting c. Primary care clinic—partially controlled setting d. Subject's home—partially controlled setting
ANS: D A subject's home would be a natural research setting, so it is paired incorrectly with "partially controlled setting."
Another name for probability sampling is: a. accidental sampling. b. purposive sampling. c. quota sampling. d. random sampling.
ANS: D In probability sampling, every member of the population has a probability higher than zero of being selected for the sample. To achieve this probability, the sample is obtained randomly.
Which of the following would be the best method for randomly assigning subjects (n = 40) to treatment (n = 20) and control (n = 20) groups in an intervention study? Assign numbers to all subjects and: a. ignore numbers; group the subjects by diagnosis or physician. b. place the first 20 subjects in one group and the last in the other. c. put even-numbered subjects in one group, odd numbered in the other. d. put numbers 1 to 40 in a box and blindly draw from the box.
ANS: D In the approach described, all 40 of the subjects have an equal chance of being assigned to either the treatment group or the control group.
In a study of liver transplant recipients, the researcher specifies that the subjects must be 18 years of age or older and the recipient of only one liver transplant. These criteria are an example of: a. demographic attributes. b. exclusion criteria. c. extraneous variables. d. inclusion criteria.
ANS: D Inclusion criteria are those characteristics that the subject or element must possess to be part of the target population.
Which of the following is true about network sampling? a. Eligibility criteria do not need to be defined carefully. b. Finding large numbers of subjects by this means is easy and economical. c. Sample representativeness is guaranteed by using this technique. d. Subjects who have knowledge of a situation, often sensitive or not socially acceptable, are identified by others in the same type of situation.
ANS: D Network sampling is useful for locating samples difficult or impossible to obtain in other ways. Network sampling takes advantage of social networks and the fact that friends tend to have characteristics in common.
A researcher wanting to explore the lives of women newly diagnosed with breast cancer obtains a random sample of the population. What part of the study will be strengthened because of the random sample? a. Feasibility b. Reliability c. Statistical power d. Validity
ANS: D Random samples increase the validity of a study.
A sample that accurately reflects the characteristics of the population from which it is drawn is a: a. cluster sample. b. purposive sample. c. random sample. d. representative sample.
ANS: D Representativeness means that the sample, accessible population, and target population are alike in as many ways as possible.
Findings of an intervention study with a convenience sample: a. are generalizable to a wider group of patients with related problems. b. are to be discounted because they are extremely biased. c. provide no useful information. d. should be replicated before being applied to a wider population.
ANS: D Representativeness of the sample is a concern in convenience sampling, and generalizability is therefore limited.
Sample attrition would be reflected by the: a. average death rate of the population under study. b. inability to access identified members of a population. c. number of patients who die while participating in a study. d. number of patients who drop out of a study.
ANS: D Sample attrition or mortality is the withdrawal or loss of subjects from a study
What is the weakest type of sample in quantitative studies?
Convenience Sampling
Sampling in research may be defined as: a. insurance that each person has a chance of being included in the study. b. establishment of criteria for eligibility to participate in a study. c. identification of the population in which the researcher is interested. d. selection of a subset of a population to represent the whole population.
ANS: D Sampling involves selecting a group of people, events, behaviors, or other elements with which to conduct a study. Samples are expected to represent a population of people.
Which of the following are not correctly paired as similar types of sampling methods? a. Convenience sampling—accidental sampling b. Network sampling—snowball sampling c. Purposive sampling—selective sampling d. Stratified random sampling—quota sampling
ANS: D Stratified random sampling and quota sampling differ in randomness; quota sampling does not allow for equal likelihood of entering the sample from the target population. Convenience and accidental sampling describe similar types of sampling methods.
A researcher is interested in studying lifestyle management in patients with inflammatory bowel disease. The researcher contacts the Crohn's and Colitis Foundation of America to determine how to best access this patient population. Patients with inflammatory bowel disease are an example of which of the following? a. Accessible population b. Element c. Sample d. Target population
ANS: D The target population is the entire set of individuals who meet the sampling criteria.
Which is the largest group from among this list? a. Accessible population b. Control group c. Sample d. Target population
ANS: D The target population is the group the researcher wants to generalize to and needs the sample to represent.
ANOVA
ANalysis Of VAriance (intraclass) -- measures more than two variables ----objectivity ----accuracy - standard error of measurement (SEM)
The nurse completed the following assessment: 63-year-old female patient has had abdominal pain for 6 days. She reports not having a bowel movement for 4 days, whereas she normally has a bowel movement every 2 to 3 days. She has not been hospitalized in the past. Her abdomen is distended. She reports being anxious about upcoming tests. Her temperature was 37° C, pulse 82 and regular, blood pressure 128/72. Which of the following data form a cluster, showing a relevant pattern? (Select all that apply.) A) Vital sign results B) Abdominal distention C) Age of patient D) Change in bowel elimination pattern E) Abdominal pain F) No past history of hospitalization
Abdominal distention Change in bowel elimination pattern Abdominal pain
validity
Ability of a test to measure what it is supposed to measure and to predict what it is supposed to predict
privacy
Ability of an individual to relate information in a protected manner.
Power Analysis
Ability to detect differences in the population or capacity to correctly reject a null hypothesis
teratogenesis
Abnormal development of the fetus.
Which section of a research article provides an overview of the study?
Abstract
Conceptual definition
Abstract meaning of a variable that usually is based on theory
Worden's four tasks of task-based grief theory
Accept the reality of the loss; Experience the pain of grief; Adjust to a world in which the deceased is missing; emotionally relocate the deceased and move on with life
Serendipity
Accidental discovery of something useful or valuable.
Which of the following is required in the delivery of culturally congruent care? A) Learning about vast cultures B) Motivation and commitment to caring C) Influencing treatment and care of patients D) Acquiring specific knowledge, skills, and attitudes
Acquiring specific knowledge, skills, and attitudes
validation
Act of confirming, verifying, or corroborating the accuracy of assessment data or the appropriateness of the care plan.
A 46-year-old woman from Bosnia came to the United States 6 years ago. Although she did not celebrate Christmas when she lived in Bosnia, she celebrates Christmas with her family now. This woman has experienced assimilation into the culture of the United States because she: A) Chose to be bicultural. B) Adapted to and adopted the American culture. C) Had an extremely negative experience with the American culture. D) Gave up part of her ethnic identity in favor of the American culture.
Adapted to and adopted the American culture.
Cultural care accommodation or negotiation
Adapting or negotiating with the patient/families to achieve beneficial or satisfying health outcomes.
Likelihood Ratios (LRs)
Additional calculations that you can perform to determine the accuracy of diagnostic or screening tests, which are based on the sensitivity and specificity results.
Homogeneity
Addresses the correlation of various items within the instrument or internal consistency; determined by split-half reliability or Cronbach's alpha coefficient
Mature minors
Adolescents of 14 and 15 years of age who are able to understand treatment risks and who, in some states, can consent to or refuse treatment.
What can the school nurse do to promote Ian's transition to a new class?
Adolescents often are self-absorbed and might not reach out to a new person who looks different from them. Ian's transition can be facilitated by a caring nurse who has a frank education session with the class before Ian's arrival.
assimilation
Adopting and incorporating characteristics of a new culture within one's practices.
Which of the following best represents the dominant values in American society on individual autonomy and self-determination? A) Physician orders B) Advance directive C) Durable power of attorney D) Court-appointed guardian
Advance directive
A nursing student is taking postoperative vital signs in the postanesthesia care unit. She knows that some ethnic groups are more prone to genetic disorders. Which of the following patients is most at risk for developing malignant hypertension? A) Ashkenazi Jew B) Chinese American C) African American D) Filipino
African American
When does implementation begin as the fourth step of the nursing process? A) During the assessment phase B) Immediately in some critical situations C) After the care plan has been developed D) After there is mutual goal setting between nurse and patient
After the care plan has been developed
What national organizations can nurses use to locate EBP resources and EBP-based clinical guidelines?
Agency for Healthcare Research and Quality, National Institute of Nursing Research, National Nursing Practice Network, and specialty nursing organizations.
Sociodemographics, cultural diversity, economic and political changes
Aging population Diverse population Increasing number of people living in poverty, homeless, and/or uninsured Disrespect for others Domestic abuse of women and children Various forms of violence in homes, schools, and public places Obesity epidemic Nontraditional families
Significant Results
Agree with those predicted by the researcher and support the logical inks developed by the researcher among the framework, questions, variables, and measurement tools.
Hinduism
Allow time for prayer and purity rituals. Allow use of amulets, rituals, and symbols.
Analysis of Covariance (ANCOVA)
Allows the researcher to examine the effect of a treatment apart from the effect of one or more potentially confiding variables.
Convenience Sampling
Also called accidental sampling Weak approach to sampling because it is hard to control for bias The sample includes whomever is available and willing to give consent. Representativeness is a concern.
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.
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.
How do benzodiazepines effect sleep?
Alter REM sleep Increase sleep time Increase daytime sleepiness
Funding Research
Although some small research projects can be undertaken with only personal funding, most research requires financial support. Money typically is needed to cover the following types of costs: Paying personnel employed by the project Purchasing or developing data collection materials, such as buying or copying paper-based instruments or obtaining biologic samples Paying for data analyses, such as sophisticated examination of blood or body fluid samples Funding travel to present the study's results to various groups Several groups have research priorities and fund nursing research that match those areas of interest. Let's look at some of those groups.
What statement is untrue regarding the atrocious medical activities of the Third Reich in Europe during the late 1930s and early 1940s?
Although terrible, at least some valuable medical information made up for the misconduct.
An 8-year-old dying child asks the nurse, "Will it hurt to die?" What is the nurse's best response?
Although the dying process itself is not painful, pain may be present due to other physiological disease processes. Pain is the most feared experience for a dying child and his family. The nurse can assure the child and family that the child will not be in pain, that the child will be kept comfortable.
2. reasoning from a single diabetic patient to all diabetic patients.(specific to the genereal)
An example of inductive reasoning is: 1. reasoning from all chronically ill patients to a single chronically ill patient. 2. reasoning from a single diabetic patient to all diabetic patients.(specific to the genereal) 3. using a standard nursing care plan to care for a specific patient. 4. using a computerized nursing care plan to care for insulin-dependent diabetic patients.
What is the purpose of conducting an exploratory analysis?
An exploratory analysis is used to examine all of the data descriptively.
morbidity
An illness or injury that limits activity, requites medical attention or hospitalization, or results in a chronic condition.
Cultural awareness
An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people
Development
An increase in capability or function.
Growth
An increase in physical size.
grief
An individual's feelings and behaviors in response to death.
Critical thinking
An individualized, creative thinking or reasoning process that the nurse uses to solve problems.
What is an integrative review of the research?
An integrative review of the research includes the identification, analysis, and synthesis of research findings from independent quantitative and sometimes qualitative studies to determine what is known and not known in a particular area.
continuity of care
An interdisciplinary process of facilitating a patient's transition between and among settings based on changing needs and available resources.
What is an interview?
An interview involves verbal communication between the researcher and the subject during which information is provided to the researcher. Interviews may be structured or unstructured.
Beneficence
An obligation to act or make a decision to benefit the patient.
Do Not Intubate (DNI) order
An order written by a physician at the family's request not to intubate a child who stops breathing.
Do Not Resuscitate (DNR) order
An order written by a physician at the family's request not to resuscitate or take other lifesaving interventions for a child who stops breathing.
Complicated grief
An unhealthy grief that is not resolved; the grief is intensified to the level that the individual is so overwhelmed that it interferes with ability to function.
Phase 3 of critical appraisal of quantitative studies
Analysis Involves a critique of logical links connecting one study element with another Overall logical development of the study must be examined.
Which of the following is a characteristics of qualitative research?
Analysis of the data involves individual interpretation
ANOVA
Analysis of variance; a statistical procedure for testing mean differences among three or more groups by comparing variability between groups to variability within groups.
What is the dominant culture in the United States?
Anglo-American with origins from Western Europe
When a subject's identity cannot be linked, even by the researcher, with his or her individual responses, this subject is said to have
Anonymity
A family member of a recently deceased patient talks casually with the nurse at the time of the patient ' s death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member? A) Denial B) Anticipatory grief C) Dysfunctional grief D) Yearning and searching
Anticipatory grief
Review the following nursing diagnoses and identify the diagnoses that are stated correctly. (Select all that apply.) A) Anxiety related to fear of dying B) Fatigue related to chronic emphysema C) Need for mouth care related to inflamed mucosa D) Risk for infection
Anxiety related to fear of dying Risk for infection
related factor
Any condition or event that accompanies or is linked with the patient's health care problem.
Adverse reaction
Any harmful, unintended effect of a medication, diagnostic test, or therapeutic intervention.
Death imagery
Any reference to death or death-related topics, such as going away, separation, funerals, and dying, given in response to a picture or story that would not usually stimulate a child to discuss death-related topics.
Nursing intervention
Any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes.
Generalization
Application of information that has been acquired from a specific instance to a general situation.
What type of quantitative research is conducted to generate knowledge that will directly influence clinical practice?
Applied research
Data Analysis
Are data analysis procedures appropriate to the type of data collected? Are data analysis procedures clearly described? Are the results presented in an understandable way? Do data analyses address each research objective, question, or hypothesis? Are the analyses interpreted appropriately? Are the statistical analyses logically linked to the design? Is the sample size sufficient to detect significant differences? Was power analysis used to determine sample size?
Interpretation of Findings
Are findings discussed in relation to each objective, question, or hypothesis? Are the findings clinically significant? Do the conclusions fit the findings from the analyses? Are conclusions based on statistically significant and clinically significant results? Are there limitations the researcher did not identify?
Research Objectives, Questions, or Hypotheses
Are the objectives, questions, or hypotheses expressed clearly? Are the objectives, questions, or hypotheses logically linked to the research purpose and framework? Are the research objectives, questions, or hypotheses linked to concepts and relationships from the framework?
Observation
Are the phenomena to be observed clearly identified and defined? Is interrater and intrarater reliability described? Are the techniques for recording observations described?
A nurse conducting a keyword search of a literature database enters the search terms "anorexia NOT bulimia" to obtain what result?
Articles that discuss anorexia only
Number of Variables
As the number of variables increases, the sample size must increase. The inclusion of multiple dependent variables also increases the sample size needed.
A relational statement says that a relationship of some kind exists between two or more concepts. For the statement "the relationship between two concepts is positive," which of the following is an accurate translation?
As the values of Concept A increase, values of Concept B can be expected to increase
Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care? A) Practice honesty with everyone, telling patients about their illness, even if the news is not good. B) Ask family members if they prefer to help with the care of the body after death. C) Provide postmortem care at the time of death to relieve family members of this difficult job. D) Value patient self-determination, understanding that each person makes his or her own decisions.
Ask family members if they prefer to help with the care of the body after death.
The nurse at an outpatient clinic asks a patient who is Chinese American with newly diagnosed hypertension if he is limiting his sodium intake as directed. The patient does not make eye contact with the nurse but nods his head. What should the nurse do next? A) Ask the patient how much salt he is consuming each day B) Discuss the health implications of sodium and hypertension C) Remind the patient that many foods such as soy sauce contain "hidden" sodium D) Suggest some low-sodium dietary alternatives
Ask the patient how much salt he is consuming each day
You have identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which general approach do you take to prioritize the nursing diagnoses? (Select all that apply.) A) Use family members and physician orders as primary resources for prioritizing your actions. B) Address the nursing diagnosis that most affects the medical diagnosis. C) Ask the patient to identify the most distressing symptom and first address that diagnosis. D) Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.
Ask the patient to identify the most distressing symptom and first address that diagnosis. Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.
2. As Tiona and her mother are preparing to leave the hospital, Tiona says, "I am going to be good so I do not have to come to the hospital anymore!" How should the nurse respond?
Assess what she means first: "Why do you think you had to come to the hospital? Did you think you were here because you weren't good at home?" After finding out what she meant...then you can respond accordingly to dispel the reason or address that her tonsils were making her sick so they needed to be taken out so she can feel better. "It had nothing to do with anything you did."
Advancing Evidence-Based Practice
Assessment of barriers to EBP Corrections of misperceptions about EBP goals and processes Questioning current clinical practice
Parteras Lay midwives
Assistance for women in childbirth and newborn care
Rehabilitation
Assisting a child with physical or mental challenges to reach his or her fullest potential through therapy and education that considers the physiologic, psychologic, and environmental strengths and limitations of the child.
Types of Hypotheses
Associative vs. causal Simple vs. complex Nondirectional vs. directional Null vs. research
3. Based on Haley's age and developmental stage, what feelings, fears, and concerns might she be expected to experience related to entry into school? What interventions would be beneficial to Haley?
Assuming she is normal for age, she would be at the school age stage with the task of industry vs. inferiority. She may identify herself as inferior due to her inability to participate and perform in classroom/recess activities. She may have increased anxiety since she has not been in school (only home-schooled). She may have separation anxiety from her mother. Interventions include: Assessment of her current level of functioning, cognitively and socially. Work with the multidisciplinary team to design appropriate accommodations for her. She may want to start school on a part-time basis, and increase hours as she is able to cope and tolerate. Work with the teacher to identify a classmate "special friend" to help her adjust to the classroom. Provide opportunities for her to be successful.
A nurse caring for a patient with pneumonia sits the patient up in bed and suctions his airway. After suctioning, the patient describes some discomfort in his abdomen. The nurse auscultates the patient's lung sounds and gives him a glass of water. Which of the following is an evaluative measure used by the nurse? A) Suctioning the airway B) Sitting patient up in bed C) Auscultating lung sounds D) Patient describing type of discomfort
Auscultating lung sounds
You are a new nurse working at XYZ hospital. Your preceptor tells you to dangle Ms. Jones' legs on the side of the bed before you attempt to assist her to a chair. You ask your preceptor why this is done and she answers, "Because I said so." This is an example of which type of evidence?
Authority
Which of the following statements about outcome variables is true?
Available measuring instruments must be sensitive enough to detect changes over time
The nurse incorporates which priority nursing intervention into a plan of care to promote sleep for a hospitalized patient? A) Have patient follow hospital routines B) Avoid awakening patient for nonessential tasks C) Give prescribed sleeping medications at dinner D) Turn television on low to late-night programming.
Avoid awakening patient for nonessential tasks
After reading the Choi (2012) article about acupuncture, how should a nurse best evaluate whether the research presented in this article was conducted in an ethical way? (Choose all that apply.)
B. It is difficult to evaluate the research ethics of the included studies because the authors did not comment on IRB or informed consent procedures. C. Although it is likely that all the included studies were performed using ethical standards, this assumption should not be made because research misconduct still occurs today.
The statement of purpose for a qualitative study would include which of the following? A. Identification of the key study variables B. Suggestions for the research tradition C. Indication of the population of interest D. Identification of the relationship among variables
B. Suggestions for the research tradition Rationale: The statement of purpose for a qualitative study would include a suggestion for the research tradition. Identification of key study variables, indications for the population of interest, and identification of the possible relationships among the variables are included in the statement of purpose for a quantitative study.
American Association of Colleges of Nursing aacn.nche.edu
BSN and higher degree schools; multiple publications, position papers; useful Internet links
To enhance their cultural awareness, nursing students need to make an in-depth self-examination of their own: A) Motivation and commitment to caring. B) Social, cultural, and biophysical factors. C) Engagement in cross-cultural interactions. D) Background, recognizing her biases and prejudices.
Background, recognizing her biases and prejudices.
Empirical Generalizations
Based on accumulated evidence from many studies and are important for the verification of theoretical statements or the development of new theory.
What characteristics are descriptive of quantitative research?
Basic elements of analysis are numbers, data are analyzed with statistics, and generalization of findings is important
What is basic research?
Basic research is designed to gain a more comprehensive knowledge or understanding of the following: Human anatomy, physiology, and biology Mechanisms and processes of disease Researchers conducting basic research may work solely in a laboratory rather than with human research participants. Close
3. pilot study.
Before implementing a large, multisite research investigation, a researcher conducts a smaller study of the planned study to identify any problematic areas. This smaller study is known as a(n): 1. abstract. 2. exploratory design. 3. pilot study. 4. proposal.
A family member asks a home care nurse what he should do if the patient's serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life? A) Encourage the family member to think more positively about the patient's new therapy B) Avoid the discussion because it has to do with medical, not nursing, diagnoses C) Initiate a discussion about advance directives with the patient, family, and health care team D) Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present
Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present
The emic approach to ethnographic research involves studying
Behavior from within the culture
Cultural skills
Being able to assess social, cultural, and biophysical factors influencing treatment and care of patients
BELIEF Assessment
Belief system; Ethics or values; Lifestyle; Involvement in a spiritual community; Education; Future events
Judaism
Believe that it is important to stay healthy. They expect the nurse to provide competent health care. Allow patients to express their feelings. Allow family to stay with dying patient.
ethical principles
Benefiance, Respect for human dignity, Justice
- personal experience
Benner (1984) emphasizes the importance of acquiring clinical knowledge and expertise through:
What factors or evidence led to changes in public health practice that reduced the infant mortality rates in the early 1900s?
By 1915, the infant mortality rate had decreased from 200 per 1,000 (the rate from 1850 to 1880) to 100 per 1,000 live births. Causes of death included communicable disease, poor nutrition, and epidemics of "summer diarrhea." Improvements in infant health stemmed from a national legislative focus on prenatal care and infant health services. Funding allowed the development of initiatives to promote the health of neonates. Regulations were enacted to improve the sanitation of milk, and artificial infant formulas were developed. All of these developments had an impact on mortality rates.
How can nurses themselves be barriers to EBP?
By not having the background to read research and not seeing the value of implementing evidence-based interventions. Often EBP involves change, and they may be opposed to changing a policy or procedure that they have used for a long time.
When beginning a search for relevant evidence, the researcher uses the bibliography of a recent relevant reference to find studies. This is called: A. Descendancy approach B. Keyword searching C. Ancestry approach D. Use of wildcards
C. Ancestry approach
Exclusion
Characteristics that can cause a person or element to be excluded from the target population Examples: Diagnosis of mental illness Less than 18 years of age Diagnosis of cognitive dysfunction Unable to read or speak English
What does a theme represent in qualitative research? A. The actual written report B. The operational definition of the study's conceptual framework C. The labeling of similar ideas shared by the study participants D. The relationship between the hypotheses and the research question
C. The labeling of similar ideas shared by the study participants
Which of the following would best describe the key objective of critical theory research? A. Long-term data collection B. Gender domination C. Transformation D. Vulnerable groups
C. Transformation Rationale: A key objective of critical theory research is transformation. Data collection over time is common in case studies. The effect of gender domination and discrimination is associated with feminist research. Groups or communities vulnerable to control or oppression are associated with participatory action research.
Name one of the most useful electronic data bases.
CIHNAL
most useful electronic data base
CINAHL
What is a control group? Experimental group?
CONTROL group does not receive the new treatment being studied and which is compared to the EXPERIMENTAL group that does receive the new treatment
Postmortem care
Care of a patient's body after death.
Culturally congruent care
Care that fits people's valued life patterns and sets of meanings generated from the people themselves. Sometimes this differs from the professionals' perspective on care.
Quantitative Designs
Case study: Survey: Needs assessment: Methodologic: Meta-analysis: Experimental: Quasi-experimental: Secondary analysis Triangulation: Pilot studies:
Concepts Relevant to Design
Causality Multicausality Probability Bias Control Manipulation
How do beta-adrenergic blockers effect sleep?
Cause nightmares Cause insomnia Cause awakening from sleep
Causal hypothesis
Cause-and-effect relationship between variables. In a true experimental design example: Persons who participate in nurse-managed home telemonitoring (HT) plus usual care or who participate in nurse-managed community-based monitoring (CBM) plus usual care will have greater improvement in blood pressure (BP) from baseline to 3 months' follow-up than will persons who receive usual care onl
What are the three types of sleep apnea?
Central, obstructive, and mixed
Sleep apnea
Cessation of breathing for a time during sleep.
transition
Change.
What compels nurses to continue learning throughout their careers to avoid becoming laggards
Changes over time regarding knowledge of effective practices
protective factors
Characteristics of a child and family that provide strength and assistance in dealing with a crisis.
Before consulting with a physician about a patient's need for urinary catheterization, the nurse considers the fact that the patient has urinary retention and has been unable to void on her own. The nurse knows that evidence for alternative measures to promote voiding exists, but none has been effective, and that before surgery the patient was voiding normally. This scenario is an example of which implementation skill? A) Cognitive B) Interpersonal C) Psychomotor D) Consultative
Cognitive
The nurse asks a patient, "Describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?" This series of questions would likely occur during which phase of a patient-centered interview? A) Setting the stage B) Gathering information about the patient's chief concerns C) Collecting the assessment D) Termination
Collecting the assessment
Ayurvedic practitioner
Combination of dietary, herbal, and other naturalistic therapies to prevent and treat illness
Voodoo practitioners Hougan (male) Mambo (female)
Combination of herbs, drumming, and symbolic offerings to cure illness, remove curses, and protect a person
Herbalist
Combination of plant, animal, and mineral products in restoring balance based on yin/yang concepts
Shaman
Combination of prayers, chanting, and herbs to treat illnesses caused by supernatural, psychological, and physical factors
Curandero/a
Combination of prayers, herbs, and other rituals to treat traditional illnesses, especially in children
Santero/a
Combination of prayers, symbolic offerings, herbs, potions, and amulets against witchcraft and curses
triangulation
Combining qualitative and quantitative methods in a single study is known as
Z-Score
Common standardized score.
Organized documentation
Communicate information in a logical order. It is also more effective when notes are concise, clear, and to the point.
Accuracy
Comparable to validity, in that it addresses the extent to which the instrument measures what it is supposed to in a study.
Phase 2 of critical appraisal of quantitative studies
Comparison Requires knowledge of what each step of the research process should be like The ideal is compared with the real. Must examine the extent to which the researcher followed the rules for an ideal study
Interrater Reliability
Comparison of two observers or two judges in a study.
Alternate Forms Reliability
Comparison of two paper-and-pencil instruments.
Which of the following is one of the characteristics of an innovation that determines the probability and speed at which an idea will be adopted?
Compatibility
What level of institutional review board (IRB) review should be undertaken for a study in which the subjects participate in a clinical trial of new medications?
Complete review by only IRB
Adults using guided-imagery relaxation have a lower heart rate, blood pressure, and perceived anxiety level that adults not using a relaxation technique. Which of the following set of characteristics best describes this hypothesis?
Complex, casual, research hypothesis
Phase 1 of critical appraisal of quantitative studies
Comprehension Read the article carefully. Identify terms you do not understand and determine their meaning in a dictionary or the glossary of Burns and Grove. Identify the steps of the research process such as purpose, design, sample etc. Read the article a second time. Highlight each step of the research process.
1. the meanings of terms may differ depending on the study framework.
Conceptual definitions are important because: 1. the meanings of terms may differ depending on the study framework. 2. they tell others how the concept will be measured in the study. 3. they provide a dictionary definition that can be understood by everyone. 4. they suggest how to precisely measure the variables of interest.
Phases in Quantitative Studies
Conceptual phase Design and Planning phase Empiracle Phase Analytic Phase Dissemination phase (Linear)
What is a conceptual model?
Conceptual: interrelated concepts or abstractions assembled together in a rational scheme by virtue of their relevance to a common theme.
Activities in a qualitative study
Conceptualizing and Planning the Study: Identifying the research problem Doing a literature review Selecting sites and gaining entrée Making broad design decisions, planning to go into the field Addressing ethical issues Conducting the Study: Making sampling decisions Deciding what questions to ask Collecting data Evaluating integrity and quality Analyzing and interpreting data Making new decisions Disseminating the Findings Seeking publication outlets Providing rich descriptions
Reliability Testing
Concerned with how consistently the measurement technique measures the concept of interest Needs dependability, consistency, accuracy and comparability If expressed as a correlation coefficient, 1.00 is perfect reliability, whereas 0.00 is no reliability. The lowest acceptable coefficient for a well-developed measurement tool is 0.80.
The nurse checks the intravenous (IV) solution that is infusing into the patient's left arm. The IV solution of 9% NS is infusing at 100 mL/hr as ordered. The nurse reviews the nurses' notes from the previous shift to determine if the dressing over the site was changed as scheduled per standard of care. While in the room, the nurse inspects the condition of the dressing and notes the date on the dressing label. In what ways did the nurse evaluate the IV intervention? (Select all that apply.) A) Checked the IV infusion location in left arm B) Checked the type of IV solution C) Confirmed from nurses' notes the time of dressing change and checked label D) Inspected the condition of the IV dressing
Confirmed from nurses' notes the time of dressing change and checked label Inspected the condition of the IV dressing
A variable that can interfere with an intervention but cannot be controlled is a(an)
Confounding variable
transductive reasoning
Connecting two events in a cause-effect relationship simply because they occur together in time; common in thoughts of preschoolers.
Once you have piloted the change in practice what should you do?
Consider whether the change is appropriate for adoption in practice. If so, insititute the change, continue to collect data, and share your results!!
In developing a strategy for observational measurement, the researcher needs to ensure
Consistency
The most critical goal of proper research design is
Consistency
The term "reliability" is best understood reflecting
Consistency of measurement obtained with use of the identified instrument
Two nurses are having a discussion at the nurses' station. One nurse is a new graduate who added, "Patient needs improved bowel function related to constipation" to a patient's care plan. The nurse's colleague, the charge nurse says, "I think your diagnosis is possibly worded incorrectly. Let's go over it together." A correctly worded diagnostic statement is: A) Need for improved bowel function related to change in diet. B) Patient needs improved bowel function related to alteration in elimination. C) Constipation related to inadequate fluid intake. D) Constipation related to hard infrequent stools.
Constipation related to inadequate fluid intake.
A nurse checks a physician's order and notes that a new medication was ordered. The nurse is unfamiliar with the medication. A nurse colleague explains that the medication is an anticoagulant used for postoperative patients with risk for blood clots. The nurse's best action before giving the medication is to: A) Have the nurse colleague check the dose with her before giving the medication. B) Consult with a pharmacist to obtain knowledge about the purpose of the drug, the action, and the potential side effects. C) Ask the nurse colleague to administer the medication to her patient. D) Administer the medication as prescribed and on time.
Consult with a pharmacist to obtain knowledge about the purpose of the drug, the action, and the potential side effects.
A patient has the nursing diagnosis of nausea. The nurse develops a care plan with the following interventions. Which are examples of collaborative interventions? A) Provide frequent mouth care. B) Maintain intravenous (IV) infusion at 100 mL/hr. C) Administer prochlorperazine (Compazine) via rectal suppository. D) Consult with dietitian on initial foods to offer patient. E) Control aversive odors or unpleasant visual stimulation that triggers nausea.
Consult with dietitian on initial foods to offer patient.
Yerbero
Consultation for herbal treatment of traditional illnesses
Granny midwife
Consultation in diagnosing and treating common illnesses and care of women in childbirth and children
Fortune Teller
Consultation to foretell outcomes of plans and seek spiritual advice to enhance good fortune and deal with misfortune.
Demographic variable
Contain sample characteristics of subjects May include age, education, gender, ethnic origin, income, medical diagnosis, etc. Demographic data are analyzed to develop sample characteristics Are found in both Quantitative and Qualitative research studies.
Unstructured Interview
Content is completely controlled by the study participant.
Structured Interview
Content is similar to that of a questionnaire, with the possible responses to questions carefully designed by the researcher.
Elements of a Strong Design
Controlling environment: selection of study setting Controlling equivalence of subjects and groups Controlling treatment (Tx) Controlling measurement Controlling extraneous variables
The nurse reviews a patient's medical record and sees that tube feedings are to begin after a feeding tube is inserted. In recent past experiences the nurse has seen patients on the unit develop diarrhea from tube feedings. The nurse consults with the dietitian and physician to determine the initial rate that will be ordered for the feeding to lessen the chance of diarrhea. This is an example of what type of direct care measure? A) Preventive B) Controlling for an adverse reaction C) Consulting D) Counseling
Controlling for an adverse reaction
Controlling the treatment is one of the elements of a good design. Which of the following statements about this element is true?
Controlling the treatment is enhanced with a clear description of all steps of the treatment
A major portion of a research article is the methods section, which includes a discussion of the study design, the sample, and the ____________ collected.
Data
Ordinal-Scale Measurement
Data are assigned to categories that can be ranked.
a unique characteristic of prospective cohort studies is that
Data are collected from subjects who are at risk for, but do not currently have the problem identified
nursing health history
Data collected about a patient's present level of wellness, changes in life patterns, sociocultural role, and mental and emotional reactions to illness.
What is data collection?
Data collection is the process of acquiring the subjects and collecting the data for the study. The actual steps of collecting the data will be specific to each study and based one the study's design and measurement techniques.
The purpose of a study was to identify caring behaviors desired by patents with (AIDS) or (HIV) infection. This purpose statement indicates that the study probably is an example of
Descriptive research
A nurse reviews data gathered regarding a patient's pain symptoms. The nurse compares the defining characteristics for acute pain with those for chronic pain and in the end selects acute pain as the correct diagnosis. This is an example of the nurse avoiding an error in: A) Data collection. B) Data clustering. C) Data interpretation. D) Making a diagnostic statement.
Data interpretation.
What is data triangulation, method triangulation.
Data triangulation: the use of multiple data sources for the urpose of validating conclusions. Method Triangulation: the use of multiple methods of data collection about the same phenomenon to enhance validity.
What are you looking for in qualitative research?
Data, things, concepts
DAR
Data—Action—Response
Sample Size
Decisions regarding sample size differ from quantitative studies Based on needs related to study purpose Number of subjects is usually smaller Case studies with only one subject may be used 6 to 10 subjects is not unusual
Which international code for ethical conduct by physicians conducting biomedical research followed the Nuremberg Code and provides more specific guidelines
Declaration of Helsinki
How do anticonvulsants effect sleep?
Decrease REM sleep time Cause daytime drowsiness
Which intervention is appropriate to include on a care plan for improving sleep in the older adult? A) Decrease fluids 2 to 4 hours before sleep B) Exercise in the evening to increase fatigue C) Allow the patient to sleep as late as possible D) Take a nap during the day to make up for lost sleep
Decrease fluids 2 to 4 hours before sleep
How does nicotine effect sleep?
Decreases total sleep time Decreases REM sleep time Causes awakening from sleep Causes difficulty staying asleep
Sample
Defines the selected group of people or elements from which data are collected for a study
Metasummaries in Qualitative Research
Definition: a synthesis of multiple primary qualitative studies to produce a narrative about a selected phenomenon Expands our knowledge base
Nursing Research
Definition: systematic inquiry or study conducted to generate new knowledge or to refine existing knowledge
Precision
Degree of consistency or reproducibility of measurements made with physiological instruments.
Other than data related to the concepts being measured to address the research objectives, questions, or hypotheses, what data can be controlled in the data collection process?
Demographic data such as age, gender, and the like, Information related to the diagnosis (For clinical studies), and Cormorbid conditions or problems in addition to the admitting diagnosis
ethnography
Describes and interprets a culture and cultural behavior Culture is the way a group of people live—the patterns of activity and the symbolic structures (for example, the values and norms) that give such activity significance. Relies on extensive, labor-intensive fieldwork Culture is inferred from the group's words, actions, and products. Assumption: Cultures guide the way people structure their experiences. Seeks an emic perspective (insider's view) of the culture Relies on wide range of data sources (interviews, observations, documents; some may be quantitative.) Participant observation is a particularly important source. Product: an in-depth, holistic portrait of the culture under study
descriptive phenomenology
Describes human experience Based on philosophy of Husserl Steps: bracketing, intuiting, analyzing, describing Bracketing (identifying and holding in abeyance preconceived views) May involve maintaining a reflexive journal
risk nursing diagnosis
Describes human responses to health conditions/life processes that may develop in a vulnerable individual, family, or community.
Belmont Report
Describes three basic principles that all research involving humans should follow
a.) Descriptive Correlational Design
Describes variables and relationships between variables There is no attempt to control or manipulate the situation.
Stages of qualitative data analysis
Description Analysis Interpretation
Which of the following should be done before analyzing data designed to test the hypotheses or questions for a research study?
Description of the sample, Establishing the reliability of measuring instruments, and Exploratory analysis of the data
the design for a study to gain more information about characteristics within a particular field of a study should be
Descriptive
2. Correlational Design
Descriptive correlational design Predictive correlational design Model testing design
Grounded Theory Methods
Descriptive mode Discovery mode Emergent fit mode Intervention mode
A nurse is preparing for change-of-shift rounds with the nurse who is assuming care for his patients. Which of the following statements or actions by the nurse are characteristics of ineffective handoff communication? A) This patient is anxious about his pain after surgery; you need to review the information I gave him about how to use a patient-controlled analgesia (PCA) pump this evening. B) The nurse refers to the electronic care plan in the electronic health record (EHR) to review interventions for the patient's care. C) During walking rounds the nurse talks about the problem the patient care technicians created by not ambulating the patient. D) The nurse gives her patient a pain medication before report so there is likely to be no interruption during rounding.
During walking rounds the nurse talks about the problem the patient care technicians created by not ambulating the patient.
In Steinsvik et al. 2011 study about sexual function post prostatectomy, what instrument was used to measure sexual function?
EPIC-50
What education would you provide to a group of classmates with regard to the reentry of a child with a chronic condition?
Educating classmates of a child with a chronic condition is not directly addressed in the textbook hints. The grade, age, and developmental level of the classmates are variables that the nurse must consider. By reflecting on the child's responses to entering school, such as fears of embarrassment and nonacceptance, the nurse can encourage classmates to empathize with the child. The nurse can prepare classmates for any changes in the child's physical appearance, energy level, and social needs. Thus, any plan for school reentry should include classmates as well as school administrators, teachers, and parents.
Sample Size in Quantitative Studies
Effect size Type of quantitative study conducted Number of variables Measurement sensitivity Data analysis techniques
Encouraging the participation to keep talking is a strategy used in interviews to
Elicit more information n a specific area
Which of the following is not part of the balancing of benefits and risk for a study?
Eliminating all risk of the study
Ethnographic viewpoints
Emic and etic approach
Yearning & searching
Emotional outbursts of tearful sobbing and acute distress
interpretive phenomenology
Emphasis on interpreting and understanding experience, not just describing it Based on philosophy of Heidegger: Heideggerian hermeneutics Bracketing does not occur. Supplementary data sources: texts, artistic expressions
3. Tiona's mother states that she is worried that her daughter will not drink enough at home. What can the nurse suggest to Tiona's mother to encourage her to drink fluids?
Encourage fluids that she likes, e.g. popsicles, smoothies, milkshakes, etc. Let her keep track of how much she drinks and decorate the chart with stickers as a reward.
5. Children Tiona's age have many fears and stressors related to hospitalization and surgery. How can her mother assist Tiona to express her feelings about the hospital experience once she is home?
Encourage medical play with dolls/equipment; encourage activities such as arts and crafts where she can express her feelings; read books to her that discuss hospitalization and ask her about her feelings.
The nurse is developing a plan of care for a patient experiencing narcolepsy. Which intervention is appropriate to include on the plan? A) Instruct the patient to increase carbohydrates in the diet B) Have patient limit fluid intake 2 hours before bedtime C) Preserve energy by limiting exercise to morning hours D) Encourage patient to take one or two 20-minute naps during the day
Encourage patient to take one or two 20-minute naps during the day
A 6-month-old child from Guatemala was adopted by an American family in Indiana. The child's socialization into the American midwestern culture is best described as: A) Assimilation. B) Acculturation. C) Biculturalism. D) Enculturation.
Enculturation.
Cultural encounters
Engaging in cross-cultural interactions that provide learning of other cultures and opportunities for effective intercultural communication development
Stratified Random Sampling
Ensures all levels of identified variables are adequately represented in the sample Needs a large population with which to start Variables often stratified Age, gender, socioeconomic status Types of nurses, sites of care
Which qualitative research methodology requires the understanding of culture before initiating data collection?
Ethnographic
Which type of qualitative research method was used by the theorist Leinger in her study of nursing practice?
Ethnographic
What are types of qualitative designs
Ethnography Grounded Theory Phenomenology
Phase 4 of critical appraisal of quantitative studies
Evaluation Involves determining the meaning and significance of the study by examining the links among the study process, study findings, and previous studies Study findings are examined in light of previous study findings. Evaluation builds on conclusions reached during the first three stages of the critique and provides the basis for the fifth step—conceptual clustering. The steps of the study are evaluated based on previous studies. Present hypotheses are based on previous hypotheses. Present design is based on previous designs. Present methods of measurement are based on previous measurement.
Which of the following statements correctly describe the evaluation process? (Select all that apply.) A) Evaluation is an ongoing process. B) Evaluation usually reveals obvious changes in patients. C) Evaluation involves making clinical decisions. D) Evaluation requires the use of assessment skills.
Evaluation is an ongoing process. Evaluation involves making clinical decisions. Evaluation requires the use of assessment skills.
What are evidence based guidelines?
Evidence based guidelines contain the best research evidence that has been synthesized by a panel of experts into comprehensive, current directions for using research in practice.
Evidence based practice is the conscious integration of _____ with _____ and _____ in the delivery of quality, cost-effective health care.
Evidence based practice is the conscious integration of best research evidence with clinical expertise and patient needs and values in the delivery of quality, cost-effective health care.
What is evidence of validity from convergence?
Evidence of validity from convergence is determined when a relatively new instrument is compared with an existing instrument that measures the same construct. They are given to a group of people at the same time and then the scores are compared. Example: two questionnaires that measure depression
What is evidence of validity from divergence?
Evidence of validity from divergence is determined when a relatively new instrument is compared with an existing instrument that measures the opposite construct. They are given to a group of people at the same time and then the scores are compared. Example: a questionnaire that measures hope and despair
Which of the following statements is true regarding evidence-based practice?
Evidence-based practice integrates best research evidence with clinical expertise and patient values for the purpose of improving patient outcomes.
What are some current priorities for clinical nursing research?
Evidenced Based Practice
Steps to objectively evaluate the degree of success in achieving outcomes of care:
Examine the outcome criteria to identify the exact desired patient behavior or response. Evaluate the patient's actual behavior or response. Compare the established outcome criteria with the actual behavior or response. Judge the degree of agreement between outcome criteria and the actual behavior or response. If there is no agreement (or only partial agreement) between the outcome criteria and the actual behavior or response, what is/are the barrier(s)? Why did they not agree?
Content-Related Validity
Examines extent to which the measurement includes all the major elements relevant to the contract being measured.
Factor Analysis
Examines interrelationships among large numbers of variables and disentangles those relationships to identify clusters of variables that are most closely linked.
What questions can you ask teens that might help you to learn some of their values?
Examples of some questions are: "Have you started to think about what you will do after graduation?" "What sports do you enjoy?" "Do you ever drive after drinking?" "What happens when you do something your parents do not approve of?"
After completing a database search, if you have any doubts or concerns regarding the validity of articles you've located, what options do you have to resolve the issue?
Exclude any materials for which you have doubts about their integrity. Verify questionable material elsewhere using a reputable source. Ask a nursing faculty member or a librarian for assistance.
For a study that involves a chart review to obtain information abut a patient's smoking history, age, gender, and incidence of cardiovascular disease, which of the following types of review by an institutional review board (IRB) will be required?
Exempt review
What level of institutional review board (IRB) review should be undertaken for a study in which the participants complete anonymous questionnaires?
Exempt status
A patient is being discharged after abdominal surgery. The abdominal incision is healing well with no signs of redness or irritation. Following instruction, the patient has demonstrated effective care of the incision, including cleansing the wound and applying dressings correctly to the nurse. These behaviors are an example of: A) Evaluative measure. B) Expected outcome. C) Reassessment. D) Standard of care.
Expected outcome.
How will the school nurse know that Haley and her family have made a successful transition from home to school?
Expected outcomes for a successful transition from home to school for Haley and her family might include: Haley says, "I have made new friends." Haley's teacher reports that her classmates have included her in all activities. Haley's mother expresses less worry about the transition and enjoyment with some respite time. Haley's sister does not express jealousy or anger about Haley's attending the same school.
What level of review by an institutional review board (IRB) should be undertaken for a study in which subjects participate in interviews about their lived experience f being a nurse?
Expedited review
Buddhism
Health is an important part of life. Good health is maintained by caring for self and others. Medications are not always accepted because of belief that chemical substances in the body are harmful.
c) Case Study Design
Exploration of single unit of study (i.e., family, group, or community) Sample is small; number of variables studied is large. Design can be source of descriptive information to support or invalidate theories. It has potential to reveal important findings that can generate new hypotheses for testing. There is no control.
A female Jamaican immigrant has been late to her last two clinic visits, which in turn had to be rescheduled. The best action that the nurse could take to prevent the patient from being late to her next appointment is: A) Give her a copy of the city bus schedule. B) Call her the day before her appointment as a reminder to be on time. C) Explore what has prevented her from being at the clinic in time for her appointment. D) Refer her to a clinic that is closer to her home.
Explore what has prevented her from being at the clinic in time for her appointment.
Normal Curve
Expression of statistical theory.
Results of ANOVA
F = 9.75 (2, 95) (p = 0.002) If there are more than two groups under study, it is not possible to determine where the significant differences are. Post hoc tests are used to determine the location of differences.
T/F: The words "proved" and "caused" should be used in research?
FALSE
A researcher who makes up results of a study is guilty of
Fabrication
What does factor analysis do?
Factor analysis examines interrelationships among a large number of variables and identifies how they may be linked or clustered together. It can aid in the identification of theoretical concepts or be useful in the development of a new questionnaire.
Which design type allows researchers to manipulate more than one intervention during the same experiment?
Factorial
developmental delay
Failure to achieve anticipated developmental milestones during specific developmental stages.
Justice
Fairness in the use of resources.
Based on the findings of the Wye (2009) paper, some health care professionals focus more on what the patient wants as opposed to treatments supported by scientific evidence.
False
A focus group typically involves at least 10 to 15 people.
False Rationale: A focus group usually involves interviews with small groups, ranging in size from 5 to 10 people.
A hypothesis most commonly involves one or two variables.
False Rationale: A hypothesis should almost always involve at least two variables and possibly more.
The nurse researcher can use CINAHL to search for relevant information published in 1975.
False Rationale: CINAHL covers nursing and allied health literature from 1982 to present.
In a nonexperimental study, correlation and causation are the same
False Rationale: In a nonexperimental study, correlation does not prove causation.
Researchers should rely heavily on secondary sources for information.
False Rationale: Researchers need to rely principally on primary sources (actual research reports written by those who conducted the study) for information.
Statistical results provide the most meaningful means of communication about a study's results.
False Rationale: Statistical results do not, in and of themselves, communicate much meaning. They must be interpreted to be of use to others.
The primary focus for analyzing the evidence in a literature review is to evaluate the quality of the evidence.
False Rationale: The primary focus of analyzing the information in a literature review is to identify important themes.
The statement of purpose makes an argument to conduct a new study.
False Rationale: The problem statement articulates the research problem and makes an argument to conduct a new study.
The true score is data obtained from the actual research study.
False Rationale: The true score is the score that would be obtained with an infallible measure. The obtained score is an actual value (datum) for a participant.
A major controversy involving qualitative research is that a relatively small amount of terminology is used.
False Rationale: A major dispute involving qualitative research is whether validity and rigor are appropriate terms. In addition, there has been a proliferation of terminology, leading to controversy.
Telephone interviews provide the best quality data for survey research.
False Rationale: Personal interviews used with survey research tend to provide the highest quality data, but they are very expensive.
Preliminary
Familiarizing yourself with the content-skimming the content.
3. Availability of subjects
Feasibility is determined by examining which of the following? 1. Researcher's credibility 2. Significance of research problem 3. Availability of subjects 4. Previous studies
Cultural pain
Feeling that a patient has after a health care worker disregards the patient's valued way of life.
Frequency Distribution
First method used to organize the data for examination. There are two types - ungrouped and grouped.
Assessment
First step of the nursing process. Activities required in the first step are data collection, validation, sorting, and documentation. The purpose is to gather information for health problem identification.
Describe appropriate methods for supporting a child during a procedure. Identify techniques appropriate for each age group.
For infants, touch, voice, a pacifier, and a bottle serve as distractions. A gentle but firm touch is reassuring to infants. Toddlers should be restrained securely. They should be allowed to cry and scream. Parents' presence will offer some comfort to the child. Allow choices that are acceptable for toddlers to make. This gives them some control over their situation. Preschool-age children also should be restrained as needed. They also should know that it is okay to cry if they want. They can be taught simple coping measures such as counting to 10. School-age children should be given explanations throughout the procedure. These children also can be taught stress-control techniques such as breathing exercises, imagery, and so on. Adolescents should be assisted to use stress-control techniques such as breathing exercises and imagery.
Nursing Research in the 20th Century
For most of the 20th century, nursing research focused on nursing education and nurses. This time has been referred to as the period when nurses were studying themselves. In the latter third of the 20th century, nurses started exploring research topics of relevance to patient care and health care systems. During this time, nurses began to conduct research studies using the naturalistic, or qualitative, paradigm.
Espiritista
Foretelling of future and interpretation of dreams; combination of prayers, herbs, potions, amulets, and prayers for curing illnesses, including witchcraft
closed ended questions
Form of question that limits a respondent's answer to one or two words.
open ended questions
Form of question that prompts a respondent to answer in more than one or two words.
Scale
Form of self-report, is a more means of measuring phenomena than the questionnaire.
grief
Form of sorrow involving the person's thoughts, feelings, and behaviors that occurs as a response to an actual or perceived loss.
nursing diagnosis
Formal statement of an actual or potential health problem that nurses can legally and independently treat; the second step of the nursing process, during which the patient's actual and potential unhealthy responses to an illness or condition are identified.
medical diagnosis
Formal statement of the disease entity or illness made by the physician or health care provider.
Hypotheses
Formal statements of expected relationships among variables
Subjects with diminished autonomy require which of the following types of documentation of informed consent?
Formal written consent document signed by the subject and/or parent or legal guardian
Steps in Systematic Reviews
Formulate purpose and identify scope. Develop specific questions or hypotheses. Establish criteria for inclusion/exclusion of studies. Conduct extensive literature search of all sources. Critique studies for scientific merit and data analysis. Analyze and interpret data. Report the review.
Components of the Research Process
Formulating the research question or problem Defining the purpose of the study Reviewing related literature Formulating hypotheses and defining variables Selecting the research design Selecting the population, sample, and setting Conducting a pilot study Collecting the data Analyzing the data Communicating conclusions
individualized education plan (IEP)
Formulation of a specific learning approach for a child with a physical or mental disability, following thorough assessment of the child's capabilities and areas of need.
Which of the following statements about frameworks in research is true?
Frameworks are important in both qualitative and quantitative research
Measures of Central Tendency
Frequently referred to a the midpoint in the data or as an average of the data.
Once a theory is formulated, it is tested through research to see if it holds true in various circumstances. It might be refined, changed, or even found to offer little assistance in understanding an issue. Consider the developmental theories presented in this chapter and ask yourself these questions: - What observations led the scientist to formulate the theory? - What are the crucial concepts or constructs of the theory? - Has the theory been tested? - Did the testing support the theory or demonstrate problems with it? - How can each theory be applied in nursing to help you better understand children and their families?
Freud developed the theory of psychosexual development. His use of psychoanalytic techniques was the impetus for the development of this theory, proposing that early-childhood experiences form the unconscious motivation for actions in later life. Freud developed a theory that sexual energy is centered to specific parts of the body and described the id, ego, and superego. Freud also described the use of defense mechanisms. His theory of childhood has been criticized because it was based on his works with adults. Freud's theory can be applied to nursing care of children and families, especially when viewing the oral needs of the infant, the anal focus of the toddler who is toilet training, and the preschool-age child's concern about sexuality and thus need for privacy. Erik Erikson's theory of psychosocial development established eight psychosocial stages that cover the lifespan. Erikson studied under Freud's daughter but focused on the psychosocial, rather than the psychosexual, nature of individuals. Erikson's theory focuses on the consequences to the individual when needs are either met or unmet. Erikson's theory is directly related to the nursing care of children, with behaviors specific to each age group being explained within each developmental stage. Jean Piaget developed a theory of cognitive development based on his observations of his own three children. He also studied the intellectual abilities of children and focused on child psychology and its application to education. Piaget's theory is essential to pediatric nursing, because the nurse must understand the child's level of cognitive thinking to formulate teaching plans and design activities for the child. Lawrence Kohlberg used Piaget's theory as a basis to develop his theory of moral development. He worked with children in several countries in developing his theory. His work has been criticized for lack of cultural sensitivity. Moral reasoning is applicable to the healthcare setting. Children can be involved in decision-making processes as appropriate. The nurse should assist the child and family in appropriate decision making.
A nurse researcher wants to interview parents and their autistic children regarding the children's sleep patterns. This study would require which type of IRB review?
Full review
Which type of IRB review is required for research involving vulnerable populations or when there are substantial risks to participants?
Full review
what is deductive reasoning?
General to specific. Positivist Paradigm. Quanitative
Which action by the nursing assistant at bedtime requires the nurse to intervene? A) Giving the patient a back rub B) Turning on quiet music C) Dimming the lights in the patient's room D) Giving a patient a cup of coffee
Giving a patient a cup of coffee
What are the two major risk factors for obstructive sleep apnea (OSA)?
Hypertension and obesity
Where is the major sleep center in the body?
Hypothalamus
A patient has been in the hospital for 2 days because of newly diagnosed diabetes. His medical condition is unstable, and the medical staff is having difficulty controlling his blood sugar. The physician expects that the patient will remain hospitalized at least 3 more days. The nurse identifies one nursing diagnosis as deficient knowledge regarding insulin administration related to inexperience with disease management. What does the nurse need to determine before setting the goal of "patient will self-administer insulin?" (Select all that apply.) A) Goal within reach of the patient B) The nurse's own competency in teaching about insulin C) The patient's cognitive function D) Availability of family members to assist
Goal within reach of the patient The patient's cognitive function Availability of family members to assist
What type of scholarly material can indicate upcoming "hot" topics and includes unpublished reports, conference papers, and grant proposals?
Grey literature
Anticipatory mourning
Grief occurring before an expected loss in anticipation of that loss.
anticipatory grief
Grief response in which the person begins the grieving process before an actual loss.
The nurse teaches a patient taking a benzodiazepine that this group of medications causes which symptom of a sleep problem? A) Nocturia B) Hyperactivity C) Grogginess and feeling hung over D) Increased sleep time
Grogginess and feeling hung over
Which of the following qualitative research methods uses a minimal literature review?
Grounded theory
Which type of qualitative research was used by Fagerhaugh and Strauss in their study of pain management?
Grounded theory
What is the Hawthorne effect?
Group knowing it is being watched/studied changes it's behavior.
Error in Physiological Measures
Grouped into the following five categories: environment, user, subject, machine, and interpretation.
a measurement strategy that is fairly new to nursing studies is the use of focus groups. Which of the following statements about focus group studies is true?
Groups are made up of subjects who are similar to ach other to encourage candid discussion
What is the independent variable in the following hypothesis? Adults using guided-imagery relaxation have a lower heart rate, blood pressure, and perceived anxiety level than those in adults not using a relaxation technique
Guided-imagery relaxation/no relaxation
What are Haley's health promotion and maintenance needs before she begins school?
Haley, along with her siblings, has the same health promotion maintenance needs of good nutrition and proper stimulation for growth and development. Well child care before school entry also includes laboratory screening tests, dental hygiene, and immunizations.
Informed consent means that participants
Have adequate information about the research Can comprehend that information Have free choice in deciding whether to participate in or withdraw from the study
Empirical
Having a foundation based on data gathered through the senses (e.g., observation or experience) rather than purely through theorizing or logic.
Connectedness
Having close spiritual relationships with oneself, others, and God or another spiritual being.
The ____________ occurs when changes noted in the dependent variable can be a result of subject reactivity and not a result of the independent variable.
Hawthorne effect
The nurse is gathering a sleep history from a patient who is being evaluated for obstructive sleep apnea. Which common symptoms does the patient most likely report? (Select all that apply.) A) Headache B) Early wakening C) Excessive daytime sleepiness D) Difficulty falling asleep E) Snoring
Headache Excessive daytime sleepiness Snoring
Which act requires that the privacy of people's health information be Protected?
Health Insurance Portability and Accountability (HIPPA)
Research focus, 1990s
Health care health care delivery issues such as cost, quality, and access
One-Tailed Test of Significance
Hypothesis is directional.
A nurse assesses a patient who comes to the pulmonary clinic. "I see that it's been over 6 months since you've been in, but your appointment was for every 2 months. Tell me about that. Also I see from your last visit that the doctor recommended routine exercise. Can you tell me how successful you have been following his plan?" The nurse's assessment covers which of Gordon's functional health patterns? A) Value-belief pattern B) Cognitive-perceptual pattern C) Coping-stress-tolerance pattern D) Health perception-health management pattern
Health perception-health management pattern
A patient who visits the allergy clinic tells the nurse practitioner that he is not getting relief from shortness of breath when he uses his inhaler. The nurse decides to ask the patient to explain how he uses the inhaler, when he should take a dose of medication, and what he does when he gets no relief. On the basis of Gordon's functional health patterns, which pattern does the nurse assess? A) Health perception-health management pattern B) Value-belief pattern C) Cognitive-perceptual pattern D) Coping-stress tolerance pattern
Health perception-health management pattern
To accomplish its mission, NINR supports clinical research, basic research, and research training on issues related to health and illness across the lifespan, from prenatal care to the elderly. The focus of research funded by NINR includes the following:
Health promotion and disease prevention Quality of life Health disparities End-of-life
NINR Research Foci
Health promotion and disease prevention Quality of life Health disparities End of life
The nursing diagnosis readiness for enhanced communication is an example of a(n): A) Risk nursing diagnosis. B) Actual nursing diagnosis. C) Health promotion nursing diagnosis D) Wellness nursing diagnosis.
Health promotion nursing diagnosis
Which of the following is a correct statement regarding a change in practice based on research evidence?
Healthcare team members and administrators need to be vigilant about monitoring the results of the implementation.
Which of the following are examples of collaborative problems? (Select all that apply.) A) Nausea B) Hemorrhage C) Wound infection D) Fear
Hemorrhage Wound infection
Examples of Evidence-Based Practice
Heparinized saline for flushing peripheral intravenous catheters Interventions such as exercise for cancer-related fatigue Prevention and treatment of pressure ulcers
4. What actions will the mother need to take in preparing the school personnel for Haley's health needs?
Her mother will transfer the records, assure that the medical information is at the school. She will meet with all appropriate personnel ahead of time, and collaborate to formulate the IHP and emergency care plan. She will bring in doctor's orders and prescriptions, and sign any parent consents required by the state/school for care. She will provide all equipment, medications, feedings, and supplies.
Positive Relationship
High score on one variable is correlated with a high score on the other variable.
Negative Relationship
High score on one variable is correlated with a low score on the other variable.
Ratio-Scale Measurement
Highest for measurement Continuum of values Absolute zero point Test scores 1 = Lowest third percentile 2 = Middle third percentile 3 = Top third percentile
Interval-Scale Measurement
Highest form of measurement and meets all of the rules of other forms of measurement: mutually exclusive categories, ordered ranks, equally spaced intervals, and a continuum of values.
The process of reading and critiquing an article includes
Highlighting or noting important content and ideas throughout the article
Experimental studies are most often conducted in which of the following settings?
Highly controlled setting
The process of external criticism is used in which of the following qualitative research methodologies?
Historical
The literature may be actual source of data in which of the following qualitative methodologies?
Historical research
A patient who is hospitalized with heart failure states that she sees her illness as an opportunity and a challenge. Despite her illness, she is still able to see that life is worth living. This is an example of: A) Hope. B) Faith. C) Values. D) Connectedness.
Hope.
The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed two chemotherapy sessions. Based on the above assessment data, the nurse gathers more information to consider making which of the following nursing diagnoses? A) Anxiety B) Hopelessness C) Spiritual distress D) Complicated grieving
Hopelessness
American Hospital Association hospitalconnect.com
Hospital links; nursing shortage and workforce issues
Historical Theory
How history might affect a certain phenomenon. Examines events of the past. Greatest value of historical knowledge is increased self-understanding. Increases nurses' understanding of their profession. Searches throughout history for generalities.
What is validity?
How well does the instrument reflect the concept being measured? Hint: validity exists on a spectrum. It is not an all or nothing phenomenon.
The nurse is taking a sleep history from a patient. Which statement made by the patient needs further follow-up? A) I always feel tired when I wake up in the morning. B) I go to bed at the same time each night. C) It takes me about 15 minutes to fall asleep. D) Sometimes I have to get up during the night to urinate.
I always feel tired when I wake up in the morning.
Which statement made by the patient indicates a need for further teaching on sleep hygiene? A) I'm going to do my exercises before I eat dinner. B) I'll have a glass of wine at bedtime to relax. C) I set my alarm to get up at the same time every morning. D) I moved my computer to the den to do my work.
I'll have a glass of wine at bedtime to relax.
Which statement made by an older adult best demonstrates understanding of taking a sleep medication? A) I'll take the sleep medicine for 4 or 5 weeks until my sleep problems disappear. B) Sleep medicines wont cause any sleep problems once I stop taking them. C) I'll talk to my health care provider before I use an over the- counter sleep medication. D) I'll contact my health care provider if I feel extreme sleepy in the mornings.
I'll talk to my health care provider before I use an over the- counter sleep medication.
Methods
INCLUDES: - the research design. - the sampling plan. -methods of measuring variables and collecting data -study procedures, including procedures to protect human rights. -data analysis methods.
Institutional review
IRB or Human Subjects Committee required by institutions receiving federal funding
Qualitative Research Contributions to Integrative Reviews
Identifies and refines questions and outcomes Identifies types of participants and interventions Augments and provides data for research synthesis Highlights inadequacies in methods Explains findings and interpretation of findings Helps make recommendations
Qualitative Study Purpose
Identifies areas of concern Gains new insights Is focus of study Identifies qualitative approach and assumptions Differs among each qualitative methodology because of philosophical orientations
Integrative Review
Identifies, analyzes, and synthesizes results from independent quantitative and qualitative studies to determine current knowledge Includes multiple types of research designs and literature types A complicated review, but gives breadth and depth to conclusions Annual Review of Nursing Research publishes integrative reviews.
What is one step a staff nurse can take to advance EBP at the point of care
Identify clinical questions related to current nursing practice.
After identifying the research question to be tested for a meta-analysis, which would the researcher complete next?
Identify sample criteria Once the research question has been delineated, the next step is to identify sampling criteria for studies to be included. Then the researcher develops and implements a search strategy, locating and screening the sample of studies that meet the criteria. Next, the researcher appraises the quality of the study evidence and extracts and records data from the reports.
Problem Statement for qualitative critical appraisal
Identify the clinical problem that led to the study. What is known and not known. Gap in knowledge is the research problem.
Objectives
Identify the designs of studies Critically appraise the quality of designs of quantitative nursing studies.
4. Music therapy
Identify the independent variable in the following hypothesis: "Cancer patients who receive music therapy complain less frequently of pain and require less pain medication than cancer patients not receiving music therapy." 1. Relaxation therapy 2. Complaints of pain 3. Pain medication use 4. Music therapy
Guidelines to reduce Errors in the diagnostic statement
Identify the patient's response, but not the medical diagnosis; identify a NANDA-1 diagnostic statement rather than the symptom; identify a treatable etiology or risk factor rather than a clinical sign or chronic problem that is not treatable through nursing interventions; identify the problem caused by the treatment or diagnostic study rather than the treatment or study itself; identify the patient response to the equipment rather than the equipment itself; identify the patient's problems rather than your problems with nursing care; identify the patient problem rather than the nursing intervention; identify the patient problem rather than the goal of care; make professional rather than prejudicial judgements; avoid legally inadvisable statements; identify the problem and the etiology to avoid a circular statement; identify only one patient problem in the diagnostic statement.
What is evidence of validity from contrasting groups?
Identifying groups that are expected (or known) to have contrasting scores on a questionnaire. Example: administering a questionnaire about depression to two groups of people, one group with known depression, one group without, and comparing their scores.
Evidence of Validity from Contrasting Groups
Identifying groups that are expected (or known) to have contrasting scores on the instrument.
Internal criticism in historical research refers to
Identifying possible biases, which threaten the accuracy of what was said
3. may be implied.
In the research report, a theoretical statement: 1. will always be clearly identified. 2. should only be discussed in the framework section. 3. may be implied. 4. can be omitted if variables are not yet well defined.
A nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing diagnosis is diarrhea related to intestinal colitis. This is an incorrectly stated diagnostic statement, best described as: A) Identifying the clinical sign instead of an etiology. B) Identifying a diagnosis based on prejudicial judgment. C) Identifying the diagnostic study rather than a problem caused by the diagnostic study. D) Identifying the medical diagnosis instead of the patient's response to the diagnosis.
Identifying the medical diagnosis instead of the patient's response to the diagnosis.
Nature of the Topic
If the study topic is clear, fewer subjects are needed. If the topic is difficult to define, then a larger sample is needed.
Culture bound syndromes
Illnesses restricted to a particular culture or group because of its psychosocial characteristics.
Manipulation
Implementation of a treatment or intervention The independent variable is controlled. Must be careful to avoid introduction of bias into the study Usually done only in quasi-experimental and experimental designs
Control
Implemented throughout the design Improved accuracy of findings Increased control in quasi-experimental research Greatest in experimental research
Degrees of Freedom (df)
Important for calculating statistical procedures and interpreting the results using statistical tables.
The 1999 reauthorizing legislation expanded the role of the agency by directing AHRQ to:
Improve quality of health care through scientific inquiry, dissemination of findings, and facilitation of public access to information Promote patient safety and reduce medical errors through scientific inquiry, building of partnerships with health care providers, and establishment of Centers for Education and Research on Therapeutics (CERTS) Established an office for priority populations to ensure that the needs of low-income groups, minorities, women, children, older adults, and individuals with special health care needs are addressed by the agency's research efforts Advanced use of information technology for coordinating patient care and conducting quality and outcomes research
4. Feasibility (ethical considerations part of feasibility)
In a research proposal, the investigator notes that written permission has been obtained from three local hospitals to access patients for the proposed study. This is an example of what aspect of a study? 1. Reliability 2. Methodology 3. Ethics 4. Feasibility (ethical considerations part of feasibility)
bracketing
In phenomenological inquiries, the process of identifying and holding in abeyance any preconceived beliefs and opinions about the phenomena under study
heterogeneity
In systematic reviews, differences in the results of individual studies that are more than a chance occurrence
What were the roles of nurses in these historical beginnings of child healthcare services?
In the 1890s, Lillian Wald, RN, recognized the need for health promotion and disease prevention among New York's immigrant population, and in her center, The Henry Street Settlement, nurses actively sought improvements in social conditions affecting health. In 1902, Wald assigned a nurse to a school as a pilot project that was successful in reducing absenteeism. This school nursing model soon spread to other cities in the United States and Canada. The nurses monitored for illness, educated about personal hygiene and disease prevention, and were successful in their goal to improve the health of children.
What is the IRB and its purpose?
In the US, a group of people affiliated with an institution who convene to review proposed and ongoing with respect to ethical considerations. *researches must submit plans to the IRB *they can approve the proposed plans, require modifications, or disapprove them
1. Volume number
In the following APA formatted reference, what does the 21 refer to? Harris, R. M., Bausell, R. B., Scott, D. E., Hetherington, S. E., & Kavanagh, K. H. (1998). An intervention for changing high-risk HIV behaviors of African American drug-dependent women. Research in Nursing and Health, 21(3), pp. 239-250. 1. Volume number 2. Issue number 3. Chapter number 4. Bibliographic reference
2. builds on previous research.
In the literature report of a study on quality of life, the researcher describes two previous investigations suggesting that spirituality is related to quality of life. This information suggests the current study is significant because it: 1. influences theology. 2. builds on previous research. 3. challenges existing theory. 4. addresses multidisciplinary concerns.
Nursing Research in the 21st Century
In this century, nurse researchers are exploring a vast array of topics in basic research and clinical research. Some researchers work in laboratories to improve patient outcomes by studying various biologic and physiologic properties of the following: Cells Body fluids Animals Other researchers in the clinical area work with people (individuals, families, groups, populations) and organizations.
A nurse is using the B-E-L-I-E-F tool to complete a spiritual assessment on a 12-year-old male who has recently been diagnosed with acute lymphocytic leukemia. Which of the following questions would the nurse use to assess the child's involvement in the spiritual community? A) Which church do you attend? B) Which sports do you like to play? C) Are there any foods you cannot eat? D) In which church activities do you participate?
In which church activities do you participate?
1. Literature review
In which section of the research report might the problem statement be located? 1. Literature review 2. Methods 3. Results 4. Implications
4. Experimental
In which type of research is there high researcher control, random sampling, and laboratory setting? 1. Descriptive 2. Correlational 3. Quasi experimental 4. Experimental
Remember the ecological theory of Bronfenbrenner and the systems or levels of interactions for each child. Assess a child you have seen in a clinical experience recently for the important microsystem, mesosystem, exosystem, and macrosystem influences. Refer to Table 5-4 in the text for a review of some areas you might consider. Then as you plan care for that child and family, ask yourself these questions: - How does the child influence each system? - How is the child influenced by each system? - Where does this lead you in planning interventions for the child?
In your assessment, you should have considered the influence of parents, significant others, childcare arrangements, school, neighborhood contacts, clubs, friends, peers, and the religious community. By taking into account the influence of each of these for each child, the nurse determines how many support systems the child has, and how involved the child is in other activities. Hospitalization will impact the child's ability to participate in these activities. The nurse should assist the child to have continued contact with the influences that are most important. This will be very individualized depending on the circumstances for the child you focused on.
Separation anxiety
Inconsolable crying and other signs of distress in an infant when parents are not present, commonly beginning in the second half of the first year of life.
Which of the following would require the researcher to increase the sample size?
Increasing the number of dependent variables
In a study examining cause-and-effect interactions, the cause portion of the interaction is represented by the
Independent variable
Independent vs Dependent variable
Independent variable: causes or influences the dependent variable. Dependent variable: hypothesized to depend on or be caused by the independent variable. EXAMPLE: In a study of how different doses of a drug affect the severity of symptoms, a researcher could compare the frequency and intensity of symptoms when different doses are administered. Here the independent variable is the dose and the dependent variable is the frequency/intensity of symptoms.
Types of variables
Independent variables Dependent variables Research variables or concepts Extraneous variables Demographic variables
Percentage Distribution
Indicates the percentage of subjects in a sample whose scores fall into a specific group and the number of scores in that group.
Setting a time frame for outcomes of care serves which of the following purposes? A) Indicates which outcome has priority B) Indicates the time it takes to complete an intervention C) Indicates how long a nurse is scheduled to care for a patient D) Indicates when the patient is expected to respond in the desired manner
Indicates when the patient is expected to respond in the desired manner
What are indirect measures?
Indirect measures attempt to measure something that is an abstract idea, a characteristic, or a concept, such as pain, stress, caring, coping, depression, anxiety. Rarely, if ever, can a single strategy measure all aspects of an abstract concept.
Agnostic
Individual who believes that any ultimate reality is unknown or unknowable.
Atheist
Individual who does not believe in the existence of God.
Spiritual well being
Individual's spirituality that enables a person to love, have faith and hope, seek meaning in life, and nurture relationships with others.
What are the five EBP levels of collaboration
Individual, organizational, regional, national, and international
What type of research, usually based on qualitative methods, is used to develop theory
Inductive
Decision Theory
Inductive and assumes that all of the groups in a study used to test a particular hypothesis are components of the same population relative to the variables under study.
A nursing student is doing a community health rotation in an inner-city public health department. The student investigates sociodemographic and health data of the people served by the health department, and detects disparities in health outcomes between the rich and poor. This is an example of a(n): A) Illness attributed to natural and biological forces. B) Creation of the student's interpretation and descriptions of the data. C) Influence of socioeconomic factors in morbidity and mortality. D) Combination of naturalistic, religious, and supernatural modalities.
Influence of socioeconomic factors in morbidity and mortality.
subjective data
Information gathered from patient statements; the patient's feelings and perceptions. Not verifiable by another except by inference.
American Academy of Nursing aannet.org
Information on nursing issues, influence on government, other organizations; promote research, national leadership
American Nurses Credentialing Center nursecredentialing.org/default.aspx
Information regarding certification programs, requirements, etc
Cue
Information that a nurse acquires through hearing, visual observations, touch, and smell.
objective data
Information that can be observed by others; free of feelings, perceptions, prejudices.
American Organization of Nurse Executives aone.org
Information; publications regarding nursing leadership, administration
A nurse has agreed to assist in collecting data from clients in a long-term-care setting. The nurse becomes concerned upon realizing that many of the clients participating in the study have documented cognitive impairments. Which ethical responsibility is being violated?
Informed consent
In the O'Flaherty study about aromatherapy, which of the following statements is true about the informed consent process used in the study?
Informed consent and assent procedures were used.
implementation
Initiation and completion of the nursing actions necessary to help the patient achieve health care goals.
Emic worldview
Insider or native perspective.
Emic Approach
Insiders view about culture. The way someone envisions their own world in that culture.
What is the role of institution in the research process
Institution may be valuable in linking ideas while interpreting findings
What are the three abstract thought process that are important to nursing
Institution, role modeling, and reasoning
Which of the following choices is an example of an item on a Likert scale?
Instructor kept convenient office hours: strongly agree; disagree; neutral; agree; strongly agree
Validity
Instrument is a determination of how well the instrument reflects the abstract concept being examined.
Evidence of Validity from Divergence
Instruments can be located that measure a construct or concept opposite to the concept measured by the newly developed instrument.
Culture
Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
Evidence-based practice
Integration of the best research evidence with an individual's clinical expertise and the patient's values or preferences.
How do hypnotics effect sleep?
Interfere with reaching deeper sleep stages Provide only temporary (1 week) increase in quantity of sleep Eventually cause "hangover" during day; excess drowsiness, confusion, decreased energy Sometimes worsen sleep apnea in older adults
What type of reliability was evaluated by Gossec et al. in their 2012 study about the Qualisex questionnaire?
Internal consistency reliability Stability reliability
Sources on a multiple-choice final examination represent an example of which of the following levels of measurement?
Interval
Which section of a research article identifies the problem being studied and includes a purpose statement and background information on the topic?
Introduction
IMRAD
Introduction Methods Results Discussion
quasi-experiments
Involve an intervention but lack either randomization or control group Two main categories of quasi-experimental designs: Nonequivalent control group designs Those getting the intervention are compared with a nonrandomized comparison group. Within-subjects designs One group is studied before and after the intervention.
Unstructured Observations
Involve spontaneously observing and recording what is seen.
Observational Measurement
Involves an interaction between the study participants and the observer(s) where the observer has the opportunity to watch the participant perform in a specific setting.
Equivalence
Involves the comparison of two versions of the same paper-and-pencil instrument or of two observers measuring the same event.
Interview
Involves verbal communication between the researcher and the subject during which information is provide to the researcher.
heart-lung death
Irreversible cessation of circulatory and respiratory functions.
A patient tells the nurse during a visit to the clinic that he has been sick to his stomach for 3 days and he vomited twice yesterday. Which of the following responses by the nurse is an example of probing? A) So you've had an upset stomach and began vomiting—correct? B) Have you taken anything for your stomach? C) Is anything else bothering you? D) Have you taken any medication for your vomiting?
Is anything else bothering you?
Range
Is obtained by subtracting lowest score from highest score Uses only the two extreme scores Very crude measure and sensitive to outliers
Critiquing Guidelines for problems and purposes
Is problem clear and concise? Is problem limited in scope? Is problem narrow to focus study? Does problem identify variables, population, and setting? Are problem and purpose able to generate knowledge? Is study feasible? Is study ethical?
Data Collection
Is the data collection process clearly described? Is the training of data collectors clearly described and adequate?
Design
Is the design used the most appropriate to obtain the needed data? Does the design provide a means to examine all of the objectives, questions, or hypotheses? Have threats to design validity been minimized? Is the design logically linked to the sampling method and statistical analyses?
Study framework
Is the framework presented with clarity? If a map or model is presented, is it adequate to explain the phenomenon of concern? Is the framework linked to the research purpose? Would another framework fit more logically with the study?
What is a typical score?
Is the numerical value or score that occurs with greatest frequency Is expressed graphically Is not always the center of distribution
Research Problem and Purpose
Is the problem sufficiently delimited in scope without being trivial? Is the problem significant to nursing? Is there evidence of researcher bias? Does the purpose narrow and clarify the aim of the study? Was the study feasible in terms of funding, expertise, subjects, facility, equipment, and ethical considerations?
Sample, Population, and Setting
Is the sampling method adequate to produce a representative sample? What are the potential biases in the sampling method? Are any subjects excluded from the study based on age, socioeconomic status, or race, without a sound rationale? Are the rights of human subjects protected? Is the setting used in the study typical of clinical settings? Was sample mortality or attrition a problem? If so, how might this influence the findings?
Standard Deviation
Is the square root of the variance Just as the mean is the "average" value, the standard deviation is the "average" difference score.
Mean
Is the sum of values divided by the number of values being summed Like the median, the mean may not be a data set value.
Median
Is the value in exact center of ungrouped frequency distribution Is obtained by rank ordering the values When number of values is uneven, may not be an actual value in data set
A nurse is caring for a patient who refuses to eat until after the sun sets. Which religion does this patient most likely practice? A) Islam B) Sikhism C) Hinduism D) Catholicism
Islam
Research hypotheses may be classified as either associative or casual. Which of the following is a characteristic of associative research hypothesis?
It identifies variables that vary or change together in an identified population
Why would a researcher need to be concerned about the administration of a pretest and posttest in a research study?
It is a threat to internal validity.
As the researcher develops the research problem and purposes of the study, he or she must take into consideration the feasibility of the study. Which of the following statements best describes the concept of feasibility?
It is an evaluation of whether the researcher has the ability and resources (e.g. facilities, time, potential subjects) and ethical protections for participants to carry out the study as proposed
What is measurement?
Measurement is the process of assigning numbers or values to individuals' health status, objects, events, or situations using a set of rules.
After reading the Choi (2012) article about acupuncture, how should a nurse best evaluate whether the research presented in this article was conducted in an ethical way? (Choose all that apply.)
It is difficult to evaluate the research ethics of the included studies because the authors did not comment on IRB or informed consent procedures. Although it is likely that all the included studies were performed using ethical standards, this assumption should not be made because research misconduct still occurs today.
Grounded theory is based on the belief that
It is possible to understand the process by which something happens, rather that just describing what is happening
If a mean weight of two groups of children were different with a p level of .03 is the difference statistically significant? What p level identifies statistical significance?
It is significant at the 0.05 level.
Validity
It is the extent to which an instrument reflects the concept being examined.
The mean is the basic statistic that forms the base for many more advanced statistical procedures. Which of the following statements about the mean is true?
It is the mathematical average of a set of scores
Which of the following characteristics is not descriptive of quantitative research?
It is used to develop a theory
When the preschool teacher talks with Joey, she finds that Joey was angry at Zach the last day he was at school. Joey said, "I told him never come back." What can the preschool teacher say to Joey?
Joey misses his friend and is reacting with sadness, depression, and guilt to Zach's absence at preschool. He may believe that he is the cause of Zach's illness and imminent death because he had bad thoughts and said things in anger to Zach. Preschool-age children must be told repeatedly that they are not the cause of a classmate's illness or death.
Types and Levels of Evidence
Journal article describing a single study Systematic review methods (meta-analysis and meta-synthesis) Intervention guidelines Patient values and preferences Expert opinion Theory-based information Compiled databases
actual nursing diagnosis
Judgment that is clinically validated by the presence of major defining characteristics.
3 ethical principles
Justice, Beneficence, Nonmaleficence
Problem Statement
Justification of need Current Significance for nursing Need significant and current references for nursing research.
Patrilineal
Kinship that is limited to only the father's side.
Matrilineal
Kinship that is limited to only the mother's side.
reorganization
Last phase of Bowlby's phases of mourning. During this phase, which sometimes requires a year or more, the person begins to accept unaccustomed roles, acquire new skills, and build new relationships.
Older adults are cautioned about the long-term use of sedatives and hypnotics because these medications can: A) Cause headaches and nausea. B) Be expensive and difficult to obtain. C) Cause severe depression and anxiety. D) Lead to sleep disruption.
Lead to sleep disruption.
A 58-year-old patient with nerve deafness has come to his doctor's office for a routine examination. The patient wears two hearing aids. The advanced practice nurse who is conducting the assessment uses which of the following approaches while conducting the interview with this patient? (Select all that apply.) A) Maintain a neutral facial expression B) Lean forward when interacting with the patient C) Acknowledge the patient's answers through head nodding D) Limit direct eye contact
Lean forward when interacting with the patient Acknowledge the patient's answers through head nodding
Palliative care
Level of care that is designed to relieve or reduce intensity of uncomfortable symptoms but not to produce a cure. Palliative care relies on comfort measures and use of alternative therapies to help individuals become more at peace during end of life.
Sometimes a search strategy identifies too many sources. How might the researcher limit the number of citations to retrieve and critique?
Limit the years from which the researcher wishes to use citations usually the most recent, combine concepts using AND so that only citations that address all of the concepts are identified, and Request citations only for articles that can be downloaded as the full-text version
American Nursing Informatics Association ania.org
Links to multiple sites for nursing informatics
American Nurses Association nursingworld.org
Links to organizations, publications (American Nurse, OJIN, books); career and job lists
Which approach to helping grieving people is most consistent with postmodern grief theories? A) Help the patient identify the tasks to be accomplished during his or her grief. B) Encourage people to recognize stages of grieving in anticipation of what is to come. C) Listen carefully to a person's story of how his or her grief experience is unfolding. D) Offer general grief timelines to help the person know when a phase will pass.
Listen carefully to a person's story of how his or her grief experience is unfolding.
Physiological Measures
Measurement methods used to quantify the level of functioning of living beings.
Measure of Dispersion
Measures of individual differences of the members of the sample.
Research problems occur when there are gaps in knowledge about how to address a significant clinical problem. Which of the following would indicate that current knowledge is insufficient and that additional study of a clinical problem is needed?
Little is known about the variables, findings of previous studies have been inconclusive and/or conflicting, and ethnic minority and women subjects have not been included in many states
Situational loss
Loss of a person, thing, or quality resulting from a change in a life situation, including changes related to illness, body image, environment, and death.
Actual loss
Loss of an object, person, body part or function, or emotion that is overt and easily identifiable.
Perceived loss
Loss that is less obvious to the individual experiencing it. Although easily overlooked or misunderstood, a perceived loss results in the same grief process as an actual loss.
Maturational loss
Loss, usually of an aspect of self, resulting from the normal changes of growth and development.
Nominal-Scale Measurement
Lowest of the four levels of measurement Categories that are not more or less, but are different from one another in some way Mutually exclusive and exhaustive categories Named categories Example: Gender 1 = Male 2 = Female
A self-care goal you set when caring for dying and grieving patients includes: A) Learning not to take losses so seriously. B) Limiting involvement with patients who are grieving. C) Maintaining life balance and reflecting on the meaning of your work. D) Admitting that you are not well suited to care for people who are grieving and asking the charge nurse not to assign you to care for these patients.
Maintaining life balance and reflecting on the meaning of your work.
What can the school nurse do to promote Ian's transition to a new class?
Maintaining ties to old friends is essential to Ian's well-being. The school nurse can incorporate time with former classmates into Ian's individualized health and educational plans as tutors or during lunchtimes.
Which of the following statements correctly describes a true experiment?
Making modifications to true experimental designs decreases their internal and external validity
What evidence led to the initiation of school health nursing?
Many children in the early 20th century were absent or sent home from school because of illness. In the Northeast corridor of the United States, physicians inspected schools and examined students to identify infectious disease.
2. Based on Marilee's developmental level, what is her understanding of Zachary's imminent death? What nursing interventions should be offered to help her say good-bye?
Marilee is in the cognitive, concrete operational stage. She understands the difference between temporary separation and death. She understands that death is permanent. She may have magical thinking that needs exploration and clarification, e.g. belief that death is a person like a grim reaper. She may have guilt if she has been resentful of the time the family has spent with Zachary since diagnosis. She may not realize that death can occur at any age (such as for her 3 year old brother). Nursing interventions include working with others on the team (such as child life specialist) to listen to her fears and answer her questions about her brother's care, visit the bedside of her brother, and create memories of her brother. Nurses (and others) will prepare Marilee to how her brother will look as his condition worsens, and what he will look like when he dies. She will be assisted to be at the bedside to talk to her brother and ask questions, participate in music/singing/spiritual rituals at the bedside, if desired by her parents. Marilee can be offered activities to help keep her brother's memory alive and say her goodbyes: art activities (creating a book for Zachary or a memory book about Zachary and her relationship for herself/family), planting a special plant (or creating a special planter).
Sabador
Massage and manipulation of bones and joints used to treat a variety of ailments, including musculoskeletal conditions
The evaluation process includes interpretation of findings as one of its five elements. Which of the following is an example of interpretation? A) Evaluating the patient's response to selected nursing interventions B) Selecting an observable or measurable state or behavior that reflects goal achievement C) Reviewing the patient's nursing diagnoses and establishing goals and outcome statements D) Matching the results of evaluative measures with expected outcomes to determine patient's status
Matching the results of evaluative measures with expected outcomes to determine patient's status
A researcher interested in studying the effect of hearing loss on self-esteem in adolescents in grades 6 through 12 would need to be aware of what type of threat to internal validity?
Maturation
What measure of central tendency is the most stable?
Mean
What are levels of central tendency (mode, median, mean) and in which type of levels of measurement would each be used?
Mean is appropriate for interval or ratio data. It is not appropriate for nominal or ordinal data. In a distribution data clusters around the mean. Median is appropriate for ordinal data Mode is appropriate for nominal scale The F test, (ANOVA) is used when the independent variable is nominal and the dependent variable is interval or ratio
Implications for Nursing
Meanings of conclusions from scientific research for the body of nursing knowledge, theory, and nursing practice.
5. Develop a family-centered nursing care plan for Zachary's family during end-of-life care.
Nursing dx and interventions will be designed for Zachary including: a. Promotion of pain management/comfort - Pain assessment using developmentally appropriate tool, e.g. FLACC to assess/evaluate medication and comfort measures - Administer pain medications/sedatives titrated to optimal comfort goal - Position Zachary so that his respiratory efforts are optimized; suction (and/or medicate) if he has increased secretions. - Utilize other comfort measures designed by family, e.g. have family member rock or hold Zachary (or lay in the bed with him); massage, music, low lighting, etc. b. Assisting child for a peaceful death - If he is alert and able to participate, help family talk to him about death in terms a 3 year old understands. Often times, child life specialists have books/stories that help a 3 year old understand what to expect. - Help family have private time with him - Create a peaceful environment once child is no longer to enjoy activities due to physiological/mental status. If possible, dc monitors (or lower the alarm volume), decrease lighting, utilize music) c. Assisting the family to provide comfort and care for Zachary - Assist with planning rituals or providing environment for spiritual care. - Help family plan/implement comfort measures for Zachary, e.g. time with him at the bedside, holding, rocking him; watching movies, reading books to him, etc. d. Assist the family to cope with Zachary's impending death - Let the family know what to expect as Zachary's physical status declines and death is imminent and answer questions for them - Coordinate/ communicate with chaplain, social worker, outside clergy/community resources to have them assist family with their feelings, planning for memorial service/remembrance of Zachary, creating a website for communication re. Zachary's status/journey (such as through caringbridge.org). - Listen to their memories, desires, grief; assist with praying or rituals that are helpful to them - Encourage them to let others help them....food (or subsidized meals in hospital), setting up sleeping arrangements, including space for one parent at the bedside e. Assist to set up follow-up for family after child's death - Connect them to available resources, which may include hospice/grief support groups, e.g Candlelighters support group (oncology pts); special resources for Marilee (support group, camps, counselor, etc).
Florence Nightingale: Crimean War Research focus, 1900 to 1940
Nursing education Student characteristics Student satisfaction
4. Describe the nursing interventions for the modified nursing care plan for diagnostic procedures, treatment, and family concerns.
Nursing interventions for the modified care plan include: Preparation for the child for the indicated tests, educating family and child with developmental appropriate methods, offering support for family concerns and linking family with available resources as needed.
Sources of research problems for nursing research include
Nursing practice, Areas of health concern, and the literature
operational vs conceptual definitions
OPERATIONAL: The PURPOSE is to change the "definition" according to the ease of use of the variable -the definition of a concept or variable in terms of the procedures by which it is to be measured *in quantitative studies CONCEPTUAL: not concrete.
Data Collection Methods
Observation Interviews Text as source of qualitative data Collect words. That is the data
A patient has limited mobility as a result of a recent knee replacement. The nurse identifies that he has altered balance and assists him in ambulation. The patient uses a walker presently as part of his therapy. The nurse notes how far the patient is able to walk and then assists him back to his room. Which of the following is an evaluative measure? A) Uses walker during ambulation B) Presence of altered balance C) Limited mobility in lower extremities D) Observation of distance patient is able to walk
Observation of distance patient is able to walk
What are observational measurements?
Observational measurements involve an interaction between the study participants and the observer(s) where the observer has the opportunity to watch the participant perform in a specific setting. They may be structured or unstructured observations.
Cultural knowledge
Obtaining sufficient comparative knowledge of diverse groups, including their indigenous values, health beliefs, care practices, worldview, and bicultural ecology
Type II Error
Occurs when the null hypothesis is regarded as true but is in fact false.
Type I Error
Occurs when the null hypothesis is rejected when it is true.
Holistic
Of or pertaining to the whole; considering all factors.
Regarding grief in older adults, which understanding helps guide your relationship with an elderly patient? A) Older adults have usually sustained many losses in life, which influence the current loss. B) Older adults with a poor memory experience grief less intensely. C) Older adults generally handle loss better because they have more experience with it. D) Social support is less important because an older adult's circle of friends has become smaller.
Older adults have usually sustained many losses in life, which influence the current loss.
Evidence-Based practice in nursing should be based
On the synthesis of findings from a collection of research studies addressing nursing practice
1. previous research findings have been synthesized.
One advantage of an integrative review of research is that: 1. previous research findings have been synthesized. 2. multidisciplinary literature has been filtered out. 3. emphasis is placed on what is not known. 4. statistical analyses of the summarized research are conducted.
1. nursing practice.
One important source for identification of a research problem would be: 1. nursing practice. 2. research textbook. 3. nursing code of ethics. 4. practice guidelines.
Describe appropriate methods for supporting a child after a procedure is completed. Identify techniques appropriate for each age group.
Parents or staff should hold, rock, and/or sing to the infant after procedures. Toddlers need comfort as well, but they also generally like stickers or a special treat afterward. Preschool-age children need praise and comfort after procedures. They enjoy being given stickers as well. It is important for children this age to have a Band-Aid or bandage so they "will not leak" or "lose their body parts." Children this age might want to draw a picture afterward or play with safe or toy medical equipment after the procedure. School-age children should receive praise for cooperation. Younger school-age children might want stickers as well. Adolescents should be told when to expect results of lab tests and other procedures. Children of all ages need to be praised for their performance, regardless of their behavior during the procedure.
As a staff nurse, what steps can you take to advance EBP as part of your team or unit
Participate in QI initiatives Participate in implementing practice changes based on evidence. Participate as a member of an EBP project team.
A clinic nurse assesses a patient who reports a loss of appetite and a 15-pound weight loss since 2 months ago. The patient is 5 feet 10 inches tall and weighs 135 pounds (61.2 kg). She shows signs of depression and does not have a good understanding of foods to eat for proper nutrition. The nurse makes the nursing diagnosis of imbalanced nutrition: less than body requirements related to reduced intake of food. For the goal of, "Patient will return to baseline weight in 3 months," which of the following outcomes would be appropriate? (Select all that apply.) A) Patient will discuss source of depression by next clinic visit. B) Patient will achieve a calorie intake of 2400 daily in 2 weeks. C) Patient will report improvement in appetite in 1 week. D) Patient will identify food protein sources.
Patient will achieve a calorie intake of 2400 daily in 2 weeks. Patient will report improvement in appetite in 1 week.
A patient has been in the hospital for 2 days because of newly diagnosed diabetes. His medical condition is unstable, and the medical staff is having difficulty controlling his blood sugar. The physician expects that the patient will remain hospitalized at least 3 more days. The nurse identifies one nursing diagnosis as deficient knowledge regarding insulin administration related to inexperience with disease management. Which of the following patient care goals are long term? A) Patient will explain relationship of insulin to blood glucose control. B) Patient will self-administer insulin. C) Patient will achieve glucose control. D) Patient will describe steps for preparing insulin in a syringe.
Patient will achieve glucose control.
A nurse assesses a 78-year-old patient who weighs 240 pounds (108.9 kg) and is partially immobilized because of a stroke. The nurse turns the patient and finds that the skin over the sacrum is very red and the patient does not feel sensation in the area. The patient has had fecal incontinence on and off for the last 2 days. The nurse identifies the nursing diagnosis of risk for impaired skin integrity. Which of the following goals are appropriate for the patient? (Select all that apply.) A) Patient will be turned every 2 hours within 24 hours. B) Patient will have normal bowel function within 72 hours. C) Patient's skin will remain intact through discharge. D) Patient's skin condition will improve by discharge.
Patient will have normal bowel function within 72 hours. Patient's skin will remain intact through discharge.
The nurse writes an expected-outcome statement in measurable terms. An example is: A) Patient will be pain free. B) Patient will have less pain. C) Patient will take pain medication every 4 hours. D) Patient will report pain acuity less than 4 on a scale of 0 to 10.
Patient will report pain acuity less than 4 on a scale of 0 to 10.
A nursing student is talking with one of the staff nurses who works on a surgical unit. The student's care plan is to include nursing-sensitive outcomes for the nursing diagnosis of acute pain. A nursing-sensitive outcome suitable for this diagnosis would be: A) Patient will achieve pain relief by discharge. B) Patient will be free of a surgical wound infection by discharge. C) Patient will report reduced pain severity in 2 days. D) Patient will describe purpose of pain medicine by discharge.
Patient will report reduced pain severity in 2 days.
Which of the following outcome statements for the goal, "Patient will achieve a gain of 10 lbs (4.5 kg) in body weight in a month" are worded incorrectly? (Select all that apply.) A) Patient will eat at least three fourths of each meal by 1 week. B) Patient will verbalize relief of nausea and have no episodes of vomiting in 1 week. C) Patient will eat foods with high-calorie content by 1 week. D) Give patient liquid supplements 3 times a day.
Patient will verbalize relief of nausea and have no episodes of vomiting in 1 week Give patient liquid supplements 3 times a day.
A patient is being discharged today. In preparation the nurse removes the intravenous (IV) line from the right arm and documents that the site was "clean and dry with no signs of redness or tenderness." On discharge the nurse reviews the care plan for goals met. Which of the following goals can be evaluated with what you know about this patient? A) Patient expresses acceptance of health status by day of discharge. B) Patient's surgical wound will remain free of infection. C) Patient's IV site will remain free of phlebitis. D) Patient understands when to call physician to report possible complications.
Patient's IV site will remain free of phlebitis.
A nurse caring for a patient with pneumonia sits the patient up in bed and suctions the patient's airway. After suctioning, the patient describes some discomfort in his abdomen. The nurse auscultates the patient's lung sounds and gives him a glass of water. Which of the following would be appropriate evaluative criteria used by the nurse? (Select all that apply.) A) Patient drinks contents of water glass. B) Patient's lungs are clear to auscultation in bases. C) Patient reports abdominal pain on scale of 0 to 10. D) Patient's rate and depth of breathing are normal with head of bed elevated.
Patient's lungs are clear to auscultation in bases. Patient's rate and depth of breathing are normal with head of bed elevated.
In a study of patients experiencing arthritis, the researcher used real names in the field notes. Which human right was violated?
Privacy
The principle of justice ensures a research subject's right to which of the following?
Privacy
A patient is recovering from surgery for removal of an ovarian tumor. It is 1 day after her surgery. Because she has an abdominal incision and dressing and a history of diabetes, the nurse has selected a nursing diagnosis of risk for infection. Which of the following is an appropriate goal statement for the diagnosis? A) Patient will remain afebrile to discharge. B) Patient's wound will remain free of infection by discharge. C) Patient will receive ordered antibiotic on time over next 3 days. D) Patient's abdominal incision will be covered with a sterile dressing for 2 days.
Patient's wound will remain free of infection by discharge.
If patient has limited hearing or visual deficits, use nonverbal communication when conducting a patient-centered interview.
Patient-directed eye gaze Affirmative head nodding Smiling Forward leaning
What type of reasoning is represented in the following example? Premises
Patients with untreated right-sided heart failure experience shortness of breath. Mr. Jones experiences shortness of breath.: Deductive reasoning
Which of the following correlational procedures looks at the extent of a Relationship between two variables?
Pearson Product Moment Correlation
Snowball technique
People in study will refer research to someone to build on study.
Once an idea is generated for a research problem, what is the next step?
Perform a review of the literature
Evaluation is based on documenting competence
Performance-based examinations Developing a structured portfolio
Correlation
Performed on data collected from a single sample Measures of the two variables to be examined must be available for each subject in the data set.
puberty
Period of life when the ability to reproduce sexually begins, characterized by maturation of the genital organs, development of the secondary sex characteristics, and the onset of menstruation in females.
Cheyne-Stokes respirations
Periods of shallow breathing alternating with apnea, a sign of imminent death.
mutagenesis
Permanent changes in the fetus' genetic material.
case manager
Person who coordinates health care to prevent gaps or overlaps.
What are the four concepts of the nursing theory?
Person, environment, health, and nursing
3. Analyze Sergio's developmental milestones. Consult the list of expected milestones in this chapter and on the Denver II Developmental Test in Chapter 9. What skills will Sergio learn next? What specific suggestions do you have for his parents as they seek to encourage his development?
Personal-Social: Sergio will work for a toy and begin to be interested in feeding himself Fine Motor: Sergio will begin reaching for objects and will develop object permanence Language: Sergio will continue to develop speech sounds, babble, and say "mama and dada" nonspecifically. He will enjoy imitating parents' speech sounds
During which phase of a full clinical trial would an efficacy study be done?
Phase III
Which type of qualitative research method was used by the theorist Benner in her study of nursing practice?
Phenomenological
Which of the following research methodologies is used to study lived experiences?
Phenomenology
The preschool-age child's grasp of meaning is generally literal. Give examples of words or phrases that might have important implications in the healthcare setting.
Phrases such as "put to sleep," "dye," and "a little stick in the arm" will mean different things to the preschool-age child than they do the adult. The nurse needs to explain procedures in simple terms without using phrases that will be misinterpreted. "You are going to go to sleep for a little while" is more appropriate than "put to sleep." The child might perceive "put to sleep" as what happened to her pet. "You will be given some medicine that will help us see pictures of the inside of your body" is more appropriate than using the word dye. The word dye might be interpreted as death, or the child may think she is going to change colors when the medication is given. "Medicine under the skin" is more appropriate than "stick in the arm" for the child who is receiving an injection. "Stick in the arm" might create a vision of an actual tree limb in the arm for the preschool-age child.
During the review of systems in a nursing history, a nurse learns that the patient has been coughing mucus. Which of the following nursing assessments would be best for the nurse to use to confirm a lung problem? (Select all that apply.) A) Family report B) Chest x-ray film C) Physical examination with auscultation of the lungs D) Medical record summary of x-ray film findings
Physical examination with auscultation of the lungs Medical record summary of x-ray film findings
4. Assume that you are the nurse in the clinic where Sergio receives health care. Briefly outline the physical measurements, developmental observations, and family assessments that you will complete at each visit.
Physical measurements: length, weight, occipital frontal circumference, all charted on a percentile chart and monitored according to child's individual trend Development: Summary of personal social, fine motor, language, and gross motor development relative to established norms and calibrated according to prematurity Family Assessments: Evaluation of risk and protective factors, family strengths and areas for growth; family resources and coping strategies; parental knowledge regarding child care.
A 10-year-old client sustained a deep laceration on her leg from falling on a rusty can. She had lost a significant amount of blood by the time she arrived at the hospital with her parents. Neither the child nor her parents agree to an emergency blood transfusion ordered by the physician. Now consider the point of view of health professionals, and suggest strategies to respect both the physician's and family's points of view.
Physicians educated in North America tend to practice from a biomedical (scientific) rather than a holistic perspective. Ordering a treatment for a child reflects the ethical principles of beneficence, an obligation to make decisions to benefit the patient, and nonmaleficence, the intent to prevent harm. Given the emergency nature of many situations involving moral conflicts around blood products, many practitioners use plasma expanders whenever possible to prevent the need to transfuse blood. However, judicial decisions to use blood products for children sometimes are sought, and the blood is transfused against the judgment of the parents.
Which of the following statements abut error in physiologic measurement is True?
Physiologic measures are subject to several sources of error
collaborative problem
Physiological complication that requires the nurse to use nursing- and health care provider-prescribed interventions to maximize patient outcomes
Which of the following is the best definition of research?
Planned and systematic activity that leads to new knowledge and/or the discovery of solutions to problems or questions.
Therapeutic play
Planned play techniques that provide an opportunity for children to deal with fears and concerns related to illness or hospitalization.
Study Designs
Plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions
solitary play
Playing alone, with one's self.
Positive and Negative correlations
Positively skewed: tail towards the right Negatively skewed: tail towards left
Sample size in quantitative studies is best determined by
Power analysis
What is a power analysis?
Power is the probability that a statistical test will detect a significant difference that exists. A power analysis can assist you to identify the sample size you will need to avoid a Type II error (or to ensure that a significant difference exists). The minimum acceptable power level is .80
Rooming in
Practice in which parents stay in the child's hospital room and care for the child.
Which of the following nursing interventions support(s) a healing relationship with a patient? (Select all that apply): A) Praying with the patient B) Giving pain medications before a painful procedure C) Telling a patient that it is time to take a bath before family arrive to visit D) Making the patient's bed following hospital protocol E) Helping a patient see positive aspects related to a chronic illness
Praying with the patient Helping a patient see positive aspects related to a chronic illness
Bias is a term used to indicate that data in a study are being distorted or slanted away from reality by some influencing factor. Which of the following statements about bias in research s true?
Preconceived ideas about what the findings of a study may be could lead to bias in interpreting data
Navajos
Prefer holistic approach to health care. They often are not on time for appointments. Promote physical, mental, spiritual, and social health of persons, families, and communities. Allow family members to visit. Provide teaching about wellness, not disease prevention, when possible.
On a cold day, Emma develops dyspnea and wheezing while running during outside playtime. The teacher brings Emma inside to the nurse. Emma asks the nurse if she was being "bad." What should the nurse say?
Preschoolers engage in magical thinking and might believe that their behavior causes symptoms or that their symptoms are a punishment for bad behavior.
Is Emma able to use her inhaler independently in preschool?
Preschoolers have the manual dexterity to use an inhaler but not the cognitive ability to decide when to use the inhaler based on asthma symptoms.
An emergency department nurse is caring for a patient who was severely injured in a car accident. The patient's family is in the waiting room. They are crying softly. The nurse sits down next to the family, takes the mother's hand, and says, "I can only imagine how you're feeling. What can I do to help you feel more at peace right now? " In this example the nurse is demonstrating: A) Prayer. B) Presence. C) Coaching. D) Instilling hope.
Presence.
How does caffeine effect sleep?
Prevents person from falling asleep Causes person to awaken during night Interferes with REM sleep
A nurse is talking with a patient who is visiting a neighborhood health clinic. The patient came to the clinic for repeated symptoms of a sinus infection. During their discussion the nurse checks the patient's medical record and realizes that he is due for a tetanus shot. Administering the shot is an example of what type of preventive intervention? A) Tertiary B) Direct care C) Primary D) Secondary
Primary
Right to freedom from harm and discomfort Beneficence—maximize good Nonmaleficence—minimize harm Right to protection from exploitation
Principle of beneficence: Above all, do no harm.
A nurse checks a patient's intravenous (IV) line in his right arm and sees inflammation where the catheter enters the skin. She uses her finger to apply light pressure (i.e., palpation) just above the IV site. The patient tells her the area is tender. The nurse checks to see if the IV line is running at the correct rate. This is an example of what type of assessment? A) Agenda setting B) Problem-focused C) Objective D) Use of a structured database format
Problem-focused
counseling
Problem-solving method used to help patients recognize and manage stress and enhance interpersonal relationships. It helps patients examine alternatives and decide which choices are most helpful and appropriate.
PIE
Problem—Intervention—Evaluation
Cultural competence
Process in which the health care professional continually strives to achieve the ability and availability to work effectively with individuals, families, and communities.
Consultation
Process in which the help of a specialist is sought to identify ways to handle problems in patient management or in planning and implementing programs.
Data Collection
Process of acquiring the subjects and collecting the data for the study.
Acculturation
Process of adapting to and adopting a new culture.
Measurement
Process of assigning numbers or values of individuals' health status, objects, vents, or situations using a set of rules.
Planning
Process of designing interventions to achieve the goals and outcomes of health care delivery.
Mourning
Process of grieving.
Sensitivity
Proportion of patients with the disease who have a positive test result or true positive.
Specificity
Proportion of patients without the disease who have a negative test result or a true negative.
Grant
Proposal developed to seek research funding from private or public agencies.
The nurse enters a patient's room, and the patient asks if he can get out of bed and transfer to a chair. The nurse takes precautions to use safe patient handling techniques and transfers the patient. This is an example of which physical care technique? A) Meeting the patient's expressed wishes B) Indirect care measure C) Protecting a patient from injury D) Staying organized when implementing a procedure
Protecting a patient from injury
DISCUSSION 1 . Sergio and his parents have many challenges and yet possess many strengths. Using the theory of resilience, list the infant's and family's risks and protective factors.
Protective factors: Baby is well loved and cared for. Mother's work is flexible so she can care for him during the day. Father is able to care for infant when mother is at work. Grandparents are close and visit often. Family has medical insurance and they access health care. Care at the clinic is continuous with caring provider Family is able to maintain housing, food, etc. Risk factors Prematurity predisposes infant to respiratory infections and possible developmental delays Parents are new parents with limited experience. Income is limited and expenses for family have increased.
Sikhism
Provide time for devotional prayer. Allow use of religious symbols.
A nurse is providing postmortem care. Which action is the priority? A) Locating the patient's clothing B) Providing culturally and religiously sensitive care in body preparation C) Transporting the body to the morgue as soon as possible to prevent body decomposition D) Providing all postmortem care to protect the family of the deceased from having to see the body
Providing culturally and religiously sensitive care in body preparation
From what field(s) did many nursing theories derive their ideas?
Psychology, physiology, sociology
When a nurse properly positions a patient and administers an enema solution at the correct rate for the patient's tolerance, this is an example of what type of implementation skill? A) Interpersonal B) Cognitive C) Collaborative D) Psychomotor
Psychomotor
Which of the following regulations is(are) used to protect animals in research studies?
Public health service policy on humane care and use of laboratory animals, animal welfare assurance statement, state and federal law
American Holistic Nurses Association ahna.org
Publications, certificate program, and continuing education course listings
When a researcher in a qualitative study chooses the participants based on what they ma be able to contribute to the study, the sampling method is called
Purposive sampling
Nonprobability Sampling in Qualitative Research
Purposive sampling Network or snowball sampling Theoretical sampling
Independent variable
Q the presumed cause the "I" ( intervention) and "C" comparison of PICO ex:does SMOKING cause lung cancer with dependent variable can be used to determine direction of influence
Guided by research questions and data are collected from a small number of subjects allowing an in depth study of phenomenon
Qualitative
Qualitative Designs
Qualitative research is a formal, systematic approach for exploring and describing persons' experiences and the meanings attached to those experiences. Qualitative studies include the following features: Focus on "how" questions Enhances in-depth understanding of specific situation or context Data collection open to modification during the study Exploration of unknown or little known areas Often uses small samples
What are the people called in quantitative studies? Qualitative studies?
Qualitative studies: study participant,. Quantitative studies: subjects.
Variable
Qualities, properties, or characteristics of people, things, or situations that are manipulated or measured in research
What is a quantitative paradigm? Qualitative paradigm?
Quant: positivist Qual: naturalist
Describes phenomena seeks to test hypothesis/ answer research questions using statistical methods
Quantitative
4. balance each other by generating different types of nursing knowledge.
Quantitative and qualitative research approaches are particularly useful in nursing because they: 1. are easy to implement. 2. require few resources. 3. are both process oriented. 4. balance each other by generating different types of nursing knowledge.
Quantitative Designs
Quantitative research is a formal, objective, systematic process that defines, measures, and reports on relationships or variables using statistical analyses. Quantitative studies include the following features: Focus on "why" questions Production of generalizable knowledge Precise use of data collection instruments Formalized and strict protocols for collecting data Investigation of a very specific and narrow area of inquiry Often use large samples
Comparison groups are a feature of which of the following research designs?
Quas-experimental study
Which design type is similar to experimental design but does not meet one of the other essential components of experimental design, lacking either randomization or a control group?
Quasi-experimental
Level 3
Quasiexperimental study -Controlled trial WITHOUT randomization
The researcher want o collect data abut the evaluation process of staff nurses on a unit. Which of the following measurement tool is best to gather the data?
Questionnaire
What type of nonprobability design gives the most representative sample?
Quota Sampling
The patient reports vivid dreaming to the nurse. Through understanding of the sleep cycle, the nurse recognizes that vivid dreaming occurs during which sleep phase? A) REM sleep B) Stage 1 NREM sleep C) Stage 4 NREM sleep D) Transition period from NREM to REM sleep
REM sleep
Which of the following elements are required in an experimental design?
Random assignment of subjects to groups, control of variance in sampling, and carefully defined variables
which of the following is an example of cluster sampling?
Random hospitals are selected in a region, and then nurses in each hospital intensive care unit (ICU) are asked to participate in the study
Which of the following statements about sampling is true?
Random or probability sampling methods require more rigor and research control
Which of the following statements gives the major difference between control groups and comparison groups in experimental research?
Random selection of subjects for the sample and random assignment to groups are hallmarks of true control groups
What is an effective way to control extraneous variables?
Randomization
When a researcher uses a survey or questionnaire, how do they know it is reliable? Hint: What statistic is used, and what is considered to be a "good number"?
Reliability of a survey or a questionnaire is tested using a statistical test called a Cronbach's alpha. A Cronbach alpha value greater than .80 means that the questionnaire is considered to be reliable. Note: Researchers will report Cronbach alpha values for PAST use of the survey or questionnaire (in other studies) and in the CURRENT study.
A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What understanding about communication enhances your therapeutic communication with this patient? A) Younger patients are usually less talkative about their diagnosis. B) All patients benefit by talking about their feelings with another person. C) Avoid discussing illness-related topics with quiet patients. D) Remain alert for signals that the patient wants to discuss his illness.
Remain alert for signals that the patient wants to discuss his illness.
Cultural care repatterning or restructuring
Reordering, changing, or greatly modifying a patient's/family's customs for a new, different, and beneficial health care pattern.
Circadian rhythm
Repetition of certain physiological phenomena within a 24-hour cycle.
Which of the following statements about replication studies is true?
Replication studies extent knowledge even if they do not confirm previous study findings
t-Test
Requires interval level measures Tests for significant differences between two samples Most commonly used test of differences
What is the most significant way of acquiring knowledge to develop an empirical knowledge base for nursing practice?
Research
Which of the following describes the basis of grounded theory methodology used in research?
Research continually use data to reformulate, revise, and test propositions until a theory evolves from the data
In some studies, researchers make a formal statement of the expected relationship between two or more variables in a specified population. This formal statement is a
Research hypothesis
Who Sets Research Priorities?
Research priorities are most often set by the groups that fund research. These groups include governmental funding through congressional appropriations, private foundations, and nursing organizations. Each of these groups has specific priorities that are determined by other factors, such as the following: Boards of directors Members Areas of focus Federal congressional mandates Research priorities encourage nurses to invest effort into areas of research that are most likely to generate the most benefit to the recipients of nursing care.
2. Subjects are able to identify a personal awareness of QOL.
Research subjects in a study of quality of life (QOL) in liver transplant recipients were asked to complete a questionnaire about their experiences following transplantation. Which of the following would be a likely assumption the researcher made in relation to this study? 1. Subjects will complete every item on the questionnaire. 2. Subjects are able to identify a personal awareness of QOL. 3. All liver transplant recipients invited to participate in the study will complete a questionnaire. 4. QOL is an important issue to liver transplant recipients.
mixed-methods
Research that integrates qualitative and quantitative data and strategies in a single study or coordinated set of studies Some questions require mixed methods. Advantages Complementarity Practicality Incrementality Enhanced validity
Using Research in Practice
Research utilization Locating published research Critical appraisal of nursing research
Structured Observational Measurement
Researcher carefully defines what he or she will observe and how the observations are to be made, recorded, and coded.
Potential Causes of Bias in Designs
Researchers Components of the environment and/or setting Individual subjects and/or sample How groups were formed Measurement tools Data collection process Data and duration of study (maturation) Statistical tests and analysis interpretation
A goal specifies the expected behavior or response that indicates: A) The specific nursing action was completed. B) The validation of the nurse's physical assessment. C) The nurse has made the correct nursing diagnoses. D) Resolution of a nursing diagnosis or maintenance of a healthy state.
Resolution of a nursing diagnosis or maintenance of a healthy state.
What ethical principle would have been violated in the Iglesias (2012) study if the participants had taken part in the research without signing an informed consent document?
Respect for person
heterogeneity
Results (effects) inevitably vary from one study to the next. Major question: Is heterogeneity just random fluctuations? If "yes," then a fixed effects model of analysis can be used. If "no," then a random effects model should be used. Heterogeneity can be formally tested but also can be assessed visually via a forest plot.
Nursing Research Results
Results provide foundation for practice decisions and behaviors Results create strong scientific base for nursing Results provide support for the quality and cost-effectiveness of interventions Application of results demonstrates professional accountability to insurers and health care consumers
Cultural care preservation or maintenance
Retaining and/or preserving relevant care values so patients are able to maintain their well-being, recover from illness, or face handicaps and/or death.
Retrospective vs prospective
Retrospective: Involves collecting data about an outcome in the present and then looking back in time for possible causes. Prospective: researchers begin with a possible cause, and then subsequently collect data about outcomes
Critique Guidelines or Comparison and Analysis
Review research text(s). Compare the steps in the study you are analyzing with the criteria in the research text(s). Analyze the logical links among the steps of the study.
A nurse is starting on the evening shift and is assigned to care for a patient with a diagnosis of impaired skin integrity related to pressure and moisture on the skin. The patient is 72 years old and had a stroke. The patient weighs 250 pounds and is difficult to turn. As the nurse makes decisions about how to implement skin care for the patient, which of the following actions does the nurse implement? (Select all that apply.) A) Review the set of all possible nursing interventions for the patient's problem B) Review all possible consequences associated with each possible nursing action C) Consider own level of competency D) Determine the probability of all possible consequences
Review the set of all possible nursing interventions for the patient's problem Review all possible consequences associated with each possible nursing action Determine the probability of all possible consequences
Which of the following is an example of secondary sources
Reviews Commentaries or interpretations Summaries of primary sources
A nurse is assigned to a new patient admitted to the nursing unit following admission through the emergency department. The nurse collects a nursing history and interviews the patient. Place the following steps for making a nursing diagnosis in the correct order. 1. Considers context of patient's health problem and selects a related factor 2. Reviews assessment data, noting objective and subjective clinical criteria 3. Clusters clinical criteria that form a pattern 4. Chooses diagnostic label
Reviews assessment data, noting objective and subjective clinical criteria Clusters clinical criteria that form a pattern Chooses diagnostic label Considers context of patient's health problem and selects a related factor
autonomy
Right for self-determination in decision making or to protect the informed choices of patients who are capable of decision making.
Which of the following is not a human right that requires protection during the conduct of a study?
Right to experience the treatment
A 10-year-old is diagnosed with type 1 diabetes and will require daily dietary management and injections of insulin. List the individual characteristics and past experiences that could act as risk factors for this child's adaptation to the disease of diabetes.
Risk factors for this child might include limited close relationships with adults, as with the child who lives in a single-parent home and has limited contact with extended adult family. Another risk factor is a slow-to-warm temperament. A child with a slow-to-warm temperament might not be receptive to the diabetes nurse educator in the beginning, initially appearing disinterested in learning. A child who has had a bad experience with finger sticks, venipuncture, and injections might be resistant to procedures necessary for a child newly diagnosed with diabetes.
The following nursing diagnoses all apply to one patient. As the nurse adds these diagnoses to the care plan, which diagnoses will not include defining characteristics? A) Risk for aspiration B) Acute confusion C) Readiness for enhanced coping D) Sedentary lifestyle
Risk for aspiration
Private Foundations
Robert Wood Johnson W.K. Kellogg Foundation Helene Fuld Trust
Generalizations
Samples cannot be generalized beyond their sampling criteria. This may lead to inappropriate generalizations: Because of language or reading ability To other types of illnesses or injuries
Sampling plan
Sampling method; defines the selection process; outlines strategies used to obtain a sample for a study; probability sampling plans and non probability sampling plans
purposive
Sampling technique where the researcher wants to select cases that are typical of the population of interest and when sensitive topics are of research interest or when very specialized populations are desired
-Quantitative, qualitative, and outcome research methods
Scientific knowledge is generated through:
Sample Size in Qualitative Research
Scope of the study Nature of the topic Quality of the data Study design
Data saturation depends on which of the following criteria?
Scope of the study, Nature of the topic, and Quality of the data
The nurse is providing health teaching for a patient using herbal compounds such as melatonin for sleep. Which points need to be included? (Select all that apply.) A) Can cause urinary retention B) Should not be used indefinitely C) May cause diarrhea and anxiety D) May interfere with prescribed medications E) Can lead to further sleep problems over time F) Are not regulated by the U.S. Food and Drug Administration (FDA)
Should not be used indefinitely May interfere with prescribed medications Are not regulated by the U.S. Food and Drug Administration (FDA)
Nursing Organizations
Sigma Theta Tau International (STTI) Oncology Nurses Society (ONS) American Nurses Foundation (ANF)
Ethnohistory
Significant historical experiences of a particular group.
3. What are the physiologic signs indicating that Zachary is approaching death?
Signs include: a. Cardiovascular: heart rate will decline, blood pressure will decline , color will become motteled, cyanotic; extremities will be cool b. Respiratory: air hungry appearance with increased work of breathing; gasping; cheyne-stokes respirations (shallow breathing with apneic pauses; may have increased secretions and gurgling c. Neurological: decreased level of consciousness; may be agitated or restless d. Other organs: progressive musculoskeletal weakness; renal perfusion decreases until there is no urine output; GI perfusion decreases, motility decreases leading to lack of toleration of enteral intake
Define the probability sampling methods and give examples of each
Simple Random Sampling Stratified Random Sampling Systematic Sampling
How would you prepare a preschooler for hospitalization?
Simple explanations, along with the use of play, are effective ways to prepare preschool-age children for hospitalization. Puppets, pictures, tours, stories, dolls, and dress-up clothes all are appropriate items to use in preparation of a child this age.
Construct Validity
Single broad method of measurement evaluation and includes content and predictive validity.
Level 6
Single descriptive or QUALITATIVE studies
Level 4
Single non-experimental study (case-control, correlational, cohort studies.
Reading and critiquing research reports constitutes an important step in the review of literature. The first step in reading a research report is to review it by
Skimming the article to get an overall sense of the content
NREM
Sleep that occurs during the first four stages of normal sleep.
Enculturation
Socialization into one's primary culture as a child
The school nurse should be watchful to prevent what kinds of behavior in Ian and his peers?
Some adolescents turn to risky or acting-out behaviors as a way of coping with stressful situations, changed body image, or fears of underachievement. The nurse can seek out Ian for discussions about his transition to school. The nurse should be alert for signs of substance abuse, depression, aggressive behavior, and unprotected sexual activity in any adolescent.
Outcomes in nursing research are considered time dependent for which of the following reasons?
Some findings may not be apparent for a long time, The results may be only temporary, and Outcomes in some instances are immediately seen
A Catholic patient with diabetes receives the following items on his meal tray on the Friday before Easter. For which of the foods does the nurse offer to substitute? A) Apple sauce B) Cheese and crackers C) Spaghetti with meat sauce D) Tossed salad with ranch dressing
Spaghetti with meat sauce
collective monologue
Speaking in separate conversations even though each person waits for the other to speak; common in speech of preschoolers.
Early intervention
Special services for infants and toddlers up to age 3 years who have developmental delay or are at risk for developmental delay.
technology-assisted
Special services for infants and toddlers up to age 3 years who have developmental delay or are at risk for developmental delay.
Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that: A) Specially educated personnel make requests. B) Requests are usually made by the nurse caring for the patient at the time of death. C) Only patients who have given prior instruction regarding donation become donors. D) Professionals need to be very selective in whom they ask for organ and tissue donation.
Specially educated personnel make requests.
Clinical practice guidelines
Specific medical and nursing assessments and interventions that occur during specific time intervals for a specific condition; often adopted by an institution for all healthcare providers to follow so that quality of care is increased and costs of care are minimized.
what is inductive reasoning?
Specific to general. Constructivist paradigm. Qualitative.
How does alcohol effect sleep?
Speeds onset of sleep Reduces REM sleep Awakens person during night and causes difficulty returning to sleep
Spiritualist
Spiritual advising, counseling, and praying to treat illness or cope with personal and psychosocial problems
Spirituality
Spiritual dimension of a person, including the relationship with humanity, nature, and a supreme being.
Standard Deviation
Square root of the variance.
Stage 2 NREM
Stage lasts 10 to 20 minutes. It is a period of sound sleep. Relaxation progresses. Body functions continue to slow. Arousal remains relatively easy.
Performance examinations
Standardized evaluation based on objective demonstration of specific required competencies; used in conjunction with written tests of knowledge about those abilities. They may require performance in actual or simulated situations, related to physical psychomotor skills or the observable evidence of other skills such as critical thinking, communication, teaching, planning, writing, or analysis and integration of data.
A nurse is orienting a new graduate nurse to the unit. The graduate nurse asks, "Why do we have standing orders for cases when patients develop life-threatening arrhythmias? Is not each patient's situation unique?" What is the nurse's best answer? A) Standing orders are used to meet our physician's preferences. B) Standing orders ensure that we are familiar with evidence-based guidelines for care of arrhythmias. C) Standing orders allow us to respond quickly and safely to a rapidly changing clinical situation. D) Standing orders minimize the documentation we have to provide.
Standing orders allow us to respond quickly and safely to a rapidly changing clinical situation
Sleep
State marked by reduced consciousness, diminished activity of the skeletal muscles, and depressed metabolism.
Spiritual distress
State of being out of harmony with a system of beliefs, a Supreme Being, or God.
Null hypothesis
States there is no difference or relationship between variables Is also called statistical hypothesis can also be associative hypothesis, also simple/complex hypothesis too. example: There is no difference in reported pain experienced by cancer patients with chronic pain who listen to music with positive suggestion of pain reduction and those who do not
Research hypothesis
States what researcher thinks is true There is a relationship between two or more variables example: Cancer patients with chronic pain who listen to music with positive suggestions of pain reduction have less reported pain than those who do not listen to music
Meta-analysis of the Research Literature
Statistically pools results from previous studies into single quantitative analysis Allows for application of scientific criteria For example, sample size, level of significance, variables
Hypothetically, if all O'Flaherty (2012) participants developed a severe rash from the aromatic oil massage, what do you think would be the most ethical approach for the researcher to take?
Stop the research study per the Nuremberg Code #9, and report all side effect findings to the IRB
database
Store or bank of information, especially in a form that can be processed by computer.
Nonprobability quota sampling is most closely related to which of the following probability sampling techniques?
Stratified random sampling
When subjects area selected randomly on the basis of their fir in categories of variables important to the study, the sampling method is referred to as
Stratified random sampling
Clinical pathways (critical pathways)
Structured care plans for a specific patient problem that outline patient goals and essential steps in the management of a child by multiple healthcare professionals within a healthcare facility.
Results (IMRAD)
Study findings
etiology
Study of all factors that may be involved in the development of a disease.
What term is used to describe the specific goal or aim of a study?
Study purpose
SOAP
Subjective—Objective—Assessment—Plan
Control group
Subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. When a true experimental design is not used, this group is usually called a comparison group.
Outliers
Subjects or data points with extreme values that seem unlike the rest of the sample.
Dependent Groups
Subjects or observations selected for data collection are related in some way to the selection of other subjects or observations.
Culture strongly influences pain expression and need for pain medication. However, cultural pain is: A) Not expressed verbally or physically. B) Expressed only to others from a similar culture. C) Usually more intense than physical pain. D) Suffered by a patient whose valued way of life is disregarded by practitioners.
Suffered by a patient whose valued way of life is disregarded by practitioners.
The "Methods" section of a research report should include a subsection on the measurement methods used. Which of the following statements related to the information to be included in this subsection?
Sufficient information about the instrument must be provided for he reader to see the link between the concept and the way it was operationalized in the study
Meta-analysis
Summarizes a number of studies focused on a topic using a specific statistical methodology to synthesize the findings in order to draw conclusions about the area of focus.
statement of purpose
Summarizes the overall study goal, identifies the key concepts, and the study group or population. Purpose statements often communicate, through the use of verbs and other key terms, the underlying research tradition of qualitative studies or whether study is experimental or nonexperimental
4. What are symptoms of dehydration that Tiona's mother should watch for over the next few days?
Sunken eyes, dry skin and mucous membranes, dizziness upon sitting up or going from sitting to standing; change in level of consciousness (more lethargic and tired); minimal urine output.
How do narcotics effect sleep?
Suppress REM sleep Cause increased daytime drowsiness
How do antidepressants and stimulants effect sleep?
Suppress REM sleep Decrease total sleep time
Narcolepsy
Syndrome involving sudden sleep attacks that a person cannot inhibit. Uncontrollable desire to sleep may occur several times during a day.
Conclusions
Synthesis of the findings.
Metasynthesis of Qualitative Research
Synthesizes qualitative research with a critical analysis of primary studies and synthesis of findings into a new theory
Hospice
System of family-centered care designed to help terminally ill people be comfortable and maintain a satisfactory lifestyle throughout the terminal phase of their illness.
Which of the following does not affect the reliability of measurements in a Study?
Systematic error
Which of the following is a synonym for the concept of research
Systematic inquiry
nursing process
Systematic problem-solving method by which nurses individualize care for each patient. The five steps are assessment, diagnosis, planning, implementation, and evaluation.
Level 1
Systematic review or meta-analysis of randomized controlled trials (RCTs)
Which of the following summarize the results and implications of large quantities of research and include articles addressing the same clinical problem?
Systematic reviews
Level 5
Systematic reviews of descriptive and QUALITATIVE studies
If every fifth baby born in a city is entered into a study, the sampling method is called
Systematic sampling
Ungrouped Frequency Distribution
Table is developed to display all numerical values obtained for a particular variable.
An older adult is receiving hospice care. Which nursing intervention(s) help the patient cope with feelings related to death and dying? (Select all that apply.) A) Teaching the patient how to use guided imagery B) Encouraging the family to visit the patient frequently C) Taking the patient's vital signs every time the nurse visits D) Teaching the patient how to manage pain and take pain medications E) Helping the patient put significant photographs in a scrapbook for the family
Teaching the patient how to use guided imagery Encouraging the family to visit the patient frequently Helping the patient put significant photographs in a scrapbook for the family
defense mechanisms
Technique used by the ego to unconsciously change reality, thereby protecting the individual from excessive anxiety.
A study requires diabetic subjects to perform one or more blood glucose determinations per day. The level of discomfort or risk for the subjects is rated as
Temporary discomfort
Ethnocentrism
Tendency to hold one's own way of life as superior to that of others.
Accuracy of a Screening Test
Test used to confirm a diagnosis is evaluated in terms of its ability to correctly assess the presence or absence of a disease or condition.
What is clinical research?
The National Institutes of Health (NIH) Director's Panel on Clinical Research (CRP) executive summary (dated December 1997), outlines a three-part definition of clinical research: Patient-oriented research in which researchers directly interact with human research participants Epidemiologic and behavioral studies Outcomes research and health services research
Manipulation is a term used in research to mean
The ability to determine the various treatments given to groups in quasi-experimental and experimental studies
Resilience
The ability to function with healthy responses, even during significant stress and adversity.
receptive speech
The ability to understand words.
Euthanasia
The act of someone, other than the patient, ending the life of a patient with a terminal condition to relieve suffering.
The funding agency that focuses most on outcomes research is
The agency of Healthcare Policy and Research
A 10-year-old client sustained a deep laceration on her leg from falling on a rusty can. She had lost a significant amount of blood by the time she arrived at the hospital with her parents. Neither the child nor her parents agree to an emergency blood transfusion ordered by the physician. Think about your response as the nurse providing care to the child and family. How would you participate in the decision-making process?
The answer should include such steps in ethical problem solving as collecting as much information as possible; identifying if surrogate decision makers exist; seeking consultation on all possible courses of action; identifying strengths and benefits of all courses of action; ensuring that the family is an active participant in any decision made; and collaborating with the physician and associated health professionals working with the family.
Anticipatory loss
The anticipation of loss experienced before the loss actually transpires.
Randomization
The assignment of subjects to treatment conditions in a random manner (determined by chance alone).
id
The basic sexual energy that is present at birth and drives the individual to seek pleasure.
Mourning
The behavioral and psychological process of adapting to the loss.
magical thinking
The belief of young children that events occur because of their thoughts or wishes.
Transcendence
The belief that there is a force outside of and greater than the person that exists beyond the material world.
How would you design the content of a smoking prevention patient education brochure for an immigrant population of parents written at the fifth- to sixth-grade level designed to help them counsel their school-aged children? Ensure that the brochure is both linguistically and culturally appropriate.
The brochure should be written in short words of no more than two syllables when possible with words familiar to the target audience (e.g., urinate might be better referred to as pass water). Medical terms should be expressed with simple language (e.g., pulmonary function might be changed to ease of breathing). The brochure should use short sentences as well with active rather than passive verbs. The words used should be well understood by the audience. Including graphics is a great idea. Make sure that they are correct and clearly labeled.
Now design the content of a smoking prevention patient education brochure for a population of 12-year-old students written at the fifth- to sixth-grade level. The brochure should be written in a way that attends to what is important to the children. Ensure that the writing is both developmentally and culturally appropriate.
The brochure should be written in short words of no more than two syllables when possible with words familiar to the target audience (e.g., urinate might be better referred to as pee with a school-aged population). Medical terms should be expressed with simple language (e.g., pulmonary function might be changed to the way you breathe). The brochure should use short sentences as well with active rather than passive verbs. The words used should be well understood by the audience (e.g., until adolescence, children have difficulty understanding abstract concepts). Including graphics is a great idea. Make sure that they are correct, attractive, and clearly labeled.
Caregiver burden
The burden family or caregivers feel when caring for the child with a chronic condition.
The nurse enters a patient's room and finds that the patient was incontinent of liquid stool. The patient has recurrent redness in the perineal area, and there is concern that he is developing a pressure ulcer. The nurse cleanses the patient, inspects the skin, and applies a skin barrier ointment to the perineal area. She calls the ostomy and wound care specialist and asks that he visit the patient to recommend skin care measures. Which of the following describe the nurse's actions? (Select all that apply.) A) The application of the skin barrier is a dependent care measure. B) The call to the ostomy and wound care specialist is an indirect care measure. C) The cleansing of the skin is a direct care measure. D) The application of the skin barrier is a direct care measure.
The call to the ostomy and wound care specialist is an indirect care measure. The cleansing of the skin is a direct care measure. The application of the skin barrier is a direct care measure.
A 10-year-old is diagnosed with type 1 diabetes and will require daily dietary management and injections of insulin. List the individual characteristics and past experiences that could act as protective factors in the child's adaptation to the disease of diabetes.
The child who has had positive experiences with new people might be very receptive to those who are interacting with him in the healthcare setting. A child with an easy temperament is likely to be more receptive to learning about his illness.
Regarding citation dates of literature to be included in a literature review for a research study, which of the following statements is true?
The literature review should include backgrounds on the variables in the study
DISCUSSION 1 . What role will the clinic nurse and case manager have in helping develop Haley's IEP and IHP?
The clinic nurse and case manager will release information, which includes history & physical. They will provide assessment information regarding child's current health status and level of function. They will provide consultation regarding their assessment and care, so that there will be continuity between the disciplines in all settings. The clinic nurse can continue to be a good liaison between the school and health care providers to provide ongoing planning and evaluation. For the IHP, they will have to provide prescriptions and detailed instructions on medications and procedures that will occur at school.
Data saturation
The collection of QUALITATIVE data to the point where a sense of closure is attained because new data yield redundant information.
Finding an appropriate measurement tool is based on which of the following assumptions?
The concept to be measured has been clearly defined
Quality improvement
The continuous study and improvement of the processes and outcomes of providing healthcare services to meet the needs of patients by examining the system and processes of care and service delivery.
Health literacy
The degree to which individuals have the capacity to obtain and understand basic health information needed to make appropriate health decisions.
What is internal validity?
The degree to which it can be inferred that the experimental treatment (independent variable), rather that confounding factors, is responsible for observed effects on the outcome., *( extent to which extraneous variables have been controlled)
What is external validity?
The degree to which study results can be generalized to settings or samples other than the one studied.
Effect Size
The degree to which the phenomenon is present in the population, or the degree to which the null hypothesis is false.
What is effect size?
The degree to which the phenomenon is present in the population, or the degree to which the null hypothesis is false.
4. the response or outcome that the researcher wants to understand.
The dependent variable is: 1. a stimulus or activity that is varied by the researcher. 2. the quality, property, or characteristic identified in the problem. 3. a characteristic or element of the human subjects involved in the study. 4. the response or outcome that the researcher wants to understand.
What is measurement error?
The difference between what you measured...and what the real or "true" measure of the variable is. The amount of error in any measure varies. There could be considerable error in one measurement and very little in the next. Measurement error exists in both direct measures (like blood pressure) and indirect measures (like pain).
absolute value
The distance a number is from zero on a number line. ALWAYS POSITIVE
Effect Size
The effect is the presence of the phenomenon being studied. The effect size is the extent to which the null hypothesis is false. When the effect size is large (large variation between groups), only a small sample is needed. Increasing the sample size increases the effect size.
which of the following is a condition for determining causality in research studies?
The effect should not occur unless the cause is, or has been, present
Nurture
The effects of environment on an individual's performance.
What is a population?
The entire set of individuals or objects having some common characteristics. *example: all RN's in NY. All fire hydrants in Pittsburgh.
Core competencies
The essential cluster of abilities and skills required for competent nursing practice.
Random variation
The expected difference in values that occurs when different subjects from the same sample are examined Difference is random because some values will be higher and others lower than the average population values
adherence
The extent to which a patient or parent acts consistently with regard to recommended care.
transferability
The extent to which findings can be transferred to other settings or groups The analog of generalizability or external validity in quantitative research
What is content validity?
The extent to which the measurement includes all of the major elements relevant to the construct being measured. How do you prove this? the ROL, the representativeness of the relevant population, and the use of content experts.
authenticity
The extent to which the researchers 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-Guba framework at a later date
Which one of the following could form the basis for a potential research study?
The majority of patient falls occur on the evening shift.
Symbolic interaction
The manor in which people make sense of social interactions and also involves interpretation that people make of certain symbols. Develop a theory based upon the behaviors they do.
2. Informed consent is often needed before diagnostic procedures are performed and prior to releasing healthcare information. What is the process for obtaining informed consent in your healthcare setting? What is the nurse's role in the process? What needs to happen before health information is released to the childcare center? How does this healthcare facility ensure compliance with HIPAA?
The first step in obtaining informed consent is to determine who has legal responsibility for the child. This may be done in partnership with social services. Prior to the procedure, the person performing the procedure will obtain the consent. The nurse is often the witness. The nurse will also be the person who is available for additional explanation if the parents/guardians need it. The nurse is responsible to assure that the proper consent is in place before the procedure is performed. A release of information signed by the parent/guardian is required before releasing information to the child care center. The child care center OR the health care provider may initiate the release of information. HIPAA regulations are posted and families sign a statement that they understand their rights. Physical privacy barriers are in place.
3. often must be inferred by the reader from the text of the report.
The framework and conceptual map for a study: 1. are always included in the study report. 2. are usually clearly identified in the report. 3. often must be inferred by the reader from the text of the report. 4. should be referred to only at the end of the study.
Nature
The genetic or hereditary capability of an individual.
egocentrism
The inability to consider the perspective of another; seeing things only from one's own point of view.
Qualitative sampling focuses on what particular part of a research study?
The incidents in the lives of the participants
Generalizability
The inference that findings can be generalized from the sample to the entire population.
2. identifying the research problem.
The initial and one of the most significant steps in conducting the research process is: 1. defining the research variables. 2. identifying the research problem. 3. stating the research purpose. 4. determining the feasibility of the study.
You are examining several instruments to find the one most appropriate for your study. Which of the following findings should be of greatest concern?
The instrument has been used in a number of studies that have not reported validity and reliability data. You find a recent article written by a credible researcher criticizing the validity and reliability and evidence that the instrument is invalid for measuring the concept of interest
Which of the following is true in relation to structure interviews?
The interviewer is required to ask the questions precisely as it has bee designed
brain death
The irreversible cessation of all functions of the brain, including the cerebral cortex and brainstem.
random sampling
The key technique employed by sophisticated survey researchers, which operates on the principle that everyone should have an equal probability of being selected for the sample.
Object permanence
The knowledge that an object or person continues to exist when not seen, heard, or felt.
conservation
The knowledge that matter is not changed when its form is altered.
What does "the level of statistical significance" mean, and what is it typically set at for nursing studies?
The level of statistical significance is the probability level at which the results of a statistical analysis are judged to indicate a statistically significant difference between the groups. The level of significance for most nursing studies is 0.05. This means that is the level of significance found in the statistical analysis is 0.05 or less, the finding is considered to be statistically significant.
Probability
The likelihood of accurately predicting an event Variations in variables occur Therefore, what is the likelihood that a specific cause will result in a specific effect?
1. Empirical literature
The literature review section of a research report might include a summary of which of the following? 1. Empirical literature 2. Funding sources 3. Proposed methods and design 4. Description of study sample
Air hunger
The most severe form of dyspnea.
Which of the following are examples of data validation? (Select all that apply.) A) The nurse assesses the patient's heart rate and compares the value with the last value entered in the medical record. B) The nurse asks the patient if he is having pain and then asks the patient to rate the severity. C) The nurse observes a patient reading a teaching booklet and asks the patient if he has questions about its content. D) The nurse obtains a blood pressure value that is abnormal and asks the charge nurse to repeat the measurement. E) The nurse asks the patient to describe a symptom by saying, "Go on."
The nurse assesses the patient's heart rate and compares the value with the last value entered in the medical record. The nurse obtains a blood pressure value that is abnormal and asks the charge nurse to repeat the measurement.
In the following examples, which nurses are making nursing diagnostic errors? (Select all that apply.) A) The nurse who listens to lung sounds after a patient reports "difficulty breathing" B) The nurse who considers conflicting cues in deciding which diagnostic label to choose C) The nurse assessing the edema in a patient's lower leg who is unsure how to assess the severity of edema D) The nurse who identifies a diagnosis on the basis of a single defining characteristic
The nurse assessing the edema in a patient's lower leg who is unsure how to assess the severity of edema The nurse who identifies a diagnosis on the basis of a single defining characteristic
A 17-year-old adolescent boy with stage IV bone cancer and in severe pain is admitted to the hospital and requests a do not resuscitate (DNR) order. The parents object to this and overrule him because he is a minor. Then he asks the nurse for an overdose of his morphine. What should the nurse do?
The nurse can request assistance from the adolescent's physician and other members of the healthcare team in thinking through this situation. Once his pain is under control, the request for an overdose may cease. The nurse can assure the adolescent that he will be kept pain-free and comfortable. The healthcare team must meet with the parents about a DNR order to discuss the best interests of the client.
What could the nurse encourage Emma to do for show-and-tell in her classroom?
The nurse could encourage Emma to bring in her flowmeter and show the other children how she uses it. This will give Emma a positive feeling of achievement, reinforce self-care, and educate her peers.
A nurse on a cancer unit is reviewing and revising the written plan of care for a patient who has the nursing diagnosis of nausea. Place the following steps in their proper order: A) The nurse revises approaches in the plan for controlling environmental factors that worsen nausea. B) The nurse enters data in the assessment column showing new information about the patient's nausea. C) The nurse adds the current date to show that the diagnosis of nausea is still relevant. D) The nurse decides to use the patient's self-report of appetite and fluid intake as evaluation measures.
The nurse enters data in the assessment column showing new information about the patient's nausea. The nurse adds the current date to show that the diagnosis of nausea is still relevant. The nurse revises approaches in the plan for controlling environmental factors that worsen nausea. The nurse decides to use the patient's self-report of appetite and fluid intake as evaluation measures.
The nurse makes the following statement during a change of shift report to another nurse. "I assessed Mr. Diaz, my 61-year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, but I don't think it's that severe. You know that back patients often have chronic pain. He seems fine when talking with his family. Have you cared for him before?" What does the nurse's conclusion suggest? A) The nurse is making an accurate clinical inference. B) The nurse has gathered cues to identify a potential problem area. C) The nurse has allowed stereotyping to influence her assessment. D) The nurse wants to validate her information with the other nurse.
The nurse has allowed stereotyping to influence her assessment.
Why would it be important for a nurse to examine adolescent identity information in caring for teens in the hospital or community?
The nurse needs to realize that adolescence is a time when the teen has a need to leave the past and be different—to establish self-identity. Rules might be broken in the quest to establish self-awareness. If the teen is diagnosed with a chronic illness during this time, difficulties may arise. The teen might rebel because the illness is interfering with the need for independence and control. Introducing the adolescent to a teen who has managed the same problem is generally very successful.
The nurse follows a series of steps to objectively evaluate the degree of success in achieving outcomes of care. Place the steps in the correct order. 1. The nurse judges the extent to which the condition of the skin matches the outcome criteria. 2. The nurse tries to determine why the outcome criteria and actual condition of skin do not agree. 3. The nurse inspects the condition of the skin. 4. The nurse reviews the outcome criteria to identify the desired skin condition. 5. The nurse compares the degree of agreement between desired and actual condition of the skin.
The nurse reviews the outcome criteria to identify the desired skin condition. The nurse inspects the condition of the skin. The nurse compares the degree of agreement between desired and actual condition of the skin. The nurse judges the extent to which the condition of the skin matches the outcome criteria. The nurse tries to determine why the outcome criteria and actual condition of skin do not agree.
DISCUSSION 1 . What role does the hospital nurse play in facilitating end-of-life care for Zachary?
The nurse: - Works with others on the healthcare team to plan nursing care that matches Zachary's physical, cognitive, emotional, and spiritual level of development. - Implements family-centered care, ensuring that Zachary's family is part of the care team and that their beliefs, feelings, and desires are respected. - Plans and provides compassionate care for Zachary and his family through death and bereavement, or provides good hand-off information if Zachary's care is done at home or another setting. - Seeks information (research/evidence), education, and mentoring to provide optimal end-of-life care to Zachary and his family.
which of the following is an example of mortality?
The participant leaves the study in the middle
Data collection
The process of acquiring existing information or developing new information.
animism
The process of attributing lifelike qualities to nonliving things; common in thoughts of young children.
A nurse from home health is talking with a nurse who works on an acute medical division within a hospital. The home health nurse is making a consultation. Which of the following statements describes the unique difference between a nursing care plan from a hospital versus one for home care? A) The goals of care will always be more long term. B) The patient and family need to be able to independently provide most of the health care. C) The patient's goals need to be mutually set with family members who will care for him or her. D) The expected outcomes need to address what can be influenced by interventions.
The patient and family need to be able to independently provide most of the health care.
A nurse is assigned to a patient who has returned from the recovery room following surgery for a colorectal tumor. After an initial assessment the nurse anticipates the need to monitor the patient's abdominal dressing, intravenous (IV) infusion, and function of drainage tubes. The patient is in pain, reporting 6 on a scale of 0 to 10, and will not be able to eat or drink until intestinal function returns. The family has been in the waiting room for an hour, wanting to see the patient. The nurse establishes priorities first for which of the following situations? (Select all that apply.) A) The family comes to visit the patient. B) The patient expresses concern about pain control. C) The patient's vital signs change, showing a drop in blood pressure. D) The charge nurse approaches the nurse and requests a report at end of shift.
The patient expresses concern about pain control. The patient's vital signs change, showing a drop in blood pressure.
A patient comes to a medical clinic with the diagnosis of asthma. The nurse practitioner decides that the patient's obesity adds to the difficulty of breathing; the patient is 5 feet 7 inches tall and weighs 200 pounds (90.7 kg). Based on the nursing diagnosis of imbalanced nutrition: more than body requirements, the practitioner plans to place the patient on a therapeutic diet. Which of the following are evaluative measures for determining if the patient achieves the goal of a desired weight loss? (Select all that apply.) A) The patient eats 2000 calories a day. B) The patient is weighed during each clinic visit. C) The patient discusses factors that increase the risk of an asthma attack. D) The patient's food diary that tracks intake of daily meals is reviewed.
The patient is weighed during each clinic visit. The patient's food diary that tracks intake of daily meals is reviewed.
Which of the following would be the most appropriate outcome for a patient who has a nursing diagnosis of spiritual distress related to loneliness? A) Encourage the patient to meditate 2 to 3 times a week. B) The patient will set up a time to speak to a close friend in 1 week. C) Encourage the patient to phone his brother and set up a time to go out for dinner. D) The patient will experience greater connections with family members in 2 months.
The patient will set up a time to speak to a close friend in 1 week.
Which outcome allows you to measure a patient's response to care more precisely? A) The patient's wound will appear normal within 3 days. B) The patient's wound will have less drainage within 72 hours. C) The patient's wound will reduce in size to less than 4 cm (1 ½ inches) by day 4. D) The patient's wound will heal without redness or drainage by day 4.
The patient's wound will reduce in size to less than 4 cm (1 ½ inches) by day 4.
A nurse is working in a health clinic on a Navajo reservation. He or she plans care for the patients knowing which of the following is true? A) The patients may not be on time for their appointments. B) The patients most likely do not trust the doctors and nurses. C) The patients probably are not comfortable if they have to remove their undergarments. D) Terminally ill patients probably want to receive the sacrament, the anointing of the sick.
The patients may not be on time for their appointments.
Ethics
The philosophic study of morality, and the analysis of moral problems and moral judgments.
2. Design
The plan in the problem-solving process is equivalent to which step in the research process? 1. Outcomes 2. Design 3. Implementation 4. Goal identification
What recommendations can the nurse provide the preschool teacher about talking with the preschool class?
The preschool teacher must be truthful and must tell the class that Zach will not be returning to their class because he is dying. Because preschoolers cannot cognitively comprehend the permanence of death, they still might expect him to return. They also might fear that they somehow caused Zach's illness, or that they also might become ill and not return to class. These fears should be discussed and allayed, and the teacher must realize that these fears and questions will be repeated many times in this age group. A class project, such as planting a tree in Zach's memory, might help the children as well as Zach's family.
2. delineate the existing knowledge base of an identified problem.
The primary purpose for reviewing relevant literature is to: 1. select the research design. 2. delineate the existing knowledge base of an identified problem. 3. interpret previous research findings. 4. develop conceptual and operational definitions of variables.
validate and refine existing knowledge and generate new knowledge that directly and indirectly influences nursing practice.
The primary purpose of nursing research is to:
Contemporary issues
The problems, changes, and concerns that are current for the present time.
What is a qualitative research synthesis?
The process and product of systematically reviewing and formally integrating the findings from qualitative studies. There are two types: a qualitative metasummary and a qualitative metasynthesis.
proximodistal development
The process by which development proceeds from the center of the body outward to the extremities.
cephalocaudal development
The process by which development proceeds from the head downward through the body and toward the feet.
DISCUSSION 1 . Identify all the roles of Drew's nurse in working with this child and his family. What other roles could nurses have within this healthcare center and in other settings to support the nursing care provided to Drew and his family? Consider the roles of a nurse manager in the healthcare setting, a nurse consultant to the childcare center, and a nurse in the emergency department.
The roles for the nurse are direct care provider, advocate, educator and case manager. The nurse is a liaison to other personnel in the preschool and any other activity in which the child participates. The nurse consultant would partner with the health care provider and family to assess, plan, implement and evaluate emergency care plans in the preschool. This plan may also include safe delegation of health care in the community setting. The emergency room nurse participates in evidence based practice for emergency treatment of seizures. Any nurse will be participating in research activities that may direct the care of children with seizures.
Representativeness
The sample, the accessible population, and the target population are alike in as many ways as possible. Need to evaluate: Setting Characteristics of subjects (age, gender, ethnicity, income, education) Distribution of values on variables measured in the study
What can the school nurse do to help Ian protect his health as he adjusts to the school setting?
The school nurse has an important role in monitoring children and adolescents with any chronic condition. Ian must be careful to build his immune system by eating nutritiously and getting adequate rest, sleep, and exercise, but not becoming exhausted. The nurse can encourage Ian's friends to watch out for him.
How can the school nurse assist with the individualized education plan (IEP) and individualized health plan (IHP)?
The school nurse must collaborate with the clinic nurse and other healthcare team members to complete an IHP. Based on the IHP, the school nurse can advocate for Haley in IEP meetings. For example, the IHP might offer information supporting the necessity of computer-assisted learning devices for Haley. The school nurse is in a crucial position to coordinate the integration of Haley's IHP and IEP.
2. What role will the school nurse have with the child, care-givers, teacher, and classmates during the facilitation of school entry?
The school nurse will receive and evaluate the child's information and formulate a plan of care for the educational environment. The information needs to be translated to the child's teachers, including daily routine, special procedures, and emergency care. He/she needs to assure that there are appropriate personnel to provide safe and effective care, which may include delegation and training. The school nurse will accompany the parents and the child to meet/greet the classmates.
- introduction
The sentence "The purpose of this study was to examine the relationship between health beliefs and breast self-examination" would most likely be found in which section of a research report?
5. Haley's 10-year-old sister attends the same school. What effects of Haley's entry into school might the sibling experience?
The sibling may feel protective and want to help out with Haley's care. She may feel embarrassed by her sister's health condition. She might also resent the extra attention Haley is getting at school, resulting in behavior problems and poor school performance.
Bereavement
The situation of having experienced loss through the death of a loved one.
A nurse gathers the following assessment data. Which of the following cues form(s) a pattern suggesting a problem? (Select all that apply.) A) The skin around the wound is tender to touch. B) Fluid intake for 8 hours is 800 mL. C) Patient has a heart rate of 78 and regular. D) Patient has drainage from surgical wound. E) Body temperature is 101° F (38.3° C). F) Patient asks, "I'm worried that I won't return to work when I planned."
The skin around the wound is tender to touch. Patient has drainage from surgical wound. Body temperature is 101° F (38.3° C).
Bias
The slanting of findings away from the truth Bias distorts the findings Research designs should be developed to reduce the likelihood of bias or to control for it.
1. Objective
The statement "This study explores the experience of caregiving by adult daughters of parents with Alzheimer disease" is an example of which of the following? 1. Objective 2. Question 3. Simple hypothesis 4. Complex hypothesis
4. Operational definition
The statement below is an example of which of the following? "In this study, pain is reflected as a score between 0 and 10 on the Post-operative Pain Rating Scale." 1. Problem statement 2. Conceptual definition 3. Associative hypothesis 4. Operational definition
For a study using one independent variables and one dependent variable, a good sample size would result if
The study had 40 participant, and 3 dropped out
What level of IRB risk/review was most likely relevant to the Iglesias et al. (2012) study about student stress?
The study underwent a full IRB review because the students would have been considered to be part of a vulnerable population.
Medical futility
The treatment of an irreversibly dying patient that provides no physiologic benefit to the patient.
Triangulation
The use of a variety of methods to collect data on the same concept.
Accurate documentation
The use of exact measurements
Etic Approach
The way outsiders view that world. People doing the research.
What is important to ask regarding physiological measures?
Their accuracy (validity), precision (consistency/reliability), and sources of error of measurement.
What provides an essential foundation for nursing practice
Theories and research
Theories link interrelated concepts to present a view of phenomenon or something that is happening in nursing. Which of the following statements about theories is (are) true?
Theories begin when research findings are organized and synthesized to explain what is happening in an identified situations, theories may originate from abstract ideas, institution, or personal experiences, and many theories are needed to stimulate new and different nursing interventions or protocols
In what way can evidence from disciplines other than nursing be helpful?
Theory based non-nursing evidence can provide a basis on which to build new evidence.
Collaborative interventions
Therapies that require the knowledge, skill, and expertise of multiple health care professionals.
What are descriptive statistics?
There are four types of descriptive statistics: frequency distributions (gender, ethnicity, marital status data) measures of central tendency (mean, median, mode - age data) measures of dispersion ( range, variance, standard deviation) standardized scores (Z-scores)
Multicausality
There is a cause-and-effect relationship between interrelating variables. There are multiple independent variables causing a change in the dependent variable.
Causality
There is a cause-and-effect relationship between the variables. The simplest view is one independent variable causing a change in one dependent variable. Independent variable (X) causes dependent variable (Y) to change.
Which of the following statements is a belief reflective of the worldview on which qualitative research is based?
There is not a single reality
How does a researcher determine what (inferential) statistical test to use? (Yikes!!!)
There's no easy answer to this one. Usually it's a combination of the following: the study's purpose the use of questions, objectives, or hypotheses the study's design (use of groups??) the level of measurement of the variables (nominal, ordinal, interval, etc)
Research variable or concept
These are the qualities, properties, or characteristics identified in the research purpose and objectives or questions that are observed or measured in a study They are used when the intent is to observe or measure variables as they exist in a natural setting without manipulation
What are some of the values that adolescents might develop?
These values might relate to respect for others, responsibility for actions, or establishing goals.
Which of the following statements about quasi-experimental designs is true?
They are an alternative for establishing causality when an experimental study might not be ethical or feasible
Which of the following statements about research objectives, questions, and hypotheses is true?
They are used to link the research problem and purpose to the study methods and analysis strategies
Appalachians
They become anxious in unfamiliar settings. Encourage communication with family and friends when ill.
Extraneous variables
They can interfere with obtaining clear understanding of relational or causal dynamics in the study They can be recognized or unrecognized and controlled or uncontrolled If the variable is not recognized until the study is in process or cannot be controlled, it is called a confounding variable An environmental variable is an uncontrolled variable relating to the setting
Which type of bias occurs when the dependent variable is influenced by changes made in the way variables are measured?
Threat of instrumentation
Animal-assisted therapy
Use of a specially trained animal to provide comfort, companionship, and distraction during an illness; often used in hospitals.
criteria for causality
Three key criteria for making causal inferences: The cause must precede the effect in time. There must be a demonstrated association between the cause and the effect. The relationship between the presumed cause and effect cannot be explained by a third variable or confounder; another factor related to both the presumed cause and effect cannot be the "real" cause.
Examine Study Feasibility
Time commitment Money commitment Researchers' expertise Availability of subjects, facility, and equipment Ethical considerations
Current documentation
Timely entries are essential in a patient's ongoing care. Delays in documentation lead to unsafe patient care.
Assimilation
To become absorbed into another culture and adopt its characteristics.
What is the purpose of the peer-review process
To ensure confidence in the quality of published works
What was the main focus of the Wye 2009 article?
To explore what occurs when patient preference and research evidence conflict.
What are chi square and analysis of variance (ANOVA) tests used for?
To identify differences among groups in a research study.
Nonmaleficence
To prevent harm.
What is the purpose of formulating a hypothesis or hypotheses?
To provide direction for the research study by identifying possible outcomes
Research is conducted for which of the following reasons?
To test theory, to develop new knowledge, and to generate theory
Critical pathways
Tools used in managed care that incorporate the treatment interventions of caregivers from all disciplines who normally care for a patient. Designed for a specific care type, a pathway is used to manage the care of a patient throughout a projected length of stay.
Kardex
Trade name for card-filing system that allows quick reference to the particular need of the patient for certain aspects of nursing care.
You are a new nurse working at XYZ hospital. Your preceptor tells you to dangle Ms. Jones' legs on the side of the bed before you attempt to assist her to a chair. You ask your preceptor why this is done and she answers, "This is what we have always done, so go do it." This is an example of which type of evidence?
Tradition
Child life specialist
Trained professional who plans therapeutic activities for hospitalized children.
A randomized clinical trial is used to study what kind of effect?
Treatment outcome
the consent form in a research proposal needs to include all the following except
Treatments provided to the control group
Which of the following statements about historical research is true?
Triangulation of data collection methods and verification from other sources make life histories more valuable
A nursing professor encourages a nursing student to conduct a spiritual assessment on a patient who is dying of end-stage heart disease. The professor's actions represent an attempt to translate the findings of the Giske and Cone (2012) article into clinical practice.
True
Based on the results of the Sanders article (2008), evidence suggests that physicians may tell patients what to without asking about the patient's preference. Physicians often use a variety of approaches to persuade the patient to take the "best" treatment.
True
Children require special protection when they are involved in a research study
True
Sampling in qualitative research is guided more by the desire for rich sources of information than by the need for random selection.
True
The study participants in the O'Flaherty study had diminished autonomy.
True
Grounded theory analysis involves the use of a constant comparative method
True Rationale: Grounded theory analysis uses a constant comparative method analysis, a method that involves comparing elements present in one data source with those in another.
A true experiment requires that the researcher manipulate the independent variable by administering an experimental treatment (or intervention) to some subjects while withholding it from others.
True Rationale: In a true experiment, the researcher manipulates or does something, usually an intervention or treatment, to some subjects and not to others.
A researcher supports inferences that he or she wishes others to make, based on the research results, by ensuring study validity.
True Rationale: Inferences of the type the researcher wishes people to make are supported by rigorous methodological decisions, minimization of threats to study validity, good proxies or stand-ins for abstract constructs, elimination or reduction of bias, and efforts to find corroborating evidence.
Nonsignificant Results
True reflection of reality. Or negative results.
Grounded Theory
Try to determine focus of problem. Try to understand a person's behavior to resolve a certain issue. Seeks to understand key social psychological processes. Based on symbolic interaction theory. Holds many views in common with phenomenology. Explores how people define reality and how their beliefs are related to actions. Attaches meaning to situations.
A nurse identifies several interventions to resolve the patient's nursing diagnosis of impaired skin integrity. Which of the following are written in error? (Select all that apply.) A) Turn the patient regularly from side to back to side. B) Provide perineal care, using Dove soap and water, every shift and after each episode of urinary incontinence. C) Apply a pressure-relief device to bed. D) Apply transparent dressing to sacral pressure ulcer.
Turn the patient regularly from side to back to side. Apply a pressure-relief device to bed.
Which design type is considered to be the "classic" experimental design in which subjects are randomized into either the intervention group or the control group and measured before and after the intervention is implemented?
Two group pretest-posttest
Scatterplot
Two scales: horizontal and vertical. Each scale is referred to as an axis.
Research hypotheses also may be classified in terms of being simple or complex. Which of the following statements correctly describes a study designed to test a simple hypothesis?
Two variables are included in the hypothesis to be addressed
What does Type1 error mean? Type 2 error?
Type 1 is an error created by rejecting the null hypothesis when it is true ( a false positive) uses the greek symbol alpha. Type 2: an error created by accepting the null hypothesis when is false (a false negative) -uses greek symbol beta
Homogeneity
Type of reliability testing used primarily with paper-and-pencil instruments or scales to address the correlation of each question to the other questions within the instrument.
1. Descriptive Study Designs
Typical descriptive design Comparative descriptive design Case study design
Quasi-experimental Design
Typically a non-random sample of convenience Most common types: Untreated comparison group design with pretest and posttest Posttest only design with a comparison group
Visual Analog Scale (VAS)
Typically used to measure strength, magnitude, or intensity of individuals' subjective feelings, sensations, or attitudes about symptoms or situations.
Comprehensive
Understanding the parts of the researcher's purpose or intent.
Analysis
Understanding the parts of the study.
Synthesis
Understanding the whole article and each step of the research process in a study.
variances
Unexpected event that occurs during patient care and that is different from CareMap predictions. Variances or exceptions are interventions or outcomes that are not achieved as anticipated. May be positive or negative.
Institutional Review Board
Universities and most major health care institutions establish an institutional review board (IRB) or Human Subjects Committee to review proposals for research studies. This committee is charged with protecting the rights of persons who participate in research. For example, IRB members are responsible for assuring that minimal regulatory review requirements are met and that these requirements are properly documented in the IRB's minutes. IRBs are charged with reviewing the following specific areas: Right to privacy and confidentiality Equitable selection of participants Potential for risks in relation to benefits In addition to reviewing the research proposal for these specific topics, IRBs also review the content of consent forms. Persons participating in medical research studies must sign consent forms as evidence that they received specific information about the study and their rights as participants.
Nocturia
Urination at night; can be a symptom of renal disease or may occur in persons who drink excessive amounts of fluids before bedtime.
2. Complex, directional, associative
What type of hypothesis is the following? "Low-fat diet is related to lower total cholesterol and higher HDL (high-density lipoprotein)." 1. Complex, directional, causal (3 variables) 2. Complex, directional, associative 3. Simple, nondirectional, research 4. Simple, directional, causal
4. Simple, directional
What type of hypothesis is the following? "Normal saline flush with heparin is more effective than normal saline flush alone in maintaining patency of an intermittent intravenous site." 1. Simple, research 2. Complex, nondirectional 3. Complex, causal 4. Simple, directional
-Outcomes research
What type of research has a major focus on examining the long- and short-term as well as the negative and positive results of care across a variety of settings?
Phenomenological Theory
What was the lived experience of a person losing their child (example). What was it like? The person is integral with environment. Reality is subjective, thus an experience is unique to the individual. Only reliable source to answer this question is the person.
What approach might have been used by Ridge and Ziebland (2012) to control for response bias in their study about depression and "coming out"?
When interviewing participants, they might have asked only non-leading questions which did not encourage the participant to respond in a preferred fashion.
Loss
When something of value is changed, no longer available, or can no longer be experienced.
Informational Redundancy
When the researcher ceases learning new information
Theoretical Saturation
When theoretical ideas seem complete
Probability Theory
Which is deductive, issued to explain the extent of a relationship, the probability that an event will occur in a given situation, or the probability that a particular outcome will result from a nursing intervention.
3. Amount of control and precision exerted by the methodology
Which of the following definitions best describes rigor in quantitative research? 1. Time frame in which the research takes place 2. Degree of aggressiveness used in acquiring the data 3. Amount of control and precision exerted by the methodology 4. Process used to synthesize findings to form conclusions from a study
3. Formation of the National Institute for Nursing Research
Which of the following historical events had a major impact on the funding for nursing research? 1. Development of local, national, and international nursing research conferences by Sigma Theta Tau 2. Initiation of the Agency for Health Care Policy and Research 3. Formation of the National Institute for Nursing Research 4. Development of a Nursing Research Council as part of the American Nurses Association
3. Cumulative Index to Nursing & Allied Health Literature
Which of the following indexes would provide the largest number of relevant nursing sources? 1. International Nursing Index 2. Nursing Studies Index 3. Cumulative Index to Nursing & Allied Health Literature 4. Index Medicus
Which of the following is the best definition of research utilization
Which of the following is the best definition of research utilization
1. The framework and hypotheses must be congruent with each other.
Which of the following is true about the relationship between a study framework and the hypotheses? 1. The framework and hypotheses must be congruent with each other. 2. The hypotheses are not meant to be testable, but the framework is. 3. If the hypotheses are stated, the researcher does not need to have a framework. 4. Hypotheses are inductively identified within the stated framework.
nondirectional hypothesis
a research hypothesis that does not stipulate the expected direction of the relationship between variables
4. Theories are constructed by people and are tentative in nature.
Which of the following is true about theoretical frameworks used in research? 1. Theories offer precise guidance in all situations. 2. Theories prove how concepts are related to one another. 3. Theories represent ultimate truth and are congruent with reality. 4. Theories are constructed by people and are tentative in nature.
2. A report of a study written by the researcher who did the study
Which of the following represents a primary source? 1. The results of a computer search related to the primary topic of interest 2. A report of a study written by the researcher who did the study 3. A published summary of the relevant research in a primary care area 4. A thesaurus that identifies key words to use in a computer search
1. Variable
Which of the following represents the most concrete term? 1. Variable 2. Concept 3. Framework 4. Construct
3. Pain perception and anxiety are positively related to one another.
Which of the following responses best describes the relational statement that is diagrammed below? Pain perception <------- (+) --------> Anxiety 1. Increased perception of pain causes anxiety. 2. Anxiety causes increased pain perception. 3. Pain perception and anxiety are positively related to one another. 4. Pain perception and anxiety are inversely related.
3. Approaches used to investigate similar problems
Which of the following types of information is consistently covered in a quantitative literature review? 1. Descriptions of effective clinical outcomes 2. Anecdotal opinions of expert researchers 3. Approaches used to investigate similar problems 4. Clinical impressions of related phenomena
3. Quasi experimental
Which of the following types of research involve at least some control by the researcher to implement the study treatment? 1. Correlational 2. Descriptive 3. Quasi experimental 4. Experimental
1. Purpose
Which of the following would identify the specific aim or goal of the study based on the identified problem? 1. Purpose 2. Literature review 3. Methodology 4. Assumptions
2. Type of dressing ---------> skin changes
Which relationship diagram below best represents the following hypothesis? "Conventional gauze dressings cause fewer skin changes in wound sites than do hydrocolloid or hydroactive dressings." 1. Gauze dressing ----------> skin changes 2. Type of dressing ---------> skin changes 3. Type of dressing <---------> wound site 4. Gauze dressing <--------- wound site
Which of the following questions would best assess a patient's level of connectedness? A) What gives your life meaning? B) Which aspects of your spirituality would you like to discuss right now? C) Who do you consider to be the most important person in your life at this time? D) How do you feel about the accomplishments you've made in your life so far?
Who do you consider to be the most important person in your life at this time?
Islam
Women prefer female health care providers. During month of Ramadan Muslims do not eat until after the sun goes down. Health and spirituality are connected. Family and friends visit during time of illness. They usually do not consider organ transplantation or donation and postmortem examinations.
expressive speech
Words a young child can speak; usually less than the child is able to understand (receptive speech).
Standing order
Written and approved documents containing rules, policies, procedures, regulations, and orders for the conduct of patient care in various stipulated clinical settings.
Standardize care plans
Written care plans used for groups of patients who have similar health care problems.
Which of the following hypotheses would be linked with a Pearson correlation coefficient analysis?
X and Y occur together
Systematic review
a rigorous synthesis of research findings on a particular research question, using systematic sampling and data collection procedures and a formal protocol.
what is the foundations or roots of scientific approach?
a set of orderly, systematic, controlled procedures for acquiring dependable, empirical, and typically quantitative information. the methodological approach is associated with positivist paradigm.
In the 2012 systematic review published by Choi et al., many of the included studies reported no adverse side effects. Do you think that it is ethical to expose research participants at the end-of-life to this level of discomfort/risk?
Yes, assuming that the patient has been adequately informed of the potential risks and benefits of the research. Yes, because high risk studies are usually balanced against a high potential for cure. This study illustrates the opposite example because low risk is adequately balanced with a low benefit.
A researcher identified modifiable risk factors that had an impact on smoking. If you wanted to do an approximate replication of that study, could you change the operational definition of the concept of "smoking"?
Yes, but the new operationalization would need to be similar to the conceptual definition
Acupuncturist
Yin treatment using needles to restore balance and flow of qi; yang treatment using moxibustion or heat with acupuncture possibly indicated to restore yin/yang balance
A 10-year-old client sustained a deep laceration on her leg from falling on a rusty can. She had lost a significant amount of blood by the time she arrived at the hospital with her parents. Neither the child nor her parents agree to an emergency blood transfusion ordered by the physician. Think about all the reasons why the parents and child might want to select a different treatment than that proposed by the physician (e.g., cultural, religious, protection of child, etc.), and suggest a course of action that respects the family's autonomy while protecting the child from hypovolemia.
Your answer might include their fear of the transmission of disease through blood products; their past experiences with such treatment; their religious orientation, which might forbid transfusions, believing them to be morally and spiritually sinful; and cultural prohibitions from using blood. Ethical issues arise from a moral dilemma, a conflict of social values and ethical principles that support different courses of action that could be correct, depending on the individual's values and beliefs. Whereas adults are permitted to refuse blood products (even when death can occur), most healthcare institutions have policies that address the care of children in need of blood products.
Which of the following statements should be cited if used in a research paper
Zithromax has shown statistically significant results in the treatment of URIs.
correlation
a bond or association between variables, within variation in one variable systematically with another
abstract
a brief description of a study, usually located at the beginning of a report
Goal
a broad statement that describes a desired change in a patient's condition or behavior
health promotion nursing diagnosis
a clinical judgment of a person's, family's, or community's motivation, desire, and readiness to increase well-being and actualize human health potential as expressed in their readiness to enhance specific health behaviors such as nutrition and exercise.
A variable in a study is characterized by which of the following essential elements?
a concept, a conceptual definition, a method of measurement
Pearson's r
a correlation coefficient that designates the magnitude of a relationship between 2 variables
emergent
a design that unfolds in the course of qualitative study as the researcher makes ongoing design decisions reflecting what has already been learned.
null hypothesis
a hypothesis stating no relationship between the variables under study; used primarily in statistical testing as the hypothesis to be rejected
directional hypothesis
a hypothesis that makes a specific prediction about the direction of the relationship between two variables
What is a true score?
a hypothetical score that would be obtained if a measure were infallible.
Which of the following statements describes how the effect size of a sample influences the null hypothesis?
a large effect size results in rejection of the null hypothesis
Expected outcome
a measurable criterion to evaluate goal achievement.
nursing-sensitive outcome
a measurable patient or family state, behavior, or perception largely influenced by and sensitive to nursing interventions
nursing-sensitive patient outcome
a measurable patient, family or community state, behavior, or perception largely influenced by and sensitive to nursing interventions
Grounded theory:
a method designed to explore a social process
Qualitative Designs
a method of research designed for discovery rather than for verification: Phenomenology Ethnography Grounded theory
Ethnography:
a method used to study phenomena from a cultural perspective
What are the two triggers that initiate a need for a change or an evidence-based practice project?
a problem-focused trigger or a knowledge-focused trigger
casual (cause and effect) relationship
a relationship between two variables wherein presence or value of one variable (the "cause") determines the presence or value of the other (the "effect")
DISCUSSION 1 . What information should the nurse include in the discharge teaching plan for Tiona's mother?
a. Medication instructions and discussion re. pain management b. Signs and symptoms to monitor for including: bleeding, inability to swallow fluids/soft food, inadequate po fluid intake, increased pain unrelieved by medication as ordered c. Encouragement of mother to promote play activities, such as medical play or art work, so that Tiona can work out her feelings re. the hospitalization d. Follow up appointment e. Phone numbers to call if they have questions
stenosis
constricting/narrowing
what is the naturalist paradigm?
an alternative paradigm (also called constructivist paradigm) to the positivist paradigm that holds that there are multiple interpretations of reality, and that the goal of research is to understand how individuals construct reality within their natural context; associated with qualitative research.
A research problem is
an area of concern or situation in need of a solution
Clinical practice guideline (CPG)
an evidence-based guide to clinical practice developed by experts in a particular field for direct application in clinical environments.
What is a pretest - posttest design?
an experimental design in which data are collected from research subjects both before and after introducing and intervention
short-term goal
an objective behavior or response that you expect a patient to achieve in a short time, usually less than a week. In an acute care setting you often set goals for over a course of just a few hours
long-tern goal
an objective behavior or response that you expect a patient to achieve over a longer period, usually over several days, weeks, or months
A research study report states that "Heart rate was recorded using a cardiac monitor." This statement is an example of
an operational definition
Quantitative (analytic)
analyzing the data through statistical analysis and (16) interpreting the results
The safeguard mechanism by which even the researcher can not link the participant with the information provided is called:
anonymity.
evaluative measures
are assessment skills and techniques (e.g., observations, physiological measurements, patient interview)
Discovery Mode
are we seeing patterns in responses of people we are asking questions to. And do they relate to one another.
Research Problem
area of concern; gap in knowledge needed for practice
Descriptive Mode
asking what is going on with this experience. Precedes all other modes first.
What is the purpose of doing a research critique?
assess the strengths and limitations of a study
A relationship between variables so that when one variable changes, the other variable changes is a(n)
associative relationship.
restoration-orientated behaviors
attending to life changes, finding new roles or relationships, coping with finances, and participating in distractions provide balance
Naturalistic practitioners
attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. Healing emphasizes use of naturalistic modalities, including herbs, chemicals, heat, cold, massage, and surgery.
qualitative paradigm
constructive or naturalistic paradigm
qualitative
constructivist
which of the following would be a key criterion for causality
cause occurring before the effect
Six important factors when choosing interventions
characteristics of the nursing diagnosis; goals and expected outcomes; evidence base (e.g., research or proven practice guidelines) for the interventions; feasibility of the intervention; acceptability to the patient, and your own competency
What statistics can be used to determine causality?
chi-square, t-tests, ANOVAs, and ANCOVAs
test used to compare the observed frequencies wih texpeced frequencies within a contingency table
chi-squared
Vulnerable populations
children, prisoners, pregnant women, terminally ill, mentally disabled
Identify some vulnerable populations
children, unconscious patients
which type of theory systematically explains relationships among phenomena
classical
Which of the following would involve an intervention? A. Survey research B. Clinical trials C. Secondary analyses D. Methodologic research
clinical trials
thrombo
clot
Many nurses in clinical settings base nursing interventions on information obtained from
colleagues
Sources of diagnostic errors
collecting, clustering, interpreting, and labeling
construct validity
combination of content validity and statistical validity for abstract variable
Normal (uncomplicated) grief
common, universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death.
Dissemination phase
communicating the findings and putting evidence into practice, research utilization
Which of the following most accurately describes the focus of outcomes research?
comparing and contrasting groups on selected preexisting variables
criterion-related validity
comparison between tool used for measurement and known criterion -- predictive -- concurrent
What are the building blocks of theories?
concepts
Researchers formulated hypotheses based on clear definitions of
concepts and variables
According to Florence Nightingale, health is defined as the absence of disease. This is an example of a(n
conceptual definition
Quantitative phases
conceptual, planning, empirical, analytic, and dissemination phases
Ethnographic Theory
concerned about a description and interpretation of cultural behaviors. Focuses on the patterns and lifeways of a cultural group. Looks at culture, material Culture, and non-material culture.
co-sleeping
in which infants and children sleep with their parents, is a culturally preferred habit; and the practice of co-sleeping varies between cultures. It is more common in nonindustrialized countries. In some parts of the world co-sleeping practices are seen as part of the bonding process and warmth and protection for an infant (i.e., against the cold). This practice is also common in the United States with Asian, Hispanic, and African American families.
tomy
incision/removal of
interdisciplinary care plans
include contributions from all disciplines involved in patient care. It is designed to improve the coordination of all patient therapies and communication among all disciplines.
loss-orientated behaviors
include grief work, dwelling on the loss, breaking connections with the deceased person, and resisting activities to move past the grief
back channeling
includes active listening prompts such as "all right," "go on," or "uh-huh." These indicate that you have heard what the patient says and are interested in hearing the full story. It encourages a patient to give more details.
Nursing care plan
includes nursing diagnoses, goals and/or expected outcomes, specific nursing interventions, and a section for evaluation findings so any nurse is able to quickly identify a patient's clinical needs and situation.
Introduction section
includes: -the central phenomena, concepts, variable under study. -the study purpose and research questions or hypotheses. -a review of related literature. -theoretical or conceptual framework. - the significance or need for the study.
Probability is how likely it is that the effect of the dependent variable was caused by the ____________ variable.
independent
Inductive vs deductive reasoning
inductive: the process of reasoning from specific observations to more general rules. deductive reasoning: the process of developing specific predictions from general princples
correlational analysis is
inferential statistic
people in qualitative studies
informant
Subjects who volunteered to receive an experimental treatment for AIDS are educated about essential study information, assessed for understanding of this information, and asked to willingly participate in the research study. This process is referred to as:
informed consent.
what are some ways to measure research variables
instruments, tools, measure? examples?
meta-synthesis
integrate and amplify across qualitative studies
meta-analyses
integrate findings across quantitative studies statistically
Cronbach's alpha is used in tool development to determine:
internal consistency.
The degree to which one can conclude that the independent variable, rather than extraneous variables, produced the change in the dependent variable is known as
internal validity.
Discussion
interpretation of the findings.
Research Question
interrogative statements that focus on what variables or concepts are to be described and what relationships might exist among them
Manipulation is the ____________, or treatment, that is being tested in an experimental study.
intervention
Cognitive skills
involve the application of critical thinking in the nursing process.
Quantitative (conceptual)
involves 1) defining the problem to be studied. 2) doing a literature review 3) engaging in clinical fieldwork for clinical studies; 4) developing a framework and conceptual definitions 5) formulating hypotheses to be tested.
Secondary analysis
involves asking new questions on data collected previously. The data may have been generated from previous formal research or may have been gathered through any previous systematic collection of data.
Central sleep apnea
involves dysfunction in the respiratory control center of the brain. The impulse to breathe fails temporarily, and nasal airflow and chest wall movement cease. The oxygen saturation of the blood falls.
Tertiary prevention
involves minimizing the effects of long-term illness or disability, including rehabilitation measures.
There is a study being conducted of adults over the age of 65 to investigate the effect of caregiver education on calming communication techniques in comparison to sedative medications on the agitation level of clients experiencing stage 2 dementia. In this study, the clients' level of agitation would be the measured
outcome
which of following best describes a dependent variable
outcome being measured
plegia
paralysis, stroke
The best measure of successful evidence-based practice is:
patient satisfaction and patient-focused clinical improvements.
The seven guidelines for writing goals and expected outcomes
patient-centered, singular goal or outcome, observable, measurable, time-limited, mutual factors, and realistic
Who is best served by development of a scientific base for nursing practice?
patients
who is best served by development of a scientific base for nursing practice
patients
pyel(o)
pelvis or kidney
Complicated grief
person has a prolonged or significantly difficult time moving forward after a loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future.
gate keeper
person who gives permission
Steps of Qualitative Studies
planning the study developing data collection studies gathering and analyzing data disseminating findings (Circular)
quantitative
positivist
quantitative paradigm
positivist paradigm
The two types of sampling plans
probability and non probability
An example of a ____________ is: "The use of alcohol by freshman at XYZ State University contributes to alcohol-related injuries and increasing numbers of visits to the local emergency room
problem statement
A ____________ is a statement about the relationship between two or more concepts.
proposition
IRB
protect pts rights
Qualitative (Ethnography)
provides a framework for studying the meanings, patterns, and lifeways of a culture in a holistic fashion.
Case study
provides an in-depth analysis of a single subject, group, institution, or social unit
Multiple Sleep Latency Test
provides objective information about sleepiness and selected aspects of sleep structure by measuring eye movements, muscle-tone changes, and brain electrical activity during at least four napping opportunities spread throughout the day.
Near Death Experience
psychological phenomenon of people who either have been close to clinical death or have recovered after being declared dead. It is not associated with a mental disorder.
Livor mortis
purplish discoloration of the skin in dependent areas
An example of a ____________ is: "To determine if brief screening for alcohol use and nursing intervention during orientation reduces self-reported alcohol use, alcohol-related injuries, and visits to the emergency room by college students during their freshman year."
purpose statement
What is random measurement error?
the difference between the measured value and the true value without pattern or direction (random). So the more times you measure the value (and average those values together)...hopefully the closer you are getting to the person's true value or score (unless your random error rate is high). Example: Think about taking the NCLEX over and over...
random error
the difference is without pattern
population
the entire set of individuals or objects having some common characteristics (e.g. all RNs in New York); sometimes called universe
What are some characteristics of significance in studies / significant studies?
the findings make an important difference in people's lives you can generalize the results far beyond the study's population / it affects large numbers of people it generates more research it contributes to theory development / becomes a theory
The purpose statement of a qualitative study is expected to identify
the focus of the investigation (e.g. an event, a phenomenon, a culture)
metasynthesis
the grand narratives or interpretative translations produced from the integration or comparison of qualitative research
Where does funding come from?
the individual, governments, groups
Complete documentation
the information within a recorded entry or a report must be complete, containing appropriate and essential information.
what does theme represent in qualitative research
the labeling of similar ideas shared by the study participants
A researcher reports that a finding in a study comparing effectiveness of two interventions is statistically significant. Which of the following statements about this study is true?
the level of significance of the statistical finding reveals nothing about the actual size of the difference
level of significance (p=.05)
the maximum probability that the research result was obtained simply by chance. a hypothesis test with a level of significance of 0.05 means that the test demands that there is less than 5% probability that the results are caused only by chance. a hypothesis test with a level of significance of 0.01 means that the test demands that there is less than 1% probability that the results are caused only by chance.
diagnostic label
the name of the nursing diagnosis as approved by NANDA International. It describes the essence of a patient's response to health conditions in as few words as possible.
Priority setting
the ordering of nursing diagnoses or patient problems using determinations of urgency and/or importance to establish a preferential order for nursing actions
Dependent variable
the outcome or response the researcher wants to predict or explain Changes in the dependent variable are presumed to be caused by the independent variable
What is a research design?
the overall plan for addressing a research question, including strategies for enhancing the study's integrity.
research design
the overall plan for addressing a research question, including strategies for enhancing the study's integrity.
Positivist Paradigm
the paradigm underlying the traditional scientific approach, which assumes that there is an orderly reality that can be objectively studied. *quant
Which of the following statements describes the special relationship between the participants and the researcher in qualitative research?
the participants are considered to be colleagues
Philosophy influences the way in which people view the world, what they consider to be real, and the beliefs, values, and attitudes they hold. Which of the following statements about nursing philosophy, practice, and research is true?
the philosophies of the nursing support both quantitative and qualitative approaches to research
Dependent variable
the presumed effect the "O" (outcome) of PICO ex. does smoking cause LUNG CANCER? dependent variable can vary based on independent variable with dependent variable can be used to determine direction of influence outcomes may have multiple causesof influence
purpose of a literature review
the primary purpose of literature reviews is to integrate research evidence to sum up what is known and what is not known.
control
the process of holding constant confounding influences on the dependent variable, or outcome,under study
Which of the following statements correctly describes the research problem and purpose of the study in a quantitative study?
the purpose statement is very specific about what will be studied, whereas the problem statement is more abstract
Readers of theoretical literature often experiences confusion in the use of the terms "conceptual model" and "theory." Which of the following statements reflect(s) general consensus about the use of these terms in nursing?
theories present a view of phenomenon that is specific enough to be used to guide research, the scope of the theories is limited in comparison with that of conceptual models, and conceptual models are broad and abstract and reflect a philosophical position
A ____________ is a set of concepts linked through propositions to explain a phenomenon.
theory
Research proposals may be eligible for an expedited review by the IRB if they involve minimal risk to participants. This means that:
there is a very low risk of harm or discomfort to study participants, no more than that involved in daily life or routine physical or psychological exams.
Research utilization
there is extensive concern that nurses have failed to realize the potential for using research findings as a basis for making decisions and developing interventions
Which of the following statements about use of descriptive statistics is true?
they are used in every research study, qualitative as well as quantitative, they are used to identify patterns in data, and they are used to address objectives of some studies
What is the best definition of intervention theories?
they show why a procedure works
What diagnosis has the highest priorities?
those related to airway status, circulation, safety, and pain
trans
through
Researchers use nonexperimental, descriptive designs for a variety of purposes, including
to assess current practice for early stages of theory development.
Why do we want to control experiments
to get rid of confounding variables
key objective of critical theory research
transformation
Operationalization
translating downward to more concrete level Moves from concept to variable to measures
Indirect care interventions
treatments performed away from the patient but on behalf of the patient or group of patients. For example: actions for managing the patient's environment (e.g., safety and infection control), documentation, and interdisciplinary collaboration.
Direct care interventions
treatments performed through interactions with patients. For example: medication administration, insertion of an intravenous (IV) infusion, or counseling during a time of grief.
A key component of meta-analysis is the calculation of an effect size index.
true
In qualitative studies, observation is unstructured
true
The Nuremberg Code was one of the first established sets of ethical standards.
true
When applying grounded thepry methods, the researcher obtains the sample first and then collects data
true
bell-shaped curve is also called normal distribution
true
clinical practice guidelines put evidence into a useful form
true
clinical rsearch became increasingly important in 1980's
true
conceptual models and theories are similar in that both can be represented by a schematic model
true
correlation coefficient iof -.38 is stronger than a correlaton coefficient of +.32
true
face validity of an instrument is based on judgment
true
in a nonexperimental study, correlation does not prove causation
true
qualitative research is allied with the constructivist tradition
true
sampling in qualitative rsearch is guided more by the desire for rich sources of information than by the need for random selection
true
true experiment requires that the researcher manipulate the independent variable by administering an experimental tx or intervention to some subjects while withholding it from others
true
reliability equation
true score ------------------- oberved score
key goal of Lincoln and Guba framework
trustworthiness
interclass consistency
two measures of a variable taken on same day
