14185464 importance of research in nursing

8/3/2019 14185464 Importance of Research in Nursing

1/23

I. Importance of Research in nursing

1. Research is an important tool for the continual development of a relevant body of

knowledge in nursing.

2. Research generates information from nursing investigations which help define the

unique role of nursing as a profession.

3. Professional accountability of nurses to their clients is demonstrated when nursesincorporate research evidence into their clinical decisions.

4. Research facilitates evaluation of the efficacy of nurses; practice which may

articulate their role in the delivery of health services.

5. Another reason for nurses to engage in research involves the spiraling costs of

health care and the cost-containment practices being instituted in health care

facilities. With research, costly trial-an-error and even unsafe interventions are

avoided.

6. Research may allow nurses to make more informed decisions as each phase of the

nursing process is clarified through research.

Research also enables nurses to

7. understand a particular nursing situation about which little is known,

8. assess the need for an intervention,

9. identify factors that must be considered in planning nursing care,

10. predict the probable outcomes of certain nursing decisions,

11. control the occurrence of undesired outcomes,

12. provide advice to enhance client health, and

13. initiate activities to promote appropriate client behavior.

II. Main difference between quanti and quali research

Similarity:

Both methodologies require researcher expertise, involve rigor in conducting the study,

and generate scientific knowledge for nursing practice.

Differences:

1. In terms of their philosophical underpinnings, quantitative research is based on

logical positivism while qualitative research is naturalistic, interpretive, and

humanistic


2/23

2. In terms of focus, quantitative research is objective, concise, and reductionist,

while

qualitative research is broad, subjective, and holistic.

3. In terms of reasoning, quantitative research is logistic and deductive while

qualitative research is dialectic and inductive.

4. In terms of their basis of knowing, quantitative research is based on discovering

cause-and-effect relationships while qualitative research is based on meaning,

discovery, and understanding.

5. In terms of their theoretical focus, quantitative research tests theory while

qualitative research develops theory

6. In terms of their basic element of analysis, quantitative research uses numbers,

while qualitative research uses words

7. Quantitative research utilizes statistics to make generalization while qualitative

research looks into individual interpretation to find the uniqueness of aphenomenon.

III.Major steps in quantitative research

Phase I: The conceptual Phase

1. Formulating and delimiting the problem

Example:

Do women who attend structured antenatal classes have higher scores in the

labor and delivery knowledge test and experience less pain in labor?

2. Next step will be to review related literatures

A. Identify key words/phrases

Pregnancy

Primigravid woman

Antenatal care and existing programs

Stages of Labor and delivery process

Labor pains

Gate control theory of pain


3/23

Learning theories

B. Identify possible resources

A. Maternal and child health nursing books

B. Surf the net Pubmed/Medline, Cochrane Library

C. Library search for relevant journals such as The American Journalof Obstetric and Gynecology Nursing, Nursing Research Journal,

Public Health Nursing Journal

3. Interview clinicians (OB-GYNe nurses, doctors, public health nurses) do

benchmarking

4. Explore theory of reasoned action, or the health belief model if these can support

proposed study.

5. Hypotheses: Women who attend structured antenatal classes obtain higher

test scores in the labor and delivery knowledge test than women whodo not attend.

Women who attend structured antenatal classes throughout

pregnancy request less analgesia during the first stage of labor.

There is no significant difference in the test scores from a labor and

delivery knowledge test between women who attend and those

who do not attend structured antenatal classes.

There is no significant difference in the number of requests for

analgesia during the first stage of labor between women who attended and

those who did not attend structured antenatal classes.

Phase II: The design and planning phase

6. Choose a nonequivalent group pretest and post test quasi-experimental

design. Since it is difficult to determine the population of all primigravid women in

Dumaguete City or the province of Negros Oriental, it is not very feasible to come

up with a sampling frame where actual subjects will be drawn. A modified sampling

design where the decision to which group will the first qualified subject should

belong will be done through simple random sampling by tossing a coin.

7. A well structured antenatal care class program will be designed. It shall include the

following topics and activities:

Normal physiology of pregnancy, labor and delivery

The psychological aspects of pregnancy, labor and delivery

Discomforts experienced during labor and how to manage them.


4/23

Prenatal exercises in preparation of the labor and delivery process

Factors that may affect pain experience during labor and delivery.

8. The population is all primigravid women on their second trimester of pregnancy

who are residing in the barangays of the randomly chosen towns and cities of

Negros oriental at the time of program implementation.

9. Cluster sampling will be used. Clusters will be the basis starting with towns andcities, two towns and two cities will be chosen at random. From these towns and

cities will be drawn the barangays included in the study. A total of four barangays

(2 urban and 2 rural) will be drawn from each of these barangays. All primigravid

mothers will be recruited from each of these barangays. To prevent contamination,

all women from the barangays that are randomly assigned to the control group will

be tested first. After the post test has been conducted for the control group,

women of the barangays randomly assigned to the experimental group will be

exposed to the structured antenatal care program after the pretest and then a post

test will also be given.

10. A 20-item knowledge test will be developed which will be used for the pre

and post test measure on knowledge. To measure number of analgesia, a

monitoring scheme will be devised which will be used to record number of askings

for analgesics indicating frequency, dosage, response and person administering

the intervention.

11. An informed consent will be secured from each participant. A set of inclusion

criteria will also be specified. Recruitment of subjects should be without any form

of coercion or threat. Women of both groups will continue to attend usual prenatal

check-ups at their barangay health stations.

12. Trainings for program facilitators and data collectors will be done at least a

month prior to actual conduct of the study. Prepared data gathering tools will be

submitted for expert scrutiny through Delphi technique. Knowledge test measure

will be submitted for item analysis and content validity with some experts.

Phase III: The empirical phase

13. A Pilot test will be done in a barangay with similar characteristics with those

included in the study. After refining all processes and protocols a Gantt chart willbe shared with all study facilitators.

14. Actual data gathering, then data processing and analysis preparation will be

done

Phase IV: The Analytic Phase

15. Data analysis using descriptive and inferential statistics

16. Interpreting results


5/23

Phase V: the Dissemination Phase

17. Present findings in proper fora

18. Utilizing findings in practice.

IV. Steps in Conducting Literature ReviewA literature review is a summary of previous research on a topic. Some questions to think about

as one develops the literature review:

*What is known about the subject?*Are there any gaps in the knowledge of the subject?*Have areas of further study been identified by other researchers that I may want to consider?*Who are the significant research personalities in this area?* Is there consensus about the topic?* What aspects have generated significant debate on the topic?*What methods or problems were identified by others studying in the field and how might they

impact my research?*What is the most productive methodology for my research based on the literature I havereviewed?

* What is the current status of research in this area?*What sources of information or data were identified that might be useful to my study?

How to do a literature Review

Steps to take:

1. Define the topic - In order to begin my literature review I must first define my research

question.

What is the purpose? What does it mean? What are the key words? Are there

other words which could be used, such as synonyms, variations in spelling? What do I

already know about the topic? What is the scope? Do I need everything ever

written in English on this topic, or just the last ten years?

2. Develop a search strategy

Compiling a list of keywords - Before beginning a search for information, it is

important to develop a search strategy that will most effectively locate useful, relevantinformation. This will often involve breaking down the research question into:

keywords or phrases; entering the search; and evaluating results to determine

whether I need to employ various strategies to broaden, narrow or otherwise

modify my research.

Analyzing the topic of a research topic usually involves making a list of keywords or

phrases. I will need to include all the key concepts or ideas contained within the research

question. It might be useful to include alternative ways of phrasing and expressing


6/23

concepts and ideas. I will think about both general terms and very specific terms for

broadening and narrowing my search. The keyword or phrase is the basic unit of any

search. I may find it helpful to consult subject dictionaries and encyclopedias, or a

textbook glossary for the common terminology of the subject area. I may also consider

the use of an index and/or thesaurus which is also advisable to establish the useful terms.

3. Identify resources

Information is available in a number of formats. It is important for me to understand the

significance of various formats so that I will know what will best suit my information

requirements.

*Books *Indexes/Abstracts Printed (e.g. CINAHL)

*Reference Materials *Electronic Databases

* Journals *Government publications

*Conference Papers * Internet (Medline, Cochrane Library)

* Dissertations * Theses

V. Examples of a statement of a problem and research questions:

Examples of a problem statement:

A. Patients concerns about reporting pain and using analgesics are

barriers to adequate pain managementDespite extensive attention

to issues of pain managementfew studies have been conducted

testing impact of intervention on cancer pain

B. Current policy at most hospitals requires the use of routine

flushing of heparin locks after administration of medication or

flushing heparin locks every 8 hours when not being used for

medication administration. However, there is disagreement on

whether flushes of low doses of heparin are necessary to maintain

the patency of heparin locks....

C. Nursing studies have shown that nursing care delivery changesaffect staff and organizational outcomes, but the effects on client

outcomes have not been studied sufficiently (Blegen, Goode, &

Reed, 1998).

Examples of Research questions:


7/23

A. What is the relationship between reported depressive symptoms

and rate of return to work for patients following cardiac surgery?

B. What is the relationship of anxiety and compliance with medications

and follow-up appointments for patients following cardiac surgery?

Examples of a problem statement and related research questions:

The Problem:

Patients concerns about reporting pain and using analgesics are

barriers to adequate pain managementDespite extensive attention

to issues of pain managementfew studies have been conducted

testing impact of intervention on cancer pain

Research Questions:

1. What is the effect of a PRN pain medication protocol in

the Cancer patients reported pain relief concerns?

2. What is the effect of a round-the-clock analgesic use

protocol in the cancer patients reported pain relief

concerns?

3. Is there is a significant difference in pain relief between

cancer patients receiving PRN pain medication and cancer

patients receiving round-the-clock pain medication?

VI. Determining Appropriate Research Design

Appropriateness of a design considers several factors. These factors includethe following:

1. To set up a situation that maximizes the possibilities of obtaining validanswers to research questions or hypotheses.

2. To achieve greater control, and thus improve the validity of the study inexamining research problem

3. The design selected must be:

Appropriate to the purpose of the studydescribe...determine differences between groups...examine relationships among...determine the effect of...

- Appropriateness to the research questiona. Whether the design does the possible job of providing trustworthy

answers to the research questions.b. A given research question can be addressed with a number of

different designs.


8/23

c. Many designs are completely unsuitable for dealing with certainresearch problems

d. There are many research questions of interest to nurses for whichhighly structured designs are unsuitable.

- Lack of Bias (The lack of unwanted influences that can produce adistortion in the results of a study.)The goals of experimental research can be summarized by four Majorquestions:

What is the strength of the evidence that a relationship existsbetween two variables?

If a relationship exists, what is the strength of the evidence thatthe independent variable of interest (e.g. an intervention),rather than extraneous variables, caused the outcome?

If the relationship is plausibly causal, what are the theoreticalconstructs underlying the related variables?

If the relationship is plausibly causal, what is the strength ofevidence that the relationship is generalizable across people,settings, and time?

4. Feasible given realistic constraints5. Effective in reducing threats to validity.Elements of a good research design:

Use of Comparison groups- Comparison between 2 or more groups

e.g. study the emotional consequences of having an abortion, to dothis, we might compare the emotional status of womenwho had an abortion with that of women with an unintendedpregnancy who delivered the baby.- Comparison of one groups status at two or more points in time

e.g. we might want to assess patients level of stress before and

after introducing a new procedure to reducepreoperative stress.- Comparison of one groups status under different circumstances.

e.g. compare peoples heart rates during two different types ofexercise.- Comparison based on relative rankings.

e.g. we hypothesized a relationship between level of pain ofcancer patients and their degree of hopefulness.

Use of methods to control extraneous variables.* Random Sampling

-increases the probability that subjects with various levels of an

extraneous variable are included and are randomly dispersedthroughout the groups within the study.

-this strategy is particularly important for controlling unidentifiedextraneous variables.* Random Assignment

-enhances the probability subjects with various levels of extraneousvariables are equally dispersed in treatment and control groups.* Homogeneity

- In this, the researcher limits the subjects to only one level of anextraneous variable to reduce its impact on the study findings.


9/23

- to use this strategy, the researcher must have previouslyidentified the extraneous variables.

- this strategy, the researcher might choose to include subjects withonly one level of an extraneous variable in the study.

Example of homogeneity:the study of breast cancer patients who have been diagnosed

within one month, at a particular stage of disease, and are receivinga specific treatment of cancer

* Blocking-the researcher includes subjects with various levels of an

extraneous variable in the sample but controls the numbers of subjectsat each level of the variable and their random assignment to groupswithin the study.

-designs using blocking are referred to as randomized blockdesigns.

-the extraneous variable is then used as an independent variable inthe data analysis.* Matching

-is used when a subject in the experimental group is randomly

selected and then a subject similar in relation to important extraneousvariables is randomly selected for the control group.

Timing of data collection is it longitudinal or cross-sectional Study site and setting is it conducted in laboratory setting or in its

natural setting? Intervention or the presence or absence of a treatmentVII. Strengths and Weaknesses of the different designs

1. True Experimental Designs:Some researchers believe that this is the most powerful research

design as it gives us cause and effect relationships.Strengths: More Controls: in the design and conduct of study

Increased internal validity: decreased threats to designvalidity

Fewer Rival HypothesesMore Practical: Ease of implementationMore Feasible: resources, subjects, time, settingMore Generalizable: Comparable to practice

Weaknesses:-There are a number of variables of interest that are not

amenable to manipulation. For instance wecannot randomly confer upon infants their weight atbirth to observe the effect of birth weight onsubsequent morbidity.

- Ethical considerations may prevent the manipulation ofthe independent variable. - You would not inflictpain for the sake of an experiment.

- Artificial circumstances may affect the results.Laboratory designs take place in an artificial setting.Easier to control for external variables but is not asgeneralizable because it constrains thehuman experience.


10/23

- Many variables of interest in nursing cannot bemanipulated; difficult or impractical to perform infield settings; the act of being studied influencesresults of a study.

- The Hawthorne Effect: effect of being in the study groupmay be sufficient to cause people to change theirbehaviors. This is the reason that double blind studiesare conducted. In which neither subject nor those

who administer the treatment knows which is theexperimental or control group.Quasi-Experimental DesignsSTRENGTHS:

More Practical: Ease of implementationMore Feasible: resources, subjects, time, settingMore Generalizable: Comparable to practiceused frequently because they are practical, feasible, and

generalizable.WEAKNESS/DISADVANTAGE involve mainly the inability to make clearcause- and-effect statements.

Can be remedied by controlling extraneous variables(alternative events that could explain the findings) a priori(before initiating the intervention) by design.Descriptive Survey DesignSTRENGTHS:

Data are gathered from a more natural setting.Large amount of data can be gathered at fairly reasonable

cost.Surveys using the questionnaire are likely to cover a wide

geographical area, reach many people, insurerespondents anonymity, and require less skill toadminister.DISADVANTAGES

It only collects self reports where selective recall mayintroduce bias.

Some respondents may not be willing to express attitudes andbeliefs on sensitive topics.

There may be no chance to observe the study participantsdirectly unless done with interview (which is moreexpensive).Correlational and Ex-post-facto ResearchADVANTAGES:

Both designs have the advantage of examining the results offactors that could not be studied because of ethicalconstraints.

Ex-post-facto research can have the researcher examines theeffect, search among the processes of the past toidentify a possible agent whose presence iscorrelated with the effect.DISADVANTAGE:

The disadvantage of ex-post-facto research is the loss ofcontrol-both manipulation and randomization.


11/23

The disadvantage of the correlational design is theresearchers tendency to attribute causality todescriptive relationships.

VIII. How to conduct probability samplingAccording to the types:

Simple random samplingObjective: Select n units out of N such that every NCn has an

equal chance.Procedure: Use table of random numbers, computer random

number generator or mechanical device.Can sample with or without replacement.f=n/N is the sampling fraction.

Stratified samplingObjective: Population of N units divided into nonoverlapping

strata N1, N2, N3, ... Ni such that N1 + N2 + ... + Ni= N; then do simple random sample of n/N in each strata.

Example:

Proportionate: If sampling fraction is equal for each stratumDisproportionate: Unequal sampling fraction in each stratum

Needed to enable better representation of smaller (minoritygroups)

Systematic samplingProcedure:

Number units in population from 1 to N.Decide on the n that you want or need.N/n=k the interval size.Randomly select a number from 1 to k.Take every kth unit.

Cluster (area) samplingProcedure:


12/23


13/23

Inferential statistics are based on the laws of probability and on theassumption that the sample/s was/were randomly selected.

There are two purposes of inferential statistics:1. Estimating population parameter from sample data2. Testing hypothesis about a population

XI. Difference between parametric and non-parametric statistical testsParametric tests are statistical tests based on assumptions that the

sample is representative of the population and that the scores are

normally distributed.Parametric Tests are characterized by three attributes:

1. They involve the estimation of a parameter2. They require measurements on at least an interval scale3. They involve several assumptions, such as the assumption that the

variables are normally distributed in the populationNonparametric tests by contrast do not estimate parameters; they are

used when the data are nominal or ordinal or when a normaldistribution cannot be assumed. This means data need not bequantitative measurements but could be in the form of qualitative responsessuch yes or no, present or absent. They are called distribution-

free statistics. Their use is encumbered with less restrictive assumptionscompared with their parametric counterparts. Their computation is alsousually quick and easy.

XII. Ethical PrinciplesThe ultimate consideration is protection of the rights of people who

participate in nursing research.Ethical concerns are especially prominent in the field of nursing

because the line of demarcation between what constitutes theexpected practice of nursing and the collection of research informationhas become less distinct as research by nurses increases.

Ethics poses particular problems to nurse researchers in somesituations because ethical requirements sometimes conflict withmethodologic considerations.

Three primary ethical principles:1. Principle of beneficence: Above all, do no harm.a. Freedom from harm

*research should be conducted only by qualified people.*Researcher must be prepared at any time during the study to

terminate the research if there is reasonto suspect that continuation would result in injury,disability, undue distress, or death.

How to remedy:-test new medical procedures or drug with animals or tissue

cultures before proceeding to test with humans.-conduct debriefing sessions that permit participants to ask

questions after their participation and by providingparticipants with written information on how they maylater contact the researchers.

b. Freedom from exploitation


14/23

Participants need to be assured that their participation, or theinformation they might provide to the

researcher will not be used against them in any way.e.g. subject reporting drug abuse should not fear

exposure to criminal authorities.c. Benefits from research

Benefits from research should accrue to society in general orto other individuals.

d. Risk/Benefit ratioThe degree of risk to be taken by those participating in the

research should never exceed the potential humanitarianbenefits of the knowledge to be gained.

2. The principle of respect for human dignitya. The right to self-determination

This means that prospective participants have the right todecide voluntarily whether to participate in a study, withoutthe risk of incurring any penalties or prejudicial treatment.This also means that people have the right to decide at any

point to terminate their participation, to refuse to giveinformation, or to ask for clarification about the purpose of thestudy or specific study procedures.

b. The right to full disclosureFull disclosure means that the researcher has fully described

the nature of the study, the participants right to refuseparticipation, the researchers responsibilities, and the likelyrisks and benefits that would be incurred.*Informed consent is based on the right to self-determination andthe right to full disclosure

3. The principle of justicea. Right to fair treatment

Study participants have the right to fair and equitabletreatment, both before, during, and after their participationin the study.b. Right to privacy

Study participants have the right to expect that anyinformation collected during the course of a study will be keptin strictest confidence.

XIII. Ways to collect data1. Data could be gathered in three ways:

Self Reports

A researcher collecting structured self-report data for a quantitative

study almost always uses a formal, written, instrument:

a. Interview Schedule the instrument used is an interview schedule

when the questions are asked orally in either face-to-face or

telephone interviews. Interviews


15/23

a. Advantages outweigh those of questionnaires in terms of

response rates, audience, clarity, depth of questioning,

missing information, order of questions, sample control,

supplementary data

b. Questionnaire or SAQ this is the instrument when respondents

complete the instrument themselves, usually in a paper-and-pencil

format

a. Self-administered questionnaires can be distributed in person,

by mail, or over the internet

b. Advantages: less costly and require less time and energy to

administer, offer the possibility of complete anonymity, and

absence of interviewer ensures no interviewer bias

Observation

Unstructured Observations

Structured Observations

o Category Systems

o Checklists

o Rating Scales

Biophysiologic Measures

o Physical Measurement Methods Chemical/biochemicalEKG, BP, I & O Pulse Oximetry

o Microbiological Blood glucose

Smears PKU

Cultures Sensitivities

Scales

Rating Scales Semantic Differentials

Likert Scales Visual Analog Scales

XIV. Ensuring validity of the study and validity of the research tool

What is validity?The best available approximation to the truth or falsity of a giveninference, proposition, or conclusionA set of standards by which research can be judged.


16/23

Conclusion validity - The extent to which the research design issufficiently precise or powerful enough for the detection of effects onthe operationalized variable should they exist

Elements of conclusion validity:Sufficient powerReasonable evidence to find that the cause and effect covarySignificant covariation

Threats to conclusion validity:

Low statistical powerViolated assumptions of statistical testsFishing and the Error Rate problemLow reliability of measuresPoor reliability of treatment implementationRandom irrelevancies in the settingRandom heterogeneity of respondents

Improving Conclusion Validity:Specific SuggestionsPretest and posttest on same scalesMatch before or after random assignment (but not in place of

random assignment)

Use covariatesIncrease reliability, especially of dependent measuresAdjust raw scores for unreliabilityEstimate desired effect magnitude in advanceEach person as own controlPresent effect and standard errorSelect homogeneous samples

Internal Validity- this refers to the degree to which it can beinferred that the experimental treatment (IV), rather thanuncontrolled extraneous variables, is responsible for observedeffects.

- This addresses the question: Given a statistical relationshipbetween the IV and the DV, is there evidence that onecauses the other?

- Extraneous variables present threats to internal validitybecause they offer competing explanations for the observedrelationships between the IV and the DV; that is, theyinterfere with cause-and-effect inferences.

- True experiments have a high degree of internal validitybecause of the controlling properties of randomization andcontrol groups. Types include:

History refers to the occurrence of external events that take placeconcurrently with the IV that can affect the DV. Example: Ifwe study the differential effect of two forms of exercise onknee extensor strength, history effects may include somesubjects participation in other athletic activities or othertherapies that affect knee extensor strength.

2. Maturation This refers to processes occurring withinthe subjects during the course of the study as a result of thepassage of time rather than as a result of a treatment or IV.


17/23

- Maturation effects may cause subjects to respond differentlyon a second measurement because they have grown older,stronger, healthier, tired or bored since the first measurement.

- Maturation is a relevant consideration in many areas ofnursing research. Maturation does not refer to aging ordevelopment exclusively but rather to any change that occurs asa function of time. Thus wound healing, postop recovery, andmany bodily changes that can occur with little or no nursing or

medical intervention must be considered as an explanation basedon the effects of the IV.

3. Testing This refers to the effects of taking a pre-test onsubjects performance on a posttest.

- The mere act of collecting data changes the response that isbeing measured particularly in those that deal withopinions and attitudes.

- In true experiments, testing may not be a problem becauseits effects would be expected to be about equal in allgroups.

- The Solomon four-group design could be used if researchers

wanted to isolate intervention effects from pre-testeffects.

4. Selection This encompasses biases resulting frompre-existing differences between groups.

- When individuals are not assigned randomly to groups. Thereis always a possibility that the groups are non-equivalent.

- They may differ in ways that are subtle and difficult todetect.

- If the groups are non-equivalent, differences on outcomesmay result from initial differences rather than from the effect of the IV.

5. Mortality Also called attrition, refers to the differential loss ofsubjects from comparison groups; that is dropouts occur forspecific reasons related to the experimental situation.

- The loss of subjects during the course of a study may differfrom one group to another because of a priori differences in interest,motivation, health, etc.

- The risk of attrition is especially great when the length oftime between points of data collection is long.

- If attrition is random (i.e. those dropping out of a study aresimilar to those remaining in it with respect to extraneouscharacteristics), then there would not be bias.

- In general, the higher the rate of attrition, the greater the

likelihood of bias.

6. Instrumentation This is concerned with the reliability ofmeasurement.

- This bias reflects changes in measuring instruments ormethods of measurement between two points of data collection.

Ruling out threats to internal validity


18/23

Many threats such as history, maturation, selection, statisticalregression, testing, instrumentation and selection interactions, can be ruledout by the use of random assignment and control groups.

Random assignment cannot rule out the effects of attrition, imitatingtreatments, or compensatory reactions.

Blinding subjects and investigators will control many of these effects. Construct Validity- Construct validity of causes and effects concerns the

theoretical conceptualizations of the intervention and response

variables and whether these have been developed sufficiently toallow reasonable interpretation and generalization of their

relationship (Portney & Watkins, 2000).- This addresses the question: Given that a cause-and-effect

relationship is probable, to what theoretical constructs canthe results be generalized?

a. Operational definition of the variables threats to constructvalidity are related to how variables are operationallydefined within a study and to potential biases introducedinto a study by subjects or experimenters.

- These threats were originally defined by Campbell and

Stanley under the category of External Validity. These arenow subdivided by Cook and Campbell into construct validityand external validity.

- When studies incorporate only one form of measurement orexamine only one form of treatment, the results will applyonly to a limited aspect of the construct. Therefore, if astudy addresses only one form of treatment op one form ofmeasurement, generalization of the results of that study islimited.

Example: Construct of pain which is multidimensional

Suppose pain is treated with relaxation exercises ortranscutaneous electrical nerve stimulation (TENS), measures

of success may vary depending on whether we assess pain by

using a visual analogue scale (VAS), by measuring range of

motion of involved joints, or by observing he efficiency of

functional tasks.

VAS reflects the patients subjective and relative feelings of

pain intensity

ROM test reflects physiological concomitants of pain

Functional evaluation is influenced by personality, attitude,

motivation, and lifestyle.

Each of these assessments measures a different aspect of pain

that reflects components of the total construct of pain.

b. Time frame within operational definitions


19/23

The element of time cannot be ignored in defining the

construct of treatment, and testing may need to be done at

various intervals to determine the range necessary to achieve

maximal effectiveness.

For example: If we study the effect of TENS over a 2-week

period, we cannot generalize outcomes to events that

might occur over a longer period of treatment. If treatmentshows no effect within this time frame, we would be inaccurate

to conclude that TENS does not work..

c. Hawthorne Effect subjects nay behave in a particularmanner largely because they are aware of their participationof a study.

Subjects often try their best to fulfil the researchers

expectations or to present themselves in the best way

possible, so that responses are no longer

representative of the natural behavior.

d. Experimenter Effects Subjects behavior ay be affected bycharacteristics of the researchers.

The investigators may react more positively to subjects in

the experimental group or give less attention to those in the

control group, because of an emotional or intellectua

investment in their hypothesis. If this is the case, the results in

the original study might be difficult to replicate in a more

neutral situation.

This threat to construct validity can be avoided by employingtesters who are blinded to subject assignment and the research

hypothesis.

External Validity this refers to the extent to which the results of a studycan be generalized beyond the internal specifications of thestudy sample.

- Addresses the question: Can the results be generalized topersons, settings, and times that are different from thoseemployed in the experimental situation?

a. Expectancy Effects- includes placebo effect and nocebo effect

Placebo effect this occurs when subjects administered a

pesudointervention show changes or

improvements. That same placebo might not have any benefits

when not administered in the context of a study.

Nocebo effect- this involves adverse side effects experienced

by those receiving the placebo.


20/23


21/23

1. Construct validity The degree to which an instrumentmeasures the construct under investigation.

Multitrait-multimethod matrix method (MTMM) - amethod of establishing the construct validity of an instrumentthat involves the use of multiple measures for a set ofsubjects; the target instrument is valid to the extent thatthere is a strong relationship between it and other measurespurporting to measure the same attribute(convergence) and a

weak relationship between it and other measures purportingto measure a different attribute (discriminability)

Convergent validity An approach to constructvalidation that involves assessing thedegree to which two methods of measuring a

construct are similar.Discriminant validity an approach to construct

validation that involves assessing the degree towhich a single method of measuring two

constructs yields different results.

Students Attitudes toward Four-day class week

Instruction: Please place a check mark on the space opposite the questionunder the column of your choice of answer. Please answer as

honestly as possible. Thank you.

ItemItem RESPONSESRESPONSES

SASA AA ?? DD SDSD


22/23

1. A four-day class week is a cost cutting1. A four-day class week is a cost cutting

strategy for the school.strategy for the school.

2. Many students can work to earn for2. Many students can work to earn for

their schooling on the extra day weekend.their schooling on the extra day weekend.

3. The best way to make students work is3. The best way to make students work is

to include the extra day weekend forto include the extra day weekend for

service-learning creditsservice-learning credits4. Many students can benefit from the4. Many students can benefit from the

extra day training in service learningextra day training in service learning

centers if they do not need the extra day tocenters if they do not need the extra day to

work.work.

5. There should be an expanded effort to5. There should be an expanded effort to

disseminate information about extra daydisseminate information about extra day

weekend to parents.weekend to parents.

6. Because many families are financially6. Because many families are financially

challenged a four-day class week will savechallenged a four-day class week will save

them the cost of the one day less a weekthem the cost of the one day less a weekfor fare and student allowance.for fare and student allowance.

7. A four-day class week also gives time to7. A four-day class week also gives time to

teachers to find extra work on the addedteachers to find extra work on the added

day off.day off.

8. A four-day work week may help curb8. A four-day work week may help curb

incidence of truancy among students.incidence of truancy among students.

9. Students need to be trained to be self-9. Students need to be trained to be self-

sufficient and the one day off may givesufficient and the one day off may give

them time to get a job.them time to get a job.10. School work is becoming heavy and a10. School work is becoming heavy and a

one day added off will prevent studentsone day added off will prevent students

from getting burnout.from getting burnout.

Critiquing

Nature of evidence-based nursingEvidence-based practice A practice that involves making clinicaldecisions on the best available evidence, with an emphasis on evidencefrom disciplined research.

According to Polit And Beck EBP is a major paradigm shift for healthcare education and practice. With EBP, a skillful clinician can no longerrely on a repository of memorized information, but rather must be adeptin accessing, evaluating, synthesizing, and using new research evidence(2008).


23/23

Best evidence refers generally to findings from research that aremethodologically appropriate, rigorous, and clinically relevant foranswering pressing questions-questions not only about efficacy, safety,and cost-effectiveness, but also about the reliability of nursingassessment measures, the determinants of health and well-being, themeaning of health or illness. (2008, p.32)

The practice of evidence-based nursing involves the following steps:

1. formulation of an answerable question to address a specific patient problem or situation

2. systematic searching for the research evidence that could be used to answer the

question

3. appraisal of the validity, relevance and applicability of the research evidence

4. integration of the research evidence with other information that might influence the

management of the patient's problems

5. clinical expertise, patient preference for alternative forms of care, and available

resources

6. implementation of the evidence-based practice decision

7. and finally, evaluation of the outcome of the decision.

14185464 importance of research in nursing

Documents