Tag Archives: research

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

 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)

 

“What are you implying?”—the question to ask about Findings*

As you read closer and closer to the end of a research report, you should start asking, “What are the implications of what this researcher found?”   In other words now that the findings show X what is the Y that we do in response?

Sometimes the researcher labels a section IMPLICATIONS. Other times implications are included in the DISCUSSION section.

What implications you look for may depend on your role. Are you a direct, inpatient care RN? Then you want to know what the research implies about the need to maintain or change practice.   Are you in staff development or teaching clinical students? Then you want to know whether this means you should be teaching something or some “how-to” differently.   Management/administrator? Then what does this mean for leadership or organizations. And,…if you’re a researcher, then you want to know what is the next question raised by this study, OR perhaps does this study need to be repeated before we can feel confident in the findings.   (Of course, if you’re a student looking at a study may mean that you are one step closer to completing one of those evidence-based assignment papers.)

If you look carefully, you will see that the researcher tells you what they think the implications are for patient care, education, management, research, students, patients, or others.

Research does not give final answers. Exhilaratingly a research article often raises more questions than it answers—especially because any research project can only narrowly be designed to examine one teeny area of reality.   (OK. Perhaps only researchers would find that thrilling.)

So, as you read think: What do these research findings mean for RN practice?

Critical Thinking Practice: Find the implications in this excerpt from the Discussion section of Brown & McCormack (2005):  The study revealed that accurate and holistic pain assessment for older people were (sic) deficient in the acute surgical setting…. As a number of older people experienced hearing difficulties, it was also possible that patients did not respond because they misunderstood or simply did not hear what they were being asked. Herr and Mobily (1991) suggest that a reliable assessment of the older persons’ pain can be best obtained if they are offered privacy rather than asked to discuss pain in a public location. Whilst this can be difficult to achieve in a ward environment, measures such as drawing the curtains or moving closer to the patient, may afford some improved degree of enhanced communication and privacy for pain assessment. (p.1295)

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*In earlier posts at http://discoveringyourinnerscientist.blogspot.com/ , I summarized what titles, abstracts, introductions, methods, results, and discussions sections of a research report are all about.

NEW site to Discovering Your Inner Scientist

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.