Tag Archives: nursing

Research design

Ebola or Other Outbreak: When We Can’t or Shouldn’t Experiment

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 What do we do to study the cause of disease when we cannot or should not expose people to disease risk (i.e., manipulate the independent variable). For example, while we want to understand Ebola transmission and outcomes, legally and ethically we cannot & should not expose people to Ebola risk factors.   We cannot do Ebola experiments on people.

Thus, we have to observe what happens when nature takes its course. One common research design in which we let disease/nature take its course is a case-control study. What is a case-control study?

Here’s a quick explanation.   The researcher looks for people who have (or had) the disease and then looks back in time at their history of exposure to risk factors for the disease. Those who have been exposed and who did not (or not yet) get the disease are the control subjects. If risk factors for the disease are not well-known then it may be difficult to find control subjects because we would have a hard time telling who was exposed.

Case-control and other studies in which we look back at what happened in the past are called retrospective studies. (In contrast, most nursing studies are prospective studies—in other words they start at the present and move forward. For example, if we were doing research on Ebola symptom management, we would try out symptom management strategies on persons with Ebola and measure into the future how well those strategies work.)

A great flow diagram and clear explanation of case control studies is at http://www.ciphi.ca/hamilton/Content/content/resources/explore/fb_case_v_cohort.html . Check it out!

Critical thinking practice: If you were to design a case-control study related to information in the excerpt below, answer these questions:

  • Who would be the case subjects?  
  • Who would be the control subjects?
  • What are the risk factors?
  • Why would the study be retrospective?

“Ebola virus, a member of the Filoviridae group, is transmitted by direct contact with blood, secretions, or contaminated objects and is associated with high case-fatality rates (28). Investigations of outbreaks in Africa suggest that Ebola infection may be more severe during pregnancy and that mortality rates are higher. Pregnant women infected with Ebola more often have serious complications, such as hemorrhagic and neurologic sequelae, than do nonpregnant patients (31). Unlike risk for death from Lassa fever, which is highest during the third trimester of pregnancy, risk for death from Ebola is similar during all trimesters (33).” (Jamieson et al, 2006, http://wwwnc.cdc.gov/eid/article/12/11/06-0152_article)

 

Evidence based nursing, Professional Nursing

In Conclusion: “Back to the future”

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A great conclusion to a study can take several forms.   One of these is like the abstract. The researcher summarizes the entire study in 100-200 words or so.   Researchers can also end with the suggestions for future research or an intriguing quote.   A great conclusion will give you the “bottom line” of why the study is important to you!

Thus it is sometimes valuable when FIRST encountering a new research article, to scan the abstract, intro, discussion/implications, and conclusion FIRST.   This will give you the big picture—the 30,000 foot level picture. Then you can get down at “ground level” and read the whole research article more carefully.

Research reports are Not mystery novels, and the plot will Not be spoiled if you read the conclusion first!  You may find that doing this makes it easier to understand the article.

If you are writing a research report yourself, then make sure that you keep the conclusion lively and interesting!   You know your project—what is THE main take away that you want readers to have?

CRITICAL THINKING….

Assume that you read the following Conclusion from Brown & McCormack (2006) BEFORE reading the rest of the article.   What ideas would you look for in the article that show up here in this “end-of-the-article-abstract-and-implications”? Which of their conclusions would you check out within the main article?

     This ethnographic study highlighted a number of issues that affected the older persons’ pain experience in the acute surgical setting. Additionally, it provided insight into how nurses approached the assessment and management of pain in this patient group. The study demonstrated the value of applying multiple sources and methods of data collection in order to obtain a more complete view of the competing forces that operate within the ward environment.

     Data analysis revealed three action cycles for further developmental work – pain assessment practices, knowledge/ insight and strategies to cope with episodes of uncontrolled pain and organization of care, along with ward culture, have been identified as having an inhibitory effect on pain management in older people. In addition, recognition that patient barriers may contribute to ineffective pain management is a point worthy of consideration.

     Improving pain management practices, therefore, requires healthcare professionals to reflect on reactions, values and beliefs surrounding pain and examine how these have the potential to influence the care provided. Consequently, there is a need for a focused, collaborative, interdisciplinary approach to challenge current pain management practices and implement change. There is a growing acknowledgement that successful interventions must deploy multiple strategies, targeting aspects of the individual, the organization, its culture and characteristics of the message, simultaneously (Kitson 2001). (p.1296)

Reference: Brown, D., & McCormack, B. (2006). Determining factors that have an impact upon effective evidence-based pain management with older people, following colorectal surgery: An ethnographic study. The Authors. Journal compilation, 1987-1298. doi: 10.1111/j.1365-2702.2006.01553.x

Evidence based nursing, Professional Nursing

NEW site to Discovering Your Inner Scientist

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Welcome to my new Discovering Your Inner Scientist blog location–a site focused on nursing evidence-based practice and scientist interests!  This site should be more user-friendly.

The blog remains focused on the interests primarily of staff RNs and is inspired by my colleagues at Dignity Health Northridge Hospital Medical Center.

For earlier posts on how to read research, go to http://discoveringyourinnerscientist.blogspot.com/  .   I plan to pick up the discussion here where that site left off, and I will continue to welcome your comments.