EBP midterm

Nonexperimental designs

-Can be used for the purpose of describing phenomena, explaining relationships and differences among variables, and predicting relationships and differences among variables -Independent variable is not manipulated -Subjects not randomized -No control group

Types of nonexperimental designs

-Descriptive -Correlational

Linking theory, research, and practice

-Reciprocal relationships to inform development of disciplinary knowledge -Effective communication with other healthcare team members to develop evidence-based practice -Special language of theory -Framework to guide nursing practice -Theory testing to address practice questions/develop new knowledge

Unethical research studies

1. Nazi experiments WWII- physicians as willing participants in crimes against humanity "nuremberg code" 2. 1930's Tuskegee syphilis study 3. 1963 Jewish Chronic Disease Hospital study-live cancer cells injected into patients with chronic disease 4. 1960s Willowbrook study- infected school children with mental disabilities with hepatitis 5. 2008 Red Wine Researcher-falsified data on papers and grants

3 common quasi-experimental designs

1. Nonequivalent control group pretest-posttest 2. Time series 3. Preexperimental designs

Parts of a research study

Abstract Intro significance of the problem background review literature methods results conclusions recommendations

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? A.Subjects will complete every item on the questionnaire. B.Subjects are able to identify a personal awareness of QOL. C.All liver transplant recipients invited to participate in the study will complete a questionnaire D.QOL is an important issue to liver transplant recipients.

B. Subjects are able to identify a personal awareness of QOL

Which relationship diagram below best represents the following hypothesis? "Conventional gauze dressings cause fewer skin changes in wound sites than dohydrocolloid or hydroactive dressings." A.Gauze dressing ----------> skin changes B.Type of dressing ---------> skin changes C.Type of dressing <---------> wound site D.Gauze dressing <--------- wound site

B. Type of dressing ---------> skin changes

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: A.manipulation B.control C.data collection D.experimental research

B. control

Hypotheses: "Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." Question: "Request for analgesics" is the: A.independent variable. B.dependent variable. C.attribute variable D.extraneous variable

B. dependent variable

Hypotheses: "Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." Question: "Perception of pain" is the: A.independent variable. B.dependent variable. C.attribute variable. D.extraneous variable

B. dependent variable.

The initial and one of the most significant steps in conducting the research process is: A.defining the research variables. B.identifying the research problem. C.stating the research purpose. D.determining the feasibility of the study.

B. identifying the research problem

An example of inductive reasoning is: A.reasoning from all chronically ill patients to a single chronically ill patient B.reasoning from a single diabetic patient to all diabetic patients C.using a standard nursing care plan to care for a specific patient D.using a computerized nursing care plan to care for insulin-dependent diabetic patients.

B. reasoning from a single diabetic patient to all diabetic patients

Model of "diffusion of innovation" (Roger's 2203)

Based on Maloney's 16% rule: once you have reached 16% adoption of any innovation, you must change your messaging and media strategy from one based on scarcity, to one based on social proof, in order to accelerate through the chasm to the tipping point

What category of research is suggested by the following research question? "Does telephone follow-up by nurses improve patients' compliance with their medication regimens?" A.Applied research B.Basic research C.descriptive research D.phenomenological research

A. Applied research

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." A.Complex, directional hypothesis B.Simple, associative hypothesis C.Simple, nondirectional hypothesis D.Complex, null hypothesis

A. Complex, directional hypothesis

A nurse who reads research articles and incorporates research findings into nursing practice would demonstrate which of the following research roles? A. Consumer B. Primary investigator C. Collaborator D. Producer

A. Consumer

The literature review section of a research report might include a summary of which of the following? A.Empirical literature B.Funding sources C.Proposed methods and design D.Description of study sample

A. Empirical literature

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? A.Natural, field B.Highly controlled, field C.Partially controlled, laboratory D.Highly controlled, laboratory

A. Natural, field

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? A.Objective B.Question C.Simple hypothesis D.Complex hypothesis

A. Objective

Which of the following would identify the specific aim or goal of the study based on the identified problem? A.Purpose B.Literature review C.Methodology D.Assumptions

A. Purpose

Which of the following is true about the relationship between a study framework and the hypotheses? A.The framework and hypotheses must be congruent with each other. B.The hypotheses are not meant to be testable, but the framework is. C.If the hypotheses are stated, the researcher does not need to have a framework. D.Hypotheses are inductively identified within the stated framework.

A. The framework and hypotheses must be congruent with each other

Which of the following represents the most concrete term? A.Variable B.Concept C.Framework D.Construct

A. Variable

A researcher investigates the effect of frequency of position change on healing of decubitus ulcers. The study would be described as: A.applied research B.basic research C.descriptive research D.phenomenological research

A. applied research

Hypotheses: "Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." Question: "Type of support" is A.independent variable. B.dependent variable C.attribute variable D.extraneous variable

A. independent variable.

A research hypothesis: A.predicts the expected results or outcomes of the study B.defines the theoretical framework for the study C.identifies the source of the problem under study D.clarifies the concepts used in the study

A. predicts the expected results or outcomes of the study

Conceptual definitions are important because: A.the meanings of terms may differ depending on the study framework. B.they tell others how the concept will be measured in the study. C.they provide a dictionary definition that can be understood by everyone D.they suggest how to precisely measure the variables of interest

A. the meanings of terms may differ depending on the study framework.

In which section of the research report might the problem statement be located? A.Literature review B.Methods C.Results D.Implications

A.Literature review

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." A.Problem statement B.Conceptual definition C.Associative hypothesis D.Operational definition

D.Operational definition

The dependent variable is: A.a stimulus or activity that is varied by the researcher. B.the quality, property, or characteristic identified in the problem C.a characteristic or element of the human subjects involved in the study D.the response or outcome that the researcher wants to understand

D.the response or outcome that the researcher wants to understand

Operational definitions

Definitions that explicitly state how the variable will be measured or operationalized; empirical definitions Ex: researchers can operationalize health as the number of self-reported upper respiratory infections per year

Internal Validity

Degree to which changes in the dependent variable can be attributed to the independent variable

External validity

Degree to which study results can be generalized to other subjects, settings, and times

Evidence Hierarchy (Pyramid model) Level 5

Descriptive or qualitative studies

Cross-sectional studies

Examine data at one point in time. Explore relationships and correlations, differences and comparisons, or both

Evidence Hierarchy (Pyramid model) Level 6

Expert opinions or case reports

Integrative

Generalizations about substantive issues from a set of studies directly bearing on those issues. Scholarly papers that synthesize published studies and articles to answer questions about phenomena of interest. Typically found in peer-reviewed professional publications.

Guidelines for Ethical Research

Give credit where credit is due, cite sources, avoid plagiarism, paraphrase or use direct quotations carefully, format citations per style guidelines

Epidemiological triangle

Host, environment, agent

Research hypothesis

Indicates that a relationship among 2 or more variables exist Ex: Increased amounts of self-esteem increase adherence to a diabetic diet in adolescents with type 1 diabetes

Quasi-experimental designs

Involve manipulation of independent variable. Does not meet essential components of experimental designs. Either lacks random assignment to groups or a control group.

6 characteristics of experimental designs

Large number of subjects Strict guidelines for study inclusion Random group assignment Homogeneity between intervention & control groups Consistent implementation of intervention Dependent variable measured in both intervention & control groups

Retrospective design

Look backward in time and usually examine exposure to the independent variable Ex: smoking is related to and a determinant of lung cancer

Narrative

Most traditional type, usually found in trade publications, subjective because writers judge which works to include and exclude Ex: stories, interviews, life experiences, field notes, autobiographies

Prevalence

Number of existing cases of disease in a population

Incidence

Number of new cases of disease during specified period of time

Primary source

Original information by the person or people responsible for creating it

Dependent variable

Outcome or variable that is influenced by the independent variable

PICO(T) question development

P: Population, patient, or problem I: Intervention, prognostic factor, exposure C: Comparison to intervention (if appropriate) O: Outcome you would like to measure or achieve T: Time

EBP

Practice based on the best available evidence, patient preferences, and clinical judgment.

Experimental designs

Provide "best evidence" to claim cause-and-effect relationship. Often include terms pretest and posttest to indicate point in time of data collection. Ex: RCT

Essential components of experimental design

Randomization, control, manipulation

Evidence Hierarchy (Pyramid model) Level 2

Randomized controlled trials

Inductive research

Research is used to develop theory and is usually qualitative

Secondary source

Resulting commentaries, summaries, reviews, or interpretations of primary sources

Designs according to time

Retrospective Cross-sectional Longitudinal

Peer reviewed and refereed

Rigorous evaluation by experts and editors

Threats to internal validity

Selection bias History Maturation Testing Instrumentation Mortality

Threats to external validity

Selection effects Reactive effects Measurement effects

Directional

Statement describing the direction of a relationship among two or more variables Ex: Increased amounts of self-esteem increase adherence to a diabetic diet in adolescents with type 1 diabetes

Nondirectional

Statement of the relationship among two variables that does not predict the direction of the relationship Ex: There is an association between the amount of self-esteem and adherence to a diabetic diet in adolescents with type 1 diabetes

Null

States there is no relationship between the variables Ex: There is no relationship between the amount of self-esteem and adherence to a diabetic diet in adolescents with type 1 diabetes

Evidence Hierarchy (Pyramid model) Level 1

Systematic reviews, meta-analysis, EBP guidelines

ANA guidelines for protecting rights of human subjects

Table 2-4: Right to self determination, right to freedom from risk or harm, scope of application, responsibilities to support knowledge development, informed consent, participation on IRB

Barriers to adopting EBP

Time Lack of value place on EBP Knowledge Technical skills Resources Lack ability read research Resistance to change Lack organizational support

6 types of true experimental designs

Two group, pretest-posttest Two group, posttest only Solomon four-group Multiple experimental groups Factorial Crossover designs

Deductive research

Typically involves quantitative designs and begins by deriving testable ideas from theories

Independent variable

Variable manipulated by the researcher

Causal hypothesis

When one variable determines the presence or change in another variable Ex: Increased amounts of self-esteem increase adherence to a diabetic diet in adolescents with type 1 diabetes

4. Which of the following validity's would be the most difficult to establish? a. Construct b. Predictive c. Criterion d. Concurrent

a. Construct

3. Which type of research involves three (3) independent variables and six (6) dependent variables? a. Experimental research b. Descriptive research c. Variable analysis d. Sociogram

a. Experimental research

In an experiment, assertive training was studied regarding its ability to help children reduce test anxiety. 5. What was the dependent variable? a. assertiveness b. anxiety level c. graduation d. training effectiveness

b. anxiety level

In an experiment, assertive training was studied regarding its ability to help children reduce test anxiety. 6. What is the independent variable? a. assertiveness b. anxiety level c. graduation d. training effectiveness

d. training effectiveness

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? A.Reliability B.Methodology C.Ethics D.Feasibility

D. Feasibility

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." A.Relaxation therapy B.Complaints of pain C.Pain medication use D.Music therapy

D. Music therapy

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." A.Simple, research B.Complex, nondirectional C.Complex, causal D.Simple, directional

D. Simple, directional

Quantitative and qualitative research approaches are particularly useful in nursing because they: A.are easy to implement. B.require few resources. C.are both process oriented. D.balance each other by generating different types of nursing knowledge.

D. balance each other by generating different types of nursing knowledge

A study framework reflects the: A.blueprint for the study B.specific plan for data collection C.data analysis strategy D.researcher's "theory" or idea about the study

D. researcher's "theory" or idea about the study

Evidence Hierarchy (Pyramid model) Level 3

Controlled trials without randomization

Associative hypothesis

A type of relationship such that when one variable changes, the other variable changes Ex: There is a relationship between the amount of self-esteem and adherence to a diabetic diet in adolescents with type 1 diabetes

Simple hypothesis

A hypothesis describing the relationship among 2 variables Ex: Increased amounts of self-esteem increase adherence to a diabetic diet in adolescents with type 1 diabetes

Complex hypothesis

A hypothesis describing the relationships among three or more variables Ex: Increased amounts of self-esteem increase adherence to diabetic diet and insulin administration in adolescents with type 1 diabetes

In which type of research is there high researcher control, random sampling, and laboratory setting? A.Descriptive B.Correlational C.Quasiexperimental D.Experimental

D. Experimental

Exclusion criteria

Characteristics of elements that will not be included in the sample

Evidence Hierarchy (Pyramid model) Level 4

Cohort studies or case control studies

Longitudinal

Collect data from the same sample at different points. Explore relationships and correlations, differences and comparisons, or both

Systematic reviews

Combine elements of the three previously discussed methods Ex: lit review

What type of hypothesis is the following? "Low-fat diet is related to lower total cholesterol and higher HDL (high-density lipoprotein)." A.Complex, directional, causal B.Complex, directional, associative C.Simple, nondirectional, research D.Simple, directional, causal

B. Complex, directional, associative

Which of the following definitions best describes rigor in quantitative research? A.Time frame in which the research takes place B.Degree of aggressiveness used in acquiring the data C.Amount of control and precision exerted by the methodology D.Process used to synthesize findings to form conclusions from a study

C. Amount of control and precision exerted by the methodology

Which of the following types of information is consistently covered in a quantitative literature review? A.Descriptions of effective clinical outcomes B.Anecdotal opinions of expert researchers C.Approaches used to investigate similar problems D.Clinical impressions of related phenomena

C. Approaches used to investigate similar problems

Feasibility is determined by examining which of the following? A.Researcher's credibility B.Significance of research problem C.Availability of subjects D.Previous studies

C. Availability of subjects

Meta-Analysis

Combine results of studies into a measurable format and statistically estimate the effects of proposed interventions. Results from multiple studies are combined in one large analysis. Can include both published and unpublished works.

Applied research seeks to solve a clinical problem in which setting? A.Controlled B.Laboratory C.Natural D.Simulated

C. Natural

Which of the following responses best describes the relational statement that is diagrammed below? Pain perception <------- (+) --------> Anxiety A.Increased perception of pain causes anxiety. B.Anxiety causes increased pain perception. C.Pain perception and anxiety are positively related to one another D.Pain perception and anxiety are inversely related

C. Pain perception and anxiety are positively related to one another

Which of the following types of research involve at least some control by the researcher to implement the study treatment? A.Correlational B.Descriptive C.Quasi-experimental D.Experimental

C. Quasi-experimental

Hypotheses: "Structured preoperative support is more effective in reducing surgical patients' perception of pain and request for analgesics than structured postoperative support." This hypothesis is A.simple, directional, research B.complex, nondirectional, null C.complex, directional, research D.simple, nondirectional, statistical

C. complex, directional, research

In the research report, a theoretical statement: A.will always be clearly identified B.should only be discussed in the framework section C.may be implied D.can be omitted if variables are not yet well defined

C. may be implied

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): A.abstract B.exploratory design C.pilot study D.proposal

C. pilot study

The purpose statement should identify the study variable(s) and what other key aspect of the study? A.Design B.measurement tools C.population D.statistics

C. population

Inclusion criteria

Characteristics each element must possess to be included in the sample