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)
Bivariate Data AnalysisIndependent Groups
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)
Bivariate Data AnalysisIndependent Groups
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
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
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
Unstructured Structured
Category Systems Checklists Rating Scales
Emic (from within) Etic (from external view point)
Interview Data Collection
Unstructured Structured
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
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