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.)

Share for Sure! Quality it is

Share your quality projects for sure!  You learned from them & so can the larger community.   Make your voice heard.

Let below encourage you to encourage you to publish, present, disseminate your quality improvement projects!!share

Davidoff & Batalden in 2005 wrote these words that still apply today:

In contrast with the primary goals of science, which are to discover and disseminate new knowledge, the primary goal of improvement is to change performance. Unfortunately, scholarly accounts of the methods, experiences, and results of most medical quality improvement work are not published, either in print or electronic form. In our view this failure to publish is a serious deficiency: it limits the available evidence on efficacy, prevents critical scrutiny, deprives staff of the opportunity and incentive to clarify thinking, slows dissemination of established improvements, inhibits discovery of innovations, and compromises the ethical obligation to return valuable information to the public.The reasons for this failure are many: competing service responsibilities of and lack of academic rewards for improvement staff; editors’ and peer reviewers’ unfamiliarity with improvement goals and methods; and lack of publication guidelines that are appropriate for rigorous, scholarly improvement work. We propose here a draft set of guidelines designed to help with writing, reviewing, editing, interpreting, and using such reports. We envisage this draft as the starting point for collaborative development of more definitive guidelines. We suggest that medical quality improvement will not reach its full potential unless accurate and transparent reports of improvement work are published frequently and widely.
share2
Critical thinking: 
What is a QI project on your unit in which others might be interested? Sketch out an outline using headings recommended here: http://ocpd.med.umich.edu/moc-qi/presenting-publishing-qi

For more Info see Davidoff & Batalden. (2005). Toward stronger evidnece on quality improvment. Draft publication guidelines: the beginning of a consensus project. Quality & Safety in Health Care, 14, 319-32. doi:10.1136/qshc.2005.014787

Not Just The Thought That Counts! (or is it?) Evidence-based gift giving.

Is it just the thought that counts?  or not?   (Probably depends on the relationship between giver & recipeient as per Paul Tournier’s The Meaning of Gifts that I highly recommend.)

In the meantime enjoy this article in the Washington Post on the holiday evidence for picking the best kinds of gifts.   OR as it is actually titled: “The trick to not giving a terrible gift this year”

Critical Thinking: Note the outcome measures cited for each study:

  1. Were they direct or indirect; & what is the advantage of eachgifts
  2. Were they self-report or observation; & what are the pros & cons of each?
  3. Were the studies descriptive? or experimental?   What does that tell you about cause & effect?
  4. Read Tournier’s tiny book, The Meaning of Gifts & draw your own conclusions.

For more info:  Ask yourself what you would most like for Christmas & check out your friends wishlists!   Check some of the studies cited in the Washington Post article, including Gino & Flynn (2011) evidence on preferences for $, solicited gifts, & unsolicited gifts.  The findings might surprise you:  http://www.sciencedirect.com/science/article/pii/S0022103111000801

 

 

“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.   

What are you asking? (or “Can HCAHPS sometimes be a DIRECT measure?”)

In a prior blog (Direct speaking about INdirect outcomes: HCAHPS as a measurement*), I argued that HCAHPS questions were indirect measures of outcomes.  Indirect measures are weaker than direct measures because they are influenced by tons of variables that have nothing to do with the outcome of interest.  But wait!! There’s more!  HCAPS can sometimes be a DIRECT measure; it all depends on what you want to know.

(If you know this, then you are way ahead of many when it comes to measuring outcomes accurately!!)

KEYKEY POINTS:

  • If your research question is what do patients remember about hospitalization then HCAHPS is a DIRECT measure of what patients remember.  
  • However if your research question is what did hospital staff actually do  then HCHAPS is an INDIRECT* measure of what staff did. 

What is HCAHPS?  HCAHPS (pronounced “H-caps”)  questions are patient perceptions of what happened, which may or may not be what actually happened.    Patients are asked to remember their care that happened in the past, and memories may be less than accurate. (See this link for more on what HCAHPS is: http://www.hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf )

Example:  HCAHPS question #16 is, “Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?”    Whether the patient answers yes or thinkerno, the response tells us only how the patient remembers it.

Why is this important?     

  • Because if you want to know whether or not RNs actually taught inpatients about their medications, then for the most direct & accurate measure you will have to observe RNs .
  • However, if you want to know whether patients remember RNs teaching them about discharge medications, then HCAHPS question #16 is one of the most direct & accurate measure of what they remember.

*FOR MORE INFORMATION on why you want to use DIRECT measures SanDiegoCityCollegeLearningResource_-_bookshelfsee https://discoveringyourinnerscientist.com/2016/11/04/direct-speaking-about-idirect-outcomes-hcahps-as-a-measurement/

CRITICAL THINKING Pick any HCAHPS question at this link and write a research question that for which it would be a DIRECT outcome measure: question(http://www.hcahpsonline.org/files/March%202016_Survey%20Instruments_English_Mail.pdf)

For your current project, how are you DIRECTLY measuring outcomes?

Bake it into your project cake!

In the last post we compared stronger direct measures of outcomes with weaker indirect
measuremeasures of project outcomes.

So…what direct measures are you “baking into your project cake”? What do you hope will be your project outcome & what measurement will show that you achieved it? –pain scores? weight? skin integrity? patient reports of a sound night’s sleep?  Share your story.  Help others learn.

Or if you just stuck with HCAHPS (or other) as outcome measure, explain why that was the best choice for your project.  (Maybe in your case it was a direct measure!)

Happy measuring!

For More Info on direct vs. indirect measures & Critical thinking: Check out t Direct speaking about INdirect outcomes: HCAHPS as a measurementquestion

Direct speaking about INdirect outcomes: HCAHPS as a measurement

When you first plan a project, you need to know what OUTCOMES you want to achieve.  You need STRONG outcomes to show your project worked! imagesCALQ0QK9

Outcome measures are tricky & can be categorized into Indirect & Direct measures:

  1. INDIRECT outcome measures are often affected by many factors, not just your innovation
  2. DIRECT outcome measures are specific to what you are trying to accomplish.

For example: If you want to know your patient’s weight, you put them on the scale (direct). weight-scaleYou don’t merely ask them how much they weigh (indirect).

Another example?  If you planned music to reduce pain, you might a) measure how many patients were already using music and their pain scores (& perhaps those not using music and their pain scores), b) begin your music intervention, and c) thmusicen directly measure how many patients started using it after you started your intervention and their pain scores.  These data DIRECTLY target your inpatient outcomes versus looking at INDIRECT HCAHPS answers of discharged patients’ feelings after the fact in response to “During this hospital stay, how often was your pain well controlled?”

Nurses often decide to measure their project outcomes ONLY with indirect HCAHPS scores.  I hope you can see this is not as good as DIRECT measures.

So why use HCAHPS at all?measuring-tape

  • They reflect institutional priorities related to quality and reimbursement
  • Data are already collected for you
  • Data are available for BEFORE and AFTER comparisons of your project outcomes
  • It doesn’t cost you any additional time or money to get the data

Disadvantages of indirect HCAHPS measures?

  • HCAHPS data are indirect measures that are affected by lots of different things, and so they may have little to do with effect of your project.
  • HCAHPS responders often do Not represent all patients because the number responding is so small–sometimes just 1 or 2

Still, I think it’s good to include HCAHPS.  Just don’t limit yourself to that. Include also a DIRECT measure of outcomethat targets the precisely what you hope will be the result of your study.

imagesCALQ0QK9You need STRONG outcomes to convince others that your project works to improve care!

CRITICAL THINKING:  McClelland, L.E., &  Vogus, T.J. (2014) used HCHAPS as an outcome measure in their study, Compassion practices & HCAHPS: Does rewarding and supporting questionworkplace compassion influence patient perceptions?    What were the strengths & weaknesses of using HCHAPS in this study? [hint: check out the discussion section]  What would be a good direct measure that you could add to HCAHPS outcomes to improve the study?

FOR MORE INFORMATION:  Whole books of measurement instruments are available through the library or a librarian can help you search for something that will measure motivation, pain, anxiety, medication compliance, or whatever it is you are looking for!!  You can limit your own literature searches by selecting “instrument” as part of your search, or you can consult with a nurse researcher for more help.

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