N580 Midterm Exam With 100% Correct Answers 2023, Exams of Advanced Education

Download N580 Midterm Exam With 100% Correct Answers 2023 and more Exams Advanced Education in PDF only on Docsity! N580 Midterm Exam With 100% Correct Answers 2023 nurses on the cutting edge - Correct Answer-promote improvement in patient outcomes accomplish this through: research, EBP, and QI nurses achieve personal growth through and expand clinical decision-making skills through... - Correct Answer-development of clinical questions literature reviews evaluation of evidence in literature application of "best available evidence" in your practice nurses as knowledgable consumers - Correct Answer-nurses must be knowledgable consumers of research who can evaluate the strengths and weaknesses of research evidence and use existing standards to determine the merit and readiness of research for use in clinical practice to use research for an EBP and to practice using the highest quality processes, you do not have to conduct research; however, you do need to understand and appraise the steps of the research process in order to read the research literature critically and use it to inform clinical decisions research definition - Correct Answer-a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge quantitative and qualitative research studies are guided by research questions nurses employ the same methods used by other disciplines yet study questions are relevant to nursing practice quantitative vs. qualititative research - Correct Answer-quantitative: encompasses the study of research questions and/or hypotheses that describe phenomena, test relationships, assess differences, seek to explain cause-and-effect relationships between variables, and test for intervention effectiveness-- numeric data are summarized and analyzed using statistics--techniques are systematic and methodology is controlled qualititative: question is about understanding the meaning of a human experience such as grief, hope, or loss--meaning of an experience is based on the view that meaning varies and is subjective--context of experience also plays a role--generally conducted in natural settings and uses data that are words or text rather than numeric to describe the experiences being studied--guided by research questions and data are collected from a small number of subjects, allowing an in-depth study of a phenomenon--subjective approach but systematic in its method QI definition - Correct Answer-systematic use of data to monitor the outcomes of care processes and improvement methods to design and test changes to continuously improve the quality and safety of health care systems uses currently available knowledge to improve health care delivery within the local setting QI elements - Correct Answer-1. conducting an assessment 2. setting specific goals for improvement 3. identifying ideas for changing current practice 4. deciding how improvements in care are measured 5. rapidly testing practice changes 6. measuring improvements in care 7. adopting practice change as new standard of care want to create measurable change across quality domains through application of these 7 steps, often through the plan, do, study, act model research vs. QI - Correct Answer-research studies generate new knowledge that is generalizable to other populations and settings QI projects use currently available knowledge to improve health care delivery within the local setting IRB should have a written policy and template for determining the difference between humans subjects research and QI research and EBP - Correct Answer-best research evidence, clinical expertise, and patient values all come together in EBP (see Venn diagram) EBP allows one to systematically use the best available evidence from research with the integration of individual clinical expertise as well as the patient's values and preferences to make clinical decisions 1. promoting innovation: technology to improve health 2. 21st century nurse scientists: innovative strategies for research careers PICO question - Correct Answer-problem/patient population intervention comparison outcome nursing research is significant to the profession of nursing because it promotes... - Correct Answer- generation of a specialized body of nursing knowledge for use in nursing practice action that demonstrates the role of a knowledgable consumer of nursing research - Correct Answer- evaluating the credibility of research findings primary value of evidence-based practice in nursing - Correct Answer-incorporating research findings with clinical expertise when individualizing patient care the research question and study purpose are located in the... - Correct Answer-introduction critical step for the QI process in health care settings - Correct Answer-adopting a practice change as a new standard of care the review of literature is important to the research process because... - Correct Answer-it guides all steps of the research process most relevant and frequently used source of nursing literature - Correct Answer-CINAHL how far back should a literature search for an academic paper or project go? - Correct Answer-3-5 years website that is an important source for clinical evidence but limited as a provider of primary documents for literature reviews - Correct Answer-Cochrane Library (see pp. 52 & 56 for tables) where do research problems come from? - Correct Answer-direct clinical experience critical appraisal from the scientific literature theories and conceptual models direct clinical experience - Correct Answer-day-to-day interactions lead to questions: do patients being discharged from a hospital have special learning needs? literature search is needed to help you find out what has been done, and to refine or focus in on the specific problem you will address critical appraisal from the scientific literature - Correct Answer-literature can serve as a starting point a reader may begin to question practices or findings because of flaws in logic or methodology, due to personal anecdotal experience or the source of the study you may find conflicting findings in literature or identify gaps in literature previous studies may have recommended replication or extension/refinement of a study theories and conceptual models - Correct Answer-theory: provides explanation of how certain concepts or abstract ideas are related to each other and serves as a basis for explaining events or predicting future events conceptual model: not in itself testable, but rather focuses attention on certain concepts and their relationships, and places these within a context of the discipline normally need many theories to explain a conceptual model defining the problem area - Correct Answer-start with broad area of interest ask what about this topic specifically interests me, what is it I really want to know continue to ask yourself these questions until you have focused your thoughts into a specific statement that you can write out stating the problem - Correct Answer-problem statements are commonly seen in grant proposals, theses, or dissertations but rarely in research articles (often implicit--more likely to have purpose statements) interrogative: do first time mothers who have attended prenatal classes report different levels of anxiety during the third stage of labor than first time mothers who have not attended classes? declarative (not common because easily confused with purpose statement): this study will determine if different levels of anxiety are reported during the third stage of labor by first time mothers who have attended prenatal classes and first time mothers who have not attended classes significance of problems - Correct Answer-pertains to value of study, not statistical significance it's important the problem has significance and that study has potential to contribute to and extend the basis of scientific knowledge problems can be significant if they impact a large number of people, cause a lot of pain and suffering or morbidity and mortality, or cost a lot of $ other measures of significance: patients/families/nurses/medical community/society will benefit form knowledge derived in the study--results will be applicable for nursing administration, education, or practice--results will be theoretically relevant--findings will support untested theory, extend/challenge existing theory, clarify a conflict of literature--findings will be able to be used to create or alter policies or practices feasibility - Correct Answer-time availability of subjects availability of facilities availability of equipment money experience of research ethical considerations problem vs. purpose of a study - Correct Answer-research problem: narrow and well-defined--what is the effect of PCA on pain ratings by postoperative patients? (specific and testable) purpose: can be much broader and can encompass aims and goals of research as well as the manner in which researcher will seek to study the problem--the purpose of this study was to determine and compare the postoperative ratings of patients receiving PCA versus standard pain management (communicates about the research problem and potentially the design) variables - Correct Answer-properties that are being studied experiments - Correct Answer-manipulate environment, resources, and people to generate a set of conditions to answer a question scientific investigation in which observations are made and data collected and involves properties of randomization, control, and manipulation choice of method - Correct Answer-depends upon problem you want to solve methods: description - Correct Answer-what is the average length of time from admission to graduation in the School of Nursing? methods: deduction - Correct Answer-patients undergoing chemotherapy for cancer often have anticipatory N/V women with breast cancer undergoing chemotherapy will have anticipatory N/V methods: induction - Correct Answer-my mother has gastric distress after eating salsa older women will experience gastric distress after eating salsa research questions - Correct Answer-these are likely to be used when the researcher is looking for information (description) or relationships (correlation) sometimes a study is conducted using research questions with the purpose of generating hypotheses qualitative studies use research questions usually more specific than research problems that are identified for a study sometimes used to answer questions about data not related to the proposed outcomes of the study hypotheses ex: how do postoperative patients communicate their pain management needs to their healthcare providers? (pain=independent variable, postoperative patients communicating their pain=dependent variable) hypotheses - Correct Answer-may not be stated explicitly but are often implied in data analysis, results, or discussion section of the article flow from research problem, lit review, and theoretical framework a statement about the relationship between 2 or more variables that suggests an answer to a research problem or addresses the study's purpose converts the research problem (or some portion of it) into a declarative statement that predicts an expected outcome explains or predicts the relationship or differences in 2 or more variables in terms of expected results or outcomes of the study wording the hypothesis - Correct Answer-clear, simple, precise should be able to identify: variables of hypothesis population being studied predicted outcome of hypothesis characteristics of a hypothesis - Correct Answer-relationship statement (between DV and IV--implies a systematic relationship--direction of relationship is usually specified using less than, more than, difference--causal or correlating relationship is usually specified) testable (must be observed, measured, and analyzed--must predict an anticipated outcome) consistent with research findings and/or defined theory base research problem-->lit review-->theoretical framework-->hypothesis directional vs. non-directional hypothesis - Correct Answer-directional: specifies the expected direction of the relationship between the IV and DV non-directional hypothesis: specifies only that a relationship exists between the IV and DV research vs. statistical - Correct Answer-research (or scientific) hypothesis: statement about the expected relationship of variables statistical (or null) hypothesis: states there is no relationship between the IV and DV hypothesis and research design - Correct Answer-the way the hypothesis is stated can give you clues as to the research design being used experimental: X1 is more effective than X2 on Y, the incidence of Y will be greater in subjects after X1 than after X2 non-experimental (correlation): X will be negatively associated with Y, there will be a positive relationship between X and Y theory and practice - Correct Answer-nursing practice is based on the theories generated and validated through research in an integrated, reciprocal manner: theory guides research and practice; practice enables testing of theory and generates research questions, and research contributes to theory building and establishing practice guidelines when critiquing a research study's theoretical framework, a nurse should keep in mind... - Correct Answer-theoretical frameworks can be implicitly or explicitly stated in a research report a theoretical framework may not be identified in all types of nursing research qualititative research - Correct Answer-naturalistic paradigm: focus on the collection of information from the perspective of individuals or groups directly living the experience interpretivism: reality is the subjective interpretation of an experience in the natural environment (reality is constructed by individual) quantitative research - Correct Answer-empirical paradigm: focus on the collection of information to test theory or specific theoretical relationships positivism: reality is stable and can be observed and described objectively (there's only one) qualitative vs. quantitative - Correct Answer-qualitative: inductive, theory generating (from the ground up--phenomenon is based on experience of individuals who have experienced that phenomenon)-- sensory methods are used such as listening or observing to gather and organize data into patterns or themes (interviews, focus groups) quantitative: deductive, theory testing--numbers are used to measure variables such as characteristics, concepts, or things (e.g., health outcomes--surveys, experiments) strengths and weaknesses of qualitative research - Correct Answer-strengths: (1) view of homogeneous exploration, (2) raise more issues through broad and open-ended inquiry, (3) understanding behaviors of values, beliefs, and assumptions weaknesses: (1) no objectively verifiable result, (2) skillful requirement for interviewers, (3) time consuming during interviewing process and intensive category process used to generate theories that can inform interventions that we can provide for that particular population focus: develop a theory from grounded in field data sample size: 20-60 (to better understand nuances and processes) data collection: interviews and some observations what is the process involved in seeking help for a STI? case study - Correct Answer-interested in a bounded situation--study a particular medical error, procedure, case, etc. and understand what was involved in that collect different sources to really understand that case focus: organization, entity, individual, or event sample size not relevant, more of a closed entitity data collection: interviews, documents, observations what are the factors that influenced a medical error in an ICU? nature of reserach question drives... - Correct Answer-the approach taken qualitative description - Correct Answer-straightforward description of a phenomenon, experience, or event not highly interpretive conceptual framework, philosophical perspective or other abstract model can be used (but isn't being tested) fits very nicely with mixed methods research to yield a more comprehensive understanding of a phenomenon obtaining qualitative data - Correct Answer-interviews focus groups observations action research interviews - Correct Answer-rely on the most in qualitative research focus on individual experiences but are influenced by the interviewer focus groups - Correct Answer-interviews with groups of people--collect information on interaction between individuals and also on what each single participant says good for community perceptions to capture interactions but may not represent individual perspectives observations - Correct Answer-to observe behaviors or processes can be a participant of a process or more of an outsider good for understanding culture and behavior but are influenced by observer (insider or outsider) action research - Correct Answer-can obtain data through groups that we work with that are actively engaged in designing interventions and identifying areas of priorities and experiences of importance, using gathered data to guide action can be patient-centered or community-centered but are not always timely and not always aligned with evidence or funding qualitative method - Correct Answer-approach or design: traditional approach/design of qualitative research? or qualitative descriptive approach? participants and setting: inclusion and exclusion criteria--sampling: purposeful (we select), convenience (whoever wants to participate is included), or random sample procedures: data collection guides analysis credibility and trustworthiness interview guide - Correct Answer-often semi-structured--want to guide conversation (inductive) but also want to allow new information to come up that we may not have in mind in terms of the phenomenon we are studying based on study purpose and approach can be guided by a theoretical framework includes open-ended, one-dimensional questions (avoid questions "and") loose guide that typically allows for the participant to identify issues beyond questions use conversational language start from general to specific use of probes types of questions used in a semi-structured interview guide - Correct Answer-opening: start getting people started talking introductory: introduce general topic of discussion transition and key questions: moves discussion into key questions driving study; ask participants to go more in depth; questions that drive the study ending questions: determine the final position of participants and assess if there is any inadequate or missing information interviewer effects - Correct Answer-interviews are social interactions rapport is very important interviewer characteristics to consider: power structures, demographic variables (race/ethnicity, gender, age), appearance, relationships skills appraising findings from qualitative research - Correct Answer-credibility transferability dependability confirmability credibility - Correct Answer-confidence in the "truth" of the findings transferability - Correct Answer-showing that the findings have applicability in other contexts dependability - Correct Answer-showing that the findings are consistent and could be repeated confirmability - Correct Answer-a degree of neutrality or the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation, or interest does the introduction give you a sense of the importance of the problem area? does the introduction place the problem within a larger framework--does it fit within a larger topic of importance? defining purpose of study is critical to the reader--should include specific aims and problem it's important that purpose/problem statement fits within literature review and theoretical framework not enough if a problem is interesting if it offers no possibility of contributing to knowledge or improving nursing practice statement of the problem - Correct Answer-look for the problem statement is the problem stated clearly and concisely? are the terms "objective(s)" or "purpose" of the study used? is the problem significant and does it have relevance to the science of nursing or health care? what is the critical argument? there should be comment on the importance on the problem--is the problem significant and does it have relevance to the science of nursing or healthcare? review of literature - Correct Answer-within introduction or background should lay out an argument supporting the rationale that the variables are connected and fit together to form the essence of the problem to be studied must be current and concise is the literature critically reviewed? are variables defined and are the designs appropriate? have important references been included? is the problem area placed in perspective of how knowledge will be added to the subject area? discusses how variables fit together and what has been done in this area of research prior to your study presents argument for studying these variables and presents logic of study does the literature review answer the following questions: what is known about the subject? what is not known? how does the literature review contribute to what is not known? see p. 261-262 literature review continued - Correct Answer-should tell what has been done and what hasn't in this area are the gaps or inconsistencies and controversies identified in the literature discussed and highlighted? and does it describe how this study will provide data to fill those gaps? are the key concepts and variables defined? are the research questions or hypotheses clearly stated and testable? logical flow of lit review is critical to reader--each variable needs to be defined and then logically flow to conclusion or summary in lit review which should explain how these variables are connected to provide rationale for problem statement/research question does the intro lead to the statement of the problem? does the lit review provide defined key concepts and variables, and present rationale for the relationship among these variables to be studied? is there a larger theoretical framework that guides the study? methodology - Correct Answer-is the method appropriate for problem being studied? is the sample studied representative of the population of interest? random sampling should be used has the method of sample selection been identified? is the sample size appropriate for the research question? are the data collection instruments described? are the data collection instruments appropriate for the research questions (and the population)? are the instruments reliable and valid? have the psychometrics been included? (psychometrics deal with the theory and development of measurement instruments--should always be included b/c tell you what patient population the instruments have been used on and what their reliability and validity are) is the design internally valid? data analysis - Correct Answer-within methods section should be presented clearly and succintly no comments on interpreting data here is there a section on how the data were analyzed? are the tables and graphs complete, self-explanatory, and accurate? does the data analysis relate to the questions being asked? is the data analysis discussed adequately? discussion - Correct Answer-want to know whether results are consistent with previous research if not, are possible explanations given for differences? are the weaknesses of study discussed? are the findings placed in context of what has been added to the knowledge base in this area? are the conclusions appropriate? do the conclusions answer the research questions posed? are clinical implications discussed? are recommendations for further study included? are the findings plaed in context of what has been added to the knowledge base in this area? refer back to research question health care research is usually only done to improve clinical practice general notes - Correct Answer-is the author known for this area of research? is the study published a referred/peer-reviewed journal? how can the results be implemented in your practice? common study objectives - Correct Answer-effectiveness: benefits of treatment as it relates to medical practice; risk vs. benefit efficacy: treatment (a drug) has the effect is should have; it does what we will eventually claim it can do safety: nature and frequency of side effects comparison: to other treatments, drugs, devices, surgery, diets, radiation therapy, etc. outcomes: the treatment saves lives, improves QOL, and/or it saves costs true experimental and quasi-experimental studies are critical when trying to make a statement of the effectiveness or ineffectiveness of a treatment is the "conclusion" justified? is the "conclusion" warranted? - Correct Answer-you have a cold (cough, runny nose, fever, watery eyes, aches and pains) I give you the pill and you take it you get better, and the cold goes away choose a "block size" in which the number of subjects is proportional within each "block" (1:1 or 2:1 or 3:1 within blocks of 2, 3, or 4 respectively) inappropriate methods for randomization - Correct Answer-research subject's initials (allows identification of study participants and introduces bias) controlling randomization - Correct Answer-neutral party (e.g., statistician, pharmacist) informs investigator of patient's group assignment central randomization (IVRS) communicator bias - Correct Answer-systematic error that enters a clinical trial and distorts the data (as oppsed to random error) affects dependent variable being studied common sources of bias: - Correct Answer-investigator bias: investigator (PI) favors one experimental group over another (PI knows who got treatment and follows them more closely)--PI should be blind to which group got treatment and which group got placebo evaluator bias: when person measuring the endpoint (such as BP) "shades" the measurements to favor one intervention over the other--evaluator guesses who received treatment and shades the measurement toward a positive result selection bias: when patients possessing important prognostic factors appear more often in one group over the other--assignment of less sick individuals to a particular treatment group (gives better results to treatment group if there was no selection bias) can be minimized by randomization and blinding blinding - Correct Answer-by keeping the identity of treatment secret, investigator bias can be minimized types of blinding - Correct Answer-triple blind: research subject, investigator and sponsor are all blinded; note, only an independent statistician knows the code double blind: neither the research subject nor the investigator know the treatment code (most common) single blind: only the research subject is shielded from knowing the treatment code (often pilot or exploratory studies are conducted as single blind or open blind) open blind: everyone knows the treatment code we only break the blind when treatment of AE depends on knowing what group patient is in potential threats to validity - Correct Answer-internal validity external validity once a study is initiated, we want to make sure internal issues within the study are held as constant as possible we want to make sure the IV makes the change in the DV (internal validity) we also want to be confident in the generalizability of the study's findings to other populations (external validity) potential threats to internal validity - Correct Answer-selection bias mortality maturation instrumentation testing history selection bias - Correct Answer-partiality is selecting research subjects mortality - Correct Answer-loss of research subjects after first data collection point (in experimental sense, doesn't mean death but means withdrawal of research subjects from the study) maturation - Correct Answer-outside processes (changes) that operate within a research subject as a function of time instrumentation - Correct Answer-changes in measurement equipment or observational techniques may cause measurements to vary between participants testing - Correct Answer-taking the same test more than once can influence the participants response the next time the test is taken history - Correct Answer-a specific event inside or outside the experimental study can have an effect on the DV potential threats to external validity - Correct Answer-selection effects measurement effects reactive effects selection effects - Correct Answer-generalizability of results to other populations (selection bias, mortality, and maturation) measurement effects - Correct Answer-changes within a research subject such as a function of time (changed posttest results due to pretesting) (maturation, instrumentation, and testing) reactive effects - Correct Answer-changes a subject's response due to being studied (Hawthorne effect) (testing, history) classic randomized, controlled clinical trial (RCT) - Correct Answer-sample is selected from the population baseline data are collected subjects are randomized intervention group: postintervention data are collect control group: postintervention data are collected pre-test/post-test control group design Solomon Four-Group design - Correct Answer-sample is selected from population subjects are randomized baseline data are collected for two groups: intervention group and control group--postintervention data are collected for both ex: intervention of exercise in a group of overweight research subjects and took weekly body weight measurements over several months strengths of quasi-experimental design - Correct Answer-practical, less expensive, generalizable, and sometimes the only feasible alternative b/c these designs are more adaptable to real-world settings replication of a study can strengthen evidence (may want to perform study more than once) weaknesses of quasi-experimental designs - Correct Answer-unable to demonstrate clear cause-and- effect relationships due to an intervention non-experimental designs - Correct Answer-process of exploring relationships, common themes in a population--not trying to establish a cause and effect--no manipulation of variables--all non- experimental designs are descriptive surveys observational studies correlational studies cross sectional longitudinal ex post facto methodologic simulation largest category of non-experimental designs - Correct Answer-descriptive studies then exploratory studies survey - Correct Answer-written (come in the mail) email telephone personal interview overlying assumption with all surveys - Correct Answer-that people are telling the truth have to be suspicious b/c researchers have found that people misrepresent certain aspects of their lives--for example, they minimize their weight general types of surveys - Correct Answer-descriptive (i.e., who bought the iPhone) explanatory (i.e., who bought the iPhone and why they bought it over other phones) exploratory (descriptive and explanatory elements but tries to explore what it's like to go through chemotherapy) advantages/disadvantages to using a previously developed survey - Correct Answer-psychometric properties are developed has established reliability and validity it's been pilot tested it's been used before you can add your data to the larger data that has been collected from it it's tough to find a survey that is going to measure exactly what you're interested in measuring may just add questions to beginning and end of it, which destroys the validity and reliability of the instrument (so need to determine psychometrics on their own) will have to request permission from the author to use the survey advantages/disadvantages to using a new survey - Correct Answer-have to spend several weeks/months developing and pilot testing designing your own survey - Correct Answer-white space: the more white space you have on your survey, the more user friendly it appears font: make it easy to read (no fancy fonts) boxes vs. lines: if you're asking a question on someone's age and you're giving them options (<17, >18, etc.), it's recommended that the line be turned into a box so the response is clearly associated with the response you're interested in (in a line, sometimes people make big checks and it's hard to figure out which one they were actually checking) questions order: can present information in earlier questions and then ask the subject an information question later on when you've already answered their question previously biased questions: avoid negative items: people tend to overlook/ignore things like "not" or "none" or a double negative relevance of each question: to what you're interested in--each question should address the topic of interest clarity of questions hints for surveys - Correct Answer-visually appealing--professional looking language/reading level should be appropriate for the subjects (between 6-8 grade, even if people are college educated) length: people may throw it in the trash if it's long wording: clear and unambiguous (like huge, big, a lot, often--subjective interpretation) clear instructions!! (are they to circle, check, etc.) do not misspell questionnaire! types of questions on surveys - Correct Answer-closed ended: must meet 2 criteria being mutually exclusive and exhaustive--can't put the true answer in two places, and it needs to cover all options (ex: how old are you? should cover birth to death: <17, 18-25, 25-30, 30-35, >35--this is exhaustive, and a person can check more than one box so it's not mutually exclusive--best way to make questions exhaustive are to include "other" and a "please explain" line) open ended: leave a blank to answer the question--should have appropriate space to answer the question--not too little space and not too much space because people will try to fit that space (ex: what is your favorite sport to watch in person?) contigency: people generally don't like--if you answered yes to the above, then go to question 18 and continue on--if you answered no the above, then continue on filler: used to disguise the intent of what you're really interested in with the survey (you could be interested in how parents punish their children and you're really interested in do they use physical means to punish their children--may be that your survey is on children's behavior and parental response and you put in filler questions about how do you respond when your child finishes their dinner? and then throw those out at the end) demographic (closed or open ended) where do you place demographic questions? - Correct Answer-beginning or end of the survey? depends on what you're asking in the survey pre-prepared no probes semi-structured questions - Correct Answer-specific questions but can follow up with probes "well tell me more about that" recording data from a personal interview - Correct Answer-tapes: video/audio (video tape you can pick up non-verbals) written (hard b/c it's hard to capture everything they're saying and you want to maintain eye contact) telephone interviews for a survey - Correct Answer-voice to voice can't see non-verbal cues may be recording it some questions are hard to say such as "look at the below list and tell me which one more accurately reflects your attitude today" and then you have to read off the list questions need to be geared toward what can be gathered via voice only email collection of surveys - Correct Answer-confidentiality is an issue use of address for other purposes response should not indicate their email address response rates by mail, telephone, and personal interview - Correct Answer-personal interview is higher if you can get to them same with telephone mail is ~33% cost of each survey collection method - Correct Answer-length of data collection is longer money to get there and back as well as the training observation research - Correct Answer-collecting data through visual observations have to determine ahead of time: what behaviors are going to be observed, who will observe, and how are they going to be observed (from a distance, using a one-way mirror, etc.), and the relationship between the observer and the subject types of observation research - Correct Answer-psychomotor skills: does the person do the LP correctly? personal habits: do they wash their hands before going in to see the patient? non-verbal communication communication patterns types of observers - Correct Answer-non-participant - overt non-participant - covert participant - overt participant - covert are you known to the subject? do you tell the subject what you're doing? non-participant: someone who is not known to the subject overt: saying what you are doing there covert: not telling them what you're doing and why you're there inter-relationship studies - Correct Answer-correlational studies: looking at relationship between two or more variables (NOT testing cause and effect)--no manipulation of the variables is there a positive relationship in that they both go up at the same time? negative relationship? no relationship? ex: is there a correlation between the age of the nurse and his/her level of assertiveness? cross sectional study - Correct Answer-data collected at one point in time data collected across subjects who are at various stages (such as cancer treatment--levels of N/V in Oct across patients who are in different chemo regimes) longitudinal - Correct Answer-collect data from a group of people over time following same people over time expensive and time consuming ex post facto studies - Correct Answer-from after the fact can be retrospective or prospective looking at differences based on some variable--no manipulation or randomization retrospective: looking at a result and then attempting to determine a cause (high cancer rate in children--all these children resided in the same area) prospective: a cause has been identified and you follow subjects to determine the outcome methodologic studies - Correct Answer-developing, testing, evaluating research instruments to measure concepts/variables simulation studies - Correct Answer-Vignettes developed and tested about your response to a situation such as ethical dilemmas write the scenario, include relevant information, and then ask people to respond study conclusions are highly dependent on... - Correct Answer-the fidelity of the data collection methods used they should be objective or free from biases, values, attitudes systematic or collected in a consistent way concepts are operationalized into measurable variables data collection methods - Correct Answer-observation self-report physiologic data existing data error - Correct Answer-every study has some level of measurement error measurement error is the difference between the true value and the measured value in a given study random - occurs when data is collected in a non-standardized and consistent way social desirability - favorable impression? (data are treated confidentially) missing data physiologic measurement - Correct Answer-use of specialized equipment to measure physical and biological status physical (weight, temperature) chemical (blood glucose level) microbiologic (cultures) anatomic (radiologic exams) advantages vs. disadvantages in physiologic measurement - Correct Answer-advantages: objective, precise, sensitive, minimizes distortion disadvantages: expensive, specialized training, environmental influences, environmental variable control considerations existing data - Correct Answer-secondary analysis is the re-use of data already collected by another researcher in a previous study to address a new research question medical records death certifications US Census Medicare/Medicaid database SEER database advantages vs. disadvantages of existing data - Correct Answer-advantages: data already collected, large sample sizes, larger samples=more sophisticated statistical analyses, time and $$ savers disdavantages: many datasets lack de-identification so are not sharable, researchers are restricted to a set list of variables construction of new measures - Correct Answer-complex and time consuming look for standardized instrument first steps for development: define the concept to be measured in target pop, develop the item and access for content validity, develop instructions for study participants, pretest and pilot test the items, estimate relability and validity appraising the evidence for data collection methods - Correct Answer-are the measures clearly identified? is rationale for their selection provided? is the method used appropriate to the problem or clinical situation studied? were data collectors adequately trained? were data collection procedures consistent? appraising the evidence for observational methods - Correct Answer-who did the observing? were observers trained to minimize bias? was there an observational guide? did the presence of the observers affect the behavior of the study participants? was informed consent used? appraising the evidence of self-report interview methods - Correct Answer-was an interview guide used? who were the interviewers and how were they trained? is there clear indication that the subjects understood the task and the questions? is there evidence of interviewer bias? appraising the evidence for questionnaire methods - Correct Answer-is the measure described adequately? is there evidence that study participants were able to answer the questions? are the items appropriately close- vs. open-ended? appraising the evidence of physiologic measurement - Correct Answer-is the instrument used appropriate to the problem? is the rationale provided for instrument selection? is there a provision for evaluation of the accuracy of the instrument? appraising the evidence for existing data - Correct Answer-are the existing data used appropriately for the problem being studied? is new information being generated by examining these data? is selection bias a consideration? a few considerations for reliability and validity - Correct Answer-one of the most important attributions of a study is that the measurement instruments reliably and accurately reflect the theory being examined failure to do so threatens the study conclusions evidence of reliability and validity is of paramount importance reliability and validity - Correct Answer-reliability=consistency (the ability of a measurement instrument to measure the attributes of a concept or a construct consistently) validity=accuracy (the extent to which an instrument measures the attribute of a concept accurately) error variance=variability due to error (chance or random may impact reliability, systematic or constant can effect validity)--the extent of variability in test scores that are attributable to error rather than a true measure of the behaviors (difficult to control as they are often caused by the person's state such as anxiety levels--systematic errors influence the validity of an instrument such as biasing the study participant's responses to questions) psychometrics for this are usually found in the methods of a research report reliability - Correct Answer-extent to which an instrument yields the same results repeatedly consistency with which it measure the intended attributes or concepts optimizes the chance of obtaining the truth reliability coefficient: 0 to 1 (1 is optimal) 3 things contribute: stability over time (test-retest reliability), internal consistency within the scale (Cronbach's alpha [common statistic used to assess this--items in an instrument all related to each other and measure the same concept and scales should be unidimensional and should measure only one concept], item to total correlations), equivalence (consistency or agreement among observers using the same measurement tool--interrater relability between >1 observer, Cohen's kappa [aim for >0.8]) entire population? if it's small, extensive resources, don't expect a high response sampling frame - Correct Answer-the list from which the potential respondents are drawn from (e.g., Registrar's office, EHR, census) must assess sampling frame errors types of sampling - Correct Answer-probability and nonprobability probability: random--generalize to the population defined by the sampling frame, allows use of statistics/test/hypotheses, can estimate population parameter, eliminates bias, must have random selection of units nonprobability: non-random--you cannot generalize beyond the sample, exploratory research/generates hypotheses, population parameters are not of interest, adequacy of the sample cannot be known, cheaper/easier/quicker to carry out probability sampling methods - Correct Answer-all elements in the population have some opportunity of being included in the sample and then there's a mathematical probability that any one of them will be selected to be included in your research nonprobability sampling methods - Correct Answer-population elements are selected on the basis of their availability perhaps they volunteer or could be based on researcher's judgment an unknown portion of the population is excluded one of most common types: convenience sampling extent to which a convenience sample, regardless of its size, represents the population is unknown voluntary response samples - Correct Answer-only representative of people that volunteer the people who didn't volunteer might be quite different random sample - Correct Answer-process of choosing the research participant from the population happens before assignment random assignment - Correct Answer-each participant has equal chance of being placed into a group probability sampling - Correct Answer-simple random sample stratified random sampling systematic sampling cluster sampling simple random sample - Correct Answer-characterized by the fact that the probability of selection is the same for every case in the population--method of selecting a specific number of units from the size of the population such that every possible sample of size has an equal chance of being drawn difficult to come by in the real world stratified random sampling - Correct Answer-population is divided into two or more mutually exclusive segments based on some categories of variables of interest in the research designed to organize the population into homogeneous subsets before sampling then drawing a random sample within each subset subpopulations=strata--non-overlapping and together comprise the entire population primary benefit: to ensure cases from the smaller strata are included to allow for better comparison systematic sampling - Correct Answer-every nth is drawn for inclusion in the sample you have 10,000 patients and you want 1000 patients for your study--you divide the number of cases in the population by the desired sample size (10,000/1000=10)--select a random number between 1 and 10, say 7--start with #7 then take every 10th record until we get our sample of 1000 units occur at same relative position in the stratum vs. for stratified, the position is determined randomly and not systematically cluster sampling - Correct Answer-sampling unit consists of a group of smaller units called elements or subunits main reason to use: for many surveys, there may not be a reliable list of elements in the population available and it would be expensive to construct such a list (such as in a country where there is not an updated list of people and we don't know how many houses there are, etc.) generates a sampling frame that is economical and often readily available less time consuming and able to implement results faster may not reflect diversity of community other elements in the same cluster might share similar characteristics might provide less information per observation than a simple random sample of the same size standard error is high compared to other sampling of the same sample size non-probability sampling - Correct Answer-convenience sampling (availability sampling) quota sampling judgment sampling or purposive sampling snowball sampling convenience sampling - Correct Answer-method of choosing subjects who are available or easy to find haphazard, accidental, etc. easier to carry out relative to other methods often shows up in university courses audience is captive in some schools you can obtain a large sample size you can never be certain what the population of participants in the study actually represent--population is unknown common type election time: use this for polls (only collects data from people who go online and vote) quota sampling - Correct Answer-designed to overcome the most obvious flaw in convenience sampling set a quota to ensure that the sample you get represents certain characteristics in proportion to the prevalence in the population you define the criteria of inclusion even when we know that it's representative of a particular characteristic from the quota that has been set, we have no way of knowing if the sample is representative of any other characteristics judgment sampling or purposive sampling - Correct Answer-elements are chosen based on the purpose of the study examples of recruitment methods - Correct Answer-media (newspaper, TV, radio, internet) social media (Facebook, Twitter, LinkedIn)--b/c of large reach and snowball effect and ability to tailor ads on social media for individuals mailings flyers databases registries clinic recruitment random digit dialing health fairs school and mail recruitment occupational screening but which recruitment method? - Correct Answer-review literature and determine what's best for specific type of research you are conducting try multiple methods, esp. to reach rural areas pilot study what happens if you have low recruitment? - Correct Answer-evaluate your sample size and speak with statitician about what effect this will have add new sites replace sites extend recruitment modify inclusion criteria (maybe they are too strict) attrition - Correct Answer-drop outs, such as for treatment non-compliance, AEs, lack of benefit, moved away, changed phone number enhancing retention - Correct Answer-make access and appointment times convenient send updates provide contact between visits remember holidays help with transportation compensation basic ethical principles - Correct Answer-respect for persons beneficence justice respect for persons - Correct Answer-people get to decide if they want to participate or don't want to participate in research people must be competent to make this decision those that can't self-determine have to be protected so someone will help with the decision of if they should participate in the research or not (such as with a child and a parent/guardian consent) beneficence - Correct Answer-do no harm want to maximize benefits and minimize risk and adverse reactions justice - Correct Answer-there needs to be fair treatment in the selection and non-prejudical treatment of individuals who choose not to participate patients vs. subjects - Correct Answer-patients: someone who comes to you to receive treatment or help (b/c you're a healthcare provider) and you provide services for the direct benefit of the patient subjects: an individual who responds to a need for participation in a research study (such as an advertisement)--may give body fluids, information on activity, etc.--there may or may not be benefit to the individual for both there are consent forms and there's no distinction in the content of the consent for either therapy or research informed consent - Correct Answer-for practice and research must be competent to be able to sign for the research study (mentally) informed (need to know what study is about, its purpose, etc.) comprehend voluntary (have to have opportunity to participate or not) requirements for informed consent - Correct Answer-purpose of research duration of participation procedures risk/discomfort (e.g., with a blood draw, it could be painful, could have excessive bleeding, may faint, etc.) benefit (or is there no benefit?) alternatives (e.g., if they want you to take drug X, is there a drug Y for you to take?) confidentiality cost (may not be a cost to you directly but may be to insurance company) contact info (for you and for the study team) special circumstances for informed consent - Correct Answer-children: cannot give informed consent under the age of 7 (parent consents for child), 7-12 you must explain the study to the child, >12 the child can give assent but not consent--age at which they can give consent varies state by state pregnant women (risks on the fetus and if there is, does the father need to be informed and sign for the study) prisoners (have limits to their freedom, on IRB there will be a prisoner representative) mental illness (ability to comprehend, are they competent to sign) obtaining consent - Correct Answer-who when where under what conditions IRB - Correct Answer-3 types (all have same requirements): academic