Transcript Nursing Research: 63-377 Dr. Wally J. Bartfay

Nursing Research: 63-377
Dr. Wally J. Bartfay
“When you make the finding
yourself – even if you’re the last
person on Earth to see the lightyou never forget it.”
Carl Sagan
Review Quiz: True or False?
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1. Schools of nursing began introducing research into the
curriculum during the 1940’s?
2. The goal of nursing research is to describe, explain, control
and predict phenomenon of interest to nursing?
3. John Snow (1850s) performed the 1st clinical trail on the
British Navy’s ship Salisbury to test his hypothesis regarding
the cause and Rx. of scurvy (low citric acid levels)?
4. Quantitative research helps develop theory and is
considered inductive in nature?
5. Nightingale’s (1850-1910) use of qualitative research
methods demonstrated that mortality for hospitalized soldiers
were significantly higher than those in the battlefield?
Elements of a good design
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(1) Appropriate to the purpose of the
investigation
(2) Appropriate to answer the research
question(s)
(3) Feasible given realistic constraints
(4) Effective in reducing threats to validity
Controlling Equivalence of Subjects &
Groups
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When comparisons are made, it is assumed that
individual units being compared are equivalent,
EXCEPT for the variables being examined
Don’t want to compare “apple & oranges” (both are
fruit per se but have very different compositions)
To establish “equivalence”, researcher defines
inclusion & exclusion criteria
Deviations from these criteria are threats to validity
Note: Although random sampling is effective
strategy for achieving equivalence, it does not
guarantee equivalence (still need to check criteria)
Controlling the treatment
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Ist step is to make a detailed description of
the treatment(s)
2nd step is to use strategies to ensure
consistency in implementing treatment (e.g.,
same nurse does dressing, use same
equipment, time, intensity, sequencing, staff
skill etc)
Note: variations in treatment reduce effect
size & internal validity is reduced
Carry-over Effect & Counter-balancing
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Certain studies, each subject receives several
treatments (e.g., relaxation, distraction or visual
imagery) or various levels of the same treatment
(e.g., different doses of med)
Occasionally, application of one treatment can affect
response to later treatments – known as “carry-over”
(e.g., effects of a cardiac med)
“Counter-balancing” is used to balance this by
administering treatments in random order rather than
being administered in same sequence
Controlling Extraneous Variables
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(1) Random sampling: increases probability
that subjects with various levels of an
extraneous variable are included & are
randomly dispersed throughout study
(2) Random assignment: Enhances
probability that subjects with various levels of
extraneous variables are equally dispersed in
treatment & control groups
Controlling Extraneous Variables
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(3) Homogeneity: more extreme form of equivalence in
which researcher limits subjects to only one level of an
extraneous variable to reduce its impact on study findings
(e.g., only menopausal females, males aged 40 to 50)
(4) Heterogeneity: no rambling sampling used here, but
researcher attempts to obtain subjects with “wide-range”
of characteristics to reduce risk of biases (e.g., various
occupations, SES, income levels)
(5) Blocking: Researcher includes subjects with various
levels of an extraneous variable in the sample, but
controls the number of subjects at each level & their
random assignment to groups within the study (e.g.,
randomly assign equal numbers of subjects into 3
separate age categories)
Controlling Extraneous Variables
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(6) Stratification: involves distribution of subjects throughout the sample, using sampling techniques similar to
blocking, but purpose is “even distribution” throughout
sample
(7) Matching: used when subjects in exp. Group is randomly
selected & then a similar subject in relation to extraneous
variable is randomly selected for control group (e.g.,
matched for HF, menstrual status, occupation, fitness level)
(8) Statistical control: Data analysis procedures that have
capacity to remove (partial-out) the variance explained by
extraneous variables before analysis of differences or
relationships between or among variables of interest are
examined
Triangulation strategies
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(1) Data triangulation: involves collection of data from
multiple sources for same study (multi-site study, note
longitudinal studies are not a form b/c their purpose is to
identify change)
(2) Investigator: 2 or more investigators with diverse
research training backgrounds examine same phenomenon
(3) Theoretical: is use of all theoretical interpretations that
could conceivably be applied to a given area
(4) Methodological: is use of 2 or more research methods in
a single study (most common type, e.g., use different
instruments to examine same phenomenon like QOL)
(5) Analysis: same data set is analyzed with 2 or more
differing analyses techniques (purpose is to provide a means
to cross-validate findings)
Clinical Trials
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Are studies designed to examine effectiveness of clinical
treatments (e.g., meds, nursing procedures, therapies)
Phase I: Used to determine issues around safety &
desirable outcomes (e.g., dose of med)- {No control or
randomization}
Phase II: Seeks preliminary evidence of efficacy & side
effects/ outcomes- {No control or randomization}
Phase III: Experiment to compare effect of new treatment/
procedure or med with current “gold standard” (e.g.,
Compare deferiprone with desferal)- also called “full-scale
definitive trials” or “randomized clinical trails” (RCTs)
Primary prevention & Health
Promotion Studies
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Involve applying treatment of primary prevention (the
cause) & then attempts to measure effect (which would
not occur if treatment was effective)
Try to measure things that do not happen (e.g.,
development of heart disease, diabetes in a community)
Hence, design involves examining changes in community,
& variables are called “indicators”
A change in the indicator is inferred to be a consequence
of effectiveness of the prevention program (treatment)
(e.g., TV based healthy eating campaign over a defined
period of time)
Outcomes Research: A brief history
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Sir William Petty (1623-1687) 1st to question effectiveness of
health care services (considered to be father of economics &
epidemiology)
French physician Louis (1787-1872) developed statistical
methods demonstrated often harmful & lethal effects of bloodletting
Semmelweiss (18th century) showed that women in labor
assisted by midwives had lower mortality than those attended
by physicians in hospital wards (hand-washing)
Florence Nightingale (1812-1910) developed 1st uniform
hospital discharge data set & used data to link mortality with Dx
& Rx’s & disseminated her findings to those who formulated
health policy (she enraged military & civilian med.
Establishment of her day)
Outcomes Research
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Designed to examine effectiveness of health care services
Strategies used from traditional scientific endeavours &
incorporate evaluative research, epidemiology & economic
theory perspectives
Nurses are taking the lead in conducting studies to examine the
outcomes of programs designed to protect or improve health of
the community
Goal is the evaluation of outcomes (time dependent) &
attribution (requires assigning place & degree of responsibility
for outcomes observed) {e.g., providers, patient compliance,
insurers, resources, etc}
Standard of care is norm on which quality of care is judged
Methodologic Research
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Studies which address the development,
testing, validation & evaluation of research
instruments (tools) or methods
May be descriptive, non-experimental or
experimental (e.g., evaluate SF-36 QOL
instruments with young children-most studies
done only on adults)
Survey Research
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Done to obtain global information about the
prevalence, distribution & interrelations of variables
within a defined population (e.g., Canada Census
Survey)
Very flexible & broad in scope
Can be applied to many populations & cover a wide
range of topics
However, info obtained is rather superficial
May appear in several formats (e.g., telephone,
paper & pencil), big problem with compliance &
validity here
Phases in Qualitative Research
Designs/ Approaches
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Phase I: Orientation & overview -determines what is
salient about the phenomenon of interest) (e.g., how
decision making occurs with treatment options for pt’s
with prostate CA)
Phase II: Focused exploration –more focused exploration
& in-depth exploration (e.g., information given about Rx
choices for prostate CA & expected outcomes)
Phase III: Confirmation & Closure – helps to establish
that findings are correct & trustworthy (e.g., go back &
discuss what researcher head subject say about Rx.
Choices & expected outcomes for prostate CA & how
decisions were arrived at alone or in combination)
Qualitative Approach & Nursing
Qualitative Research
Methods
Guide practice
Contribute to
Instrument
development
Build nursing
theory
Qualitative Approach & Nursing
How does it guide practice, contribute to instrument
Development & build nursing theory?
Use personal stories
To understand
Health experiences
Use “the voice” of
Subjects to
evaluate
Instruments
(new & old)
Enables systematic
Structuring of
ideas/ themes
From subjects life
experiences
Note: The researcher is the “instrument” here
Qualitative Research Methods
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(1) Phenomenological: is a process of learning &
constructing the “meaning of human experiences”
through intensive dialogue with subjects who are
living the experiences (e.g., women with breast CA)
(2) Grounded Theory Method: Inductive approach
that uses a systematic set of procedures to arrive at
theory about basic social processes (e.g.,
organizational characteristics of self-help groups for
parents with special needs children)
Qualitative Research Methods
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(3) Ethnographic method: derived from Greek term
“ethnos” meaning people, race or cultural group- it
focuses on the scientific description & interpretation
of cultural or social groups & systems (Aboriginal
health)
(4) Case-study method: Study of a selected
phenomenon that provides an in-depth description of
its dimensions & processes (e.g., selenium-deficient
induced cardiomyopathy in nutritionally deprived runaway child)
Bonus assignment due Sept.29
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Have a great week…