Nursing Research

Nursing Research Lecture №18

PART IІ

Types of Non-probability Sampling

Convenience (Accidental) Sampling

Quota Sampling Purposive Sampling Network Sampling Theoretical Sampling

Non-Probability Sampling

Purposive Sampling (Non-Randomized)

Theoretical Sampling

Convenience Sampling

Quota

Network

Caution Areas on Data You see what you look for You look for what you know Appropriate statistical strategies

for certain types of numbers If you are a hammer, the world

looks like a nail

Dealing With Data (ch. 11)

Developing Data Collection Forms Planning Data Collection Process Planning he Organization of Data Planning Data Analysis Planning Interpretation &

Communication of Findings Evaluation of the Plan

Data Collection Tasks Recruiting Subjects Maintaining Consistency Maintaining Controls Protecting Study Integrity Problem-Solving

Physiological Measures:Reliability and Validity

Accuracy measurement that has the most precise identifiers

for the level of measurement sought Selectivity

the ability to identify that which is really want to sometimes called specificity

Precision the amount of reproducibility in measurement

Sensitivity The amount of a changed parameter that can be

detected Sources of Error

Data Collection Problems People Problems Researcher Problems Institutional Problems Event Problems Measurement Validity Measurement Reliability

Computer Support for Data Data Input Data Storage Data Retrieval Statistical Analysis

Numbers and Use of Numbers Nominal (subjective)

A Named category given a number for convenience, e.g. males are 1 and females are 2

Ordinal (subjective) A scale that is subjective but shows a direction, e.g.

pain scale, cancer staging, all Likert scales Interval (objective)

Numbers where the interval between them is meaningful, and there is no absolute zero but an arbitrary zero, e. g. a temperature. These numbers can be less than zero.

Ratio (objective) Numbers where there is an absolute zero which

means it is absent or there is a denominator that allows for comparison of meaning and . e. g. number of cases or infections per 100 hospital days, stage 2 skin breakdown per 100 patients.

Bivariate Data AnalysisIndependent Groups

Nominal Data Chi squared (Two or more samples) Phi (Two samples) Cramer’s V (Two samples) Contingency Coefficient (Two

samples) Lambda (Two samples)


Ordinal Data Mann-Whitney U Kolmogorov-Smirnov (two-sample test) Wald-Wolfowitz Run Test Spearman Rank-Order Correlation Kendall’s Tau Kruskal-Wallis One-Way Analysis of

Variance by Rank (three or > samples)


Interval or Ratio Data t Test for independent samples Pearson’s Correlation Analysis of Variance (Two or more

samples) ANOVA Simple Regression Multiple Regression Analysis (two or

more samples)

Bivariate Data AnalysisDependent Groups

Nominal Data McNemar Test Cochran Q Test (three or more samples)

Ordinal Data Sign Test Wilcoxon Matched-pairs, Signed-Ranks Friedman Two-Way Analysis of Variance

by Ranks (for three or more samples)

Bivariate Data Analysis Dependent Groups

Interval or Ratio Data t Test for Related Samples Analysis of Covariance (for three or

more samples) ANCOVA

Multivariate Data Analysis

Interval or Ratio Data Multiple Regression Analysis Factorial Analysis of Variance Analysis of Covariance Factor Analysis Discriminate Analysis Canonical Correlation Structural Equation Modeling Time-Series Analysis

Working with Descriptive Data:A Toolkit for Health Care Professionals Using Descriptive Statistics

Correlational DescriptivePredictive Descriptive

Model Testing Descriptive

Statistics vs. Tools Inferential Statistic Analysis

Statistics (regression, correlation, t-test, F-test, Multivariate testing etc.)

Descriptive Statistic Analysis Tools to display information

Critical Path Process (p. 524)

1. Select the process2. Define the process3. Form a team4. Create the critical path5. Make the path a working

document

Critical Pathway for Complaints of Chest Pain in

ED

O 2 , IV ,B lo od s , E K G

N o p re v io ussym p to m s

G o od H e a lthM in . R isk fa c to rs

O 2 , IV , B lo od s , E K GA S A , N itro g lyce rn

P re v io ussym p to m s

H a s so m e riskfa c to rs

O 2 , IV , A S A , B e ta ,B lo cker, M o rp h in e ,C a rd ia c C a th L ab

C C U

P re v io u s C A Dm a n y risk

fa c to rs

E D P atie n tsc /o ch es t p a in

Force Field Analysis

Driving Forces(support efforts)

Comparable to Other Schools

Recent drop in NCLEX ratesFaculty requests

Restraining Forces(conflict with efforts)

Significant Change in Policy

More students would failDSN had 90-94% NCLEX

rates with 72%

Driving Issues for Moving Minimum Grade at DSN From 72% to 74%

Indicators to be Used in Hospitals

Quantitative measures Related to one or more dimensions

of performance Help provide data that (when

analyzed) give information about quality

Direct attention to potential problems

Types of Indicators Sentinel-event indicators

Serious injury or death indicator

Aggregate-data indicators Rating for med errors and patient complaints

Continuous-variable indicators Number of new bed sores per day

Rate-based indicators Infections per 1000 patient days

Run Charts Probably most

familiar/used tool Used to identify

trends/patterns in a process over time

Helps track if target level has been attained/maintained

Run Chart – Trend ChartUsed for Self Comparison

0

20

40

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Unit XUnit X

Quarterly report of new bed sores for Unit X 2008

Comparison Run Charts – Trend Charts-(Dangerous because these are not ratio numbers)

0

10

20

30


Unit XUnit A

Unit B

Unit XUnit AUnit B

Quarterly report of new bed sores for Units A, B, & X for 2008

Histograms

Bar charts that display: Patterns of variation The way measurement data are

distributed Snapshot in time

May be more complex to establish; consult statistics textbook if needed

Comparison Run Charts – Trend Charts-(Dangerous because these are not ratio numbers)

0

5

10

15

20

25

30


Unit XUnit AUnit B

Quarterly report of new bed sores for Units A, B, & X for 2008

Comparison Run Charts – Trend Charts for Delta Hospital (can be compared equally)

0

2

4

6

8

10

12

14

16


Unit XUnit AUnit B

Quarterly report of new bed sores per 1000 patientdays for Units A, B, & X for 2008.

Control Chart

Max.

Min.

Std.

0.005 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

x x x

x x x x x

0.003 x x x

x

0.000

This is the control chart for infections from I.V.s on Unit XWith 3 case per 1000 patient days as the standard (std)for 2008.

Pie Charts Descriptive data Shows a distribution by category Compared to the Whole

Pie Distribution of new bed sores for hospitalized patients at Delta Hospital

Unit XUnit AUnit B

Total of 140 new bed sores reported in 2008

43

37

36

Scatter Diagrams

Graphs that show statistical correlation between 2 variables

Used when group wants to: Test a theory Analyze raw data Monitor an action taken

Scatter Diagram Process

Min. Program Passing rates in %

NCLEX Scores by %

72

74

76

100%

Surveys

Survey’s can carry a risk to them. Also know what Likert Scale you are using and why (1-4, 1-5, 1-10 most common).

These are Ordinal Numbers

Naturalistic Inquiry— (Ch. 3) Qualitative Research Methods

Phenomenology Ethnography Auto-ethnography Grounded Theory Descriptive Qualitative Historical ?

Non-Probability Sampling

Purposive Sampling (Non-Randomized)

Theoretical Sampling

Convenience Sampling

Quota

Network

Observational Measurement

Unstructured Structured

Category Systems Checklists Rating Scales

Emic (from within) Etic (from external view point)

Phenomenology Research:“The Lived Experience”

Phenomenology is a science whose purpose is to describe the appearance of things as a lived experience.

It allows nursing to interpret the nature of consciousness in the world.

It can be descriptive or interpretive (hermeneutic).

It is a philosophy, an method, and an inductive logic strategy

Design Characteristics Purposive samples of 7-20 usually going

for saturation. Instrument is the researcher Data collection is by interview of groups

or individual that are verbatim, taped, and field notes.

Data collection is directly tied to analysis, that eventually is coded or structured into themes.

Unique Features of Phenomenology

Most of the literature review is conducted at the end of the data collection. It is believed the CF biases the data collection and analysis. Like Grounded Theory but without a BSP or

bias already in mind. It is conducted by gathering interview

data from others. It is never quantitative, but some would

prefer to try and keep it objective.

Five Steps of the Method Shared Experience is presented Transform the lived experience into an

experience the subject would agree with Code the data Put it into written form and create

confirmation of the data texts. Create a complete integration of all of

these for a research document NOTE: In come cases, researchers need

to have Bracketing to control an over-riding bias or emotional response

Qualitative Research RigorsThe Five Standards (Ch. 13)

Descriptive Vividness Methodological Congruence Theoretical Connectedness Analytical Preciseness Heuristic Relevance

Defining Naturalistic RigorStandards 1 and 2 Descriptive vividness

narratives are texturized, thick, and full of details

the writer shows connections and level of membership

Methodological congruence details of exactly how the data is

gathered with ethical rigor. Does the method match the design?

Defining Naturalistic RigorStandards 3, 4 and 5

Analytical preciseness the data is transformed across several

levels of abstraction moving raw data to clusters,

interpretations, or theory Theoretical connectedness

ensuring the theoretical schema is clear and related to the data being collected and a lens for analysis

Heuristic relevance readers must recognize the phenomenon as

applicable, meaningful, & recognizable

Other Types of Rigor Using Trustworthiness

Trustworthy questions Trustworthy approach Trustworthy in analysis Trustworthy and authenticity of data

Ethnography Research Defined as:

“Learning from People”By Spradley

Four Types of Ethnography Classical

Years in the field, constantly observing and making sense of actions. Includes description and behavior. Attempts to describe everything bout the culture.

Systematic Defines the structure of a culture.

Interpretive (hermeneutic) To study the culture through inference and analysis

looking for “why” behaviors exist. Critical

Relies on critical theory. Power differentials, who gains and who loses, what supports the status quo.

Historical Roots Early 1900s had several introductions Herodotus wrote about travel in Persia Malinowski’s Study of Trobriand Islanders Hans Stade wrote about his being in

captivity by the wild tribes of Eastern Brazil The School of Sociology in Chicago, where

the city was a laboratory from all the immigrants (dancers, muggers, case studies)

Observation Methods Emic

From within the research itself as a member or participant of some type.

Etic From the outside looking in like a

camera. It can be a peripheral issue or external observer member.

Fundamental Constructs Is usually “etic” on the outside like a camera Sometimes they are “emic”, on the inside as

one of the actors (more in sociology) Researcher is the instrument Fieldwork is where the work occurs Focus is on culture Involves cultural immersion There is a tension and reflexivity between

the researcher as a member or researcher as researcher

Stages of Ethnography Participant observation (gain access,

rapport, trust) Descriptive observation (9) (space, actors,

activities, objects, act, event, time, goal, and feelings)

Ethnographic record (field notes, verbatim, old records, amalgamate the information)

Domain analysis Focused observation (what is now critical)

Stages in Ethnography-2 Taxonomic analyzing (categorize) Componential analysis

(components of the selected areas)

Discover cultural themes Take a cultural inventory Write up the ethnography

Rigors for Ethnography Plausibility

It is very easy to accept as truth Credibility

Not exactly self evident, so you look at sources of evidence

Thick Description Writing in such detail as to know exactly what is

going on. We could also use the Five Standards

Sources of Errors Personal reactivity False inferences Gaps in writing, remembering, and

interpreting Going Native

Grounded Theory Research

Started by Glaser and Strauss in 1967 Used extensively in nursing research Takes into account the concepts of

George Herbert Mead (1934) regarding symbolic interaction theory- how we give meaning to situations, words, objects, symbols

Is very individualistic in meaning Most often used to study areas which

previous research exists

Steps in Grounded Theory are conducted

simultaneously Observation Collection of data Organization of data Review of additional literature Forming theory from the data Using Constant Comparative

Analysis

Data Collection Methods Have qualitative and quantitative

properties

Interviews (one on one, groups) Observation Records (retrospective analysis) Surveys (quantitative) Questionnaires (could be

quantitative) Demographic data

Constructs of Grounded Theory Conceptual framework comes from the

data rather than the literature review There is always an over-riding social

issues being addressed called the Basic Social Process (BSP)

Researcher focuses on dominate processes rather than describing the setting, or unit

You compare all data with all other data

Constructs of Grounded Theory You may change data collection

methods in mid stream to be more appropriate to what has already been discovered

The researcher is to be doing most sequential tasks all at the same time

Constant Comparative Analysis Get data, look at it, look at the

literature, look at previous data, go get more data, look at more literature, look at all the data, etc.

Revise the question, collection method, and keep collecting data, look at literature, compare to old data, etc.

Sampling Methods Called Theoretical Sampling

Based on the current question Add new groups to the sample based

on what it is you have learned (may need more men in the sample, or more people over the age of 70, etc.)

The sample being used moves as the theory develops

Coding the data Look for positive AND negative

cases related to your social process Step One: read, describe, and

interpret Step Two: constant comparison and

clustering Step Three: reduce it to a BSP

Conducting Grounded Theory

Be aware of the social life of the participants Make less assumptions in the beginning Sensitizing to the literature, Bracket if needed Layers of reality are explored, assess your

own energy to go further Spend enough time with participants and data Be observant to how the participants are

doing Learn the symbols being used to create this

reality Sample across time

Case Studiesfrom Stake (2000) and Yin (1994)

These are OBJECT or METHOD issues Object: Has to do with what you want to

study not an approach to how to study it Method: Can be quantitative or

qualitative method (analytically, vs. holistically)

Questions are aimed at “How” or “Why”(rarely “What”)

Single or multiple cases-usually1or 2

Purpose of Case Studies Seeks the unique features (particular) while also

describing the common by describing: The nature of the case The case’s history and background The physical setting Other contexts (economics, political, legal, aesthetic

issues) Other cases through which this case is recognized Through the informants by which the case is known

Examine changes across time (multiple case) Same group of different group

Case Study Rigor Yin (1994) treats this as a positivistic

activity, therefore: Construct, Internal, and external validity Reliability This is not just a pilot study for quasi- or full

experimental designs. It is different. Stake (2000) treats it more naturalistic

Thick description is key Auditability (can it be followed by the reader)

Observational Measurement Could Use all of These


Category Systems Checklists Rating Scales

Emic (from within) Etic (from external view point)

Interview Data Collection


Describing interview questions Pretesting the interview protocol Training interviewers Preparing for an interview Probing Recording interview data

Coding methods

Problem Revisions I am curious about the

standardized treatment protocols for circumcision of a new borne.

NEXT REVISION NEXT REVISION NEXT REVISION NEXT REVISION

Problem Statements-Questions dictates the design

What is experience of police officers who were wounded in the line of duty related to their ability to return to work?

What are the unique features of Hospitals that have NP conducting all surgical admission assessments?

There is (is no) statistically significant difference in iatrogenic diseases between nurse to patient ratios of 1:5 vs 1:8 on General Medical Units.

Does the birthing center philosophy show a relationship to the type of care provided and if so, what is the relationship.

How did the July 08 BSN cohort at DSN obtain a 99% NCLEX pass rate?

Special Research Designs Triangulated, Mixed, Blended Historical Research Action Research Outcome Research Intervention Research

TriangulationBlended Designs

First used by Campbell and Fiske in 1959. Denzin in 1989 identified four different

types. Data Triangulation Investigator triangulation Theoretical triangulation Methodological Triangulation

Kimchi, Polivka, and Stevenson (1991) have suggested a fifth type Multiple Triangulation

Data Triangulation Collection of data from multiple

sources Intent is to obtain diverse views of

the same phenomenon. (Longitudinal is different and is looking for change)

Validate data by seeing if it occurs from different sources

Investigator Triangulation Two or more investigators with

different research backgrounds examining the same phenomenon

Clarifies disciplinary bias Adds to validity of data

Theoretical Triangulation Using all the theoretical

interpretations that could conceivably be applied to a given area

Each view is critically examined for utility and power

Increased the confidence of the hypothesis

Can lead to even greater T. F. beliefs

Methodological Triangulation

The use of two or more research methods in a single study Design level Data collection level

Two major types Within-method (all are one

philosophy) Across-method (across philosophies)

Pros and Cons of Triangulation Very trendy in the 90’s Can be used with smaller N Combined methods may just be

the rise of a new method There are philosophical risks Complex designs and therefore

complex analysis

Action Research: AKA clinical research, clinical inquiry,

A systematic investigation conducted by practitioners involving the use of scientific techniques in order to improve their performance.

Kurt Lewin (1946).

Advantages of Action Research:

The reflective practitioner Contributes to the knowledge base of

teaching practice-self awareness Supports the professional development

of practitioners –more competent in research issues

Builds a collegial network Identifies problems and seeks solutions

in a systematic fashion It can be used at all levels and in all

areas of education

Examples of Action Research Pick a topic Define the problem Select a design Select subjects Collect the data Analyze the data Application of results WHAT MAKES IT ACTION RESEARCH

What Makes it Action Research Invested in rigorously empirical

(positivistic), and reflective and interpretive (naturalistic)

Engages people who have traditionally been called “subjects” who are active in the research process.

Results have a practical outcome related to lives or work of participants.

Outcome Research p.272-317Came from evaluation research of the 70’s and

80’s

Focuses on the end result of patient care and linked to the process that caused the outcome

Momentum is from policy makers, insurers, and the public

Level of concern: 1. Care by clinician, 2. Amenities, 3. Care by the patient, 4. Care received by community

More complex that it may appear

Evaluation of Outcome Research Process Evaluation

Involves Standards of Care Involves Practice Styles Involves Cost of Care

Structure Evaluation Elements of the Structure Philosophies of Management & Decision

Making Process Evaluate Structure Issues and their impact

on the care provided Lacks a set methodology

Indicators of Outcome Research Many Descriptive Indicators for

Nursing Care: NDNQI, Picker, Stage all bed sores on patients at

admission vs. during stay and at discharge.

There must be a clear link between outcome and process

We see practice based web sites: AHRQ, APRNet, PBRN group,

Sampling in Outcome Research Large heterogeneous samples, but not

randomized. They want a full spectrum of the population.

However, they want samples who were treated and those who were not treated to compare differences in outcomes.

Risks, no random sample, small sample sizes are often used putting all their inferential statistics at risk for error.

Intervention Research It is used to give “Causal

Explanations” for what is being seen

Uses quantitative and qualitative methods

It is more than a single research event, but it deals with multiple issues over time

Intervention Research Process Extensive search of what information is

available Heavy emphasis on the intervention and

refining its use Field tested to see if it will work It will involve a host of studies over time Has a host of informants who explain

the local culture and what it will take to get data

Intervention Research Methods

Integrative lit. reviews Consumer publications Standards/ guidelines Meta-analysis Health policy analysis Personal exp.

Reflections Consensus conferences Retrospective chart

reviews Descriptive-

Correlational studies

Observation Case study Focus groups Qual. Studies Concept analysis New media Position Papers Delphi studies Outcome studies

Risk for Use of Intervention Research Risk is asking the wrong question Inadequately trained interveners Poorly defined intervention Many confounding variables that can show

up Too complex to manage and integrate Long time can change many factors: i.e.

who is doing it, where can you still collect data, level of commitment by locations, etc.

Criteria for Intervention Research Design: The intervention is---

Effective Replicable Simple to use Practical Generalizability Compatible with local customs and

values

Historical Research Thought of as qualitative because it

lacks sampling, treating, and controls. Uses Quantitative language, i.e. validity

and reliability of data—best primary sources of data.

Looks at external criticism of data (where, when, by whom), and internal criticism of data (reliability, authentic, biased lens of writer)

Process of Historical ResearchNo Visible Rigor from Qualitative or Quantitative

Research Outline Watch for cross-referencing Be prepared to spend months to years

collecting the data Careful attention to note taking for all

data collection A synthesis of all the data collected and

may need an interpretive strategy Develop a writing outline Write your Historiography

Nursing Research

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