authority – from persons with expertise and power to influence
borrowing – appropriating and using knowledge from other fields or practices
trail and error- with this strategy knowledge is gained by experience in uncertainty and not usually shared
personal experience – enables the nurse to cluster ideas into a meaningful whole
role modeling – by imitating the behaviors of an expert.
intuition – insight into a situation that cannot be explained logically
reasoning- processing and organizing ideas to reach conclusions.
Inductive reasoning – from the specific to the general
deductive reasoning – from the general to the specific
probes are queries made by the researcher to gain more info
interviews may be transcribed to look for themes in what was said.
They are conducted by a moderator or facilitator.
Group dynamics can help people to express and clarify their views in ways that are less likely to occur in one-on-one interviews.
coding the data and identifying patterns or themes.
The researcher may need to engage in reflexive thought and
interpreting the data / identifying usefulness for clinical practice or further research.
2.Knowledge is co-constructed by the persons involved in an interaction.
3. Human behavior are choices influenced by the past and present as well as by the physical, psychological, and social contexts of the behavior or experience.
4. Time and context influence individual and group perspectives.
2. the Tuskegee Syphilis study
3. the Willowbrook Study
4. the Jewish Chronic Disease Hospital Study
In all of these studies, while physicians were the primary investigators…nurses understood the nature of the research, identified potential research subjects, delivered treatment to the subjects, and served as data collectors.
1. protect life, health, privacy, and the dignity of human subjects
2. exercise greater care to protect subjects from harm in non-therapeutic research
3. conduct research only when the objective outweighs the risks and burdens to the subjects
Researchers must develop research projects to comply with the HIPAA privacy rule.
anonymity and confidentiality
protection from discomfort and harm
Confidentiality is the researcher’s management of private information shared by the subject or participant.
2. comprehension of this information by the participant
3. competence (comprehension) of the participant to give consent
4. voluntary consent of the participant
1. indicates the significance of the problem
2. provides a background for the problem
3. includes a problem statement
To identify possible relationships among variables
To delineate differences between or among existing groups
2. Does it build on previous nursing research?
3. How does it promote theory testing or development?
4. Does it address current concerns or priorities in nursing?
2. How will the costs of the study be paid for?
3. How will you find your sample, facility, or equipment that you need for the study?
4. Is the purpose of your study ethical and are your subject’s rights being protected?
In other words….how will we measure the variables, how will we select subjects / participants, what statistics will we use, etc…
1.) indicate whether they are to be identified or described
2.) identify relationships among variables
3.) determine differences among two or more groups with regard to the variables.
1.) describe variables
2.) examine relationships among variables
3.) use independent variables to predict dependent variables
4.) determine differences among two or more groups with regard to the variables.
**it is really only a matter of choice whether a researcher identifies objectives/aims or questions for their descriptive or correlational study.**
A clearly stated hypotheses includes the variables to be manipulated or measured, identifies the population to be examined, and indicates the proposed outcomes for the study.
Hypotheses influence study design, sampling methods, data collection and analysis, and interpretation of findings.
One specific type of correlational research study, a predictive correlational study, also uses independent and dependent variables. You don’t have to know this fact for this class…we keep IV’s and DVs at the quasi-experimental and experimental levels in our class to keep it simple, but it’s something I’d like you to be aware of.
They are observed and / or measured in the study. There is no “treatment” with these kinds of variables and no cause-effect relationships are examined
Example: What is the conceptual definition of “blood pressure”?
Answer: The force exerted by the blood against the walls of the blood vessel.
Example: What is the operational definition of “blood pressure”
Answer: The result you get when you check the blood pressure of the first subject with a manual BP cuff. 120/70
2. to identify gaps in the knowledge base
3. to explain how the study being reported contributed to building knowledge in this area.
Use primary sources in your papers and research as frequently as possible and summarize what they say yourself.
Consider this…in your papers and scholarly work, only quote a secondary source when you cannot locate and read a primary source for yourself, as you are trusting the author’s interpretation / perception / bias of what they have read. What if they are incorrect….?
Theories are abstract…not concrete.
Concepts are defined in a particular way to present ideas relevant to a theory.
-> if they have a broad, abstract meaning they may also be called a “construct”.”
-> if they have a more narrow, concrete, well defined meaning, they may be called a “variable”.
2. sample size and selection methods
3. using valid and reliable instruments
4. using data collection methods that partially control the environment.
Note: There are three types of correlational designs: descriptive correlational, predictive correlational, and model testing.
Ex. diagnosis, age, co-morbidities, and post-surgery complications all affect a patient’s length of stay.
Think about it: strengths and threats to a study’s validity provide a major basis for making decisions about whether a study’s findings are accurate and should be used in practice….or not.
precisely defined independent variable / intervention
researcher-controlled manipulation of the independent variable / intervention
researcher control of the experimental situation and setting,
clearly identified sampling criteria
carefully measured dependent variables
Remember: when elements are persons, they can be called subjects or participants depending on the research design.
The difference is random because some subjects will score higher and others will be lower than the average (mean) population value. (Think: IQ scores…we don’t all have the same IQ.)
As the sample size increases, random variation decreases, improving representativeness of the results.
Because these subjects have something in common, their values tend to be similar to others in the sample, but different from the values that might be achieved in the general population. This can introduce bias into the results.
Probability sampling methods increase the sample’s representativeness of the target population.
stratified random sampling
Ex. names on a slip of paper and draw from a basket, using a random numbers table, etc.
Stratification ensures that all levels of the identified variables are adequately represented in the sample.
purposeful or purposive sampling
network or snowball sampling
The minimum acceptable level of power for a study is 80%. This power level results in a 20% chance that the study will fail to detect existing effects (Type II error). A power analysis is done BEFORE a study is conducted to know how many subjects you will need.
The statistical test tells you whether the variables are related or there is a difference between the groups. The effect size is then calculated to examine the STRENGTH of the relationship or the SIZE of the difference between the groups.
So…do a power analysis before the study starts to be sure you get the right sample size for your study. Then…calculate the descriptive and inferential statistics on your data. Last, calculate an effect size after the statistical tests are completed.
Quasi-experimental and experimental = smaller numbers of subjects because there is more control in the desig,
ordinal (data is in categories that can be ranked – pain, dyspnea with ADLs)
interval (data is in categories with equal numerical distances between them and no absolute zero point – temperature)
ratio (data is in categories, has equal numerical distances and has an absolute zero point – weight)
Example: Think about taking the NCLEX over and over…
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?!?!
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.
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.
Hint: validity exists on a spectrum. It is not an all or nothing phenomenon. We try to determine the degree of validity an instrument or questionnaire has for a specific sample or situation.
How do you prove this?
1. do the items in the scale reflect the description from the ROL?
2. how do content experts rate the items on the scale?
3. how might potential subjects respond to items on the scale?
Example: administering a questionnaire about depression to two groups of people, one group with known depression, one group without, and comparing their scores.
Example: two questionnaires that measure depression
Example: a questionnaire that measures hope and despair
Ex. Rate your pain on a 1 – 10 scale with 10 being the worst….
Ex. strongly agree, agree, uncertain, disagree, strongly disagree.
collecting data in a consistent way
maintaining research controls as indicated in the study design
determine differences among groups
Demographic variables are usually described with descriptive statistics.
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.
If the p value is less than or equal to 0.05, then the result is considered to be statistically significant. Decision theory requires that this cutoff point be absolute.
Generalization extends the implications of the findings from the sample studied to a larger population.
In plain terms…this means, that the researchers conclude that significant results exist in a study, when really, they don’t.
In plain terms…this means the researchers conclude that the study results are non-significant when in reality…the results were significant!
The minimum acceptable power level is .80
frequency distributions (gender, ethnicity, marital status data)
measures of central tendency (mean, median, mode – age data)
measures of dispersion ( range, variance, standard deviation, confidence intervals, standardized scores, and scatterplots)
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)
A positive relationship (the result will be close to +1)
No relationship. (the result will be close to 0)
Example: can we predict the length of a hospital stay of a patient with a certain diagnosis?
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
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
it has implications for other disciplines besides nursing
it is frequently referred to in the literature
evidence is based on population data and may be difficult to apply to people as individuals.
agencies / administrators may not always provide resources to
2.) inadequate knowledge on how to implement EBPchanges in practice.
3.) heavy workloads with limited time to make evidence-based changes in practice.
4.) limiting RN’s authority to change patient care based on research findings
5.) limited support from administrators or medical staff to make evidence-based changes in practice.
6.) providing limited funds to support research-based changes for practice
7.) providing few rewards for RNs delivering evidence-based care to patients and families.
the evidence has been synthesized by teams of researchers and clinicians to develop strong evidence-based guidelines for practice.
the evidence is easily accessible
it helps agencies meets accreditation requirements and assists with obtaining magnet status
I: intervention needed for practice
C: comparisons of interventions to determine the best for practice
O: outcomes needed for practice
process improvement data
internal / external benchmarking data
identification of a clinical problem
national agencies or organizational standards and guidelines
philosophies of care
observation from institutional standards committee
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
a solid foundation of knowledge and skills
access to EBP mentors
and organizational cultures that support evidence-based care
organizational culture (P&P, politics, or a “we’ve always done it that way” philosophy)
lack of EBP knowledge / education
lack of access to evidence / information
manager / leader resistance
access to information
clearinghouse of evidence-based practice information (online)
organizational support / awareness
fellow nurses (7% of respondents reported this)
nurse leaders and managers (8% of respondents reported this)
provide the time, educational skills building sessions, and resources necessary for staff nurses to implement EBP
create EBP mentors to work with staff nurses to consistently implement and sustain EBP.
the ANA’s Code of Ethics
findings from experimental research is stronger than non-experimental research
similar findings from more than one study are stonger than findings from just one study
2.) determine the clinical relevance of the research (ex. are the results applicable to and feasible in clinical practice)
1.) close the gap between research and practice
2.) provide guidance
3.) standardize practice
4.) identify and inform about new advances and trends
It may take up to two decades for original research to be put into routine nursing practice.
advocate for the use of support surfaces therapies (specialty beds)
good skin care practices, providing nutritional support, and encouraging early mobility
lack of equipment or available peers to reposition patients effectively
lack of time
cluster care to minimize sleep disruptions
optimizing mechanical ventilation modes that enhance sleep
assessing for the presence of the s/sx of delerium
providing early mobility
using complimentary therapies (massage, music, etc.)
develop nurse-driven protocols to help provide consistent medical and non-medical interventions that help to promote sleep
Radiography. Other methods when daily radiography for confirmation is not feasible include pH testing of the aspirate, aspirate color. Whenever there is doubt about the tip of the tube’s location, do not use and request an x-ray.
ensuring that chemical and mechanical therapies are maintained to reduce the risk of VTE.
early mobility / exercise is also an important intervention in the prevention of VTE.