Ch. 14 Introduction to additional Research Methodologies in Nursing: Mixed Methods and Outcomes Research

22. What is the role of evidence-based practice in outcomes research? a. Evidence-based practice identifies practice standards that can be evaluated using patient outcomes. b. Evidence-based practice defines practice styles and patterns used in professional practice. c. The standards used in evidence-based practice clearly identify desired patient outcomes. d. There is a clear link between evidence-based practice and improved patient outcomes.

22. What is the role of evidence-based practice in outcomes research? a. Evidence-based practice identifies practice standards that can be evaluated using patient outcomes. b. Evidence-based practice defines practice styles and patterns used in professional practice. c. The standards used in evidence-based practice clearly identify desired patient outcomes. d. There is a clear link between evidence-based practice and improved patient outcomes.

12. Which government agency supports research to improve the outcomes and quality of health care? a. AHRQ b. ARRA c. CIHI d. FDA

ANS A The Agency of Healthcare Research and Quality (AHRQ) supports research designed to improve the outcomes and quality of health care. The American Recovery and Reinvestment Act (ARRA) is not a government agency; funding from this act allowed AHRQ to expand its work in support of comparative effectiveness research. The Canadian Institute for Health Information (CIHI) helped to establish national Canadian standards for collecting and reporting financial and statistical data from health service organizations. The Federal Drug Administration (FDA) regulates the research and distribution of medications.

9. Which would be an example of an interdependent role for nurses in the Nursing Role Effectiveness Model? a. Administering a medication to a patient b. Arranging for home healthcare services c. Initiating a fall risk protocol d. Performing an admission assessment

ANS B Interdependent role functions in the Nursing Role Effectiveness Model include communication, case management, and coordination of care. Dependent role functions include execution of medical orders and physician-initiated treatments. Independent role functions include assessment, diagnosis, and nursing-initiated treatments.

18. What is an important aspect of outcomes research as defined by Donabedian? a. Selection of only proximal outcomes to streamline outcomes research b. The need for patients or recipients of care to define which outcomes are desirable c. The need to link outcomes with specific nursing processes d. The use of population groups rather than individuals for outcome studies

ANS C In outcomes research, according to Donabedian, there is a need to clearly link identified outcomes with the processes that caused the outcomes. Outcomes research involves studies of all outcomes of nursing care. Donabedian does not identify the need to study patient feelings about outcomes or care. Donabedian does not identify the need to use population groups rather than individuals for outcome studies.

15. To help meet the requirements for magnet recognition, which organization will a hospital participate in? a. The American Nurses Association (ANA) b. The Agency of Healthcare Research and Quality (AHRQ) c. The National Database of Nursing Quality Indicators (NDNQI) d. The National Quality Forum (NQF)

ANS C Participation in NDNQI meets requirements for the Magnet Recognition Program. Although the ANA is the organization that oversees the Magnet Recognition Program, hospitals do not join this organization. The AHRQ supports research designed to improve the outcomes and quality of health care. The NQF was created as a national standard-setting organization for healthcare performance measures.

27. A researcher wishes to widely disseminate findings of outcomes research to influence practice in a variety of settings. Which methods might this researcher use? a. A series of presentations and publications in professional and public forums b. An oral presentation at an international conference c. Publication in scholarly, peer-reviewed journals d. Writing about this research in a chapter of a nursing textbook

ANS: A Employing a series of presentations and publications in many venues is the only approach that achieves a widespread dissemination of the research findings. An open forum for exchange of ideas is excellent but is not sufficient in the eyes of outcomes researchers. Outcomes researchers consider wide dissemination of the results to providers and consumers necessary to promote change in healthcare practices. Presenting the findings, even at a prestigious conference, is not sufficient in the eyes of outcomes researchers. Outcomes researchers consider wide dissemination of the results to providers and consumers necessary to promote change in healthcare practices.

16. Which is one of the indicators used by the National Database of Nursing Quality Indicators (NDNQI)? a. Assessment, intervention, and reassessment of pediatric pain b. Clinical Laboratory Improvement Amendment (CLIA) standards c. Protocols for monitoring biometric equipment used in hospitals d. The number of hours hospital residents work per week

ANS: A NDNQI identifies and develops nursing-sensitive quality measures. Assessment, intervention, and reassessment of pediatric pain is one of the indicators it uses. CLIA standards are those applied to hospital laboratory personnel and equipment. Biometric equipment standards are not nursing-sensitive measures. Standards about hospital residents are not nursing-sensitive measures.

2. Which of the following are true statements about critical appraisal of outcomes studies? Select all that apply. a. Focus on similarity of the exposed cohort and unexposed (control) cohort b. Focus on adequacy and completeness of follow-up c. Focus on reliability and validity of the outcome measure(s) d. Focus on statistical and clinical insignificance of the study findings e. Focus on differences of the exposed cohort and unexposed (control) cohort

ANS: A, B, C Critical appraisal of outcomes studies focuses on similarity of the exposed cohort and unexposed (control) cohort, adequacy and completeness of follow-up, reliability and validity of the outcome measure(s), and statistical and clinical significance of the study findings.

25. A researcher identifies a group of Native American subjects who are at risk for type 2 diabetes mellitus and follows this group over time to observe actual rates of acquiring this disease. This is an example of a a. clinical database. b. prospective cohort study. c. qualitative study. d. quasi-experimental study.

ANS: B A prospective cohort study is an epidemiologic study in which the researcher identifies a group of people who are at risk for a condition and follows them over time. A clinical database is a collection of data about a group of patients. A qualitative study is a nonexperimental study to examine attributes of a group of subjects. A quasi-experimental study is one in which the researcher has less control over independent variables than in a random-controlled trial.

23. What type of sample is generally used in outcomes studies? a. Small sample b. Heterogeneous sample c. Homogeneous sample d. Volunteer sample

ANS: B Because the target population in outcomes studies is often heterogeneous, it is necessary to obtain large, heterogeneous samples. A small sample would not provide a heterogeneous sample. Typical sampling criteria for outcomes research include obtaining a very large, heterogeneous sample in which all patients have the likelihood of being represented. A volunteer sample is generally not encouraged, as it does not allow for the researcher to influence the sample characteristics.

3. What mixed-methods design strategy is used when the researcher begins with collection and analysis of qualitative data, followed by collection of quantitative data? a. Convergent concurrent strategy b. Exploratory sequential strategy c. Explanatory sequential strategy d. Parallel design

ANS: B Exploratory sequential designs may be used when the researcher wants to expand on what is known about a phenomenon and the researcher does not want the content of the quantitative instruments to bias data collected qualitatively. Convergent concurrent designs are used when the researcher collects quantitative and qualitative data at the same time, analyzes each set of data, and integrates the findings. Explanatory sequential designs are used when the researcher collects and analyzes quantitative data, and then collects and analyzes qualitative data to explain the quantitative findings. Parallel design is often called convergent concurrent strategy because quantitative and qualitative data collection processes are conducted at the same time.

8. Which is an example of a type of nursing service that might be evaluated in outcomes research? a. Application of wound care products b. Clinical care protocol implementation c. Glucose monitoring for newly diagnosed diabetics d. Using a Braden Scale for skin assessment

ANS: B Nursing services can include staffing and education of nurses as well as implementation of protocols and standards of care. Application of products, monitoring patient status, and using measurement scales are all examples of nursing interventions.

6. The goal of outcomes research is to a. determine the most cost-effective nursing interventions in patient care. b. examine the end results of patient care from various health interventions. c. help providers make end-of-life decisions about patient care. d. improve patient satisfaction with nursing care.

ANS: B Outcomes research focuses on the end results of healthcare practices and interventions. Cost-effectiveness is one possible outcome, but other patient outcomes may be more important. Outcomes research is not solely about end-of-life care and is not focused on end-of-life decision making. Patient satisfaction is one result but is not the goal of all outcomes research.

10. In an outcome study, a researcher demonstrates a link between the number of mothers who successfully breastfeed their infants and the number of maternal-child nurses who are baccalaureate prepared. This illustrates a. interdependent nursing role functions. b. nursing-sensitive patient outcomes. c. patient-sensitive outcomes. d. the Nursing Role Effectiveness Model.

ANS: B Outcomes that are nursing sensitive are those that are influenced by nursing care decisions and actions as well as those associated with nursing staffing, education, and assignments. Interdependent nursing functions are those that include both nurse-initiated and physician-initiated treatments. Patient-sensitive outcomes are those that are influenced by different aspects of patients, such as age, gender, or disease process. The Nursing Role Effectiveness Model examines outcomes that are nursing sensitive.

17. Which is an important finding in outcomes research about Advanced Practice Nursing (APN) practice? a. APNs provide care that is equivalent to that provided by doctors at a fraction of the cost. b. Care by APNs shows equivalent or improved outcomes to that provided by physicians. c. Hospital readmission rates are slightly higher for patients who use APNs for primary care. d. The level of patient satisfaction is greater with APNs regardless of clinical outcomes.

ANS: B There is abundant research demonstrating the safety and effectiveness of APNs. In a search of all random-controlled trials comparing APNs to usual care, findings consistently showed that care by APNs resulted in equivalent or improved outcomes. Studies are not reported showing equivalent care at reduced cost. Studies do not show increased readmission rates. Patient satisfaction is high, but so are positive clinical outcomes.

1. Which of the following are true statements about the mixed-methods design strategy known as convergent concurrent strategy? Select all that apply. a. A strategy used when the researcher collects and analyzes quantitative data, and then collects and analyzes qualitative data to explain the quantitative findings. b. It is selected when a researcher wishes to use quantitative and qualitative methods to confirm, cross-validate, or corroborate findings using a single sample or two samples from the same population. c. A strategy used when the researcher collects quantitative and qualitative data at the same time, analyzes each set of data, and integrates the findings. d. It may be used when the researcher wants to expand on what is known about a phenomenon and the researcher does not want the content of the quantitative instruments to bias data collected qualitatively. e. Parallel design is often called exploratory sequential strategy because quantitative and qualitative data collection processes are conducted at the same time.

ANS: B, C Convergent concurrent strategy is selected when a researcher wishes to use quantitative and qualitative methods to confirm, cross-validate, or corroborate findings using a single sample or two samples from the same population. It is also used when the researcher collects quantitative and qualitative data at the same time, analyzes each set of data, and integrates the findings. Explanatory sequential strategy is used when the researcher collects and analyzes quantitative data, and then collects and analyzes qualitative data to explain the quantitative findings. Exploratory sequential designs may be used when the researcher wants to expand on what is known about a phenomenon and the researcher does not want the content of the quantitative instruments to bias data collected qualitatively. Parallel design is often called convergent concurrent strategy because quantitative and qualitative data collection processes are conducted at the same time.

2. The mixed-methods design strategy that begins with the collection, analysis, and interpretation of quantitative data, followed by a qualitative phase is known as a. convergent concurrent strategy. b. exploratory sequential strategy. c. explanatory sequential strategy. d. parallel design.

ANS: C Explanatory sequential designs are used when the researcher collects and analyzes quantitative data, and then collects and analyzes qualitative data to explain the quantitative findings. These studies are most useful in providing answers to "why" and "how" questions that arise from quantitative findings. Convergent concurrent designs are used when the researcher collects quantitative and qualitative data at the same time, analyzes each set of data, and integrates the findings. Exploratory sequential designs may be used when the researcher wants to expand on what is known about a phenomenon and the researcher does not want the content of the quantitative instruments to bias data collected qualitatively. Parallel design is often called convergent concurrent strategy because quantitative and qualitative data collection processes are conducted at the same time.

24. Which type of study design is commonly used in outcomes studies? a. Phenomenological b. Qualitative c. Quasi-experimental d. Random-control trial

ANS: C Quasi-experimental studies and observational research designs are most commonly used for outcomes research to provide effectiveness and efficiency. Phenomenological and qualitative studies do not account for effects of variables on patient outcomes. Random-controlled trials also seek to provide evidence about the effects interventions, but, with outcomes studies, the intervention is not limited to medications or clinical procedures.

11. The development of the Uniform Hospital Discharge Data Set and the Universal Minimum Health Data Set was helped by a. establishing guidelines for outcomes research. b. identifying the contribution of nursing care to patient outcomes. c. prescribing data elements to be monitored in outcomes research. d. reporting financial and statistical data from hospitals.

ANS: C The data sets facilitated consistency in data collection among healthcare organizations by prescribing the data elements to be gathered. The data sets helped facilitate standards about data elements but did not establish guidelines for outcomes research. The Nursing Role Effectiveness Model helped to identify the contribution of nursing care to patient outcomes. The Canadian Institute for Health Information established a reporting system to report financial and statistical data from hospitals.

4. A nurse researcher explains the challenges associated with using a mixed-methods design to a group of RN-BSN students? Which statement by a nursing student indicates the need for further teaching? a. "The capacity of mixed-methods designs to answer the research question depends on effective methods for integrating the data from each component." b. "Seeking and receiving funding may be necessary to ensure completion of a study." c. "The research team should consist of health professionals with similar education and experiences." d. "Mixed-methods studies require time commitment that may exceed that required for single method studies."

ANS: C The research team should consist of health professionals with different education and experiences. When the research team is multidisciplinary, the team members bring different perspectives, skills, and expertise. Mixed-methods research strategies require a depth and breadth of research knowledge, as well as a significant commitment of time and resources.

19. Which is an example of a distal outcome in outcomes research? a. Glucose monitoring skills in patients receiving diabetic teaching b. Hospital readmission rates in patients admitted for myocardial infarction c. Pain scores before and after pain medication d. Patient perception of tobacco advertising among COPD patients

ANS: D A distal outcome is one which is removed from proximity to the care or service received and is more influenced by external (nontreatment) factors. Quality of life is an example of a distal outcome. Glucose monitoring skills, hospital readmission rates, and pain scores are proximal outcomes because they are related directly to nursing interventions and not to external forces.

26. A nurse identifies an unusual incidence of acute lymphocytic leukemia (ALL) in school-age children in a nearby community and conducts a study to examine exposure to a variety of water pollutants from a local industry. This is an example of a a. phenomenological study. b. qualitative study. c. prospective cohort study. d. retrospective cohort study.

ANS: D A retrospective cohort study is an epidemiologic study in which the researcher identifies a group of people who have experienced a particular event and examines possible previous causes for this event. Qualitative and phenomenological studies are nonexperimental studies to examine attributes of groups of subjects. A prospective cohort study is an epidemiologic study in which the researcher identifies a group of people who are at risk for a condition and follows them over time.

21. A nurse uses a care map to guide nursing interventions for patients with COPD. This is an example of using a. evidence-based practice. b. practice patterns. c. practice styles. d. standards of care.

ANS: D A standard of care is a norm according to which quality of care is judged and includes guidelines, critical paths, and care maps. Evidence-based practice includes clinical guidelines, critical paths, and standards of care. A practice pattern is a concept representing the variation in what type of care is provided. A practice style represents variation in how care is provided.

20. In outcomes research, a magnet-designated hospital is an example of which type of variable? a. Dependent b. Intervention c. Outcome d. Structural

ANS: D Magnet designation indicates certain standards of structure including shared governance, implementation of nursing practice, and autonomy. A dependent variable is one that is affected by manipulation of another variable. An intervention variable is one that is manipulated to examine the effects of this manipulation on a dependent variable. An outcome variable is one that is linked to patient care.

1. Which of the following accurately describes the purpose of a mixed-methods study? a. To capitalize on the weaknesses of numbers and words to answer different components or stages of a research question b. To capitalize on the weaknesses of numbers and words to answer similar components or stages of a research question c. To capitalize on the strengths of numbers and words to answer similar components or stages of a research question d. To capitalize on the strengths of numbers and words to answer different components or stages of a research question

ANS: D Mixed-methods studies allow researchers to capitalize on the strengths of numbers and words to answer different components or stages of a research question. All other statements are incorrect.

7. What is the key construct in Donabedian's theory of outcomes research? a. Efficiency of healthcare delivery b. Healthy outcomes c. Professional accountability d. Quality of care

ANS: D Quality of care is the overriding construct of Donabedian's theory of outcomes research. Efficiency, healthy outcomes, and professional accountability all may be examined during outcomes research, but none of these is the key construct.

14. The National Quality Forum was established in 1999 for which purpose? a. To identify and develop nursing-sensitive quality measures b. To support state and health system efforts to implement and evaluate medical liability reform models c. To allow the AHRQ to expand its work supporting comparative effectiveness research d. To set standards for healthcare performance measures

ANS: D The National Quality Forum sets standards for healthcare performance measures. The NDNQI identifies and develops nursing-sensitive quality measures. The AHRQ supports state and health system efforts to implement and evaluate medical liability reform models. The ARRA allows the AHRQ to expand its work supporting comparative effectiveness research.

13. Which organization includes nursing-sensitive outcomes measures in its performance measurement portfolio? a. Agency of Healthcare Research and Quality b. Department of Health and Human Services c. National Guideline Clearinghouse d. National Quality Forum

ANS: D The National Quality Forum was created as a national standard-setting organization for healthcare performance measures and includes nursing-sensitive measures in its portfolio. The Agency of Healthcare Research and Quality supports research designed to improve the outcomes and quality of health care. The Department of Health and Human Services includes the Agency of Healthcare Research and Design. The National Guideline Clearinghouse is a resource for evidence-based guidelines.

5. In critically appraising a mixed-methods design study, the nurse researcher may ask "Was the need to use mixed methods established?" and "Did the mixed-methods strategy fulfill the purpose or purposes of the study." What quality standard criterion is the researcher using? a. Significance b. Expertise c. Methods d. Appropriateness

ANS: D The appropriateness criterion addresses whether the design was appropriate for the study's purpose, beginning with the researchers establishing a need to use mixed methods. The significance criterion addresses if the relevance and significance of the research question was described. The expertise criterion addresses if the researcher or research team possess the necessary skills and experience to implement the study. The methods criterion addresses the timing, data collection and analysis, interpretation, and integration of findings; as well as, describing reliability and validity of quantitative methods, trustworthiness, dependability, and credibility of qualitative methods, and protection of human subjects in the study.