Tag Archives: reading research

Telling the Future: The Research Hypothesis

What is a research hypothesis?   A research hypothesis is a predicted answer; an educated guess.  It is a statement of the outcome that a researcher expects to find in an experimental study.Hypothesis

Why care?  Because it tells you precisely the problem that the research study is about!  Either the researcher’s prediction turns out to be true (supported by data) or not!
A hypothesis includes 3 key elements: 1) the population of interest, 2) the experimental treatment, & 3) the outcome expected.  It is a statement of cause and effect. The experimental treatment that the researcher manipulates is called the independent or cause variable.  The result of the study is an outcome that is called the dependent variable because it depends on the independent/cause variable.

For example, let’s take the hypothesis “Heart failure patients who receive exmeds2perimental drug X will have better cardiac function than will heart failure patients who receive standard drug Y.”  You can see that the researcher is manipulating the drug (independent variable) that patients will receive.  And patient cardiac outcomes are expected to vary—in fact cardiac function is expected to be better—for patients who receive the experimental drug X.

Ideally that researcher will randomly assign subjects to an experimental group that receives drug X and a control group that receives standard therapy drug Y.   Outcome cardiac function data will be collected and analyzed to see if the researcher’s predicted answer (AKA hypothesis) is true.

In a research article, the hypothesis is usually stated right at the end of the introduction or background section.

If you see a hypothesis, how can you tell what is the independent/cause variable and the dependent/effect/outcome variable?question   1st – Identify the population in the hypothesis—the population does not vary (& so, it is not a variable).   2nd – Identify the independent variable–This will be the one that is the cause & it will vary.  3rd – Identify the dependent variable–This will be the one that is the outcome & its variation depends on changes/variation in the independent variable.

PRACTICE:  What are the population, independent variable(s) & dependent variable(s) in these actual research study titles that reflect the research hypotheses:

FOR MORE INFORMATION:  See SlideShare by Domocmat (n.d.) Formulating hypothesis at http://www.slideshare.net/kharr/formulating-hypothesis-cld-handout

 

Is a Picture Worth 1,000 words?

Sometimes the best way to answer a research question is to have the participants draw pictures & explain them.  In fact, some have identified art as a powerful communication tool between children and researchers.   The pictures are then analyzed for themes that show up in the drawings.  No numbers or statistics are used.

Methods: When Brady (2009) wondered how children defined a “good nurse,” she asked 22 ethnically diverse, hospitalized girls and boys aged 7-12 years to draw a picture of a good nurse and a bad nurse.  After the children drew their pictures she asked them to tell her what the nurse was wearing and doing.

Results & discussion: What did the pictures say? Drawings and comments suggested that the children focused on these 5 thematic characteristics for a good nurse:  “communication; professional competence; safety; professional appearance; and virtues,” (p.543) such as honesty, listening, kindness, trustworthiness, & being reassuring & fun. 11-year-old Jason communicated some of it in GoodNurse_BadNurse2Figure 4 on page 552.   12-year-old Luke also showed a sharp contrast in Figure 7 on page 556 that is at the top of this blog.  Children valued a reciprocal relationship with their nurses, caring, and safe/professional behavior. Play was one of many things important to them.

Commentary: While the sample is not representative of a larger group and I would question the authors claim to use grounded theory, the study forms the basis for further research.  Additionally these ideas can help us listen more closely to our own pediatric patients.   It would be particularly interesting to compare these 5 themes to how adult patients of various ages describe a good nurse and a bad nurse.

Critical thinking:  How do you think these children’s perspectives compare with the perspectives of your own pediatric patient population?QUESTION

For more information: See Brady, M. (2009). Hospitalized children’s views of the good nurse, Nursing Ethics, 16(5). doi: 10.1177/0969733009106648

Stand & Deliver: Evidence for Empathy in Action

Patient Pain Satisfaction.  It’s a key outcome of RN empathy in action.CARE

Imagine that you are hospitalized and hurting.   During hourly rounds the RN reassures you with these words:We are going to do everything that we can to help keep your pain under control. Your pain management is our number 1 priority. Given your [condition, history, diagnosis, status], we may not be able to keep your pain level at zero. However, we will work very hard with you to keep you as comfortable as possible.” (Alaloul et al, 2015, p. 323).

Study? In 2015 a set of researchers tested effectiveness of the above pain script using 2 similar medical-surgical units in an academic medical center—1 unit was an experimental unit & 1 was a control unit.  RNs rounded hourly on both units.  handsOn the experimental unit RNs stated the script to patients exactly as written and on room whiteboards posted the script, last pain med & pain scores.  Posters of the script were also posted on the unit.   In contrast, on the control unit RN communication and use of whiteboard were dependent on individual preferences.  Researchers measured effectiveness of the script by collecting HCAHPS scores 2 times before RNs began using the script (a baseline pretest) and then 5 times during and after RNs began using it (a posttest) on both units.

Results? On the experimental units significantly more patients reported that the team was doing everything they could to control pain and that the pain was well-controlled (p≤.05). And while experimental unit scores were trending up, control unit scores trended down. Other findings were that the RNs were satisfied with the script, and that RNs having a BSN or MSN had no effect.

Conclusions/Implications?When nurses used clear and consistent communication with patients in pain, a positive effect was seen in patient satisfaction with pain management over time. This intervention was simple and effective. It could be replicated in a variety of health care organizations.” (p.321) [underline added]

Commentary: While an experiment would have created greater confidence that the script caused the improvements in patient satisfaction, an experiment would have been difficult or impossible.  Researchers could not randomly assign patients to experimental & control units.  Still, quasi-experimental research is relatively strong evidence, but it leaves the door open that something besides the script caused the improvements in HCAHPS scores.

questionCritical thinking? What would prevent you from adopting or adapting this script in your own personal practice tomorrow?  What are the barriers and facilitators to getting other RNs on your unit to adopt this script, including using whiteboards?  Are there any risks to using the script?  What are the risks to NOT using the script?

Want more info? See original reference – Alaloul, F., Williams, K., Myers, J., Jones, K.D., & Logsdon, M.C. (2015).Impact of a script-based communication intervention on patient satisfaction with pain management. Pain Management Nursing, 16(3), 321-327. http://dx.doi.org/10.1016/j.pmn.2014.08.008

“Oh Baby!” Evidence-based Naming Prevents Events

EBP Preventive Action:  Evidence-based, distinct infant naming can avoid sentinel events related to misidentification of newborns (TJC, 2015).

Problem:  Misidentification errors of NICU babies are common newborn3(Gray et al., 2006).   About 12% of the 4 million born in U.S. hospitals were admitted to NICU’s.  At birth every infant requires quick application of an armband, and when parents have not yet decided on a name the assigned name is often quite nondistinct (e.g., BabySmith).


Evidence:
A pretest/posttest of a new, more infant-specific naming system was “conducted in order to examine the effect of a distinct naming convention that incorporates the mother’s first name into the newborn’s first name (e.g., Wendysgirl) on the incidence of wrong-patient errors. We used the Retract-and-Reorder (RAR) tool, an established, automated tool for detecting the outcome of wrong-patient electronic orders. The RAR tool identifies orders placed on a patient that are retracted within 10 minutes and then placed by the same clinician on a different patient within the next 10 minutes” (Adelman et al., 2013). newborn2Their results? RAR events were reduced by 36.3%.   Their recommendations? Switch to a distinct naming system.

Using something like Judysgirl Smith is infant specific. “In the case of multiple births, the hospital adds a number in front of the mother’s first name (ex: 1Judysgirl and 2Judysgirl)” (TJC).

TJC recommends:

  • “Stop using Babyboy or Babygirl as part of the temporary name.
  • Change to a more distinct naming convention.
  • Train staff on the distinct naming convention.
  • Follow the recommendation in National Patient Safety Goal 01.01.01 and implement use of two patient identifiers at all times.
  • As soon as parents decide on their baby’s name, enter that name into the medical record instead of the temporary name.”

Commentary: While this is just one study, RNs should evaluate whether it is riskier to continue any current practice of non-distinct naming or to switch practices to distinct naming. No risks were identified to the distinct naming system & it likely requires only the resource investment of educating staff.  Adelman et al.’s (2013) study is current, moderately strong, quasi-experimental evidence that showed a significant decrease in errors that could have sentinel event outcomes. Any who make the switch should monitor outcomes. All who don’t make the switch should, too!

Critical Thinking: Examine the risks, resources, & readiness of staff in your facility to make the switch to a distinct NICU infant naming system?  question Should the naming system be extended to all infants?

Want more information?  See

“I wonder as I wander…. ” DNP or PhD? What’s the diff?

Ever wonder what the difference is between the new Doctorate of Nursing Practice (DNP) and the Doctorate of Philosophy in nursing (PhD)?      examine baby

In short the focus of PhD education is to prepare the RN to create original research.  In contrast, DNP education is to prepare the RN to apply existing research to nursing practice.

Being a nurse practitioner (NP) is NOT the difference.  Also while some PhDs become skilled in applying research to practice & some DNPs do research,…their doctoral course preparation & final projects are quite different!

For more information:  Here’s a great comparison chart from one doctoral program:  https://nursingandhealth.asu.edu/degree-programs/doctoral-vs-phd-degrees-at-asu

Critical reflection: Based on your own personal career goals….questionIf you were to return for a doctorate, which would you find most useful?

METHODS in the Research Madness

[This is a re-post from 2014.  If you weren’t a reader then….read on…..]

fisheye booksResearch article sections are: Title, Abstract, Introduction/background,Methods, Results, Discussion, & Implications/Conclusions

METHODS =  Design, Sample, Setting, & Data collection instrument

Sometimes these above elements of METHODS are subheadings.

Sometimes not.

  • Key point #1: Design= overall plan for answering the question or proving the hypothesis.  KEYThe 2 basic types of design are 1) experimental & 2) non-experimental.   In experimental, the researcher does something to the subjects and measures the effects of that something.  In non-experimental, the research merely observes and describes what is happening without doing anything to change it.
  •  KEYKey point #2: Setting=where the study is conducted: home, hospital, office, classroom, on KEYan ocean cruise, or other.
  • Key point #3: Sample includes who/what subjects were in & excluded from the study; how many subjects were in the study; & whether subjects were selected using random methods or non-random methods.   In random selection every eligible subject has the same chance of being selected. That’s called probability sampling.  An example is drawing names from a hat.  In non-random selection only the most nearby subjects are asked to be in the study. That’s called non-probability or convenience sampling.  An example, using a clipboard to survey people who walk into a mall one day. [Note: Subjects can be people, animals, charts, hospitals, or nations.]

(Whew!….Enough for now.)

Critical Thinking Exercise:  Find the Design, Setting, & Sample in this excerpt of Methods from Mohammedkarimi et al, (2014): question

“A double-blind, randomized clinical trial (RCT) was performed among 90 adult patients with acute headache in Shahid Rahnemoon Emergency Center of Yazd city of Iran (45 patients in lidocaine group and 45 patients in placebo group). Patients with history of epilepsy, allergy to lidocaine, signs of skull base fracture, Glasgow Coma Scale (GCS) < 15, patients younger than 14 years and patients who had received any medication in previous 2 h were excluded.”

Introduction to Introductions!

I have a lot of new readers, so let’s revisit the standard sections of a research article.  They are:

  • Introduction (or Background)
  • Review of literature
  • Methods
  • Results (or findings)
  • Discussion & Implications
  • Conclusion

If we begin at the beginning, then we should ask: “What’s in an Introduction?”  Here’s the answer:

“[a] …Background of the problem or issue being examined,

[b] …Existing literature on the subject, and

[c] …Research questions, objectives, and possibly hypothesis” (p. 6, Davies & Logan, 2012)

This is the very 1st section of the body of the research article.  In it you will find a description of the problem that the researcher is studying, why the problem is a priority, and sometimes what is already known about the problem.  The description of what is already known may or may not be labelled separately as a Review of Literature.

KEYKey point #1: Articles & research that are reviewed in the Intro/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 there are no recent studies the author should explain.

KEY
Key point #2The last sentence or two in the Intro/Background is the research question or hypothesis.  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 should be!

Happy research reading!

Critical Thinking: Do the sections of the abstract AND the sections of the research article match above headings?  Does it match the description of Introduction? Take a look at the free article by Kennedy et al. (2014). Is there a relationship between personality and choice of nursing specialty: An integrative literature, BMC Nursing, 13(40). Retrieved from the link http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267136/.  question

 

A 33,000 foot view: The Abstract

 Abstracts are great; abstracts are not enough!
An abstract will not give you enough information to accurately 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.
airplaneWingIsland
Abstracts can mislead you IF you do not read the rest of the article.  They are only a short 100-200 words and so the authors have to leave out key information.   You may misunderstand study results if you read only the abstract.   An abstract’s 33,000 foot level FootprintsInSand
description of a study, cannot reveal the same things that you can learn from an up-close look at details.  You want to know exactly who was in the study, exactly what the researcher did, & exactly how outcomes were measured!  You want to follow the researcher’s footprints up close, not just do a fly-over.
So…what is the takeaway?  Definitely read the abstract to get the general idea.  Then read the article beginning to end.  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 try a re-read or get some help understanding any difficult sections.   This is an important step toward EBP.   [revised from my former blogsite]
Critical thinking:  What info is missing from this abstract at this link that you would want to know before using the findings of this pain study to practice?
http://www.ncbi.nlm.nih.gov/pubmed/25659796QUESTION

Does Data Drive you Dotty? Then watch this!

Does the very idea of looking at data make your eyes cross and set your teeth on edge?EyesCrossed

If so, I have the solution for you!!   And you DO need a solution because Data–>Information–>Best Practices.

You might be surprised that in less than 10 minutes John Hicks at https://www.youtube.com/watch?v=–r9_R60Jws will have you able to describe the basic approach to data.   He gives you 4 key steps & builds from there.HappyFaces

I promise: No eyes glazing over. No getting lost in numbers and calculations. No problem. Don’t worry; be happy.

LearningI can feel it.  Your research reading skills have gone up a notch!  (And for those of you who are masters of data & analysis, enjoy this link for teaching others.)

For more Info: Watch his great follow-up, short, & sweet videos for more on statistics.

CRITICAL THINKING: First watch the video above—click here if you didn’t yet do that. Second outline the 4 steps using the abstract below. Third, answer these questions: Are the data quantitative or qualitative? Are the data are continuous or discrete? Are the data are primary or secondary?

Anjdersson, E.K., Willman, A., Sjostrom-Strand, A. & Borglin, G. (2015). Registered nurses’ descriptions of caring: A phenomenographic interview study. BMC Nursing. doi: 10.1186/s12912-015-0067-9

“Background: Nursing has come a long way since the days of Florence Nightingale and even though no consensus exists it would seem reasonable to assume that caring still remains the inner core, the essence of nursing. In the light of the societal, contextual and political changes that have taken place during the 21st century, it is important to explore whether these might have influenced the essence of nursing. The aim of this study was to describe registered nurses’ conceptions of caring. Methods: A qualitative design with a phenomenographic approach was used. The interviews with twenty-one nurses took place between March and May 2013 and the transcripts were analysed inspired by Marton and Booth’s description of phenomenography. Results: The analysis mirrored four qualitatively different ways of understanding caring from the nurses’ perspective: caring as person-centredness, caring as safeguarding the patient’s best interests, caring as nursing interventions and caring as contextually intertwined.  Conclusion: The most comprehensive feature of the nurses’ collective understanding of caring was their recognition and acknowledgment of the person behind the patient, i.e. person-centredness. However, caring was described as being part of an intricate interplay in the care context, which has impacted on all the described conceptions of caring. Greater emphasis on the care context, i.e. the environment in which caring takes place, are warranted as this could mitigate the possibility that essential care is left unaddressed, thus contributing to better quality of care and safer patient care.” [quoted from http://www.ncbi.nlm.nih.gov/pubmed/25834478]

 

 

“Who’s in?” Sampling Made Simple

So many great resources are out there at your fingertips.   In the next few blogs, I’ll point you to some of them.Heart Books

If you have not yet discovered the hidden jewel of the tab, “Research Made Simple,” on the Evidence-Based Nursing website at http://ebn.bmj.com/ , you should check out its full text pdf articles. An especially nice resource if you are in graduate school or maybe even a BSN course on research.

Here is a sample of one from June 9, 2014 of the population of articles at EBN.

ball sample“Sample selection is a key factor in research design and can determine whether research questions will be answered. …It is critical to take the time to clearly identify the population of interest for the specific research question. Nursing researchers are usually interested in answering questions about very specific patient populations which can span an incredible array of possibilities applying to international, national, local and organisational contexts. Research populations closely reflect nursing specialties, some of which are gender (eg, pregnant women) and age specific (eg, adolescent diabetes). It is rarely feasible to conduct a study that reaches every patient in the population of interest, therefore a subset or sample of that population is selected for study.” (para 1-2 Retrieved from http://ebn.bmj.com/content/17/2/32.short?g=w_ebn_research_tab ) [note: I added the bold]

I invite you to use the comments section to post URLs for other great sites!

Critical Thinking: Read the previous blog on representatives & then QUESTIONdecide for yourself whether this single EBN article on sampling is representative of clear & simple explanations. Samples can be things, not just people. What questions should you ask me about my sampling procedure?

For More: Check out tab “Research Made Simple,” on the Evidence-Based Nursing website at http://ebn.bmj.com/ .   OR try this <5 minute simple sampling youtube video  https://www.youtube.com/watch?v=Gs-gLeYuDZw