Research Final

electronic databases

-CINAHL, PubMed, Cochrane Library -CINAHL: cumulative index to nursing and allied health literature, great for nursing research -Cochrane Systematic Review: provides the most information on evidence based practice

why a formal literature review is not performed in grounded theory

Grounded theory describes a research approach to construct theory where no theory exists or where existing theory fails to provide evidence to explain. Because of this, a literature review would not be used since there is nothing to go off when starting Grounded Theory. The researcher goes in naive.

primary purpose of EBP nursing

allows one to systematically use the best available evidence from research with the integration of individual clinical expertise, as well as the pt's values and preferences, to make clinical decisions

Middle Range Nursing Theories

applicable to nursing practice -Contain a limited number of concepts and are focused on a limited aspect of reality -More easily tested through research and more readily used as frameworks for research studies -Theories of uncertainty of illness (Merle H. Mishel)

Situation-Specific theories

deals with certain illness -Sometimes referred to as "micro-range," "practice," or "prescriptive" theories -More specific than middle range theories; composed of a limited number of concepts -Narrow in scope; explain a small aspect of phenomena and processes of interest to nurses; usually limited to specific populations or field of practice -Becoming a mother (Mercer)

external validity

deals with possible problems of generalizability of the study's findings to additional populations and to other environmental conditions -questions under what conditions and with what subjects the same results can be expected to occur -Reactive effects: subject's responses being studied; may respond to investigator not bc of study procedures but just due to being studied ---Hawthorne effect -Selection effects: generalizability of the results to other population; researcher cannot attain the ideal sample population -Measurement effects: administration of a pretest in a study affects the generalizability of the findings to other populations; pretesting affects post testing which affects generalizability outside study

1850s

Nurses first championed quality health care in what era?

introduce yourself and ask for an appt at a later date

The author of the nursing theory on which you are basing a review is in attendance at a social function. What might you do next?

the 1990s

Unethical research studies have taken place in the US as recently as:

meta-analysis

summary of a number of studies focused on a question/topic using a specific statistical methodology to synthesize the findings in order to draw conclusions about the area of focus

systematic review

summation and assessment of a group of research studies that test similar research questions -if statistical techniques are used to summarize and assess the studies, the systematic review is labeled meta-analysis

quality improvement

systematic use of data to monitor the outcomes of care processes as well as the use of improvement methods to design and test changes in practice and for the purpose of continuously improving the quality and safety of health care systems

null hypothesis

the hypothesis that there is no significant difference between specified populations, any observed difference being due to sampling or experimental error

longitudinal studies

explore differences and relationships among variables but collect data from same group multiple different times -advantages: each subject is followed up separately and thereby serves as his or her own control, increased depth of responses can be obtained, early trends in the data can be analyzed, assess changes in variables over time and both relationships and differences can be explored between variables -disadvantages: data collection may take a long time increasing costs in time/effort/money, testing effects may be a threat, mortality is a significant threat owing to the increased potential for attrition

uniformity- quantitative research

helps keep the study controlled and avoids potential of bias on the dependent variable or outcome variable

questionnaires

paper and pencil instruments, may be open ended or close ended -referred to as "instruments", "surveys", "scales", or "tools" -most useful when there is a finite set of questions

stratified random sampling

population divided into homogenous strata or subgroups, allows more representativeness, makes comparisons among subsets, disproportionately small stratum oversampled to adjust for underrepresentation, time consuming, costly, difficult to obtain all information

non-directional hypothesis

predict that there will be a difference between the groups but not the direction of the difference

qualitative data

primarily words -data is usually words, either an interview or description

secondary source of literature

published articles or books that are written by persons other than the individual who conducted the research study or developed the theory

open-ended questions

require content analysis -ex: please list 3 reasons why you chose to stay at your job

primary source of literature

research articles and books by original author

theory

set of interrelated concepts that provides a systematic view of a phenomenon

data collection

should be conducted in a systematic way -uniform, consistent, standard

steps of (most) qualitative research processes

-Acknowledge broad assumptions of inquiry in your area of interest -Is a specific problem apparent that should be addressed? -Draft broad exploratory research problems -Consider different sources of data for analysis -Analyze data using inductive and deductive methods ---Specific to general -Review of literature → study design → sample → defining recruitment and data collection→ description of the setting → data collection → data representation (coding, categories, themes, interpretation) → data analysis

beneficence

-Acts of kindness or charity that go beyond duty -Obligations derived from beneficence: --Do no harm --Prevent harm --Prevent evil --Promote good -Principle applied: *sound research design, competent investigators, favorable risk-benefit ratio*

evidence based practice

-Collection, evaluation, and integration of valid research evidence, combined with clinical expertise, and an understanding of patient and family values and preferences to inform clinical decision making --Research studies gathered and assessed to make decisions about application to practice

nurse's role in health care QI development

-Florence Nightingale championed QI by systematically documenting high rates of morbidity and mortality resulting from poor sanitary conditions among soldiers serving in the Crimean War of 1854. -Overall goal is to help build nurses' competencies in the are of patient centered care, teamwork and collaboration, patient safety, informatics, and evidence based practice. -Align national, organizational, and until level goals for QI. -Recognize external drivers of quality -Develop skills to apply QI models and tools

theories/frameworks outside of nursing in research

-Freud's theory (psychoanalytic theory of personality development) -Erikson's theory (psychosocial development) -Constructivist theory (learning theory) -Theory is generated as the outcome of a research study (qualitative design) -Theory is used as a research framework, as the context for a study (qualitative or quantitative designs) -research is undertaken to test the theory (quantitative design)

use of sampling in inclusion/exclusion criteria

-Inclusion= eligibility ---Characteristics of population or sample should be congruent -Exclusion= delimitations -Established to control for extraneous variability or bias that would limit the strength of evidence contributed by the sampling plan -Ex: age, marital status, socioeconomic status, religion, ethnicity, level of education, age of children, health status, diagnosis

odds ratio

-Odds ratio best describes the data in case control studies. It's the probability of an event. It's calculated by dividing the odds in the treated or exposed group by the odds in the control group. -If the OR= 1.0, there is no difference. If OR is less than 1.0, the event is less likely in the treatment group than in the control group. If OR is greater than 1.0, the event is more likely to occur in the treatment group than in the control group.

PICO

-P= population: the individual patient or group of patients with a particular condition or health care problem -I= intervention: particular aspect of healthcare that is of interest to the nurse or health team; therapeutic, preventative, diagnostic, or organizational -C= comparison: standard care or no intervention, a comparison of 2 treatment settings -O= outcome: more effective outcome

concepts r/t sampling

-Populations: well defined set with specific properties, may be humans, medical records, specimens. It is a whole, every member of a group -Sampling: selecting a fraction or percentage of a population -Sample: set of elements (usually individuals) that make up the population -Target population: entire set of cases about which the researcher would like to make generalizations -Accessible population: available population that meets the criteria -Inclusion and exclusion criteria

qualitative research

-Seeks to answer difficult "why" questions ---Explanatory and descriptive ---Discovery oriented; explanatory, descriptive, and inductive in nature; uses words rather than numbers to explain a phenomenon -Often used when just beginning to understand a phenomenon or if a new perspective is needed -Phenomena studied in naturalistic settings -Attempts to interpret phenomena in terms of the meanings people bring to them -Used when attempting to understand the nature of a phenomenon

respect for persons

-Treat individuals as autonomous agents -Don't use a person as a means to an end -Allow people to choose for themselves -Give extra protection to those with limited autonomy -Principle applied: *informed consent, respect for privacy*

audibility in qualitative research

-accountability by the adequacy of information leading the reader form the research question and raw data through various steps of analysis to the interpretation findings -should be able to follow reasoning of the researcher step by step through -explicit examples of data, interpretations, and synthesis

testability of research hypotheses

-can the research question be tested by measuring the relationship between the independent and dependent variables? -the variables can be observed, measured, and analyzed -the hypothesis is either supported or not supported after the data have been collected and analyzed

steps of Quality Improvement (QI) project

-conducting an assessment -setting specific goals for improvement -identifying ideas for changing current practice -deciding how improvements in care will be measured -rapidly testing practice changes -measuring improvements in care -adopting the practice change as a new standard of care

methodological research and tool development

-development and evaluation of data collection instruments, scales, or techniques -psychometrics: theory and development of measurement instruments through research process (to implement techniques, researcher must have sound knowledge of psychometrics) -not interested in relationship of independent and dependent variable, interested in finding intangible construct and making it tangible with instrument or protocol -steps: define concept to be measured, formulate instrument items, develop instructions for users and respondents, testing instruments reliability and validity

intervention fidelity in quantitative research

-ensures that every subject receiving the intervention or treatment receives the identical intervention or treatment (means trustworthiness or faithfulness) -researcher actively standardizes the intervention and planned how to administer the intervention to each subject in the same manner under the same conditions

how experimental design differs from a non-experimental design

-experimental has randomization, control, and manipulation -nonexperimental: independent variable not manipulated, subjects not randomized, no control group, provides level IV evidence

overview of research hypothesis

-flows from the research question, lit review, and theoretical framework -predicts the expected outcome -formulated before the study is started b/c it determines how data are collected, analyzed, or interpreted -like the research questions, hypotheses are often not stated explicitly in a research article -hypotheses are embedded in the data analysis, results, or discussion section

randomization

-found in true experimental designs -each subject has equal change of being assigned to the control group or experimental group -assumes that any important intervening variable will be equally distributed between the groups, minimizing variances and decreasing selection bias

purpose and importance of literature review

-provides the development and foundation of a research study -provides the development and foundation of the theoretical framework -essential to EBP in nursing

importance of research to profession of nursing

-increasing nursing knowledge -be knowledgeable about evaluating research studies -nurses role in research at BS and MS levels

content contained in typical sections in quantitative articles

-introduction includes the background information found on the topic -discussion has the interpretation of the results

referred journals in a review of the literature

-peer reviewed -strengthens credibility

directional hypothesis

-predict the direction of the outcome -they state in what way and in what direction X will influence Y

independent variable

-presumed to have effect on dependent variable -manipulated in experimental -X -not manipulated in non experimental, assumed to occur before study

quantitative design

-seeks to test relationships or answer a question -explains cause and effect relationships -seeks to describe phenomena -objectivity is important -theory testing

qualitative design

-seeks to understand the meaning of human experience -usually conducted in natural settings -seeks to describe experiences -subjective approach -theory generating

survey studies in design, data collection, and scope

-survey studies may be descriptive, exploratory, or comparative -collects detailed descriptions of existing variables -samples may be small or large, broad or narrow, do not attempt to determine causation, seek to relate variables to each other

justice

-treat people fairly -share burdens and benefits of research fairly -principle applied: *equitable selection of subjects*

randomization of study participants

-used when required number of subjects from the population is obtained in such a manner that each subject has an equal chance of being selected -eliminates bias, aids in attainment of a representative sample and can be used in various designs

homogenous sampling

-using homogenous subjects makes a straightforward step of control. they have similarity in respect to the extraneous variables relevant to the particular study -means the study can only be generalized to population that has those similar characteristics -achieved by using inclusion and exclusion criteria

dependent variable

-varies depending on independent -not manipulated but observed -variable we are interested in understanding -Y

data saturation

-when you reach the point in data collection when subjects are saying the same things as previous participants -data collection can be stopped at this point

purpose of grounded theory

-widely used by social scientists, largely b/c it describes a research approach to construct theory where no theory exists or in situations where existing theory fails to provide evidence to explain a set of circumstances -to move beyond individual stories of study participants or describe a phenomenon -think of it as an explanation for why things are the way they are

elements of a well-developed, testable research question

3 characteristics should be evident: -the variables being considered are clearly identified -population being studied is specified -possibility of empirical testing is implied think PICO

document this in the report conclusion

A nurse researcher completes a study and finds there is a need for continued research. What is the most appropriate response?

review the resources in the articles

A nurse researcher finds four useful resources. What is an appropriate next action?

opinion leader

A nurse wishes to adopt a change in care based on EBP. Whom is it most important for the nurse to gain input from?

theory

A set of interrelated concepts that provide a systematic view of a phenomenon is:

15%

Approximately what percent of extra subjects are needed to ensure the ability to detect differences between groups or that the effect of an intervention remains intact? When calculating sample size using power analysis, the total sample size needs to consider that attrition or dropouts will occur.

10 years

At what age can children give sole consent to research?

8th grade

At what grade level should informed consent be written?

synthesis

Critical reading requires four stages of understanding. What is the last stage?

Table

For the nurse who has limited time to review a research article, where would be the best place to find the answer to the clinical question?

descriptive study

In the following scenario, which type of research design should the researcher use? A researcher wants to collect detailed information about a phenomena and use the data to make more intelligent plans for improving them.

materials and concepts amenable to qualitative studies

Methods: interview, survey, focus group, NATURALISTIC SETTING •Review or synthesize existing knowledge •Investigate existing situations or problems •Provide solutions to problems •Explore and analyze general issues •Construct or create new procedures or systems •Explain new phenomena •Generate new knowledge •...or a combination of any of the above!

review the literature

The first step in the qualitative research process is to do what?

psychometrics

The most significant and critically important aspect of methodological research addressed in measurement development is called what?

patient outcomes

To evaluate success of the EBP, it is most important to include what?

Compare only online and 1:1 sessions

To increase accuracy in the previous example, which might the new researcher consider first?

All of the above (strong leadership, clear strategic vision, visionary staff in key positions, a climate conductive to experimentation and risk taking)

What is (are) the most important component(s) for a receptive context for EBP?

systematic review

What is an assessment of a group of research studies that test a similar research question?

continue as before

What is the best response in the following scenario? A nurse researcher has determined that an intervening variable might slightly affect both randomized sample groups.

Is the framework for research clearly identified?

What is the first question to ask when critiquing the theoretical framework of a research study?

conducting an assessment

What is the most common first step in the quality improvement process?

PICO (population, intervention, comparison, outcome)

What is the most important step in applying evidence to practice?

Manipulation of an independent variable

What is the primary difference in experimental and nonexperimental designs?

Could something else explain the results?

What question is most important when evaluating evidence of experimental studies?

Snowball sampling

What type of sampling includes using the internet and social networking to locate samples that are otherwise difficult or impossible to locate?

benchmarking

When a nurse incoporates tools to help identify when performance is below an agreed upon standard signaling the need for improvement, the nurse is using what?

evidence-based nursing

When completing a literature search for a clinical question, what is the first resource the nurse should use?

When the population size is very small

When might an entire population be used in a research study?

Harm

Which EBP clinical category would the nurse be using in the following scenario? A clinical nurse has noticed an increased incidence in urinary tract infections and would like to find the best practice to minimize this.

Maslow's hierarchy of needs theory

Which component creates the research design in a tobacco cessation study?

Mortality

Which internal validity threat is suspected in the following scenario? A college health center identifies lack of testicular self-examination among students and implements an intense summer wellness program focusing on the benefits of testicular self-examination. Afterward, a count indicates an increased number of students who do not complete testicular self-examinations.

X will significantly improve Y in population B

Which is a "good" hypothesis when X is independent and Y is dependent?

home

Which is the best naturalistic setting for studying parent's food choices for their toddlers?

Intervention

Which must be explicitly identified in a research article?

methodological research

Which process will the researcher use in the following scenario? A nurse researcher wants to develop a tool to collect information on the experience of families with children in the intensive care unit.

community based participatory research

Which qualitative research method would be best to find an effective intervention that discourages youths from initiating tobacco use?

Cochrane Systematic Review

Which source provides the most information on evidence based practice?

test hypotheses

Which statement made by a nurse indicates that more education on the clinical application of qualitative research is needed? "Results of qualitative research can be used to.."

Observational methods are used to gather data on physiologic parameters

Which statement regarding observational methods used in nursing research does the nurse identify as true?

this method reduces problems with consent

Which statement regarding the use of existing data for nursing research does the nurse identify as true?

anonymity

Which term refers to subjects' identity not being identifiable or linked to their individual response even by the researcher?

After only design

Which type of design or technique best identifies causation?

concealment without intervention

Which type of observation is being used in the following scenario? A researcher uses a one-way mirror to observe interactions of caregivers and infants who have feeding problems.

Quasi-experimental

Which type of research design is described? A wellness center wishes to determine whether a stress-reduction series of classes increases perceived efficacy of participants. A pre/post questionnaire was administered to all participants.

experimental

Which type of research design should be used in the following scenario? A nurse researcher is investigating the effects of yoga and blood pressure. One group of subjects is participating in a yoga class and the other group is not.

Situtation specific theories

Which type of theory would be best to use when studying self care habits of patients with T1DM?

Ishikawa diagram (Fishbone diagram)

Which would be the best method for the nurse to describe a cause and effect relationship?

All of the above (the researcher, the research team, the nurse, the caregiver)

Who is legally and ethically responsible to protect study subjects from physical or mental harm or discomfort?

a mixture of management and direct care providers

Who would be the most effective person(s) to implement EBP changes?

It is not required, allowing the theory to emerge

Why would you choose not to do an exhaustive literature search for the grounded theory method on the initiation of tobacco use by youth?

integrative review

a focused review and synthesis of either research or theoretical literature on a particular area that follows specific steps of literature integration and synthesis without statistical analysis and can include both quantitative and qualitative articles

cluster (multistage) sampling

a successive random sampling of units that progress from large to small, sampling units or clusters that can be selected by simple random or stratified random sampling methods. More economical with time and money, but more sampling errors occur and hard to handle all the statistical data

external drivers of quality associated with QI

accreditation, payment, public reporting, and performance measurement

objectivity in conception of study design

can be derived from literature -can be achieved through a thorough review of the literature and the development of a theoretical framework -literature review presented so that reader judge the objectivity of the research question

simple random sampling

carefully controlled process, researcher defines the population (a set), lists all the units of the population (a sampling frame), and selects a sample of units (a subset) from which the sample will be chosen) -REPRESENTATIVENESS IS MAXIMIZED, time consuming and inefficient

internal validity

did the independent variable really make a difference or change in dependent? -Researcher rules out other factors or threats as rival explanations of the relationship between the variables -History: specific event that may have an effect on the dependent variable that occurred inside or outside experimental setting -Instrumentation: changes in the measurement of the variable or observational techniques that may account for changes in obtained measurement -Maturation: developmental, biological, psychological processes that operate within an individual as a function of time and are external to the events of the study -Mortality: loss of study subjects from first-data collection point to second data-collection point -Testing: effect of taking a pretest on the subjects posttest score ---Taking a pretest could sensitize individual and improve their score -Selection bias: a partiality in choosing the participants in a study

variables

have different values assigned to them -employment rate, religious affiliation, experimental treatment, grade point average, etc.

feasibility

how possible it is to carry out a study -questions to ask include... is there time? is the population of interest available? are facilities, equipment, and money adequate? does the researcher have the experience and skills necessary? are there ethical difficulties (concern)?

sampling types: nonprobability

inclusion in a group is not random, less generalizable, less representative -Convenience: use of the most readily accessible persons or objects as subjects in a study, easy to recruit subjects, used most with quantitative non experimental or qualitative studies, risk of bias is greatest in this type -Quota: knowledge about characteristics of the population of interest used to build representativeness into the sample, identifies the strata of the population and proportionally represents the strata in the sample -Purposive: subjects selected who are considered to be typical of the population, useful in studying populations with unusual/rare characteristics, assumes errors of judgement in overrepresenting or underrepresenting characteristics of the population in the sample

control- quantitative research

making sure you have something to compare results to (something that's not receiving the intervention) -accomplished by ruling out extraneous or mediating variables that compete with explanation of outcome

Grand Nursing Theories

most abstract, hard to apply to real nursing practice -Sometimes referred to as "nursing conceptual models" -Include the theories/models that were developed to describe the discipline of nursing as a whole or theorize about the place of people and their health in the world -Nursing theories used in practice and research ---Describing people's reactions to health, illness, the environment as it relates to health and illness -The most important thing about the use of grand nursing theoretical frameworks for research is the logical connection of the theory to the research question and the study design -These works are used as the conceptual basis for practice and research and are tested in research studies -Grand nursing theories are all-inclusive conceptual structures that tend to include views on person, health, and environment to create a perspective of nursing -Most abstract level of theory has established a knowledge base for the discipline of nursing -Martha Rogers: "Science of Unitary Beings"

sampling types: probability

uses randomization to assign elements, more generalizable, more representative, strongest type, used in experimental and quasi-experimental studies -simple random, stratified random, cluster (multistage)

extraneous (mediating) variable

variables that occur during the study that interfere with or influence the relationship between the independent and dependent variable