research exam2 – Flashcards

a systematic process using both inductive and deductive reasoning to confirm and refine existing knowledge and to build new knowledge

focuses on moving research findings into practice

systematic process that helps nurses discover answers and resolve problems that are important to administration, education, clinical practice

addresses problem in a clinical setting. designed to provide answers that will better guide nursing practice to improve the health status and care of individuals who require nursing services. nursing intervention and patient responses goal: to improve care

finding a practical use for findings from a research study or studies in the real world of nursing practice Sometimes classified as conceptual, instrumental, or persuasive Refers to finding a practical use for findings from a research study or studies in the real world of nursing practice The process *starts with the research findings* that were generated and seeks to find a practical application. Example- CAUTI, Hand Hygiene

Applying research findings to clinical practice, but it is more than just reading some articles and trying new ideas. There are steps involved in the process. 1. ask the research question 2. search and collect the evidence 3. appraise the evidence to evaluate strengths and weaknesses 4. implement best evidence evaluate the outcome

i) Definition = "conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about patient care delivery to individuals or groups of patients and in consideration of individual needs and preferences" ii) Starts with identification of a clinical problem and seeks research-based evidence to support decision making iii) Emphasizes a deliberate and systematic problem-solving approach iv) Makes use of research-based materials on which to base decisions v) Expands the conceptualization of research utilization. Seeks to find, critically examine, and synthesize all of the available evidence about defined clinical problems. vi) Integrates evidence with the clinical expertise of the nurse to make decisions about patient care. vii) Considers how the decisions fit individual patient needs and preferences. Acknowledges that clinical expertise is key to integrating decisions into a specified care setting.

consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.(Actions ? improvements) What are we doing and how do we make it better

EBP expands the conceptualization of research utilization. So while research utilization starts with the research and moves to seeking practical applications, EBP begins with a clinical problem and seeks research- based evidence to support clinical- decision making. Main thing that I am getting from this: EBP considers how the decisions fit individual patient needs and preferences. It acknowledges that clinical expertise is key to integrating decisions into a specified care setting. Research Utilization just looks for a way to fit a finding from research into clinical practice (not considering a specific patient's needs or looking at the big picture) Research utilization is more narrow; EBP is expanded and more complex

The evidence hierarchy gives us a way to organize and rank any evidence that we have discovered from strongest to weakest.

the quality of evidence within a category may vary Example in Level 1: clinical practice guidelines could be formulated by a national panel of experts using the best evidence available from all relevant research studies and SRRs This would yield very high quality Level 1 evidence If a clinical practical guideline was produced using sparse research evidence, or had not been subject to a rigorous review by experts, the resulting quality of evidence would be suspect and might not offer the best support for practice

If the review uses a number of well designed research studies and a well formulated systematic approach to evaluating the studies

single research studies. Individual studies need to be well designed and produce definitive results to be considered high quality evidence Studies that have design problems, extremely small samples, or indeterminate or non-significant results are not very useful in providing supportive evidence

Level 1: Clinical Practice Guidelines based on evidence drawn from a comprehensive review and rating of available research studies and systematic reviews Level 2: Systematic reviews including integrated literature reviews and meta-analysis of experimental research studies Level 3: Single experimentally designed research studies Level 4: Systematic reviews including integrated literature reviews, meta-analysis, and metasynthesis of non-experimental/qualitative research studies Level 5: Single non-experimental or qualitative research studies Level 6: Non-research driven expert opinion or committee reports

CINAHL (Cumulative Index to Nursing and Allied Health Literature) Covers nursing and allied health literature from 1982 to present Contains citations, abstracts (for most entries), and names of any data collection instruments Can be searched through a commercial vendor (e.g., OVID) or directly through www.cinahl.com i) Covers nursing, allied health, and psychosocial issues ii) Provides indexing for more than 3,000 periodicals iii) Lists all applicable English-language nursing journals plus publications from the NLN and the ANA. iv) Offers access to books on healthcare, conference proceedings, standards of practice, nursing dissertations, and selected software. v) Uses its own specialized directory of subject headings

i) Offers much greater coverage of medicine and medical specialty. ii) Developed by the National Library of Medicine iii) Well-known as the foremost source for materials. iv) Contains more than 20 million indexed citations from over 5,000 journals in medicine, nursing, dentistry, veterinary medicine, allied health, and preclinical sciences dating as far back as 1950. Developed by the U.S. National Library of Medicine Covers nursing, biomedical, and health journals published in over 70 countries Can be accessed for free anywhere in the world via PubMed Uses a controlled vocabulary called MeSH (Medical Subject Headings) to index entries tutorial on MeSH terms tutorial on MeSH terms advanced

Uses a technique called probabilistic searching ? when a set of search terms and limits is entered and a search is run, the search results are rated by the relevancy of the citations and listed starting with the most relevant

CINAHL, Medline, Cochrane collaboration ahrq?

i) Excellent resource for systematic reviews ii) Produces periodic evidence reports on specified topics designed to improve the quality of health care offered in the United States

Mode of Reasoning Deductive Research Process High Structured Scope Focuses on smaller number of specific concepts. Usually has larger sample sizes. Preconceptions Researchers base research questions or hypotheses on preconceived ideas of how study concepts interrelate. These facilitate development of research questions or hypotheses. Setting/Conditions Collects information under conditions of high control. For example: laboratories or use of structured study procedures. Methods/Instruments Uses structured process and formal instruments for data collection. Analysis Statistical analysis of numerical data. Researcher interprets statistical findings.

Mode of Reasoning Inductive Research Process Fluid, flexible, iterative Scope Attempts to understand the entirety of a phenomenon. Smaller samples sizes usually acceptable. Preconceptions Researchers approach studies without preconceived ideas regarding study outcome. Method stresses importance of participants interpretation of events and circumstances, rather than the researchers' ideas of what the research will "prove". Setting/Conditions Doesn't attempt to control the context of the research, but attempts to capture the picture in its entirety. For example: naturalistic settings. Methods/Instruments Uses methods such as observation and interviewing for data collection. Analysis Local analysis of narrative information. Analysis and data collection move back and forth. Researcher interprets narrative findings

PHASE 1: CONCEPTUALIZE THE PROBLEM PHASE 2: DESIGN THE STUDY PHASE 3: IMPLEMENT THE DESIGN PHASE 4: ANALYZE/INTERPRET THE DATA PHASE 5: USE THE RESULTS

Formulate the problem Review the literature (1) Before and after research; don't let it create bias Develop the research question Identify a philosophical position

Select research approach Identify setting/participants Develop interview and observation plan Ensure study rigor

Address ethical considerations Recruit participants Collect data Achieve saturation

Analyze (concurrent with data collection) Describe the sample Present the findings and interpretation

Disseminate the findings Use findings in nursing practice

prior to world war II, science did not consider ethics as an essential part of research. After the atrocities of human experimentation in concentration camps were exposed, it led to the development of the Nuremberg Code (1949) Nuremberg Code - a set of standards regarding the conduct of research.

Because of abuses occurring in research, in 1974 congress passed the National Research Act which further appointed legal scholars ethicists, researchers, and physicians who composed a landmark report referred to as the Belmont Report. It helped to define boundaries between therapy and research, and delineated three key ethical principles for consideration in the conduct of research using human subjects - respect for persons, beneficence, and justice

statement that describes the proposed research, including the purpose of the study, what the participants will do, the length of time participation will take, and the potential risks.

when one person divulges information to another person or group, the info will be kept private unless explicit permission is given for information release.

Certificates of Confidentiality are issued by the National Institutes of Health (NIH) to protect the privacy of research subjects by protecting investigators and institutions from being compelled to release information that could be used to identify subjects with a research project

information that has no identifying features that would potentially link a participant to the research study. different than confidentiality because even the researcher cannot identify the participant.

agreement of child or person lacking capacity to participate in research. When the parent or guardian consents and the child or adult lacking capacity assents, study participation may begin.

recognizes that individuals are autonomous human beings and have the capacity to make their own decisions.

he likelihood that an injury or loss will occur in the future; it's not always possible to have risk-free research.

= things that have a good effect, such as promoting well-being or avoiding costs.

Essentially the same thing as respect for persons - they are an individual and have the right to make their own decisions.

the right to know exactly will happen to them and what risks/benefits are to be expected

Moral, ethical, legal, and political discussions use the concept of dignity to express the idea that a being has an innate right to be valued, respected, and to receive ethical treatment. i) Strives to protect the multiple and interdependent interest of the person - from bodily to psychological to cultural integrity. ii) Basically don't make them feel like less of a person/embarrass them/harm their dignity in any way duhhhhhh

recognizes that individuals are autonomous human beings and have the capacity to make their own decisions. i) Requires special consideration for those who are vulnerable and lacking the capacity to fully and knowingly consent to research participation.

i) IRB is responsible for evaluating the potential risks ii) Identify risks, determine that risks will be minimized; identify benefits and determine that risks are reasonable in relation to the benefits analysis that seeks to quantify the risk and benefits and hence their ratio. Exposure to personal risk is recognized as a normal aspect of everyday life. A certain level of risk in our lives is accepted as necessary to achieve certain benefits.

reflects the division of the benefits derived from research that are balanced against the burdens that such research might engender.

Fabrication-to make up information Falsification-altering or adding information that is false Plagiarism- taking someone else's work or ideas and passing them off as one's own.

independent variable: variable that is used to explain or predict the change or variation in the dependent variable a variable (often denoted by x ) whose variation does not depend on that of another. dependent variable: aka outcome variable a variable (often denoted by y ) whose value depends on that of another. ex: In a study that is researching whether "an omega 3 enriched diet" will improve heart health by decreasing "CRP levels", the "type of diet" is the independent variable and the "levels of CRP in the blood" is the dependent variable. The independent variable can be considered the cause, while the dependent variable is the effect.

This is a guide to ask a clinical question. P- Population denotes the characteristics of the pts or clients for whom the intervention is intended ex: is the population children, teenagers or adults? male or female? inpatients or outpatients? I- Intervention (interest) particular intervention or a more broad area of interest ex: an intervention might be the use of gel-based handwashing products or the use or electronic thermometers C- Comparison can be an alternative intervention or the status quo. ex: you might ask about the effectiveness of gel-based handwashing products compared to soap and water, or the accuracy of electronic versus mercury based thermometers. O- Outcomes (consequences) ex: we wants to determing the effectiveness (outcome) of 2 hand washing techniques or the accuracy (outcome) of 2 temperature measuring techniques in our two examples above. T- Time T stands for time and specifies the time it takes for the intervention to achieve the outcome. The time frame is optional and not appropriate in all questions. Therefore we will represent it as "(T)". ex: in the hand washing technique study the time frame might be after a 30 second wash.

a) Participants = individuals possessing knowledge about the topic that the researcher wishes to study and who agree to be a part of the research. b) Population = all of the people who have knowledge about the topic. Differs from participants in that they may not all want to participate in the study. c) Sample = literally everything I am finding says that participants and sample are the same thing... so yeah

Participants: individuals possessing knowledge about the topic that the researcher wishes to study and who agree to be a part of the research. In qualitative research participants is used vs. subject This better reflects them since they are not acted upon but rather are active participants in sharing their knowledge about the area of study. The participants are the experts in the study Population: The participants that the researcher wants to study. The participants possess certain common characteristics that identify them as a part of the population. Sample: a smaller piece of the population of interest Selection of sample members guided by desire for information-rich sources "Representativeness" not a key issue Random selection not considered productive

i) Relies on very few samples (often 10 or fewer) ii) Participants must have experienced phenomenon of interest (i.e. death of loved one, SIDS)

Typically involves samples of 20-40 people Selection of participants who can best contribute to emerging theory (usually theoretical sampling) Used to generate knowledge about "why" or 'how" Broad theory or explanation of a process Theory development

Mingling with many members of the culture - a "big net" approach Informal conversations with 25-50 informants Multiple interviews with smaller number of key informants

an approach to research in communities that emphasizes participation and action. It seeks to understand the world by trying to change it, collaboratively and following reflection. PAR emphasizes collective inquiry and experimentation grounded in experience and social history.

essential in evaluating the worth of a research study, "a term denoting scientific rigor in qualitative research" involves establishing credibility, transferability, dependability, and confirmability

i) Concerns the "truth value" of qualitative data, analysis, and interpretation. ii) Encompasses five criteria (1) Credibility = truthfulness or believability of the findings. (a) Ensured through extended contact with participants in the field. (2) Dependability = how stable or constant qualitative data remains over time. (3) Confirmability = captures a sense of objectivity in the research (a) Would others examining these data confirm these findings? (b) Audit trails (4) Transferability = ability to transfer study findings to other similar situations. (5) Authenticity = the extent to which the researchers fairly and faithfully show a range of different realities and convey the feeling/tone of participants' lives as they are lived (a) No analog in quantitative research (b) Added to the Lincoln-Guba framework at a later date

the point where no more data needs to be collected the point in data collection when no new or relevant information emerges with respect to the newly constructed theory the researchers are no longer learning new things from the interviews also shown when participants confirm data that was previously collected

a technique that improves the accuracy, credibility, validity, and transferability of a study checking the conclusions that the researchers make with the participants to make sure that their opinions were appropriately assessed sharing findings with participants, allowing for corrections c) Member checking = providing feedback to participants about emerging interpretations; obtaining their reactions i) A controversial procedure - considered essential by some but inappropriate by others

a) Trustworthiness is a term that denotes scientific rigor in qualitative research. b) Consists of credibility, transferability, dependability, and confirmability (book) i) Ginger adds authenticity

essential in determining the quality of qualitative research Trustworthiness allows readers to see the qualitative research as reliable is the research dependable? is the research transferable? is the research credible? is the research valid?

purpose: to see if conclusions made in specific scenarios can be used to make broader conclusions related to a phenomenon provides depth of understanding not possible with quantitative research to settle an issue that arose in relation to practice concerns or lack of information in literature essentially the same as quantitative, some wanted to know if there was an answer to a problem and one couldn't be found in literature methods: process: conceptualize the problem design the study implement the design analyze/interpret the data use the results data collection: data can be collected through group interviews, individual interviews, focus groups

a) Methods of sampling i) Convenience sampling ii) Snowball iii) Purposive iv) Theoretical - always with grounded theory b) Gathering Methods i) Ethnography (1) Purpose = researchers want to know more about people and the group of which they are a part. (2) Mingling with many members of the culture - a "big net" approach (3) Informal conversations with 25=5- informants (4) Multiple interviews with smaller number of key informants. (5) Researcher enters as a stranger and tries to understand the culture (a) Uses interviews and observation ii) Phenomenology (1) Purpose = trying to discover how people make sense of their world. (2) Relies on very small samples, often 10 or fewer (3) Participants must have experienced phenomenon of interest (4) Intensive interviews with open-ended questions iii) Grounded Theory (1) Purpose = researchers seek to discover new information that leads to the development of a relevant theory. (2) Typically involves samples of 20-40 people (3) Selection of participants who can best contribute to emerging theory (4) Used to generate knowledge about "why" or "how" (5) Broad theory or explanation of a process

Interviewing: the most commonly used method for collecting data. Represents a practical way of gathering information about a diverse array of topics. Unstructured: conversational, totally flexible. Use of grand tour questions. Semistructured: Use of a topic guide. = guided by a series of broad, open-ended questions, allowing exploration of peoples' experiences or understandings regarding the area of study. focus group interviews: interviews in small groups (5-10 people) led by a moderator. Life histories: narrative self-description of life experiences, often chronology. Observation: requires the presence of the researcher in the research setting. Researchers must decide what to observe. Rooted in anthropology and is important for ethnographies. i) Watching the participants in the social situation of their world rather than relying only on information shared in interviews. ii) Benefits: (1) Direct access to reality (2) Can discover if information participants have shared matches what is happening (3) May help investigators discover and explore relevant areas that interviews had not previously revealed. field notes: specifically associated with ethnographic studies and refers to the written comments that investigators make during the process of observation. They may be done immediately after the observation process and consist of recording any information about the context of the situation observed, of specific behavior or activities observed, or of notes about impressions or thoughts regarding the observations.

credibility: Truthfulness or believability of the findings. One way to ensure credibility is to have extended contact with participants in the field. transferability: refers to the ability to transfer study findings to other similar situations. dependability: examines how stable or constant qualitative data remain over time. Research changes over time, like their method. It is important to note adaptation as well as analytic processes used. confirmability: captures a sense of objectivity in the research. The question of confirmability is "would others examining this data confirm the findings?" Audit trails are an accounting of the research process that provides a record of analytic decision-making others can track.

a) Credibility i) Refers to confidence in the truth of the data and interpretations of them ii) The equivalent of internal validity in quantitative research iii) Arguably the most important criterion for assessing the quality and integrity of a qualitative inquiry iv) Improved with use of member checking b) Transferability i) The extent to which findings can be transferred to other settings or groups ii) The equivalent of generalizability or external validity in quantitative research c) Dependability i) Refers to stability of data over time and over conditions ii) The equivalent of reliability in quantitative research iii) Look for researcher to describe how the study evolves, any additional questions identified, and/or description of how they analyzed data iv) Must thoroughly describe data collection and analysis methods d) Confirmability i) Refers to neutrality - the potential for congruence between two or more people about data accuracy, relevance, or meaning ii) The equivalent of objectivity in quantitative research iii) Look for descriptions of triangulation in data collection and/or data analysis iv) Audit trails help with confirmability

*What should the key quality-related goals be, and what terminology should be used? *A major dispute has involved whether "validity" and "rigor" are appropriate. *Some reject these terms and concepts totally, some think they are appropriate, and others have searched for parallel goals.

Begins with the first interview audio-taped data field notes on-to typed transcripts Data analysis is time-consuming and potentially mentally taxing process uninterrupted time periods facilitate the analysis process bc it allows researchers the ability to maintain their train of thought many different processes w/ steps for data analysis these are basic steps: reading and rereading the transcript to obtain a feel for the information that is shared identifying information that tends to cluster together developing a description for themes that emerge, providing an interpretative statement for the theme supporting the identified theme with evidence

a) Investigator triangulation i) Use of two or more researchers to make data coding, analytic, and interpretive decisions b) Stepwise replication i) Dividing the research team into two groups to undertake parallel analyses and interpretations that are then compared c) Theory triangulation i) Use of competing theories, hypotheses, or conceptualizations in the analysis and interpretation of data d) Search for disconfirming evidence i) as the analysis proceeds, through purposive/theoretical sampling of cases that can challenge interpretations e) Negative case analysis i) A specific search for cases that appear to discredit earlier hypotheses f) Inquiry audit i) A formal scrutiny of the data and relevant supporting documents and decisions by an external reviewer

Attempts to discover how people make sense of their world Examines the commonalities and differences of people's interpretations of their experiences The research questions relate to the nature of specific experiences such as: "what are parent's experiences of being present during resuscitation of their child?" "What are patient experiences of living with their cancer diagnosis?" Researchers must go to the individuals who have had that experience to get an in depth description of it During and following extensive interviews w/ people about the nature and meaning of the experience, the investigator analyzes and interprets the narrative information by identifying and describing common themes from the recorded dialogues The final product: a comprehensive, narrative description that describes and interprets the themes i) Tries to make sense of how people interpret their world ii) Typical questions relate to the nature of specific experiences iii) Open-ended interview questions iv) deductive

A field research tradition that has its roots in anthropology Reflects the work of describing a culture Both a process and the end of a completed study Conducted when researchers want to know more about people and the group of which they are a part Research questions center around everyday life and seek to discover meanings which are taken for granted i) Field research tradition ii) reflect the work of describing a culture iii) Researchers do this type of study when they want to know more about people and the group of which they are a part. iv) Questions center around everyday life and seek to discover meanings which are taken for granted. v) deductive

Opposite of a quantitative study Rather than beginning with a theory, researchers seek to discover new information that leads to the development of a relevant theory The researchers begin with a specific situation from which a more generalized theory is drawn? the developed theory is the end product Goal: to develop useful theories that are relevant to real world phenomena Working from the "ground up" bc they do not have a preconceived idea about what the research outcome will be. The investigators know the area researched, gather data about that area, & then examine the data to see the kinds of info that emerge Data is collected via interviews and sometimes observation iv) Questions center around concerns or problems that are important to practice with the goal of developing a theory. "How do sexual assault survivors seek help with emotional recovery?"

researchers compare the second transcribed interview to the first, then the third interview to the first and second ones and so forth

-identifies specific procedures used for the sampling process that are associated with the coding phase Three phases: 1. Open sampling early in the study enables the investigator to gather as much info as possible very open to persons, places, and events where investigators can uncover the most relevant info about the study topic 2. Relational or variational sampling In this phase where they are further developing study categories and subcategories investigators are looking for individuals who have knowledge that is more specific 3. Discriminate sampling final phase sampling is very deliberate participants are selected because of their ability to validate and clarify (or refute) the relationships of categories in the emerging theory

examines account of past events to search for truth Does not necessarily follow a set methodology Use existing data sources (ex. narrative materials and artifacts) primary and secondary sources oral history: recent event, possible to interview the people in the event Analysis occurs throughout data collection i) Examines accounts of past events to search for truth ii) Conducted to facilitate understanding of the nursing discipline by giving us insight into our growth as a profession and a better appreciation about decisions that influence practice. iii) Built on positivist research traditions, unlike other research methods

A qualitative method to understand how an issue or problem works problems=cases Researchers attempt to extrapolate from one case info that might be applicable to similar cases or situations Data collection: relies on multiple resources, including document examinations, interviews, formal and informal conversations, focus groups, journal excerpts, and phone conversations

a) Locating i) Literature search - use databases and make sure question is well-formulated ii) Look for systematic reviews iii) Search for CATs and information sheets b) Appraising i) Start with the clinical guidelines and examine the summary, credibility, and applicability ii) Then start with systematic reviews and look at same characteristics - summary, credibility and applicability iii) Finally look at summary, credibility, and applicability of individual studies iv) Appraise evidence as a whole to know if it is enough evidence to support your intervention c) Incorporating i) Requires communication, involving the patient, and clinical expertise. ii) The clinician's assessment of the situation, the needs of the patient, the availability the resources, and the skills required to implement the intervention will help determine the success of the intervention. iii) Interventions that require staff training, equipment, and/or supplies usually require a protocol so that everyone in the institution is on the same page. d) Disseminating i) Present an inservice or use a podcast or hold a roundtable discussion ii) Share your findings with other healthcare professionals (1) Poster or podium presentations iii) The most effective and widespread way to get the message out is through publication in a professional journal.

Identify clinical problems: a patient care situation encountered in nursing practice that requires a solution collect evidence by searching the literature define and refine the topic select appropriate resources choose appropriate databases define search parameters and run search examine search results collect resources from the search appraise the evidence: examine evidence collected by conducting an evidence appraisal. This is the process of systematically evaluating literature and guidelines found that are relevant to a selected nursing problem. this is when you choose the level of evidence integrate the evidence and implement the intervention: putting the whole picture together. using the evidence found and by strategizing with key players to address the complexities of the plan. evaluate the outcomes: process of determining the effectiveness of the evidence-based intervention. disseminate the outcomes: many projects that make a difference in health care fade into obscurity simply because the individuals involved fialed to communicate the outcomes to others. this might include local venues such as a unit or the hospital. this may be when poster presentations at conferences are used.

debriefing is a technique where a peer ensures the collection of valid data collection. they look at overemphasized information, underemphasized information, vague information, errors, biases or assumptions made by researchers.