Tag Archives: reading research

Correlation research, non-experimental research, Uncategorized

Correlation Studies: Primer on Design Part 2

Leave a comment

REMEMBER:

Research design = overall plan for a study.

The 2 major categories of research study design are:

  1. Non-experimental, observation-only studies, &
  2. Experimental testing of an intervention studies.

Correlation study designs are in that first category. Correlation studies focus on whether changes in at least one variable are statistically related to changes in another. In other words, do two or more variables change at the same time.

Such studies do not test whether one variable causes change in the other. Instead they are analogous to the chicken-and-egg dilemma in which one can confirm that the number of chickens and eggs are related to each other, but no one can say which came first or which caused the other. Correlation study questions may take this form, “Is there a relationship between changes in [variable x] and changes in [variable y]?” while a correlation hypothesis might be a prediction that, “As [variable x] increases, [variable y] decreases.”

An example of a question appropriate to this design is, “Are nurses’ age and educational levels related to their professional quality of life?” Sometimes a yet-unidentified, mediating variable may be creating the changes in one or all correlated variables. For example, rising nurse age and education may make them likely to choose certain work settings with high professional quality of life; this means the mediating variable of work setting—not age or education—might be creating a particular professional quality of life.

Alert! Correlation is not causation.
Descriptive research, Research design

Primer on Research Design: Part 1-Description

Leave a comment

A research design is the investigator-chosen, overarching study framework that facilitates getting the most accurate answer to a hypothesis or question. Think of research design as similar to the framing of a house during construction. Just as house-framing provides structure and limits to walls, floors, and ceilings, so does a research design provide structure and limits to a host of protocol details.

Tip. The two major categories of research design are: 1) Non-experimental, observation only and 2) Experimental testing of an intervention.

DESCRIPTIVE STUDIES

Non-experimental studies that examine one variable at a time.

When little is known and no theory exists on a topic, descriptive research begins to build theory by identifying and defining key, related concepts (variables). Although a descriptive study may explore several variables, only one of those is measured at a time; there is no examination of relationships between variables. Descriptive studies create a picture of what exists by analyzing quantitative or qualitative

data to answer questions like, “What is [variable x]?” or “How often does it occur?” Examples of such one-variable questions are “What are the experiences of first-time fathers?” or “How many falls occur in the emergency room?” (Variables are in italics.)  The former question produces qualitative data, and the latter, quantitative.

Descriptive results raise important questions for further study, and findings are rarely generalizable. You can see this especially in a descriptive case study: an in-depth exploration of a single event or phenomena that is limited to a particular time and place. Given case study limitations, opinions differ on whether they even qualify as research.

Descriptive research that arises from constructivist or advocacy assumptions merits particular attention. In these designs, researchers collect in-depth qualitative information about only one variable and then critically reflect on that data in order to uncover emerging themes or theories. Often broad data are collected in a natural setting in which researchers exercise little control over other variables. Sample size is not pre-determined, data collection and analysis are concurrent, and the researcher collects and analyzes data until no new ideas emerge (data saturation). The most basic qualitative descriptive method is perhaps content analysis, sometimes called narrative descriptive analysis, in which researchers uncover themes within informant descriptions. Figure 4 identifies major qualitative traditions beyond content analysis and case studies.

Alert! All qualitative studies are descriptive, but not all descriptive studies are qualitative.

Box 1. Descriptive Qualitative Designs

DesignFocusDiscipline of Origin
EthnographyUncovers phenomena within a given culture, such as meanings, communications, and mores.Anthropology
Grounded TheoryIdentifies a  basic social problem and the process that participants use to confront it.Sociology
PhenomenologyDocuments the “lived experience” of informants going through a particular event or situation.Psychology
Community participatory actionSeeks positive social change and empowerment of an oppressed community by engaging them in every step of the research process.Marxist political theory
FeministSeeks positive social change and empowerment of women as an oppressed group.Marxist political theory
Data collection, nursing research, Outcome measurement, quantitative research, reading research, Reliability & validity, research, research methods

Testing the Test (or an intro to “Does the measurement measure up?”)

Leave a comment

When reading a research article, you may be tempted only to read the Introduction & Background, then go straight to the Discussion, Implications, and Conclusions at the end. You skip all those pesky, procedures, numbers, and p levels in the Methods & Results sections.

Perhaps you are intimidated by all those “research-y” words like content validity, construct validity, test-retest reliability, and Cronbach’s alpha because they just aren’t part of your vocabulary….YET!

WHY should you care about those terms, you ask? Well…let’s start with an example. If your bathroom scale erratically measured your weight each a.m., you probably would toss it and find a more reliable and valid bathroom scale. The quality of the data from that old bathroom scale would be useless in learning how much you weighed. Similarly in research, the researcher wants useful outcome data. And to get that quality data the person must collect it with a measurement instrument that consistently (reliably) measures what it claims to measure (validity). A good research instrument is reliable and valid. So is a good bathroom scale.

Let’s start super-basic: Researchers collect data to answer their research question using an instrument. That test or tool might be a written questionnaire, interview questions, an EKG machine, an observation checklist, or something else. And whatever instrument the researcher uses needs to give them correct data answers.

For example, if I want to collect BP data to find out how a new med is working, I need a BP cuff that collects systolic and diastolic BP without a lot of artifacts or interference. That accuracy in measuring BP only is called instrument validity. Then if I take your BP 3 times in a row, I should get basically the same answer and that consistency is called instrument reliability. I must also use the cuff as intended–correct cuff size and placement–in order to get quality data that reflects the subject’s actual BP.

The same thing is true with questionnaires or other measurement tools. A researcher must use an instrument for the intended purpose and in the correct way. For example, a good stress scale should give me accurate data about a person’s stress level (not their pain, depression, or anxiety)–in other words it should have instrument validity. It should measure stress without a lot of artifacts or interference from other states of mind.

NO instrument is 100% valid–it’s a matter of degree. To the extent that a stress scale measures stress, it is valid. To the extent that it also measures other things besides stress–and it will–it is less valid. The question you should ask is, “How valid is the instrument?” often on a 0 to 1 scale with 1 being unachievable perfection. The same issue and question applies to reliability.

Reliability & validity are interdependent. An instrument that yields inconsistent results under the same circumstances cannot be valid (accurate). Or, an instrument can consistently (reliably) measure the wrong thing–that is, it can measure something other than what the researcher intended to measure. Research instruments need both strong reliability AND validity to be most useful; they need to measure the outcome variable of interest consistently.

Valid for a specific purpose: Researchers must also use measurement instruments as intended. First, instruments are often validated for use with a particular population; they may not be valid for measuring the same variable in other populations. For example, different cultures, genders, professions, and ages may respond differently to the same question. Second, instruments may be valid in predicting certain outcomes (e.g., SAT & ACT have higher validity in predicting NCLEX success than does GPA). As Sullivan (2011) wrote: “Determining validity can be viewed as constructing an evidence-based argument regarding how well a tool measures what it is supposed to do. Evidence can be assembled to support, or not support, a specific use of the assessment tool.”

In summary….

  1. Instrument validity = how accurate the tool is in measuring a particular variable
  2. Instrument reliability = how consistently the tool measures whatever it measures

Fun Practice: In your own words relate the following article excerpt to the concept of validity? “To assess content validity [of the Moral Distress Scale], 10 nurses were asked to provide comments on grammar, use of appropriate words, proper placement of phrases, and appropriate scoring.“ From p.3, Ghafouri et al. (2021). Psychometrics of the moral distress scale in Iranian mental health nurses. BMC Nursing. https://doi.org/10.1186/s12912-021-00674-4

reading research, Research student, Writing

Easy to read. Hard to write.

2 Comments

Musings:  For me the most difficult to write sections of a research report are the Intro/Background and Discussion.  And yet,  those are apparently the easiest to read for many.   My students at least tend to read only those sections and skip the rest.

Why? For the author, Intro/Background and Discussion require hard, critical thinking about what is already known about the topic (Intro/Background) and then what one’s findings mean in light of that (Discussion).  For research consumers, the language used in these sections is more familiar, ordinary sounding words.  On the other hand, writing the technical nature of other sections (Methods, Instruments, Results) is pretty straightforward with scientifically standardized vocabulary and structure.  But, for readers, those same sections contain potentially unfamiliar research terminology that is not part of everyday conversation– i.e., scientific vocabulary.  Quantitative studies often create more reader difficulty.

My solution for myself as a writer? To spend time making sure that the first sentence of every paragraph in Intro/Background and Discussion makes a step-by-step argument supported by the rest of the paragraph. Follow standardized structure for the rest.  Keep  language  precise  yet  simple  as  possible.

Solution for research readers? Read the whole article understanding what you can and keep a research glossary handy (e.g., https://sites.google.com/site/nursingresearchaid/week-1. Even if practice doesn’t make you perfect, it works in learning a new language–whether it is  a ‘foreign’ language or a scientific one.

Critical Thinking:  Test out your reading skills with this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503597/   .  Do the authors make systematic arguments in Intro/Background & Discussion? What makes this article hard or easy to read?

Happy Summer! -Dr.H

Literature review, reading research

Introduction to Introductions!

1 Comment

In a couple of recent blog entries I noted what you can and cannot learn from research 1) titles & 2) abstracts. Now, let me introduce you to the next part of research article:  Introduction (or sometimes called Background or no title at all!).   Introduction immediately follows the abstract.Start

The introduction/background  “[a] outlines the background of the problem or issue being examined, [b] summarizes the existing literature on the subject, and [c] states the research questions, objectives, and possibly hypothesis” (p. 6, Davies & Logan, 2012)

This section follows the abstract. It may or may not have a heading(s) of “Introduction” or “Background” or both.  Like the abstract, the Introduction describes the problem in which the researcher is interested & sometimes the specific research question or hypothesis that will be measured.

In the Intro/Background you will get a more full description of why the problem is a priority for research and what is already known about the problem (i.e., literature writing-handreview).

Key point #1: Articles & research that are reviewed in theIntro/Background should be mostly within the past 5-7 years.  Sometimes included are classic works that may be much older OR sometimes no recent research exists.   If recent articles aren’t used, this should raise some questions in your mind.   You know well that healthcare changes all the time!!  If old studies are used the author should explain.

Key point #2:  The last sentence or two in theIntro/Background is usually the research question or hypothesis (unless the author awards it its own section).  If you need to know the research question/hypothesis right away, you can skip straight to the end of the Intro/background—and there it is!

Critical Thinking: 1) Read the abstract then 2) Read the 1st section of this 2015 free full-text article by Marie Flem Sørbø et al.:  Past and recent abuse is associated with early cessation of breast feeding: results from a large prospective cohort in Norway

  • Is it called Introduction/Background or both?
  • What literature is already available on the problem or issue being examined?
  • What are the research questions/hypotheses?  (After reading above you should know exactly where to look for these now.)

For More Info:  Check out especially Steps #1, #2, & #3 of How to read a research article.

Evidence based nursing, evidence based practice, Literature review, reading research, research

33,000 foot view isn’t enough! Get down on the Ground To See What’s Really Happening!

1 Comment

My last blog post listed the usual sections of a research report (title, abstract, introduction, methods, results, & discussion/conclusion); and I illustrated the amazing things you can learn from only an article title!Its not enough

This week? Abstracts.   Abstracts are great; abstracts are not enough!

An abstract gives us only enough info to INaccurately apply the study findings to practice.

An abstract typically summarizes all the other sections of the article, such as  the question the researcher wanted to answer, how the researcher collected data to answer it, and what that data showed.  This is great when you are trying to get the general picture, but you should Never assume that the abstract tells you what you need to know.

Wrong WayAbstracts can mislead you IF you do not read the rest of the article.  They are only a short 100-200 words and so they leave out key information.   You may misunderstand study results if you read only the abstract.   An abstract’s 33,000 foot level description of a study, cannot reveal the same things that can be revealed in the up-close & personal description of the full article.

So…what is the takeaway?  Definitely read the abstract to get the general idea.  Then read the full article beginning to end to get the full & beautiful picture of the study.  Davies & Logan (2012) Butterflyencourage us,  Don’t give up reading the full article just because some parts of the study may be hard to understand.  Just read and get what you can, then re-read the difficult-to-understand parts.  Get some help with those PRN.

 

Critical thinking:   What info is missing from the below abstract that you might want to know?

J Nurses Prof Dev. 2016 May-Jun;32(3):130-6. doi: 10.1097/NND.0000000000000227.    Partnering to Promote Evidence-Based Practice in a Community Hospital: Implications for Nursing Professional Development Specialists. Highfield ME1, Collier A, Collins M, Crowley M.

ABSTRACT: Nursing professional development specialists working in community hospitals face significant barriers to evidence-based practice that academic medical centers do not. This article describes 7 years of a multifaceted, service academic partnership in a large, urban, community hospital. The partnership has strengthened the nursing professional development role in promoting evidence-based practice across the scope of practice and serves as a model for others.

More info on abstracts & other components of research articles?  Check out Davies & Logan (2012) Reading Research published by Elsevier.

Literature review, Professional Nursing

It was the best of evidence; it was the worst of evidence.

Leave a comment

evidencebased practiceEvidence-based practice = best available evidence + expert clinical judgment + patient & family values/preferences.

When clinicians diagnose & treat based on outdated or inadequate knowledge, then outcomes are at best uncertain.  The internet itself is a poor information source; & colleagues may be no more up-to-date that you.

Good sources are the world-wide Cochrane Collaboration and the specific evidence-based Homepractice journals that are beginning to grow–these take best information from the research report all the way through clinical recommendations.   For research reports per se, PubMed is a comprehensive, U.S. tax-supported Findingsdatabase; & there when you find information that fits using your key search terms, you can also look for related articles & get full-text through interlibrary loan or online.  Another strategy is take the article that fits your clinical issue to your librarian, and ask for help in finding more research on the identical clinical issue.

While no one can read everything in the literature, everyone can read something. You can do a focused review on any particular problem.

Critical thinking:  Is there a clinical issue that you think could use a better solution?  Plug related words into PubMed & see what you can learn.question

For more information see fulltext at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC226388/

Evidence based nursing, IOM, Leadership, Professional Nursing, reading research

Strong nursing leadership is essential to evidence-based practice

1 Comment

priority“The Institute of Medicine (IOM) set a goal that, by 2020, the majority of healthcare practices and decisions would be evidence-based. … Yet…only three percent of the executive-level nurse leaders surveyed ranked EBNP as a top priority at their own organizations. What’s worse, more than half said EBNP is practiced at their organizations only “somewhat” or “not at all.”  Posted on July 19, 2016 by HTimothy  at American Sentinel.   

For full text see the source link: http://www.americansentinel.edu/blog/2016/07/19/strong-nursing-leadership-is-essential-to-evidence-based-practice/

Critical Thinking: Given all the demands of the healthcare questionenvironment, how can we make this goal happen.   

Evidence based nursing, Grounded theory, pain assessment, Pain management, Qualitative research, Uncategorized

Afraid to Relieve Pain? You may have Opiophobia

Leave a comment

fear5In pain management are you afraid to give comfort to your patients with appropriate medications?   Are you afraid to be comforted when in pain?  Have you encountered families or care partners, who are afraid to comfort their loved one in pain by giving pain medications?

In a classic 2002 qualitative study, “Fearing to Comfort,” Zerwekh, Riddell, & Richard identified that RNs, physicians, patients, families, and health systems were afraid to relieve pain with appropriate use of pain medications.  They were Not doing evidence-based practice, but fear-based practice. barrier

Fear barriers include, but are not limited to 1) patients’ fear of addiction, fear of distracting the MD from the main treatment plan, and loss of control; 2) MDs’ avoiding the needs of the dying, fear of rewarding drug-seekers, or equating pain management with euthanasia; 3) RNs’ avoiding pain, failing to switch to palliative goals at end of life,  and fear of killing the patient; 4) families’ fears of addiction, side effects, & killing their loved one; and 5) health facilities’ not giving unique consideration to those at end of life, inadequate staffing, & time constraints (Zerwekh et al., 2002).

This is an issue because irrational problems cannot be simply solved by giving rational Pain fistinformation.   We have to find evidence-based practices that can create a change of heart, if you will.  As Zerwekh et al wrote: “Because fear is so influential in decisions to keep pain under control, palliative educational approaches must go beyond providing information to fill deficits in palliative knowledge.”
We must learn evidence-based ways to overcome fear and control pain.  Why?  Because pain interferes with living life.  Who are we protecting when we fear appropriate pain medications?  Not the patient.

FearRemedy?  Palliative care education must confront the fears and remove them through cognitive restructuring that includes learning to question beliefs about addiction etc.  Role playing, role modeling, and an expert walking through this with the provider or family who is afraid.  Beyond this helping people to recognize their own fears of pain & death, and providing the very best available information on pain management (Zerwekh et al).

CRITICAL THINKING:  Have you been afraid?  Or seen others afraid?  How can you solve this problem using evidence-based practice that = BEST available evidence + Clinical judgment + Patient/family preferences & values? Be specific because if you haven’t yet encountered the problem of fearing to comfort, be assured that you will.fear4

FOR MORE INFORMATION:   Read full text Zerwekh et al (2002) online.   It could change your life & the life of those for whom you care!!

Literature review, reading research

Google’s Beauty is Only Skin Deep: Go for the Database!

Leave a comment

maxresdefaultGoogle–not to mention yahoo, bing & other web search engines–are mere popularity contests of literature.   Google Scholar is a step up, but it is still a search engine.  It can miss important articles entirely.

If you want to be sure that you are getting the BEST, you gotta look in the right place if you want to find the right articles on the right topic at the right time!Beauty contest winner

You need a Database!

Don’t believe me?  Watch “What are databases and why you need them?”(youtube 2:34)

Reputable publishers give away very few articles for free, so when you want the best literature out there you need a Database that will systematically help you to find quality articles that fit your topic.

PubMed.gov is a tax funded database that is highly comprehensive.  CINAHL is strong on nursing literature.  If you are enrolled in a university, you have access to lots of full-text articles at no added cost.  Check with your librarian if your database search is not turning up what you need–with a few hints, you could get the best.

Needle in haystackFor more info:  Look for that needle in the haystack.