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Flashcards in exam prep week 1 - 7 Deck (100)
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1
Q

Define evidence-based nursing practice

A

When nurses make clinical decisions using the best available scientific and evidence-based research, including patient values and preferences, clinical expertise and experience

2
Q

Why is EBP important to health professionals?

A
Ensures:
accountability 
professional standards
clinical competence and safety 
improved practice and service
applying research to the real world of work
3
Q

What are to two categories of evidence?

A
  1. non-research based

2. research based

4
Q

What is the definition of research?

A

Is a formal, rigorous and precise process of inquiry that is planned and systematic

5
Q

Why is research important for nurses?

A

Enables better understanding through discovery of knew knowledge
Improves practice based on evidence

6
Q

Where is evidence located?

A

CINAHL
Joanna Briggs Institute
MEDLINE
Cochrane library

7
Q

what is a systematic review?

A

Findings from a number of studies (usually quantitative) answering the same clinical question
Is stronger than one individual study

8
Q

What is a meta-analysis?

A

Takes all the statistics from the systematic review to draw a conclusion
Gives a useful summary that weights study findings based upon the strength of the methodology

9
Q

What is a meta-synthesis?

A

Involves analysis of several qualitative studies and summarises the findings

10
Q

What are the 7 components of research reports?

A
  1. Title
  2. Abstract
  3. Introduction/aim
  4. Methods used
  5. Results/findings
  6. Discussion
  7. References
11
Q

What does the introduction compromise of?

A

Defines the problem

Formulates the aim or question

12
Q

What does the methodology compromise of?

A

Is the development and implementation of a plan for the research

13
Q

What is in the results/findings?

A

Documentation of the findings of the data analysis

14
Q

What is included in the discussion/conclusion section?

A

The interpretation of the findings

Draws conclusions and makes recommendations

15
Q

An abstract summarizes a research report… what does it usually include?

A
Background
Research question or aims
Findings
Conclusion
(use it to see if it may answer your question)
16
Q

Methodology includes?

A

The research design (qualitative, quantitative)
Sample (participant) selection from population group
Procedures and data collection methods
Data analysis

17
Q

Quantitative design includes?

A
Hypothesis
Control group
Survey
Random/convenience sample
Variables measured by instruments or tools 
Reliability/validity of instruments
statistical analysis
Objectivity
18
Q

Quantitative research includes?

A

A partial picture of a phenomenon is of interest
numerical information
The researcher is at ‘arms length’ from the data collection process
Validity has a specific meaning in quantitative reseach

19
Q

Qualitative design includes?

A

No numbers
Focus is on subjective information
No control of phenomenon
Focus is on understanding complexity of people within the context of their lives
Includes naturally occurring conditions
Ensures answers will be as meaningful and accurate as possible
Ensures rigor/validity

20
Q

Qualitative research includes?

A

A complete picture of a phenomenon is of interest
Non-numerical information
The research is NOT at ‘arms length’ from the data collection process
Rigor has a specific meaning in qualitative research

21
Q

Discussion should include?

A

A summary of the key findings
Comparison of findings with previous findings
Speculation about the reason for the results of the study
Implications for practice

22
Q

Discussion summary should …

A

Address the results that directly relate to the research question
Can include unexpected results
Includes results that the researcher believes are important

23
Q

Discussion:

Comparison and Speculation

A

Compares the results with those from previous studies

Considers the findings from different theoretical perspectives

Offers explanation for the results including rationale to support this explanation

24
Q

Discussion:

Implications for Practice

A

Interprets what the study and its results mean for practice

Makes suggestions for practice consistent with this interpretation and the supporting evidence (EBN)

25
Q

Limitations…

A

Qualitative research – rigor

trustworthiness, confirmability, transferability, credibility

Quantitative research – reliability and validity

Measurement - reliability, validity
Design – internal and external validity

26
Q

Conclusions…

A

Summarise:
New knowledge derived from the study
Consistency or otherwise of findings with previous knowledge
Limitations (design, sample, measures, procedures)
Recommendations (practice, education, research)

27
Q

The research design identifies:

A

How subjects /participants recruited

What will happen during the study

How data will be analysed

When the study will end

28
Q

Non-experimental Quantitative research design includes?

A

Correlation

Descriptive

29
Q

Experimental Quantitative research design includes?

A

Quasi-experimental

Experimental

30
Q

Qualitative research design includes?

A
Historical
Ethnography
Phenomenology 
Grounded theory 
Descriptive exploratory
31
Q

Purpose of Qualitative Research

A

To understand personal experiences, interpretations from participant’s view

Help understand naturally occurring social phenomena

Explore attitudes, beliefs, values and experiences of participants

Searches for individuals’ perspective of reality

Interested in people’s experience of the world

Acknowledges that the researcher impacts on & is part of the research process

32
Q

The Researcher in Qualitative Designs…

A

Visible in research process

Spends time in field

Personal contact and insight

33
Q

What are the common types of qualitative research

A

Descriptive exploratory

Phenomenology

Grounded theory

Ethnography

Historical

34
Q

What is Descriptive Exploratory?

A

Has overtaken other methodologies

Not a specific approach

A generalised approach: tends to include common aspects of others

Collects “rich narrative data from small samples”

Describes situations

35
Q

Describe Phenomenology

A

Studies phenomena in their natural setting

Aims to describe experience

Discovers the ‘lived’ experience eg. living with cancer

Involves in-depth interviews (2-3 hours talking to someone)

36
Q

Research questions: Phenomenology

A

Provides us with in depth data about specific lived experiences

eg. Describe the experience of the before and after of losing a partner

What is the lived experience of … ?

What is the meaning of …. ?

What is the quality of…..?

37
Q

Describe grounded theory

A

Examines processes

Examines inter-relationships among concepts to develop theory

Interviews, examination of documents & observation

Focuses on social processes, meaning and developing theory

Recognizes links - builds theory from that

38
Q

Grounded theory is used when?

A

When little study done in the area

To find new understandings or perspectives on unknown or unclear phenomena

To look at and understand social process that come from our behavior

eg. Behaviors of family members in ICU

39
Q

Research questions of grounded theory would include?

A

What does … ? (recovery mean to ICU patients)

How do …. ?

What is the process of ….? (social processes, interventions and developing theories from that)

40
Q

What is Ethnography?

A

Doesn’t have to be race or religion, could be people who use illicit drugs

Understand the culture of a group of people

Insider (emic) as well as outsider (etic) approach

Researcher often participant observer-embedding within culture

Observations often supported with interviews

Time taken to establish trust

41
Q

Research question: Ethnography

A

Usually about patterns of behavior within the social context of a culture/subculture

Nursing: questions that concern how cultural knowledge, norms, values influence the health experience

eg. Culture of different wards; ICU, theater, students / a group that has something in common

42
Q

Historical Research

A

Looking what has happened in the past and relating it to the future

Examines past as perceived at the time

Historical documents (eg diaries) and recordings often examined

Description of the past based on documented information

43
Q

Research question: Historical

A

Any questions relating to exploring the facts, events, ideas and people’s lives in history

What was it like to be a person in ….?

eg. the use of side rails historically and in the future

44
Q

Rigor in Qualitative Research

A

Trustworthiness/rigor interchangeable

Confirmability - audit trail

Transferability - external check

Credibility - data collection

(researcher need to be trusted by the participants)

45
Q

Research Question example

A

What allows some people to adapt or cope with illness when others don’t?

Research question could be:

“Does previous experience with serious illness improve a person’s ability to cope with subsequent serious illness

46
Q

Hypothesis

A

A tentative prediction about relationship between two or more variables in study

Must be testable - eg. is there a relationship between smoking and acncer

Can be more than one hypothesis in a study-each tested separately

Testable research hypotheses state the expected relationship between the independent variable (cause) and the dependent variable (affect) within a population

47
Q

Hypothesis Example

A

(Does the independent variable cause a change in the dependent variable?)

Question: Does the ‘temperature of normal saline’ (independent variable) used in endotracheal (ETT) suctioning affect ‘heart rate alterations?’ (dependent variable)

Hypothesis: Room temperature normal saline used in ETT suctioning results in greater decline in heart rate alterations than body temperature normal saline

48
Q

Hypothesis testing:

A

Allows generalisability of findings

Answers questions eg:

- What is the relationship between the 	 variables?
- What are the changes over time?
49
Q

The statement of the hypothesis should

include:

A

Variables of the hypothesis
Population being studied
Predicted outcome of hypothesis

50
Q

Sources of Research Problems

A

Clinical experience

Nursing literature

Social issues

Theories

51
Q

Critiquing Research Problems, Questions & Hypotheses

A

Does the report answer: “why ask the question” & “what do we know”?

Does report include clearly identified background/literature review?

Does background discuss clinical problem?

Does literature review explain importance of question?

Is literature review important & current?

If theory presented, is it relevant?

Is problem/question/hypothesis connected to literature/theory?

Is question relevant to clinical problem?

52
Q

Hierarchies of Evidence are for?

A

Traditionally based on quantitative methods

Minimise bias and remove effect of confounding variables

Systematic reviews of Randomised Controlled Trials (RCTs) at top

Opinion at the bottom

53
Q

List the hierarchies of evidence…

A

Systematic reviews - meta analysis (Quant)
RCTs
Cohort studies
Case - control
Cross - sectional studies
Case series, case reports
Ideas, opinions, editorials, anecdotal (Qual)

54
Q

How Do We Evaluate Qualitative Methodology?

A

Qualitative research: ? Lacks rigor/legitimacy/generalisability

Generally ranked low on evidence pyramid

A different way of evaluation needed?

If asking quantitative question (treatment effectiveness): quantitative pyramid for intervention studies appropriate

If asking question about how patient’s experience a particular health issue/intervention: qualitative pyramid would help guide an evidence review

55
Q

Evidence Pyramid for Qualitative Studies

A
Level I
Generalizable studies
Level II
Conceptual studies
Level III
Descriptive studies
Level IV
Single case study
56
Q

Single case study:

A

interviews with only one participant. Poor evidence for practice. May lead to more robust studies based on ideas generated

57
Q

Descriptive studies:

A

usually not guided by theory. Usually conducted to capture personal experience of participants

58
Q

Conceptual studies:

A

use theoretical concepts to guide sample selection- based in the literature on the clinical question

59
Q

Generalisable studies:

A

also use theory to guide sample selection but extend beyond one specific population to capture diversity of experience

60
Q

Implications for Nursing

A

Nurses and qualitative researchers tend to approach situations form a holistic viewpoint
Nurses and qualitative researchers appreciate that there is no single reality- reality changes over time and is unique to each person
Therefore evaluating levels of evidence of qualitative research can highlight unique contribution nursing makes to patient care (different to medicine)

61
Q

Types of quantitative research studies

A

Descriptive

Correlational

Quasi-experimental

Experimental

62
Q

Quantitative Descriptive design

A

Accurate portrayal of phenomenon of interest

Used to answer research questions that seek to describe - (eg. of teenage mothers, how many are using the postnatal services?) interviews, questionnaires etc. numerical… if it was qualitative it would ask their experience of this

May use observation, survey, questionnaires, interviews

Longitudinal/cross-sectional - Retrospective/prospective… both elements of time

Standing back and not getting involved personally

63
Q

Correlational design

A

Used to answer research questions that seek to link or connect (eg. the correlation between heart bypass and stress)

Enable examination of relationships between two or more variables & comparison between groups

Used to quantify strength of relationship between variables

64
Q

Quasi-experimental design

A

Allows generalisation (most of the elements of the experiment but with something or one thing missing)

Experimental treatment manipulated

“Natural experiment”

Some characteristic of true experiment missing:

  • control
  • randomisation
65
Q

Experimental design

A

Involves observation & data collection with specific criteria and protocol

Three identifying
properties:
- randomisation (randomly select population)
- control (eg. give drug A - to ...)
- Manipulation (Give drug B - to...)

Used to test cause & effect relationships (eg. smoking causing cancer)

Double blinded randomized controlled trial = the best

66
Q

Experimental designs types

A

Randomised Controlled Trials (RCT)

Blinded RCTs (participants are anonymous)

Double-blinded RCTs (researcher and participants are both anonymous) = no bias

67
Q

Time in quantitative studies

A

Retrospective: data collected about past events - for as long as it takes within reason

Prospective: data collected about events as they occur

Cross sectional studies - data collected at one point in time

Longitudinal studies - data collected over a period of time (days/weeks)

Cross-sectional - Prospective = + (Today - specific infectious diseases in child care)
Cross-sectional - Retrospective = ++
Longitudinal - Prospective = ++
Longitudinal - Retrospective = + (Over period of time in the past)

68
Q

Control in Quantitative Research

A

Researcher needs to have control over study

Procedures to ensure uniform/constant conditions (homogeneous - sample is the same)

Control over variables (independent/dependent/extraneous)

eg. A is controlling B (not something else)
A is fixing B
(need to make sure the measuring tool is accurate)

69
Q

Variables

A

Variable: aspect of interest that differs among different people/situations

Independent variable: manipulated - give to the controlled group - cause - smoking

Dependent variable: measured - measure what happened when we gave then cigarettes - effect - cancer

Extraneous variable: needs to be controlled

A has an affect on B

70
Q

Validity and reliability

A

Study is valid if it measures what it claims to measure

Measurement instrument accurately measures what it is supposed to measure

Two main types:
internal validity: accurately measures - cause or relationship

external validity: generalisable (can we generalize the results with the population?)

is there a relationship between group A and group B?

71
Q

REMEMBER!!

A

The appropriate research design is the one that will best answer the research question

72
Q

Define POPULATION:

A

Well-defined group with specified characteristics
ALL individuals researcher interested in studying
Target population: the population to study/generalise findings to

73
Q

Inclusion for Sampling Criteria:

A

Identify how individuals selected
Stated characteristics ensuring homogeneous group of subjects
Should be common characteristics
Enable generalisability of findings

74
Q

EXCLUSION CRITERIA:

A

Characteristics that deem a participant inappropriate for inclusion in the study
May be stated or implicit

eg those cognitively impaired or with language issues

75
Q

Sampling is:

A

Process of selection of study subjects

Represents entire population

76
Q

Purpose of Sampling:

A

Increase efficiency of study

Maintain representativeness

Minimise bias (quantitative)

Represent the characteristics of interest of target population

77
Q

It is important to Understand Sampling Because You Want to Know:

A

Does the study address the population about whom we have a clinical question?

Does the sample accurately reflect /form a part of the population addressed in the study?

Does the sampling approach limit the usefulness of the findings?

78
Q

Sampling definitions:

A

Sample: subset of overall population

Element: most basic unit

Sampling frame: list of population elements/individuals

79
Q

Sampling examples:

A

Population: All Childcare Centres CCCs (in Australia)

Sample: 14 (CCCs) in Perth

Element: each CCC

Sampling frame: List of all registered CCCs in Perth

80
Q

Probability Sampling:

A

Objective

Includes:

		- simple random sampling
		- stratified random sampling
		- cluster sampling
		- systematic sampling
81
Q

Distinguishing Characteristics of Probability Sampling:

A

Each element has possibility of being chosen to take part in study

The probability of being chosen is unknown

All members of the population are physically present or listed in sampling frame

Each element appears only once in sampling frame

82
Q

Advantages of sampling

A

No researcher bias

Maximises representativeness

83
Q

Summary of Probability Sampling:

A

Primary characteristic:
a random selection of elements from the target population- each element has an equal & independent chance (probability) of being selected in the sample

84
Q

Simple Random Sampling:

A

All population elements identified

Random number generation to select sample

85
Q

Disadvantages of simple random sampling:

A

Time consuming & inefficient

Difficult to obtain complete list of population

86
Q

Stratified Random Sampling:

A

Aim: to increase representativeness of sample

Population divided into homogeneous subsets (strata)

Elements randomly selected from strata

Proportional stratified: sample size from each strata proportional to size of strata

87
Q

Proportional Stratified Sampling

A

The undergraduate population of students = 5% Aboriginal
20% Asian-born
75% Caucasian

Then the proportionate sample of 100 students = 5,20,75

Often used if comparisons between strata of unequal membership wanted

Can be stratified according to any number of attributes eg gender, age, ethnicity, religion

Similar to quota sampling

88
Q

Cluster Sampling:

A

Successive random sampling of units/clusters

Progresses from large to small

Must all meet sample eligibility criteria

Clusters may be selected by simple random or stratified random methods

Can make it easier to obtain a random sample
eg.
1st stage = states of Australia

2nd stage = cities, suburbs, street blocks

3rd stage = households

89
Q

Systematic Sampling

A

Involves selection of members of a population for a sample at fixed intervals i.e. every “nth” case

Similar to simple random sampling- more convenient & efficient

Individuals to be chosen must NOT be listed in some order that creates bias

eg.
Population = 5000

Select every 100th case on list (sampling frame)

NB case 1= randomly selected

eg if 73 is first no. randomly selected, then those matching 173, 273, 373 etc included in sample

90
Q

Sample Size: Power Analysis

A

Quantitative: sample size determined prior to starting study

No of factors influence sample size eg design, need for generalisability, cost

Power analysis: mathematical strategy

Allows researchers to determine sample size needed

Allows researchers to determine how large a sample size is need

To determine sample size needed to detect a real relationship or difference in the phenomenon under study if it exists

Study suitable “powered” provides confidence in interpreting findings

91
Q

Sample Size: Qualitative Research:

A

Qualitative studies do NOT usually begin with predetermined sample size

No formal criteria for determining sample size
Therefore no rules for determining when small/large enough

Richness of data more important

Around 8-15 but variable

Data saturation: point at which data repetitive- no new information received

92
Q

Non-Probability Sampling:

A

Subjective judgements contribute to choosing sample

Every member of population does NOT have equal chance

Less rigorous than probability sampling

Limits generalisability

Main types:

			- convenience
			- quota
			- purposive
			- snowball
			- theoretical
93
Q

Non-Probability Sampling: Quantitative Research

A

Small exploratory studies

Useful when information on total population unknown/unavailable

Less rigorous

Tends to produce less accurate & less representative samples

Limits generalisation

94
Q

Convenience Sampling

A

Uses most readily available subjects

Common in clinical research

Advantages: easy & inexpensive

Disadvantages: increased risk of bias

Self-selection also leads to bias

95
Q

Snowball Sampling

A

Type of convenience sampling

Use original participants contacts: social networks

Used when difficult to otherwise identify participants

Useful for accessing diversity of experience

96
Q

Quota Sampling

A

Goal: to make sample more representative

Used to access different subgroups of as population

Characteristics important to study used to set quotas

eg.
5,000 nurses in a city:

20% diploma (100)
40% certificate (200)
40% degree (200)
= total 500
=10% of 5,000 using proportional quota sampling
97
Q

Purposive Sampling

A

Intentional selection

Cases included- handpicked

Can be used when unusual group under study
e.g. rare genetic disease

Goal: focus on particular aspect of phenomenon

98
Q

Theoretical Sampling

A

Usually in Grounded Theory studies

Generate data for theory generation

Starts from homogenous(small) sample

Moves to heterogenous (larger) sample

Occurs sequentially alongside data analysis

99
Q

Sampling Bias

A

Bias: unintended factor changes results- incorrect conclusions

Distorts findings

Difficult to interpret results

100
Q

Sampling Goals: Qualitative

A

Find best sources of data relevant to study aims/objectives

Obtain insights into the phenomenon of interest

Obtain sample representative of population of interest

Obtain sample that allows effects of specified variables to be distinguished from other variables