Tag Archives: reading research

Evidence based nursing, nonrandom trials, Pain management, Pain script, Professional Nursing, reading research

Stand & Deliver: Evidence for Empathy in Action

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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

Evidence based nursing, Literature review, nonrandom trials, reading research

“Oh Baby!” Evidence-based Naming Prevents Events

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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

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

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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?

Evidence based nursing, Literature review, reading research

METHODS in the Research Madness

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[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.”

Evidence based nursing, Professional Nursing, reading research

Introduction to Introductions!

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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 #2:  The 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

 

Evidence based nursing, Literature review, Professional Nursing, reading research

A 33,000 foot view: The Abstract

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 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
Data, Evidence based nursing, reading research

Does Data Drive you Dotty? Then watch this!

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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]

 

 

reading research, Sampling

“Who’s in?” Sampling Made Simple

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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

Evidence based nursing, Literature review, Research design, Sampling

“That is so random!” But is it Representative?

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What makes a good sample in research?  One thing.  And it isn’t random selection.  (Surprised?)

Portrait of a diversity Mixed Age and Multi-generation Family embracing and standing together. Isolated on white background. [url=http://www.istockphoto.com/search/lightbox/9786738][img]http://dl.dropbox.com/u/40117171/group.jpg[/img][/url]It is representativeness.  No matter how the sample was picked, it must be representative of all those in the larger population, if the researcher wants to say anything about anyone who wasn’t in the study.  Now, of course, it is true that random selection is more likely to give you a representative sample, but it is no guarantee.  Only likely.

What is random sampling?  It is when every member of the larger population has an equal chance of being selected for the study sample.  Example? Drawing names out of a hat.  It is well-accepted practice to generalize research results from a random sample to others like those being studied (assuming that all other aspects of the study are strong).

In contrast a convenience (or nonprobability) sample is when some people are more likely to be chosen to be in the study than others.  You shouldn’t generalize the results of these studies because the samples may Not represent others.

Example of when random sampling doesn’t work: Let’s say you have a mixture of red, green, & yellow apples, and you select a sample that has only yellow apples.  (The red & green ones are going to be offended!–They’re left out.)  You now have a sample that is biased in favor of yellow apples!   Your sample does Not represent the larger population of apples…even if you used random methods to get it.  If you want to apply the study to red & green & yellow apples…well….you must get some of them in your sample, too. The yellow apples might not be at all like the other types and studying just yellow might mislead you into thinking something about the red & green ones that isn’t true!   Of course you could study all the millions of apples in the world and exclude none, but that would be pretty cumbersome and expensive.   So, it’s better to go for a representative sample!

When else doesn’t random sampling create a representative sample?   If I am doing historical research, say on the Nursing Department at California State University/Northridge, then I want to hand pick the specific RNs by name who were in charge of the Department from the beginning.  Randomly selecting nurses from those who worked at the University won’t represent those leaders.

QUESTIONCritical Thinking:  Take a quick look at the linked abstracts. How were the samples selected?  How representative are the samples of a larger population of interest?  Could you generalize the results to other people, and if so to whom?

Want more information on sampline? Check this out.  It takes < 5 minutes:

https://www.youtube.com/watch?feature=endscreen&v=be9e-Q-jC-0&NR=1

Evidence based nursing, Literature review, Professional Nursing, reading research

“The Sky is Falling!” (or Don’t be an EBP Chicken Little)

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We all know the story of Chicken Little, right?  Chicken Little is walking through the forest, an acorn falls and hits her on the head, then Chicken Little  runs about in a panic telling everyone, “The sky is falling! The sky is falling!” A lot of the animals are convinced, and the fox—who knows the truth that it was only an acorn—convinces Chicken Little & some other animals to come into his den to be safe from the falling sky. There he eats them. Interestingly the fox used the correct evidence well. Chicken Little & fox chicken littlecompany used evidence poorly and created a safety hazard for themselves!

Moral of the story? Don’t be a Chicken Little when it comes to reading and applying research to practice. Get all the facts before you share the research findings with others. Don’t read only the “acorn” of abstract, introduction, and discussion, and then assume that you know what the research study shows and that you can apply it to your work. Don’t turn an acorn into a falling sky!

How to avoid being an EBP Chicken Little? To avoid being an Evidence-Based Practice (EBP) Chicken Little, you should follow the example of Samantha in this research fairy tale: “Samantha…read the study abstract. Then, while Chicken Little and her friends waited anxiously, she read the introduction, the literature review, the research questions, the methods section, the findings, and the discussion section. Then she went back and read all the sections again. Finally, as Chicken Little hopped around her impatiently, she reread the findings. “Chicken Little, have you and your friends read the entire study?” asked Samantha.” (source: https://www.son.rochester.edu/student-resources/research-fables/chicken-little.html)

Why go to all this trouble? I’m busy. The reasons to take time and effort to read the WHOLE study are many. First, the subjects may not be at all like your own patient population—what if the researchers studied only “left-pawed albino hamsters”? Second, the research might not be a strong meta-analysis or randomized controlled trial whose results can actually be applied to other times and places—what if the researchers just watched subjects walk around, but didn’t test what makes them walk better?  A third reason is that the results might be statistically significant, but clinically irrelevant!—what if researchers were studying pain, but everyone in the study had 1-2 on the pain scale?

You don’t want to endanger patient safety by misunderstanding and misapplying research and then be “eaten alive” by adverse patient outcomes or by critics, who will see through your mistakes. Remember in the fairy tale Chicken Little and his careless friends misunderstood the facts, and hence were susceptible to being eaten by a fox.

What if you don’t know how to read research? No problem. Everyone who knows how to read research now had to learn it—no one was born knowing.  So,…you can learn it, too!  It doesn’t take magical powers.  Countless resources are online; others are in your hospital or in a university research course. If you check the box on this page to follow the EBP blog, (I hope) it will help, too. Go back and read earlier blogs on sections of a research report.

For more information on how to be an EBP Chicken Little (NOT) see the very creative research fairy tale by Jeanne Grace (copyright Rochester College) at https://www.son.rochester.edu/student-resources/research-fables/chicken-little.html

Critical thinking:

  1. After reading Grace’s fairy tale at the above link list at least three (3) things that Chicken Little might have learned, had she read the whole article!
  2. Compare an abstract with a full article, and check out the differences. Specifically compare the abstract at  http://www.ncbi.nlm.nih.gov/pubmed/2606078 with what you learn about them from the full article at http://www.ncbi.nlm.http://www.ncbi.nlm.nih.gov/pubmed/2606078nih.gov/pmc/articles/PMC4449996/. Did reading the whole article change the way you understand how orQUESTION whether the study might apply to your work? If so, how? And if not, why not?