Category Archives: research

Nightingale: Avante garde in meaningful data

In honor of Nurse Week, I offer this tribute to the avante garde research work of Florence Nightingale in the Crimea that saved lives and set a precedent worth following.

Nightingale was a “passionate statistician” knowing that outcome data are convincing when one wants to change the world.  She did not merely collect the data, but also documented it in a way that revealed its critical meaning for care.

As noted by John H. Lienhard (1998-2002): Nightingale coxcombchart“Once you see Nightingale’s graph, the terrible picture is clear. The Russians were a minor enemy. The real enemies were cholera, typhus, and dysentery. Once the military looked at that eloquent graph, the modern army hospital system was inevitable.  You and I are shown graphs every day. Some are honest; many are misleading….So you and I could use a Florence Nightingale today, as we drown in more undifferentiated data than anyone could’ve imagined during the Crimean War.” (Source: Leinhard, 1998-2002)

As McDonald (2001) writes in the BMJ free, full-text,  Nightingale was “a systemic thinker and a “passionate statistician.”  She insisted on improving care by making policy & care decisions based on “the best available government statistics and expertise, and the collection of new material where the existing stock was inadequate.”(p.68)

Moreover, her display of the data brought its message home through visual clarity!

Thus while Nightingale adhered to some well-accepted, but mistaken, scientific theories of the time (e.g., miasma) her work was superb and scientific in the best sense of the word.   We could all learn from Florence.

CRITICAL THINKING:   What issue in your own practice could be solved by more data?  How could you collect that data?   If you have data already, how can you display it so that it it meaningful to others and “brings the point home”?

FOR MORE INFO:

HAPPY NURSE WEEK TO ALL MY COLLEAGUES.  

MAY YOU GO WHERE THE DATA TAKES YOU!

 

 

So you want to do a research study…..

So you want to do a research study?   Wonderful!

Here are 5  bits of advice to get started:

  1. If you haven’t done a scientific research study before or don’t have a PhD, then realize that your project will go much more smoothly if you consult with a PhD or someone with experience.

You bring the great clinical ideas, & the experienced researcher will bring research design expertise.  The design is the overall research plan for getting and analyzing the data to answer your question or to find out how well your new ideas work.  That person resiliencewill know the technical things you need to plan into your study in order to make the study ‘sparkle’ and to get approval from human subjects review committees.  The person doesn’t have to be an expert on your topic.  You fill that role, or soon will!

  1. If you have access to a librarian who is good at helping you look for current literature, s/he is one of your Best friends in getting a project done.

Searching for on-target literature from the millions of publications out there takes some special skills.  Of course you can learn these on your own, but how much nicer to talk with a librarian about the key ideas in your project and allow them to use their special skills to help you.  As an experience researcher, I can tell you that good Heart Bookslibrarians are worth their weight in gold!  Librarians can help you find what others have learned about your topic already, and then you can build on that knowledge.  [note: check out Finding the Needles in the Haystacks: Evidence Hunting Efficiently & Effectively for more]

  1. Because it’s your first foray into research, you might want to stick with a descriptive study.

What does that mean?  It means that you will collect data about what the current situation is.  For example, you might measure the average days to return of bowels sounds on your unit, OR the number of minutes it takes to do some task, OR the interruptions of patient sleep during the night.  describeThis will help you to establish whether or not there really is a problem to be solved.  Descriptive studies are much simpler to conduct and analyze than experimental studies in which you measure something, make an improvement, and then see if the improvement improved things. For example, you would measure sleep interruptions, institute a quiet time, and then measure sleep interruptions again to see if there were fewer.  [check out “What it is.” – a primer on descriptive studies for more]

  1. Pick a topic you are really jazzed about!

jazzEvery researcher from time to time can feel ‘bogged down’ or bored with what they are doing, & one of the best protections against that is making sure you think the topic is super-interesting in the first place.  If you get a little bored or stuck later don’t be surprised; it just means you’re pretty normal.  Those stuck times might even feel like “hitting the wall” in a long race, and once you get past it things get better.   Remind yourself why you loved the topic in the first place.  Talk to your PhD friend or a mentor for encouragement.  Take a little break.  Read something really interesting about your topic.

  1. Have fun!

While not every step of the research study process will make you want to jump up, sing, and dance, the process as a whole is really rewarding and great fun.  You will be empowered by new learning—not just about your topic, but about how to do research!

Critical thinking:  What’s a topic of interest to YOU?   Write a descriptive question that you could answer with research.  (Check out You Got A Problem With That? Try PICO*for more help.)

“Here Comes Santa Claus?” What IS the Evidence?

How strong is the evidence regarding our holiday Santa Claus (SC) practices? And what are the opportunities on this SC topic for new descriptive, correlation, or experimental research?  Although existing evidence generally supports SC, in the end we may conclude, “the most real things in the world are those that neither children nor men can see” (Church, as cited in Newseum, n.d.).santa3

If you want to know the answers, check out: Highfield, M.E.F. (2011).  Here comes Santa Claus: What’s the evidence? Advanced Emergency Nursing Journal, 33(4), 354-6. doi: http://dx.doi.org.libproxy.csun.edu/10.1097/TME.0b013e318234ead3   Using bona fide published work, the article shows you how to evaluate the strength of evidence and how to apply it to practice.   You can request a full-text for your personal use from your library or from the author via www.researchgate.net/home .  

Critical thinking: Check out this related research study with fulltext available through PubMed: Black Pete through the eyes of Dutch children
(https://www.ncbi.nlm.nih.gov/pubmed/27322583 ).   Write a follow-up research question based on the findings of this study & post in comments below.

For more info: For those unfamiliar with ResearchGate, it is a site where you can track authors who publish in your area of interest, and you can set up your own profile so that people can track your work.  Take a look.   

Your chance to shine!

Join the Honor Society of Nursing, Sigma Theta Tau International and more than 2,000 of your peers in Indianapolis, Indiana, USA, 28 October – 1 November 2017, for the 44th Biennial Convention. Experience STTI’s largest event, which features more than 800 oral and poster presentations, networking opportunities, and more.

Call for Abstracts
Opportunities are now available to submit abstracts for the 44th Biennial Convention.
Submission Deadline: 9 November 2016.

For more information: http://www.nursingsociety.org/connect-engage/meetings-events/biennial-convention/call-for-abstracts

Ouch! Whose Pain Feels Worse?

levels-of-evidenceIs pain experience as diverse as our populations?  This week I came across an interesting meta-analysis.

A meta-analysis (MA) is one of the strongest types of evidence there is. Some place it at the top; others, 2nd after evidence-based clinical practice guidelines.  (For more on strength of  evidence, click here.)

MA is not merely a review of literature, but is a statistical integration of studies on the same topic.  MA that is based on integration of randomized controlled trials experiment(RCTs) or experimental studies is the strongest type of MA.  MA based on descriptive or non-experimental studies is  a little less strong, because it just describes things as they seem to be; & it cannot show that one thing causes another.

MA example: This brand, new MA included 41  peer-reviewed, English-language, experimental studies with humans:  Kim HJ, Yang GS, Greenspan JD, Downton KD, Griffith KA, Renn CL, Johantgen M, Dorsey SG. Racial and ethnic differences in experimental pain sensitivity: Systematic review and meta-analysis. Pain. 2016 Sep 24 [Epub ahead of print] doi: 10.1097/j.pain.0000000000000731. PMID: 27682208.    All 41 studies used experimental pain stimuli such as heat, cold, ischemic, electrical and others and compared differences between racial/ethnic groups.

Pain reliefMain findings?  “AAs [African Americans], Asians, and Hispanics had higher pain sensitivity compared to NHWs [non-Hispanic Whites], particularly lower pain tolerance, higher pain ratings, and greater temporal summation of pain.” (https://www.ncbi.nlm.nih.gov/pubmed/27682208)  (Temporal summation is the increase in subjective pain ratings as a pain stimulus is repeated again and again.)

Critical thinking:  Given that this is a well-done meta-analysis and that the pain was created by researchers in each study, how should this changequestion your practice?  Or should it?   How can you use the findings with your patients?  Should each patient be treated as a completely unique individual? Or what are the pros & cons of using this MA to give us a starting point with groups of patients?  [To dialogue about this, comment below.]

For more info? Request the full Kim et al. article via interlibrary loan from your med center or school Heart Bookslibrary using reference above.   It is available electronically pre-publication.   Also check out my blog on strength of different types of evidence.

Happy evidence hunting. -Dr.H

“Two roads diverged in a yellow wood, and sorry I could not travel both and be one traveler, long I stood and looked down one as far as I could…” R.Frost

Below is my adaptation of one of the clearest representations that I have ever seen of when the roads diverge into quality improvement, evidence-based practice, & research.  Well done, Dr. E.Schenk PhD MHI, RN-BC!qi-ebp-research-flow-chart