I. Importance of Research in nursing1. Research is an important tool for the continual development of a relevant body of knowledge in

nursing.2. Research generates information from nursing investigations which help define the unique role of

nursing as a profession.3. Professional accountability of nurses to their clients is demonstrated when nurses incorporate research

evidence into their clinical decisions.4. Research facilitates evaluation of the efficacy of nurses; practice which may articulate their role in the

delivery of health services.5. Another reason for nurses to engage in research involves the spiraling costs of health care and the

cost-containment practices being instituted in health care facilities. With research, costly trial-an-error and even unsafe interventions are avoided.

6. Research may allow nurses to make more informed decisions as each phase of the nursing process is clarified through research.Research also enables nurses to

7. understand a particular nursing situation about which little is known, 8. assess the need for an intervention,9. identify factors that must be considered in planning nursing care, 10. predict the probable outcomes of certain nursing decisions, 11. control the occurrence of undesired outcomes, 12. provide advice to enhance client health, and13. initiate activities to promote appropriate client behavior.

II. Main difference between quanti and quali research

Similarity:

Both methodologies require researcher expertise, involve rigor in conducting the study, and generate scientific knowledge for nursing practice.

Differences:

1. In terms of their philosophical underpinnings, quantitative research is based on logical positivism while qualitative research is naturalistic, interpretive, and humanistic

2. In terms of focus, quantitative research is objective, concise, and reductionist, while qualitative research is broad, subjective, and holistic.

3. In terms of reasoning, quantitative research is logistic and deductive while qualitative research is dialectic and inductive.

4. In terms of their basis of knowing, quantitative research is based on discovering cause-and-effect relationships while qualitative research is based on meaning, discovery, and understanding.

5. In terms of their theoretical focus, quantitative research tests theory while qualitative research develops theory

6. In terms of their basic element of analysis, quantitative research uses numbers, while qualitative research uses words

7. Quantitative research utilizes statistics to make generalization while qualitative research looks into individual interpretation to find the uniqueness of a phenomenon.

III. Major steps in quantitative research

Phase I: The conceptual Phase

1. Formulating and delimiting the problemExample:“Do women who attend structured antenatal classes have higher scores in the labor and delivery knowledge test and experience less pain in labor?”

2. Next step will be to review related literaturesA. Identify key words/phrases

PregnancyPrimigravid womanAntenatal care and existing programsStages of Labor and delivery processLabor painsGate control theory of painLearning theories

B. Identify possible resourcesA. Maternal and child health nursing books

B. Surf the net Pubmed/Medline, Cochrane LibraryC. Library search for relevant journals such as The American Journal of Obstetric

and Gynecology Nursing, Nursing Research Journal, Public Health Nursing Journal3. Interview clinicians (OB-GYNe nurses, doctors, public health nurses) do benchmarking4. Explore theory of reasoned action, or the health belief model if these can support proposed study.5. Hypotheses: “Women who attend structured antenatal classes obtain higher test

scores in the labor and delivery knowledge test than women who do not attend.”

“Women who attend structured antenatal classes throughout pregnancy request less analgesia during the first stage of labor.”

“There is no significant difference in the test scores from a labor and delivery knowledge test between women who attend and those who do not

attend structured antenatal classes.”

“There is no significant difference in the number of requests for analgesia during the first stage of labor between women who attended and those

who did not attend structured antenatal classes.”

Phase II: The design and planning phase

6. Choose a nonequivalent group pretest and post test quasi-experimental design. Since it is difficult to determine the population of all primigravid women in Dumaguete City or the province of Negros

Oriental, it is not very feasible to come up with a sampling frame where actual subjects will be drawn. A modified sampling design where the decision to which group will the first qualified subject should belong will be done through simple random sampling by tossing a coin.

7. A well structured antenatal care class program will be designed. It shall include the following topics and activities:

Normal physiology of pregnancy, labor and deliveryThe psychological aspects of pregnancy, labor and deliveryDiscomforts experienced during labor and how to manage them.Prenatal exercises in preparation of the labor and delivery processFactors that may affect pain experience during labor and delivery.

8. The population is all primigravid women on their second trimester of pregnancy who are residing in the barangays of the randomly chosen towns and cities of Negros oriental at the time of program implementation.

9. Cluster sampling will be used. Clusters will be the basis starting with towns and cities, two towns and two cities will be chosen at random. From these towns and cities will be drawn the barangays included in the study. A total of four barangays (2 urban and 2 rural) will be drawn from each of these barangays. All primigravid mothers will be recruited from each of these barangays. To prevent contamination, all women from the barangays that are randomly assigned to the control group will be tested first. After the post test has been conducted for the control group, women of the barangays randomly assigned to the experimental group will be exposed to the structured antenatal care program after the pretest and then a post test will also be given.

10. A 20-item knowledge test will be developed which will be used for the pre and post test measure on knowledge. To measure number of analgesia, a monitoring scheme will be devised which will be used to record number of askings for analgesics indicating frequency, dosage, response and person administering the intervention.

11. An informed consent will be secured from each participant. A set of inclusion criteria will also be specified. Recruitment of subjects should be without any form of coercion or threat. Women of both groups will continue to attend usual prenatal check-ups at their barangay health stations.

12. Trainings for program facilitators and data collectors will be done at least a month prior to actual conduct of the study. Prepared data gathering tools will be submitted for expert scrutiny through Delphi technique. Knowledge test measure will be submitted for item analysis and content validity with some experts.

Phase III: The empirical phase

13. A Pilot test will be done in a barangay with similar characteristics with those included in the study. After refining all processes and protocols a Gantt chart will be shared with all study facilitators.

14. Actual data gathering, then data processing and analysis preparation will be done

Phase IV: The Analytic Phase

15. Data analysis using descriptive and inferential statistics16. Interpreting results

Phase V: the Dissemination Phase

17. Present findings in proper fora18. Utilizing findings in practice.

IV. Steps in Conducting Literature Review

A literature review is a summary of previous research on a topic. Some questions to think about as one develops the literature review:

*What is known about the subject? *Are there any gaps in the knowledge of the subject? *Have areas of further study been identified by other researchers that I may want to consider? *Who are the significant research personalities in this area? * Is there consensus about the topic? * What aspects have generated significant debate on the topic? *What methods or problems were identified by others studying in the field and how might they impact my research? *What is the most productive methodology for my research based on the literature I have reviewed? * What is the current status of research in this area? *What sources of information or data were identified that might be useful to my study?

How to do a literature Review

Steps to take:

1. Define the topic - In order to begin my literature review I must first define my research question. What is the purpose? What does it mean? What are the key words? Are there other words which

could be used, such as synonyms, variations in spelling? What do I already know about the topic? What is the scope? Do I need everything ever written in English on this topic, or just the last ten years?

2. Develop a search strategyCompiling a list of keywords - Before beginning a search for information, it is important to develop a

search strategy that will most effectively locate useful, relevant information. This will often involve breaking down the research question into:

keywords or phrases; entering the search; and evaluating results to determine whether I need to employ various strategies to broaden, narrow or otherwise modify my research. Analyzing the topic of a research topic usually involves making a list of keywords or phrases. I will need to include all the key concepts or ideas contained within the research question. It might be useful to include alternative ways of phrasing and expressing concepts and ideas. I will think about both general terms and very specific terms for broadening and narrowing my search. The keyword or phrase is the basic unit of any search. I may find it helpful to consult subject dictionaries and encyclopedias, or a textbook glossary for the common terminology of the subject area. I may also consider the use of an index and/or thesaurus which is also advisable to establish the useful terms.

3. Identify resources Information is available in a number of formats. It is important for me to understand the significance of various formats so that I will know what will best suit my information requirements. *Books *Indexes/Abstracts Printed (e.g. CINAHL) *Reference Materials *Electronic Databases

* Journals *Government publications *Conference Papers * Internet (Medline, Cochrane Library) * Dissertations * Theses

V. Examples of a statement of a problem and research questions:Examples of a problem statement:A. “Patients’ concerns about reporting pain and using analgesics… are barriers to adequate pain

management…Despite extensive attention to issues of pain management…few studies have been conducted testing impact of intervention on cancer pain…”

B. “Current policy at most hospitals requires the use of routine flushing of heparin locks after administration of medication or flushing heparin locks every 8 hours when not being used for medication administration. However, there is disagreement on whether flushes of low doses of heparin are necessary to maintain the patency of heparin locks....”

C. “Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently” (Blegen, Goode, & Reed, 1998).

Examples of Research questions:

A. What is the relationship between reported depressive symptoms and rate of return to work for patients following cardiac surgery?

B. What is the relationship of anxiety and compliance with medications and follow-up appointments for patients following cardiac surgery?

Examples of a problem statement and related research questions:The Problem: “Patients’ concerns about reporting pain and using analgesics… are barriers to adequate pain management…Despite extensive attention to issues of pain management…few studies have been conducted testing impact of intervention on cancer pain…”Research Questions:

1. What is the effect of a PRN pain medication protocol in the Cancer patients’ reported pain relief concerns?

2. What is the effect of a round-the-clock analgesic use protocol in the cancer patients’ reported pain relief concerns?

3. Is there is a significant difference in pain relief between cancer patients receiving PRN pain medication and cancer patients receiving round-the-clock pain medication?

VI. Determining Appropriate Research Design

Appropriateness of a design considers several factors. These factors include the following:

1. To set up a situation that maximizes the possibilities of obtaining valid answers to research questions or hypotheses.

2. To achieve greater control, and thus improve the validity of the study in examining research problem3. The design selected must be:

Appropriate to the purpose of the studydescribe...determine differences between groups...examine relationships among...determine the effect of...

- Appropriateness to the research questiona. Whether the design does the possible job of providing trustworthy answers to the research

questions.b. A given research question can be addressed with a number of different designs.c. Many designs are completely unsuitable for dealing with certain research problemsd. There are many research questions of interest to nurses for which highly structured designs

are unsuitable.- Lack of Bias (The lack of unwanted influences that can produce a distortion in the results of a study.)The goals of experimental research can be summarized by four Major questions:

What is the strength of the evidence that a relationship exists between two variables? If a relationship exists, what is the strength of the evidence that the independent

variable of interest (e.g. an intervention), rather than extraneous variables, caused the outcome?

If the relationship is plausibly causal, what are the theoretical constructs underlying the related variables?

If the relationship is plausibly causal, what is the strength of evidence that the relationship is generalizable across people, settings, and time?

4. Feasible given realistic constraints5. Effective in reducing threats to validity.

Elements of a good research design: Use of Comparison groups

- Comparison between 2 or more groups e.g. study the emotional consequences of having an abortion, to do this, we might compare the emotional status of women who had an abortion with

that of women with an unintended pregnancy who delivered the baby.- Comparison of one group’s status at two or more points in time

e.g. we might want to assess patient’s level of stress before and after introducing a new procedure to reduce preoperative stress.

- Comparison of one group’s status under different circumstances.e.g. compare people’s heart rates during two different types of exercise.

- Comparison based on relative rankings.e.g. we hypothesized a relationship between level of pain of cancer

patients and their degree of hopefulness. Use of methods to control extraneous variables.

* Random Sampling-increases the probability that subjects with various levels of an extraneous variable are

included and are randomly dispersed throughout the groups within the study.-this strategy is particularly important for controlling unidentified extraneous variables.

* Random Assignment

-enhances the probability subjects with various levels of extraneous variables are equally dispersed in treatment and control groups.* Homogeneity

- In this, the researcher limits the subjects to only one level of an extraneous variable to reduce its impact on the study findings.

- to use this strategy, the researcher must have previously identified the extraneous variables.

- this strategy, the researcher might choose to include subjects with only one level of an extraneous variable in the study.

Example of homogeneity: the study of breast cancer patients who have been diagnosed within one month, at a

particular stage of disease, and are receiving a specific treatment of cancer* Blocking

-the researcher includes subjects with various levels of an extraneous variable in the sample but controls the numbers of subjects at each level of the variable and their random assignment to groups within the study.

-designs using blocking are referred to as randomized block designs.-the extraneous variable is then used as an independent variable in the data analysis.

* Matching-is used when a subject in the experimental group is randomly selected and then a subject

similar in relation to important extraneous variables is randomly selected for the control group.

Timing of data collection – is it longitudinal or cross-sectional Study site and setting – is it conducted in laboratory setting or in its natural setting? Intervention or the presence or absence of a treatmentVII. Strengths and Weaknesses of the different designs

1. True Experimental Designs:Some researchers believe that this is the most powerful research design as it gives us cause

and effect relationships.Strengths: More Controls: in the design and conduct of study

Increased internal validity: decreased threats to design validityFewer Rival HypothesesMore Practical: Ease of implementationMore Feasible: resources, subjects, time, settingMore Generalizable: Comparable to practice

Weaknesses:-There are a number of variables of interest that are not

amenable to manipulation. For instance we cannot randomly confer upon infants their weight at birth to observe the effect of birth

weight on subsequent morbidity. - Ethical considerations may prevent the manipulation of the

independent variable. - You would not inflict pain for the sake of an experiment.

- Artificial circumstances may affect the results. Laboratory designs take place in an artificial setting. Easier to control for

external variables but is not as generalizable because it constrains the human experience.

- Many variables of interest in nursing cannot be manipulated; difficult or impractical to perform in field settings; the act of

being studied influences results of a study.- The Hawthorne Effect: effect of being in the study group may

be sufficient to cause people to change their behaviors. This is the reason that double blind studies are conducted. In which neither subject nor those who administer the treatment knows which

is the experimental or control group. Quasi-Experimental DesignsSTRENGTHS:

More Practical: Ease of implementationMore Feasible: resources, subjects, time, settingMore Generalizable: Comparable to practiceused frequently because they are practical, feasible, and generalizable.

WEAKNESS/DISADVANTAGE – involve mainly the inability to make clear cause-and-effect statements.

Can be remedied by controlling extraneous variables (alternative events that could explain the findings) a priori (before initiating the intervention) by design.

Descriptive Survey DesignSTRENGTHS:

Data are gathered from a more natural setting.Large amount of data can be gathered at fairly reasonable cost.Surveys using the questionnaire are likely to cover a wide geographical area, reach many people, insure respondents’ anonymity, and

require less skill to administer.DISADVANTAGES

It only collects self reports where selective recall may introduce bias.Some respondents may not be willing to express attitudes and beliefs on sensitive topics.There may be no chance to observe the study participants directly unless done with interview (which is more expensive).

Correlational and Ex-post-facto ResearchADVANTAGES:

Both designs have the advantage of examining the results of factors that could not be studied because of ethical constraints.Ex-post-facto research can have the researcher examines the effect, search among the processes of the past to identify a possible

agent whose presence is correlated with the effect.DISADVANTAGE:

The disadvantage of ex-post-facto research is the loss of control-both manipulation and randomization.The disadvantage of the correlational design is the researcher’s tendency to attribute causality to descriptive relationships.

VIII. How to conduct probability samplingAccording to the types:

Simple random sampling

Objective: Select n units out of N such that every NCn has an equal chance.

Procedure: Use table of random numbers, computer random number generator or mechanical device.Can sample with or without replacement.f=n/N is the sampling fraction.

Stratified samplingObjective: Population of N units divided into nonoverlapping strata N1,

N2, N3, ... Ni such that N1 + N2 + ... + Ni = N; then do simple random sample of n/N in each strata.

Example:

Proportionate: If sampling fraction is equal for each stratumDisproportionate: Unequal sampling fraction in each stratum

Needed to enable better representation of smaller (minority groups)

Systematic samplingProcedure:

Number units in population from 1 to N.Decide on the n that you want or need.N/n=k the interval size.Randomly select a number from 1 to k.Take every kth unit.

Cluster (area) samplingProcedure:

Divide population into clusters.Randomly sample clusters.

List of clients

StrataAfrican-American Ot

hers

Hispanic-American

List of clients

Random subsamples of n/N

Strata African-American OthersHispanic-American

Measure all units within sampled clusters.

Multistage samplingCluster (area) random sampling can be multi-stage.Any combinations of single-stage methods.

Example: Choosing students from schools Select all schools; then sample within schools. Sample schools; then measure all students. Sample schools; then sample students.

IX. Steps in conducting Random Assignment in experimental research:Example: In a study of primigravid women attending structured antenatal classes, random assignment could be done as follows:1. Prepare a list of the names of all primigravid women who qualify to participate in the study. 2. Write each name on pieces of papers. Roll all the pieces of papers and place in a box or jar.

Shake the box thoroughly.3. Make a decision whether to assign the first drawn name to experimental or control or toss a

coin to make this decision e.g. Head to experimental group and tail to control group.4. Draw the first name. After noting the name, replace the rolled paper inside the box or jar

(random with replacement).5. Draw the next name and toss the coin again. After noting to which group that name belong

replace the rolled paper inside the box or jar.6. Continue the steps 4 and 5 until all names are assigned to either of the two groups.

NB: If a name is picked more than once just replace it but take first assignment as final.

X. A comparison of descriptive and inferential statistics:Descriptive statistics, such as the mean, summarize research data from a sample, while inferential statistics use the data from randomly drawn samples, both to infer characteristics of the population from which the samples was drawn and to test statistical hypotheses. Descriptive statistics may be used whether or not random sampling has been used, but inferential statistics requires random sampling and other processes based on the principles of probability.

Descriptive Statistics are used to present quantitative descriptions in a manageable form. This method works by reducing lots of data into a simpler summary. While of basic importance, such findings are usually limited to the sample under study, unless the process of random sampling has been used.

Descriptive statistics are used to describe and synthesize data obtained from empirical observations and measurements while Inferential statistics allows the researcher to go beyond the description and summary of data.

Inferential statistics are based on the laws of probability and on the assumption that the sample/s was/were randomly selected.There are two purposes of inferential statistics:

1. Estimating population parameter from sample data2. Testing hypothesis about a population

XI. Difference between parametric and non-parametric statistical testsParametric tests are statistical tests based on assumptions that the sample is representative

of the population and that the scores are normally distributed.Parametric Tests are characterized by three attributes:

1. They involve the estimation of a parameter

2. They require measurements on at least an interval scale 3. They involve several assumptions, such as the assumption that the variables are

normally distributed in the populationNonparametric tests by contrast do not estimate parameters; they are used when the data are nominal or ordinal or when a normal distribution cannot be assumed. This means data need not be quantitative measurements but could be in the form of qualitative responses such “yes” or “no”, “present” or “absent”. They are called distribution-free statistics. Their use is encumbered with less restrictive assumptions compared with their parametric counterparts. Their computation is also usually quick and easy.

XII. Ethical PrinciplesThe ultimate consideration is protection of the rights of people who participate in nursing research.Ethical concerns are especially prominent in the field of nursing because the line of demarcation between what constitutes the expected practice of nursing and the collection of research information has become less distinct as research by nurses increases.Ethics poses particular problems to nurse researchers in some situations because ethical requirements sometimes conflict with methodologic considerations.

Three primary ethical principles:1. Principle of beneficence: Above all, do no harm.

a. Freedom from harm*research should be conducted only by qualified people.*Researcher must be prepared at any time during the study to

terminate the research if there is reason to suspect that continuation would result in injury, disability, undue distress, or death.

How to remedy:-test new medical procedures or drug with animals or tissue cultures before

proceeding to test with humans.-conduct debriefing sessions that permit participants to ask questions

after their participation and by providing participants with written information on how they may later contact the researchers. b. Freedom from exploitation

Participants need to be assured that their participation, or the information they might provide to the researcher will not be used against them

in any way.e.g. subject reporting drug abuse should not fear exposure to criminal

authorities.c. Benefits from research

Benefits from research should accrue to society in general or to other individuals.d. Risk/Benefit ratio

The degree of risk to be taken by those participating in the research should never exceed the potential humanitarian benefits of the knowledge to be gained.

2. The principle of respect for human dignitya. The right to self-determination

This means that prospective participants have the right to decide voluntarily whether to participate in a study, without the risk of incurring any penalties or prejudicial treatment. This also means that people have the right to decide at any point to

terminate their participation, to refuse to give information, or to ask for clarification about the purpose of the study or specific study procedures.

b. The right to full disclosureFull disclosure means that the researcher has fully described the nature of the study, the participants’ right to refuse participation, the researcher’s responsibilities, and the likely risks and benefits that would be incurred.

*Informed consent is based on the right to self-determination and the right to full disclosure 3. The principle of justice

a. Right to fair treatment Study participants have the right to fair and equitable treatment, both before, during, and after their participation in the study.

b. Right to privacyStudy participants have the right to expect that any information collected during the course of a study will be kept in strictest confidence.

XIII. Ways to collect data1. Data could be gathered in three ways:

Self ReportsA researcher collecting structured self-report data for a quantitative study almost always uses

a formal, written, instrument:a. Interview Schedule – the instrument used is an interview schedule when the questions are

asked orally in either face-to-face or telephone interviews. Interviewsa. Advantages outweigh those of questionnaires in terms of response rates, audience,

clarity, depth of questioning, missing information, order of questions, sample control, supplementary data

b. Questionnaire or SAQ – this is the instrument when respondents complete the instrument themselves, usually in a paper-and-pencil format

a. Self-administered questionnaires can be distributed in person, by mail, or over the internet

b. Advantages: less costly and require less time and energy to administer, offer the possibility of complete anonymity, and absence of interviewer ensures no interviewer bias

ObservationUnstructured ObservationsStructured Observations

o Category Systemso Checklistso Rating Scales

Biophysiologic Measures o Physical Measurement Methods Chemical/biochemical

EKG, BP, I & O Pulse Oximetry o Microbiological Blood glucose

Smears PKUCultures Sensitivities

Scales

Rating Scales Semantic DifferentialsLikert Scales Visual Analog Scales

XIV. Ensuring validity of the study and validity of the research toolWhat is validity?

The best available approximation to the truth or falsity of a given inference, proposition, or conclusionA set of standards by which research can be judged.

Conclusion validity - The extent to which the research design is sufficiently precise or powerful enough for the detection of effects on the operationalized variable should they exist

Elements of conclusion validity:Sufficient powerReasonable evidence to find that the cause and effect covarySignificant covariation

Threats to conclusion validity:Low statistical powerViolated assumptions of statistical testsFishing and the Error Rate problemLow reliability of measuresPoor reliability of treatment implementationRandom irrelevancies in the settingRandom heterogeneity of respondents

Improving Conclusion Validity:Specific SuggestionsPretest and posttest on same scalesMatch before or after random assignment (but not in place of random assignment)Use covariatesIncrease reliability, especially of dependent measuresAdjust raw scores for unreliabilityEstimate desired effect magnitude in advanceEach person as own controlPresent effect and standard errorSelect homogeneous samples

Internal Validity - this refers to the degree to which it can be inferred that the experimental treatment (IV), rather than uncontrolled extraneous variables, is responsible for observed effects.

- This addresses the question: “Given a statistical relationship between the IV and the DV, is there evidence that one causes the other?”

- Extraneous variables present threats to internal validity because they offer competing explanations for the observed relationships between the IV and the DV; that is, they interfere with cause-and-effect inferences.

- True experiments have a high degree of internal validity because of the controlling properties of randomization and control groups. Types include:

1. History – refers to the occurrence of external events that take placeconcurrently with the IV that can affect the DV. Example: If we study the differential effect of two forms of exercise on knee extensor strength, history effects may include some subjects’ participation in other athletic activities or other therapies that affect knee extensor strength.

2. Maturation – This refers to processes occurring within the subjects during the course of the study as a result of the passage of time rather than as a result of a treatment or IV.- Maturation effects may cause subjects to respond differently on a second

measurement because they have grown older, stronger, healthier, tired or bored since the first measurement.- Maturation is a relevant consideration in many areas of nursing research.

Maturation does not refer to aging or development exclusively but rather to any change that occurs as a function of time. Thus wound healing, postop recovery, and many bodily changes that can occur with little or no nursing or medical intervention must be considered as an explanation based on the effects of the IV.

3. Testing – This refers to the effects of taking a pre-test on subjects’ performance on a post-test.

- The mere act of collecting data changes the response that is being measured particularly in those that deal with opinions and attitudes.

- In true experiments, testing may not be a problem because its effects would be expected to be about equal in all groups.

- The Solomon four-group design could be used if researchers wanted to isolate intervention effects from pre-test effects.

4. Selection – This encompasses biases resulting from pre-existing differences between groups.

- When individuals are not assigned randomly to groups. There is always a possibility that the groups are non-equivalent.- They may differ in ways that are subtle and difficult to detect.- If the groups are non-equivalent, differences on outcomes may result from initial differences rather than from the effect of the IV.

5. Mortality – Also called attrition, refers to the differential loss of subjects from comparison groups; that is dropouts occur for specific reasons related to the experimental

situation.- The loss of subjects during the course of a study may differ from one group to another because of a priori differences in interest, motivation, health, etc.- The risk of attrition is especially great when the length of time between points of data collection is long. - If attrition is random (i.e. those dropping out of a study are similar to those remaining in it with respect to extraneous characteristics), then there would not be bias. - In general, the higher the rate of attrition, the greater the likelihood of bias.

6. Instrumentation – This is concerned with the reliability of measurement.

- This bias reflects changes in measuring instruments or methods of measurement between two points of data collection.

Ruling out threats to internal validityMany threats such as history, maturation, selection, statistical regression, testing, instrumentation and selection interactions, can be ruled out by the use of random assignment and control groups. Random assignment cannot rule out the effects of attrition, imitating treatments, or compensatory

reactions.Blinding subjects and investigators will control many of these effects.

Construct Validity - Construct validity of causes and effects concerns the theoretical conceptualizations of the intervention and response variables and whether these have been

developed sufficiently to allow reasonable interpretation and generalization of their relationship (Portney & Watkins, 2000).

- This addresses the question: “Given that a cause-and-effect relationship is probable, to what theoretical constructs can the results be generalized?”

a. Operational definition of the variables – threats to construct validity are related to how variables are operationally defined within a study and to potential biases introduced into a study by subjects or experimenters.

- These threats were originally defined by Campbell and Stanley under the category of External Validity. These are now subdivided by Cook and Campbell into construct validity and external validity.

- When studies incorporate only one form of measurement or examine only one form of treatment, the results will apply only to a limited aspect of the construct. Therefore, if a study addresses only one form of treatment op one form of measurement, generalization of the results of that study is limited.

Example: Construct of pain which is multidimensional

Suppose pain is treated with relaxation exercises or transcutaneous electrical nerve stimulation (TENS), measures of success may vary depending on whether we assess pain by using a visual analogue scale (VAS), by measuring range of motion of involved joints, or by observing he efficiency of functional tasks.

VAS – reflects the patient’s subjective and relative feelings of pain intensity

ROM test reflects physiological concomitants of pain

Functional evaluation is influenced by personality, attitude, motivation, and lifestyle.

Each of these assessments measures a different aspect of pain that reflects components of the total construct of pain.

b. Time frame within operational definitions The element of time cannot be ignored in defining the construct of treatment, and

testing may need to be done at various intervals to determine the range necessary to achieve maximal effectiveness.

For example: If we study the effect of TENS over a 2-week period, we cannot generalize outcomes to events that might occur over a longer period of

treatment. If treatment shows no effect within this time frame, we would be inaccurate to conclude that TENS does not work..

c. Hawthorne Effect – subjects nay behave in a particular manner largely because they are aware of their participation of a study.Subjects often try their best to fulfil the researcher’s expectations or to present themselves in the best way possible, so that responses are no longer

representative of the natural behavior.

d. Experimenter Effects – Subjects’ behavior ay be affected by characteristics of the researchers.

The investigators may react more positively to subjects in the experimental group or give less attention to those in the control group, because of an emotional or intellectual investment in their hypothesis. If this is the case, the results in the original study might be difficult to replicate in a more neutral situation.

This threat to construct validity can be avoided by employing testers who are blinded to subject assignment and the research hypothesis.

External Validity – this refers to the extent to which the results of a study can be generalized beyond the internal specifications of the study sample.

- Addresses the question: “Can the results be generalized to persons, settings, and times that are different from those employed in the experimental situation?”

a. Expectancy Effects- includes placebo effect and nocebo effect

Placebo effect – this occurs when subjects administered a pesudointervention show changes or improvements. That same placebo might not have any

benefits when not administered in the context of a study.

Nocebo effect - this involves adverse side effects experienced by those receiving the placebo.

b. Novelty Effects – When treatment is new, subjects and researchers alike might alter their behavior in various ways.- Results mat reflect reactions to the novelty rather than to the intrinsic nature of an intervention; once the treatment is more familiar, results may be different.

c. Interaction of history and treatment effects – this concerns the ability to generalize results to different periods of time in the past or future.Example: If we look at the results of nutritional studies for reducing cholesterol in the

diet, results may be quite different today from results obtained 20 years ago, when knowledge about the effect of diet and exercise on CV fitness was less developed, and when society and the media were less involved in promoting fitness and health.

d. Measurement Effects – Researchers collect a considerable amt of data in most studies, such as pretest information, background data, and so forth. The results may

not apply to another group of people who are not also exposed to the same data collection (attention-giving) procedures.

Other threats to external validity:

1. Interaction of selection and treatment – When samples areconfined to certain types of subjects it is not reasonable to generalize results to those who do not have these characteristics.

2. Interaction of setting and treatment – If we demonstrate a causal relationship between an exercise program and functional improvement using patients in a rehabilitation

hospital, can we generalize these findings to a nursing home or to home care? This question can only be answered by replicating effects in different settings.

Ensuring validity and reliability of research toolsValidity – the degree to which an instrument measures what it is supposed to

measure.1. Face validity refers to whether the instrument looks as though it is measuring the

appropriate construct2. Content validity – concerns with the degree to which an instrument has an

appropriate sample of items for the construct being measured.3. Criterion-related validity- The degree to which scores on an instrument are correlated

with some external criterion.Predictive validity – the adequacy of an instrument in differentiating between people’s performance on some future criterion.Concurrent validity – refers to an instrument’s ability to distinguish individuals who differ on a present criterion.

1. Construct validity – The degree to which an instrument measures the construct under investigation.

Multitrait-multimethod matrix method (MTMM) - a method of establishing the construct validity of an instrument that involves the use of multiple measures for a set of subjects; the target instrument is valid to the extent that there is a strong relationship between it and other measures purporting to measure the same attribute(convergence) and a weak relationship between it and other measures purporting to measure a different attribute (discriminability)

Convergent validity – An approach to construct validation that involves assessing the degree to which two methods of measuring

a construct are similar.Discriminant validity – an approach to construct validation that involves

assessing the degree to which a single method of measuring two constructs yields different results.

Students’ Attitudes toward Four-day class week

Instruction: Please place a check mark on the space opposite the question under the column of your choice of answer. Please answer as honestly as possible. Thank you.

ItemItem RESPONSESRESPONSES SASA AA ?? DD SDSD

1. A four-day class week is a cost cutting 1. A four-day class week is a cost cutting strategy for the school.strategy for the school.

2. Many students can work to earn for 2. Many students can work to earn for their schooling on the extra day weekend.their schooling on the extra day weekend.3. The best way to make students work is 3. The best way to make students work is to include the extra day weekend for to include the extra day weekend for service-learning creditsservice-learning credits4. Many students can benefit from the 4. Many students can benefit from the extra day training in service learning extra day training in service learning centers if they do not need the extra day to centers if they do not need the extra day to work.work.5. There should be an expanded effort to 5. There should be an expanded effort to disseminate information about extra day disseminate information about extra day weekend to parents.weekend to parents.6. Because many families are financially 6. Because many families are financially challenged a four-day class week will savechallenged a four-day class week will save them the cost of the one day less a week them the cost of the one day less a week for fare and student allowance.for fare and student allowance.7. A four-day class week also gives time to7. A four-day class week also gives time to teachers to find extra work on the added teachers to find extra work on the added day off.day off.8. A four-day work week may help curb 8. A four-day work week may help curb incidence of truancy among students.incidence of truancy among students.9. Students need to be trained to be self-9. Students need to be trained to be self-sufficient and the one day off may give sufficient and the one day off may give them time to get a job.them time to get a job.10. School work is becoming heavy and a 10. School work is becoming heavy and a one day added off will prevent students one day added off will prevent students from getting burnout.from getting burnout.

Critiquing

Nature of evidence-based nursingEvidence-based practice – A practice that involves making clinical decisions on the best available evidence, with an emphasis on evidence from disciplined research.

According to Polit And Beck EBP is a major paradigm shift for health care education and practice. With EBP, a skillful clinician can no longer rely on a repository of memorized information, but rather must be adept in accessing, evaluating, synthesizing, and using new research evidence (2008).Best evidence refers generally to findings from research that are methodologically appropriate, rigorous, and clinically relevant for answering pressing questions-questions not only about efficacy, safety, and cost-effectiveness, but also about the reliability of nursing assessment measures, the determinants of health and well-being, the meaning of health or illness. (2008, p.32)

The practice of evidence-based nursing involves the following steps:

1. formulation of an answerable question to address a specific patient problem or situation2. systematic searching for the research evidence that could be used to answer the

question3. appraisal of the validity, relevance and applicability of the research evidence4. integration of the research evidence with other information that might influence the

management of the patient's problems5. clinical expertise, patient preference for alternative forms of care, and available

resources6. implementation of the evidence-based practice decision7. and finally, evaluation of the outcome of the decision.