Research EXAM #4 Flashcards
Rating Systems for Grading levels of evidence
Level I (most credible/best form of evidence/full blown experiments)
– Multiple randomized controlled trials (RCTs) reported as meta-analysis, systematic review, or
meta-synthesis, with results that consistently support a specific intervention or treatment
– Randomized trials with large sample sizes and large effect sizes
Level II:
– Evidence from well-designed controlled studies, either randomized or nonrandomized, with
results that consistently support a specific intervention or treatment
Level III:
– Evidence from studies of intact groups
– Ex-post-facto and causal-comparative studies
– Case-control or cohort studies
– Evidence obtained from time series with and without an intervention Single experimental or
quasi-experimental studies with dramatic effect sizes
Level IV :
– Evidence from integrative reviews
– Systematic reviews of qualitative or descriptive studies
– Theory-based evidence and expert opinion Peer-reviewed professional organization standards
Characteristics of Level I Grading of Evidence
most credible/best form of evidence/full blown experiments
– Multiple randomized controlled trials (RCTs) reported as meta-analysis, systematic review, or
meta-synthesis, with results that consistently support a specific intervention or treatment
– Randomized trials with large sample sizes and large effect sizes
Systemic review
The person writing the review did the literature review
Which design is the gold standard for testing interventions?
Experimental design = Level 1
Gold standard for evidence-based practice
Experimental design
Randomized Controlled trials, clinical trials
Highly structured studies of cause and effect applied to determine the effectiveness of an intervention
Why is experimental design the gold standard for evidence-based practice
They provide convincing support for the value of a treatment
Uses of QUANtitative methods
Measure the probability of alternative explanations
for outcomes
● Isolate and evaluate the effect of an intervention
on an outcome
– e.g. patient is taking too many pills, how do you determine which one is actually working? Eliminate drug one at a time
● Answer questions about cause and effect
– Confounding or extraneous
When you think of QUANtitative, what does it mean?
– Cost and effect
– Influence and relationship
QUANtitative variables are measured by
– Independent variables (IV)
– Dependent variables (DV)
– Extraneous (confounding) variables
An independent variable (IV) is
■Controlled by the researcher
■Introduced into the experiment
■Manipulated by the researcher
Purpose of extraneous variables (confounding)
If it exists, you must:
■Identify, eliminate, control
Use of QUANtitative measurement
○ Direct or indirect
○ Prospective or retrospective
○ Primary or secondary sources
○ Reliability and validity of primary concern
Primary vs. secondary sources
Primary: gathering data from person directly; looking for the original author
– “I did this study. These are my outcomes.”
Secondary: data already collected
– e.g. going through medical records to go through BPs and blood sugars
– taking information and quoting me on MY study; got it from somebody else’s article
Difference b/w retrospective vs. prospective measured data in QUANtitative measurement
Retrospective = taking data from something that already happened (the data was there)
– e.g. were the patient in the last 3 months satisfied with their meals?
Prospective = collecting data now to use in the future (don’t know when/how/where)
– e.g. birth cohort study
Reliability vs. validity
Reliability: QUANtitatve study done over and over with different populations, AND the findings are “consistent”
Validity: when the instrument measures what it was designed to measure
– e.g. study to measure anxiety, and better not measure excitability –> study not valid, b/c instrument using is not being used the way it’s supposed to be measured
what do you do in study to check validity? instrument used
Reliability vs. Validity
Reliability = consistency
Validity = instruments you are using in QUANTitative study tests what it was designed to test
— instrument to test anxiety, but realized you’re testing excitement —> using the wrong instrument/design and therefore NO longer valid
A priori
The researcher has to lay out EVERYTHING in front before conducting the study (everything they’re doing, methodology, design, sample sizes, location of sample sizes, laid out) —> IRB and come back —> CANNOT change b/c jeopardize subject (even if they thought of something better that can impact the study)
Constructivist Research
— Discover the meaning and interpretations of events, phenomena, or experiences
— Study cases in their natural setting and analyze the interpretations
— People construct their own knowledge based on their experiences
Characteristics of a priori study
A priori selection of design
○The design is selected after the research
question is clarified
○No change applied once the design is
chosen
■Ensures credibility
■Reduces bias
Casual design/studies
● Randomized group assignment
● Highly controlled conditions
● Results are quantitatively analyzed
— inferential statistics: BPs
– to analyze the demographic, will be descriptive statistics: 35 males and 45 females
Quasi-Experimental design
● Similar to experimental
● Studies of cause and effect
● Subjects are not randomly assigned to groups
● Major difference
○ uses convenience sampling
○ Or existing groups
Cause and effect examples
●What is the effect of continuous, low-level
zinc ingestion on the occurrence of the
common cold among young adults?
●Does ATI practice questions improve NCLEX
results of nursing students?
Quasi-Experimental vs. Experimental
Quasi-experimental: will not be randomized assigned; use existing groups or convenience sampling
Experimental:
QUANtitative designs that focus on intact groups
● Ex post facto research (“after the fact”)
● Causal-comparative: comparing each group b/c receiving different type of intervention
– e.g. 3 stress relieving intervention: one gets massages, one exercises, one solely education packet
● Case/control
Time-series designs
● Type of quasi-experimental
● Measurement of a group over time
● IV manipulated at some point in time
● Group serves as its own control
● Enable the researcher to:
○ Determine effectiveness of intervention
○ Quantify timing of effects
– e.g. Does low carb diet decrease BG at 3 weeks, 3 months, 6months; check for trending?
How is QUANtitative research is used in practice?
– Assessment of procedures
– Dx of nursing problems
– Effectiveness of interventions
– Evaluating patient outcomes
Design used to answer this question:
How do patients with chronic pulmonary hypertension respond to a lung transplant?
Case research methods
Design used to answer this question:
How do nurses on a neonatal unit respond to a medication error causing a death?
Case research methods
Design used to answer this question:
How nurses are portrayed in the media?
Content analysis
Design used to answer this question:
What are the perceived barriers for ethnically diverse students in nursing programs?
Content analysis
Design used to answer question:
What is the nature of moral distress in nurses related to witnessing futile care in the critical care unit?
Phenomenology
Design used to answer question:
What are the long-term implications for intimacy of couples in which the husband has been treated for prostate cancer?
Phenomenology
Example of QUALitative design to answer question:
Which cultural issues emerge during a merger between a for-profit hospital and a not-for-profit hospital?
Ethnography
Example of QUALitative design to answer question:
What is the culture of the waiting room for the open-heart surgery unit?
Ethnography
Example of design to answer question:
Which relationships and interactions affect intimate-partner violence?
Why are CCRN unhappy?
Grounded theory (the root cause)
Example of design to answer question:
Which relationships and reactions lead to teen pregnancy?
Grounded theory
Define statistical significance + example
The intervention MADE A DIFFERENCE; the intervention caused the outcome; was not any extraneous variable; treatment caused the outcome based on that intervention
— e.g. people who exercise vs. who DO NOT exercise
Define clinical significance + provide example
In research, can be used in practice; can make a difference in a patient’s outcomes
Snowball sampling + example
— A nonprobability sampling method that relies on referrals from the initial subjects to recruit additional subjects.
— This method is best used for studies involving subjects who possess sensitive characteristics or who are difficult to find.
_____________________
E.g. members who belong to a club and encountered similar issues
Informed consent + inclusion criteria
As long as their friends that they are trying to recruit meet their requirements
— e.g. nurses on the pediatric unit that has worked for >10yrs
Difference between snowball sampling vs. extreme case sampling
Snowball:
Extreme case sampling: nothing in between
— e.g. interview 2 RNs, choose 1 RN that in 20yrs, have made ZERO mistakes vs. interview RN that has killed a patient;
What is data saturation
The point at which no new information is being generated and the sample size is determined to be adequate.
Field notes in a qualitative study + example
— Detailed descriptions of the context, environment, and nonverbal communications observed during data collection and inserted by the researcher into the transcripts to enrich the data interpretation process
— Written down as soon as possible
— e.g. When watching a group of people eating at lunch you’re writing down what they’re talking about, touching hands, friendly, people caring for each other
Saturation in QUALitative data means
There is no more new information to obtain
Trustworthiness in a QUALitative includes what specific characteristics?
— Credibility
— Confirmability
— Dependability
— Transferability
Credibility
Results represent the realities of the participants
— As far as you know, they’re telling you the truth about their experience
Confirmability
— Enhance objectivity by reducing bias in the research process
— Confirm all of this by ensuring it is the truth and free from bias
Dependability
— Repetition of the study with similar subjects in similar circumstances results in consistent findings
— All of the questions you used, how its analyzed, if repeated with similar group of people in similar situations —>
— If you get anything different —> not dependable
Transferability
— Results can be transferred to situations with similar subjects and settings
Which studies look at reliability and validity?
QUANTitative study
Characteristics of QUALitative designs
— Emergent design
— Data gathered directly from informants, through observation, or from documents
— Questions that reflect exploration of perceptions
— Constant comparison analysis
— Referred to as traditions
— Design elements are focused on achieving understanding
— must be trustworthy
How is data gathered for QUALitative designs?
Through informants through observation, or from documents
Emergent design for QUALitative designs
— Analyzing as the data as it is being collected
— To see the trend comparing updated data to earlier data to see trends and themes
— e.g. on participant #3, the trend will tell you if you’re on the right track after interviewing participant #1; you’ll know if you need to tweak the question
What does a low p-value evaluate?
To ensure triangulation of the data, the researcher may collect data in all of the following ways to prove accuracy: (select all that apply)
a. Documents
b. Interviews
c. Field notes
d. Observations
e. Reports
A, B, C, D, E
Qualitative researchers strive to achieve data saturation. Which of the following explains data saturation?
a. New data continues to emerge and interviews must continue
b. No new data emerges, consistent themes are present
c. The sample size has not been achieved
d. The researcher is exhausted and must end the research
B. No new data emerges, consistent themes are present
What is the first step in a quantitative or qualitative research study?
a. Establish the design
b. Conduct the literature review
c. Choose the statistical tests
d. Conduct the data collection
B. Conduct the literature review
The novice researcher is conducting a qualitative study. The researcher is checking the field notes for trends. Which of the following best describe field notes?
a. Detailed information gathered by the researcher on the environment
b. Use of extreme cases within the research subjects
c. Stratified purposeful sampling
d. Separating researcher bias from the study findings
A. Detailed information gathered by the researcher on the environment (they’re out there and making notes)
In a quantitative study using ‘cause and effect’, which of the following are correct?
a. The cause must precede the effect
b. The effect must precede the cause
c. The cause and effect are not related
d. Cause and effect are qualitative in nature
A. The cause must precede the effect
True or False
‘Apriori’ in quantitative research refers to establishing the components of the study such as design, sample size, and statistical analyses upfront without making any changes.
Trueee
T/F
In qualitative research, the researcher strives for trustworthiness to ensure credibility
True
T/F
The focus of qualitative research is to identify the meaning of an experience or event
True
In qualitative research, triangulation entails:
a. Cross-check data for credibility
b. Compare treatment and control groups for differences
c. Achieve a large sample size for generalizability
d. Use Nvivo to complete data analyses
A. Cross-checking data for credibility
Triangulation
Cross-checking all the data
NVIVO is to _________ data as SPSS is to _________ data
NVIVO = QUALitative
SPSS = QUANTitative data
T/F
Bracketing and reflexivity refers to the researcher identifying their own bias
True
Bracketing + its purpose
— Researcher separates own perspectives and assumptions from the participants information
— uses parenthesis “( )” around your bias
— Purpose: help prevent researcher bias
e.g. Researcher should not interject their feelings/bias about not eating pork does, so must bracket/separate feelings about pork from what my participants are saying
Methods to ensure trustworthiness in QUALitative research
— Bracketing
— Triangulation
— Member checking
— Audit trial
— Reflexivity
Reflexivity
Researcher acknowledges own bias, values and interests
— e.g. researcher uses bracketing to reduce this bias
Types of QUALitative traditions
— Case research methods
— Content analysis
— Phenomenology
— Ethnography
— Grounded theory
T/F
Qualitative researchers focus on validity rather than trustworthiness
False
The qualitative researcher ensures dependability in the research study by ensuring which of the following?
a. Increase objectivity and evade bias.
b. Transfer results to similar situations and subjects = transferability = QUALitative
c. Repetition of the study to a similar situation reveals consistent results.
d. Applies audit trail
C. Repetition of the study to a similar situation reveals consistent results
T/F
Transferability is to qualitative research as generalizability is to quantitative
True
What are the four (4) different types of triangulation?
— Data source
— Investigator
— Theory
— Method
Define fine the following types of qualitative research design.
a. Grounded theory: don’t know much , so start to gather info
b. Content analysis: analyzing content that already exists (e.g. historical documents/words from another time)
c. Phenomenology: explores a phenomenon(a); e.g. exploring the meaning of the phenomenon of people who experience hurricanes)
d. Ethnography: anything you want to know about a particular culture (e.g. food)
e. Case research method: in-depth, take time, doing everything about that person (e.g. cancer patient— diet, exercise, education status, work, alt medicine)
A, B, C, D
The researcher decides to use a ‘snowball’ sampling method to recruit participants. Which of the following best describes this method?
a. Send questionnaires to all available email listings.
b. Ask the research participants to invite friends from the football team to participate who meet the inclusion criteria.
c. Ask the research participants to invite friends from the football team to participate even though they may not meet the inclusion criteria.
d. Assign participants into control and treatment groups once they meet inclusion criteria.
B. Ask the research participants to invite friends from the football team to participate who meet the inclusion criteria.
T/F
During stratified purposeful sampling, the researcher adheres to the inclusion criteria to include participants and then may classify participants into age groups e.g. males aged 12 to 16 years.
True (it is stratified)
Stratified purposive sampling
— Participants meet the inclusion criteria 1st
— Maybe stratified by demographics (e.g. according to age, gender, education, etc.)
— e.g. only obtain data with patients that only delivered their babies at Saint Mary’s
The qualitative researcher uses purposeful sampling to ensure that:
a. Randomization occurs.
b. Participants are chosen who can best inform the research question.
c. Purposeful sampling is used by quantitative researchers.
d. A large sample size is possible.
B. Participants are chosen who can best inform the research question
T/F
The qualitative researcher is able to compare the data during data collection to check for trends and themes and maybe edit the questions as needed.
True
Qualitative researchers use the term ‘emergent’ design during the data collection process. What does this refer to?
a. The data are analyzed using the SPSS data sheet.
b. The data are analyzed as they are collected.
c. The data are analyzed at the end of the data collection process.
d. The data is collected in an emergency.
B. The data are analyzed as they are collected
Explain in your own words how qualitative research differs from quantitative research?
QUALitative: used to identify the meaning of a phenomenon, event, or experience for an individual
— uses feelings, trustworthiness, data saturation, subjective; transferability
—
—
QUANTitative: based on reliability and validity; uses #s, larger sample, generalization, experimental/non-experimental, objective
—
—
Differentiate between types of qualitative designs
Define multivariate analysis + example
The simultaneous analysis of multiple variables
— e.g. determining if BP is different in the AM or PM, and is associated w/ Na intake, weight, and stress level
Define univariate + examples
Analysis of a single variable in descriptive statistics or a single dependent variable in inferential analysis
— primary focus of descriptive and summary statistics
— may also be applied when only one group is included or involves a single DVariable
— e.g. differentiating whether BP is affected more by exercise in the AM or in the PM; even though 2 groups (AM & PM) are included in the study, the analysis focuses on a single dependent variable….BP
Bivariate analysis
Analysis of 2 variables at a time
— Most common = correlation studies
— e.g. determining if BP is associated w/ Na intake; 2 variables = BP + Na, are analyzed to determine any relationship b/w them
Define PICOT
Patient
Intervention
Comparison
Outcome
Time
Define audit trail + example
Detailed documentation of sources of information, data, and design decisions
— e.g.
Content analysis
a qualitative traditions
—
differentiate between different types of qualitative designs eg. ethnography, content analysis, grounded, phenomenology
reliability, validity, triangulation (different types), confirmability, dependability, statistical significance, low p-value and statistical significance (check your text for this).
trustworthiness, types of sampling methods discussed in class e.g. purposeful, snowball
PICOT, multivariate, bivariate, univariate (number of variables)
A priori, field notes, audit trail, experimental, quasi- experimental.
Low p-value means + statistical significance
Indicates that the probability the results were due to chance is also very small —> test is said to have a statistical significance
Statistical significance
— Comparison of differences to standard error and the calculation of the probability of error that give inferential analysis its strength
— One important measure that dete
— Determines whether research is truly applicable to practice
— Often misinterpreted as scientific evidence when it is actually a measure of error
— e.g. Turning the button on a website from red to green will equate to more clicks
Snowball sampling
— Researcher maybe unable to locate potential participants
— The chosen participants are asked to find others who meet the inclusion criteria
— Have some research participants, but since having difficulty, try to recruit friend
— interviewing at Tennis Club in Glen Allen; ask friends if they are willing to participate in research study about environment at that club
Data source triangulation + example
Multiple data sources are used in a study
— e.g. interview multiple informants about a place or time to corroborate the information
— e.g. interviewing diverse key informants to give credence to the findings
Investigator triangulation
More than one investigator is used to collect, analyze or interpret the data
Theory triangulation
Use multiple perspectives, may use different theories to examine the situation, or use variety of published literature
— Multiple perspectives are obtained from other researchers or published literature
Method triangulation
Multiple data collection methods are used
— e.g. interviews, observations, document review
Saturation in QUALitative data means
There is no more new information to obtain
