Nursing Research Study Guide PDF

Nursing research ○ A systematic inquiry designed to develop trustworthy evidence about issues of importance to nurses and their clients Constructivist paradigm ○ Corresponds with QUALITATIVE research methods ○ Inductive reasoning (hypothesis GENERATION) ○ Mu...

Nursing research ○ A systematic inquiry designed to develop trustworthy evidence about issues of importance to nurses and their clients Constructivist paradigm ○ Corresponds with QUALITATIVE research methods ○ Inductive reasoning (hypothesis GENERATION) ○ Multiple interpretations of reality ○ Grounded in real life experiences Positivist paradigm ○ Corresponds with QUANTITATIVE research methods ○ Deductive reasoning (hypothesis TESTING) ○ Quantifiable objectives ○ Looking for truth, eliminating chance ○ Controls statistical analysis ○ Generalized to the population as a whole because of statistics ○ The researcher is independent from that being researched Qualitative research ○ Patterns of association or influence, not cause and effect; how themes or processes are connected ○ Poses questions about phenomenon that cannot be quantified/measured ○ Information from participants about their experience is used inductively to develop the theory ○ Increases our sensitivity and understanding of patients experiences, subjective experience - often referred to as phenomenon ○ Ethnography Understanding patterns of groups in social-cultural contexts, often means the researcher participates in the life of the group being studied Example: Encounter with a difference: Mental health nurses and Indigenous Australian users of mental health services ○ Phenomenology Understanding the lived experience and what they mean Example: The experience of early memory loss ○ Grounded theory Understanding social-psychological processes that occur in an experience Example: Facing children suffering from physical abuse: The decision-making process of non-abusing caregivers ○ Narrative inquiry ○ Transferability Quantitative research ○ Relationship between independent and dependent variables; cause and effect or associative (e.g., smoking causes lung cancer); sex (male or female) is related to life expectancy ○ Starts with a theory and test it through deduction ○ Experimental:  Intervention or treatment; control over extraneous variables. Most often to test causal relationships (e.g., Randomized Controlled Trial, Non-Randomized Controlled Trial) ○ Non-experimental: No intervention or treatment; data collected on existing characteristics (e.g., survey, cross-sectional study) Generalizability ○ The criterion used in quantitative studies to assess the extent to which the findings can be applied to other groups and settings ○ Is not about sample size but about characteristics of the sample Research methods ○ The techniques used to structure a study and to gather and analyze information in a systematic fashion ○ Quantitative Experimental: Randomized Controlled Trial, Non-Randomized Controlled Trial Non-Experimental: Survey, Cross-Sectional Study ○ Qualitative Grounded theory Phenomenology Ethnography Transferability Narrative inquiry Scientific method ○ a set of orderly, systematic, controlled procedures for acquiring dependable, empirical – and typically quantitative – information; the methodologic approach associated with the positivist paradigm Evidence-informed practice ○ Utilization of research by nurses in their practice ○ A practice that involves making clinical decisions based on an integration of the best available evidence, most often from disciplined research, with clinical expertise and patient preferences ○ May also be called research-based nursing practice, evidence-based practice, evidence-based decision making, and evidence-informed practice ○ To participate in evidence-informed practice RNs need to be comfortable with critical appraisal of research Systematic review ○ Systematic reviews are the STRONGEST evidence - more thorough because they include only high-quality studies ○ A rigorous synthesis of research findings on a particular research question, using systematic sampling and data collection procedures and a formal protocol ○ Teams of researchers follow a structured protocol for identifying all strong studies on a subject (published, not published, in other languages) ○ Evidence-based guidelines are considered to be systematic reviews Meta-synthesis  ○ The grand narratives or interpretive translations produced from the integration or comparison of findings from qualitative studies Meta-analysis ○ A technique for quantitatively integrating the results of multiple studies addressing the same or highly similar research question ○ Some researchers pool results from studies and re-analyse the data and this is called a meta-analysis Integrative review ○ Majority of literature reviews fall into this category ○ Involves a synthesis of the literature, summarize key themes and provide supportive data ○ These reviews will have a comprehensive search, evidence of synthesis and critical appraisal Descriptive narrative review ○ Gathering data that describe events and then organizes, tabulates, depicts, and describes the data collection ○ Synthesize the information about a topic but description and critical appraisal of individual studies is minimal ○ Weak and strong studies are given equal weight ○ Not possible to assess the quality of evidence from such a review. It would provide a good overview of strategies and tools ○ Useful for clinicians but further appraisal would be needed Journal club ○ A group that meets in clinical settings to discuss and critique research articles appearing in journals Cochrane Collaboration ○ An international organization that aims to facilitate well-informed decisions about health care by preparing systematic reviews of the effects of health care interventions Joanna Briggs Institute ○ Developed linkages across the world to promote and support EBP through systematic reviews, practice recommendations and consumer information design Clinical practice guidelines ○ Practice guidelines that are evidence-based, combining a synthesis and appraisal of research evidence with specific recommendations for clinical decisions Research utilization ○ The use of some aspect of a study in an application unrelated to original research Knowledge translation ○ “As a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system” ○ Getting the findings out to the public ○ The dissemination phase Communicating the findings and using the findings in practice Cause and effect  ○ The relationship between two variables wherein the presence or value of one variable (the “cause”) determines the presence or value of the other (the “effect”) ○ Quasi-experimental (analytic) Clinical trial ○ A study designed to assess the safety, efficacy and effectiveness of a new clinical intervention, often involving several phases Concept ○ An abstraction based on observations of behaviours or characteristics (e.g., fatigue, pain) Conceptual definition ○ The abstract or theoretical meaning of the concept ○ Example: Concept of uncertainty - the inability to determine the meaning of illness-related situations Credibility ○ Achieved to the extent that researchers can engender confidence in the truth of the data and their interpretations ○ A criterion for evaluating integrity and trustworthiness in qualitative studies, referring to confidence in the truth of the data; analogous to internal validity in quantitative research Inductive reasoning ○ Hypothesis GENERATION ○ Associated with constructivist paradigm and qualitative research methods Deductive reasoning ○ Hypothesis TESTING ○ Associated with positivist paradigm and quantitative research methods Critique ○ An objective assessment of a study’s strengths and limitations Findings ○ The results of the analysis of research data Inference ○ A conclusion drawn from the study evidence, taking into account the methods used to generate that evidence Journal Article ○ A research report appearing in professional journals such as Research in Nursing Health or Health or International Journal of Nursing Studies Randomness ○ Allowing certain aspects of the study to be left to chance rather than to researcher or participant choice ○ An important tool for achieving control over confounding variables and for avoiding bias ○ Important concept in quantitative research, involving having certain features of the study established by chance rather than by design or personal preference Reflexivity ○ The process of reflecting critically on the self and of attending to personal values that could affect data collection and interpretations of the data ○ Can be a useful tool in quantitative as well as qualitative research - self awareness and introspection can enhance the quality of any study  ○ Self reflection about his or her own biases, preferences and preconceptions Reliability ○ Consistently and accurately measured ○ The extent to which a measurement is free from measurement error; more broadly, the extent to which scores for people who have not changed are the same for repeated measurements Validity ○ The soundness of the evidence - whether findings are convincing, are well-grounded, and support the desired inferences ○ A quality criterion referring to the degree to which inferences made in a study are accurate and well-founded; in measurement, the degree to which an instrument measures what it is intended to measure Statistical significance ○ A term indicating that the results from an analysis of sample data are unlikely to have been caused by chance, at a specified level of probability Statistical test ○ An analytic tool that estimates the probability that obtained results from a sample reflect true population values Transferability ○ The extent to which qualitative findings can be transferred to other settings ○ An important mechanism for promoting transferability is the amount of rich descriptive information qualitative researchers provide about study contexts Trustworthiness ○ The degree of confidence qualitative researchers have in their data and analyses, most often assessed using the criteria of credibility, transferability, dependability, confirmability, and authenticity Triangulation ○ The use of multiple sources of referents to draw conclusions about what constitutes the truth ○ Useful strategy in both qualitative and quantitative research Scientific merit ○ The degree to which a study is methodologically and conceptually sound in quantitative research ○ Reliability and validity Anonymity ○ When researchers cannot link participants to their data ○ Usually includes removing identifying information such as name, MCP, etc ○ If data need must be identified (i.e., reasons of treatment) data are decoded but there is a master list stored separately that allows linkage of identifiers to the data Assent ○ The agreement of someone not able to give legal consent, consent is required of the patent or legal guardian Belmont report  ○ Provided a model for many guidelines adopted by the medical research council of canada (MRC) and the social sciences and humanities research council (SSHRC) in canada Beneficence ○ Ethical principle that involves maximizing benefits for study participants and preventing harm Code of Ethics ○ Fundamental ethical principles established by a discipline or institution to guide researcher’s conduct in research with human (or animal) participants Confidentiality ○ A pledge that any information research participants provided will not be reported in a manner that identified them Consent form ○ Written agreement signed by a study participant and a researcher concerning the terms and conditions of voluntary participation in a study Descriptive theory ○ Broad characteristics that thoroughly accounts for a phenomenon Middle-range theory ○ Explain particular aspects of phenomena ○ Usually have more relevance to researchers and not as abstract as grand theories. More susceptible to testing theories of stress, coping, comfort Attrition ○ Loss of participants overtime If people are dropping out you need to ask yourself why this is happening, is it due to the study? For example, they could be dropping out due to side effects Blinding ○ Also referred to as masking ○ Used in some quantitative studies to prevent biases stemming from people’s awareness ○ Involves concealing information from participants, data collectors, or care providers to enhance objectivity Case-control design ○ Cases with a certain condition are compared to controls without it (had the outcome or did not have the outcome) Example: looking at the safety with new equipment Cohort design ○ A nonexperimental design in which a defined group of people is followed overtime to study outcomes for the cohort; also called a prospective design Control group ○ Subjects in an experimental study who do not receive the experimental intervention and whose performance provides a counterfactual against which the effects of an intervention can be measured Correlation ○ A bond or association between variables, with variation in one variable systematically related to variation in another ○ Correlation does not prove causation  There is a relationship there Correlational study ○ Nonexperimental design ○ Research that examines relationships between variables, can be directional or nondirectional ○ No control of the independent variable Crossover design ○ Repeated measures ○ Experimental design ○ Subjects are exposed to more than one treatment; then crossover to another treatment; serve as their own controls (within subject design) ○ They must be randomly assigned to different ordering to be a true experiment Cross-sectional design ○ Time dimension ○ Data are collected at a single point in time for different groups (or multiple times in a short period) ○ Cross sectional is often referred to as a snapshot ○ Appropriate for describing the status of a phenomenon or relationships (correlation) among variables at a fixed point in time ○ Data are collected on the independent and dependent variables at the one time ○ Economical and easy to manage ○ May be competing explanations for observed findings ○ A study design in which data are collected at one point in time; sometimes used to infer change over time when data are collected from different age or developmental groups External validity ○ The degree to which study results can be generalized to settings or groups other than the one studied History threat ○ The occurrence of events external to an intervention but concurrent with it, which can affect the outcome variable and threaten the study’s internal validity Internal validity ○ The degree to which it can be inferred that the experimental intervention (independent variables), rather than confounding factors, caused the observed effects on the outcome ○ Refers to the extent that we can say that the exposure of interest is truly influencing the outcome of interest Intervention ○ In experimental research, the treatment being tested Longitudinal design ○ Involves collecting data multiple times over an extended period of time ○ There may or may not have been an intervention. May be follow-up of a certain condition ○ Greatest challenge is attrition ○ Time dimension Matching  ○ The pairing of participants in one group with those in a comparison group based on their similarity on one or more characteristic, to enhance group comparability and to control confounding variables Maturation threat ○ A threat to the internal validity of a study that results when changes to the outcome (dependent) variable result from the passage of time Placebo ○ Expectation of a benefit, regardless of the actual intervention Hawthorne effect ○ Type of human behavior reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed ○ Awareness of being in a study, has an impact on findings Hierarchy of evidence ○ A ranked arrangement of the validity and dependability of evidence based on the rigor of the method that produced it; the traditional evidence hierarchy is appropriate primarily for cause-probing research ○ Systematic review is the highest level of evidence ○ Expert opinion, case reports, etc are at the lowest level of evidence Conceptual definition ○ Abstract or theoretical meaning of the concept Example: Concept of uncertainty - the inability to determine the meaning of illness-related situations Operational definition ○ The definition of a concept or variable in terms of the procedures by which it is to be measured ○ Refers to how the concept will be measured. What will be done to collect information on the concept Construct ○ An abstraction or concept that is invented (constructed) by researchers based on inferences from human behavior or human traits Grounded theory ○ Qualitative ○ About understanding social-psychological processes that occur in an experience Ethnography ○ Qualitative ○ About understanding patterns of groups in social-cultural contexts ○ Often means the researcher participates in the life of the group being studied Phenomenology ○ Qualitative ○ About understanding the lived experience of individuals and what they mean Data ○ Pieces of information obtained in a study Outcome variable ○ A term often used to refer to the dependent variable  Experimental research ○ Category of quantitative research ○ Intervention or treatment; controlled over extraneous variables. Most often to test causal relationships (Randomized controlled trial, non-randomized controlled trial) Literature review ○ Summarize evidence on a topic ○ Often contain a problem statement as part of the argument for conducting the review ○ Types: Descriptive narrative literature review Integrated or integrative narrative review Systematic reviews Observational study ○ Studies in which the researcher collects data without introducing an intervention Relationship ○ Bond or a connection between two or more variables Research design ○ The overall plan for addressing a research question, including strategies for enhancing the study’s integrity Sample ○ A subset of a population comprising those selected to participate in a study Theme ○ A recurring regularity emerging from an analysis of qualitative data Theory ○ An abstract explanation of some aspect of the world and has concepts that are connected to show relationships ○ Relevant in both qualitative and quantitative research Quantitative: hypothesis testing Qualitative: hypothesis development Abstract ○ A brief description of a study, located at the beginning of a report Dependent variable ○ Caused by another variable (outcome, effect) Example: heart disease Independent variable ○ Causes of influences the dependent variable ○ Example: manipulated, treatment, intervention Hypothesis ○ A statement of predicted relationships between variables Variable (attribute, categorical, continuous, created, extraneous, mediating) ○ Variable: an attribute that varies, that is, takes on different values (e.g., body temperature, heart rate, age, height) ○ A characteristic of a person or thing that can vary ○ Attribute variable: a pre-existing characteristic of a person or thing Sex, Marital status height  ○ Created variable: determined by the researcher Different levels of an intervention ○ Continuous variable: can take on a range of values on a continuum Height, weight, BMI, age ○ Categorical variable: discrete values, not continuous; differences in the variable can be categorized Ethnicity, sex, gender ○ Independent variable: causes or influences the dependent variable Manipulated, treatment, intervention ○ Dependent variable: caused by another variable (outcome, effect) Heart disease ○ Extraneous (confounding variable): interferes with or confounds the relationship between the independent and dependent variable Needs to be controlled either in the research design or by statistical procedures ○ Mediating variable: a variable that influences the relationship between the independent and dependent variables (a “go between” Coping mediates the relationship between uncertainty and anxiety Population ○ The entire set of individuals or objects having some common characteristics Blinding ○ Process of preventing those involved in a study (participants, intervention agents, data collectors or healthcare providers) from having information that could lead to a bias, particularly information about which treatment group a participant is in; also called masking Bias ○ Any influence that distorts the results of a study and undermines validity Confounding variable ○ Extraneous (confounding variable): interferes with or confounds the relationship between the independent and dependent variable Needs to be controlled either in the research design or by statistical procedures Debriefing ○ Communication with study participants after the participants have completed the study ○ May be in the form of a presentation or report that explains the results - key findings Ethical dilemma ○ In order to do one thing right you have to do another wrong Full disclosure ○ The communication of complete, accurate information to potential study participants Informed consent ○ A process in the ethical conduct of a study that involves obtaining people’s voluntary participation in a study, after informing them of possible risks and benefits Research Ethics Board ○ The institutional group that convenes to review proposed and ongoing studies with respect to ethical considerations Minimal risk  ○ Anticipated risks that are no greater than those ordinarily encountered in daily life or during the performance of routine tests or procedures Stipend ○ Monetary or other payment to individuals participating in a study as an incentive for participation and/or to compensate for time and expenses Risk benefit assessment ○ An assessment of the relative costs and benefits, to an individual study participant and to society at large, of participation in a study; also, the relative costs and benefits of implementing an innovation Vulnerable group ○ Special groups of people whose rights in studies need special protection because of their inability to provide meaningful informed consent or because their circumstances place them at higher-than-average-risk adverse effects ○ Children, pregnant and breastfeeding women, mentally or emotionally disabled people, physically disabled people, terminally ill people, institutionalized people (prisoners, residents of long-term care facilities) CINAHL ○ Provides information for locating references and abstracts for most citations Google Scholar ○ A popular bibliographic search engine that includes articles in journals from scholarly publishers in all disciplines and also includes books, technical reports and other documents MEDLINE database ○ Premier source for bibliographic coverage of the biomedical literature MeSH ○ Provides a consistent way to retrieve information that may use different terminology for the same concepts Primary source ○ Firsthand reports of facts or findings; in research, the original report prepared by the investigator who conducted the study ○ It is important to reply on primary sources (original studies) and not secondary sources Secondary source ○ Second-hand accounts of events or factors; a description of a study prepared by someone other than the original researcher ○ Literature reviews are secondary sources Conceptual and theoretical framework ○ The conceptual underpinnings of a study - e.g., a theoretical framework in theory-based studies or conceptual framework in studies based on a specific conceptual model PICO questions ○ Most quantitative research questions focus on relationships between variables and use a PICOT format P - Population I - Intervention (independent variable) C - Comparison (variable)  O - Outcome (dependent variable) T - Time Pre-test post-test design ○ An experimental design in which data are collected from research subjects both before and after introducing an intervention Prospective design ○ A study design that begins with an examination of a presumed cause and then goes forward in time to observe presumed effects; also called a cohort design ○ Example of a correlational study (nonexperimental design) Quasi-experimental ○ Quantitative design ○ Analytic ○ NRCT, controlled before and after, uncontrolled before and after, cohort ○ A type of design for testing an intervention in which participants are not randomly assigned to treatment conditions ○ Used for their practicality for things occuring in their natural settings ○ May have manipulation but lacks randomization, may lack control group ○ Weaker ability to draw cause-effect inference Randomization (random assignment) ○ The assignment of participants to treatment conditions in a random matter ○ Equal chance of being assigned to the experimental or control group ○ Can control confounding variables ○ Property of experimental design RCT ○ A full experiential test of an intervention, involving random assignment to treatment groups; sometimes, a phase III of a clinical trial ○ Most powerful design for testing cause and effect ○ Pre-test - Post-test Retrospective design ○ An outcome is observed and is linked to a potential cause from the past ○ Case-control design - cases with a certain condition are compared to controls without it (had the outcome or did not have the outcome) ○ Correlational study Statistical conclusion validity ○ The degree to which inferences about relationships from a statistical analysis of the data are correct Threat to validity ○ In research design, reasons that an inference about the effect of an independent variable on an outcome could be wrong Time-series design ○ A quasi-experimental design involving the collection of data over an extended period of time, with multiple data collection points both prior to and after introducing an intervention Validity  ○ Measures what the study set out to measure Controlled before and after ○ Quasi-experimental design ○ Nonequivalent control group pretest - posttest design No randomization of subjects into groups (control and treatment) but pretest and posttest data Collection of baseline data for both groups Because there is no randomization it cannot be assumed that the experimental and comparison group are equivalent at the outset Uncontrolled before and after ○ Adequate time series ○ Time series design (before-after) Collecting data over an extended period of time and introducing the treatment during the period (makes it different than longitudinal design) 4 observations before treatment and 4 observations after treatment No randomization or control group Inadequate time series Tri-Council Policy Statement ○ A joint policy of Canada’s 3 federal research agencies - the canadian institutes of health research (CIHR), the natural sciences and engineering research council of canada (NSERC), and the social sciences and humanities research council of canada (SSHRC) 2. Know the key criteria to appraise for a systematic review (e.g., two reviewers, databases used) Systematic reviews are the strongest evidence available Step 1: Formulate a Research Question: the strength of a systematic review lies in the presentation of a clear, answerable research question ○ Using the PICO(T) Model Population Intervention Comparison Outcome Time Step 2: Develop a Research Protocol: a document that states what you plan to do and how you plan to do it ○ Includes: Background information PICO Question A search strategy Databases you plan to search Outline of search methods Inclusion and exclusion criteria Description of methods used to analyze and critically appraise results Step 3: Conduct a Thorough Literature Search  ○ Be as comprehensive as possible Step 4: Apply Inclusion and Exclusion Criteria Step 5: Perform Data Extraction/Abstraction ○ Recording specific information from each of the studies Step 6: Conduct a Quality Appraisal of Included Studies ○ Minimum of two independent reviewers ○ Assessment of internal and external validity Step 7: Complete Data Analysis and Compile Results Step 8: Interpret Results 3. Explain how RNs can play a role in research utilization and evidence-informed practice. Read widely and critically Attend professional conferences Learn to expect evidence that a procedure is effective Become involved in a journal club Pursue and participate in evidence-informed practice projects Be an advocate in your work environment 4. Know the major and minor attributes of evidence as described in Giddens Major attributes: ○ Replicability - Repeated ○ Reliability - Consistently and accurately measured ○ Validity - Measure what the study set out to measure Minor attributes: ○ Publicly available ○ Understandable ○ Useable 5. Explain the difference between the positivists and constructivists paradigm. Positivist Paradigm: ○ Corresponds with quantitative research methods ○ Deductive (hypothesis testing) ○ Looking for truth, eliminating chance ○ The researcher is independent from that being researched ○ Controls statistical analysis ○ Generalized to the population as a whole because of statistics Constructivist Paradigm: ○ Corresponds with qualitative research methods Stories of real life experience, subjective experience (phenomenon) ○ Inductive (hypothesis generation) ○ Multiple interpretations of reality ○ Grounded in real life experiences ○ Voices of the participants in the research is crucial 6. Identify barriers to evidence-informed practice for RNs. Quality and nature of the research ○ E.g., limited availability of strong research for some areas, limited KT  Characteristics of the nurses ○ E.g., nurses attitudes and education Organizational factors ○ E.g., necessary supports are often not in place 7. Identify the sources of research problems Research problem: the problem that the researcher would like to solve or contribute to solving Sources: ○ Researcher’s personal interest ○ Clinical experience ○ Nursing literature ○ Social issues ○ Theories ○ External sources 8. Construct research questions using PICO PICOT format ○ P - Population ○ I - Intervention (independent variable) ○ C - Comparison (variable) ○ O - Outcome (dependent variable) ○ T - Time 9. Explain the difference between the research questions for Qual and Quant studies Qualitative: ○ Poses questions about phenomenon that cannot be quantified/measured ○ Increases our sensitivity and understanding of patients experiences ○ Corresponds to the Constructivist Paradigm and Inductive reasoning ○ Types: Grounded Theory - Processes, social structures Phenomenology - Lived experience Ethnography - Culture, society, roles Quantitative: ○ Precisely measured and quantified ○ Corresponds to the Positivist Paradigm and Deductive reasoning ○ Types: Experimental (analytic) Quasi-experimental (analytic) - cause and effect Descriptive survey designs (e.g., “how much on a scale of 1-10) Exploratory descriptive designs Data analysis 10. Understand the difference between directional and non-directional hypotheses. Directional hypotheses: ○ Specifies the expected direction of the relationship between the independent and dependent variable ○ E.g., “Older people are more likely to fall than younger patients”  Non-Directional hypotheses: ○ Saying that a relationship exists, no specifying the variables ○ Indicates the existence of a relationship between the variables, it does not specify the anticipated direction of the relationship ○ E.g., “There is a relationship between a patient's age and the likelihood of falling” 11. Explain the difference between inductive and deductive reasoning. Inductive reasoning: ○ Conclusions based on observations (specific to general) ○ Hypothesis generation ○ Constructivist paradigm (qualitative research) Deductive reasoning: ○ Specific predictions from broad principles (general to specific) ○ Hypothesis testing ○ Positivist paradigm (quantitative research) 12. Explain the components of a hypothesis Statements of expected relationships Sometimes informed by theory Hypothesis are often expressed to indicate absence of a relationship ○ Null hypothesis: No relationship between the independent and dependent variables ○ Tested through statistical analysis ○ Whether the hypothesis has a high probability of being correct (less than 0.05), that the observed findings or the research hypothesis would have occurred by chance, supporting the decision to reject the null hypothesis Quantitative research only 13. Explain the steps in a quantitative study Conceptual Phase ○ Formulating the problem (research question, significance, relevant to practice, methodological issues, feasibility, ethical concerns) ○ Reviewing the literature ○ Undertaking clinical fieldwork as needed ○ Defining the theoretical framework and concepts ○ Formulating hypothesis The Design and Planning Phase ○ Selecting a research design ○ Developing the intervention protocol ○ Identifying the study population ○ Determining the plan for sampling ○ Determining the methods to measure the variables ○ Planning how to protect human rights (ethical concerns) ○ Finalize the plan (pre-test instruments; conduct a pilot study) The Empirical Phase ○ Collecting the data ○ Preparing the data for analysis (coding)  The analytic phase ○ Analyzing the data (statistical analysis) ○ Interpreting the findings (in light of previous research, implications for practice and future research) The Dissemination Phase (Knowledge Translation) ○ Communicating the findings ○ Using the findings in practice 14. Explain the steps in a qualitative study Conceptualizing and Planning the Study ○ Identifying a problem (topic for which little is known) ○ Literature review ○ Selecting a site and gaining entry ○ Designing the study ○ Ethical concerns (human rights) Conducting the Study ○ Sampling, data collection, and data analysis typically occur concurrently Interpreting the Findings ○ Usefulness for practice (e.g., understanding human experience, designing interventions, assessment tools; implications for future research - testing theory, hypotheses, measurement tools) Knowledge Translation ○ Disseminating the findings 15. Explain the purposes of literature reviews Primary purpose: Summarize evidence on a topic Stand-alone reports with the aim of communicating state of the evidence (what is know and not known) Lay foundation for new studies (e.g., gap to address, methodology) Help researchers interpret the findings (e.g., discussion section of an article) Qualitative methodology the literature review may have other purposes (e.g., GT collect data before examining the literature and turn to the literature as the theory takes shape) Literature reviews often contain a problem statement as part of the argument for conducting the review 16. Identify the types of literature reviews*** Descriptive narrative literature review ○ Synthesize the information about a topic but description and critical appraisal of the individual studies is minimal ○ Weak and strong studies are given equal weight ○ Not possible to assess the quality of the evidence from such a review. It would provide a good overview of strategies and tools ○ Useful for clinicians but further appraisal would be needed Integrated or integrative narrative reviews ○ Majority of literature reviews fall into this category ○ Involve a synthesis of the literature, summarize key themes and provide supportive data  ○ These reviews will have a comprehensive search, evidence of synthesis and critical appraisal Systematic reviews (SR) ○ Specifically used for a review that meets certain criteria ○ Teams of researchers follow a structured protocol for identifying all strong studies on a subject (published, not published, in other languages) ○ More thorough than other literature reviews because they include only high-quality studies ○ Cochrane and Joanna Briggs devoted to developing and publishing SRs Reviewers receive training and specific protocol is used ○ Evidence-based guidelines are considered to be systematic reviews ○ Some researchers pool results from studies and re-analyse the data and this is called a meta-analysis 17. Know the steps for locating evidence 1: Define your topic 2: Select databases 3: Select search terms 4: Compile and run your search 5: Document your search 18. Provide guidelines for critiquing literature reviews Does the review seem thorough and up-to-date? Did the review use primary sources? Well-organized, clear? Did the review critically appraise key studies? Did the review identify a gap? If the review is in the intro for a study did it support the need for the study? If the review aim was to summarize evidence for clinical practice did it draw appropriate conclusions about practice implications? 19. Know the attributes of ethics as outlined in Giddens Ethical problems and dilemmas ○ Ethical problems can be straight forward or have competing priorities ○ Ethical dilemma is in order to do one thing right you have to do another wrong Ethical analysis and decision-making ○ There is much to decide and think through 20. Relate the seven primary values in the Code of Ethics for Registered Nurses to research*** 1: Providing safe, compassionate, competent and ethical care 2: Promoting health and well-being 3: Promoting and respecting informed decision-making 4: Honouring dignity 5: Maintaining privacy and confidentiality 6: Promoting justice 7: Being accountable 21. Explain the three core principles of the TCPS***  Beneficence (concern for welfare) ○ Researchers have a duty to prevent or minimize harm and maximize benefits ○ Participants must not be subject to unnecessary harm or risk (e.g., injury, stress, loss of wages, loss of social support) ○ Persons are treated in an ethical manner ○ Protection from exploitation ○ Participants in a study must not place participants at a disadvantage ○ Should not take advantage of the nurse-client bond Respect for human dignity ○ Respect for persons incorporates the dual moral obligations to respect autonomy and to protect those with developing, impaired or diminished autonomy. The person is free to choose without interference ○ Right to self-determination ○ Right to full disclosure (e.g., study fully described, person’s rights to refuse participation, potential risks and benefits) ○ Right to self-determination and right to full disclosure = informed consent ○ Certain factors may diminish a person’s ability to exercise their autonomy Justice ○ The obligation to treat people fairly and equitably ○ Fairness entails treating all people with equal respect and concern ○ Equity requires distributing the benefits and burdens of research participation in such a way that no segment of the population is unduly burdened by the harms of research of denied the benefits of the knowledge generated from it ○ Involves the right to fair treatment and the right to privacy 22. Explain how researchers can take into account cultural and traditions of Indigenous people in Canada Indigenous group as a partner in the research and consulted throughout all phases of the research process Tri-council developed guidelines for researchers and REB’s to consider when engaging in research Consult with elders, local groups and researchers that are Indigenous 23. Explain important considerations that researchers need to take related to vulnerable groups. Children: ○ Cannot give consent ○ Require informed consent of parents or legal guardian ○ If at least 7 years old offer an opportunity to assent to the research ○ If at least 13 years old obtain consent from child as well as parents/guardians ○ Need someone to consent on their behalf ○ Still needs to be done ethically; if the child really does not want to do it but if the parents are still consenting for it to happen Pregnant and breastfeeding women: ○ Take into account potential harms and benefits to the embryo, fetus or child Mentally or emotionally disabled people:  ○ People whose cognitive impairment or mental illness make them incompetent to give consent ○ Obtain written consent from legal guardian Physically disabled people: ○ Special procedures may be required (hearing impaired, written consent only; illiterate, verbal consent, witness) Terminally ill people: ○ May not personally benefit ○ Need to pay careful attention to risk/benefit ○ Ensure that care and comfort are not compromised Institutionalized people ○ May feel obligated to participate ○ May believe care would be compromised if failed to cooperate ○ Ensure that voluntary nature of participation is emphasized. Assure that personal care or situation will not be compromised by failure to participate 24. Explain the potential risks and benefits for research participants*** Benefits: ○ Intervention that otherwise would not be available ○ Opportunity to discuss a problem, provide information about one’s situation, etc ○ Opportunity to learn more about one’s situation, condition ○ Satisfaction in being helpful ○ Monetary or other material gain Risks: ○ Physical harm (e.g., side effects/injury from treatment) ○ Physical discomfort, fatigue ○ Inconvenience, loss of time ○ Psychological or emotional discomfort or distress (e.g., about embarrassment, etc) ○ Social risks (e.g., stigma) ○ Loss of privacy ○ Financial costs (e.g., travel, child care) Try to interview around their child care schedule As the interviewer you should work around their schedule, they should not have to work around you 25. Know what actions would be considered research misconduct*** Fabrication ○ Making up study results and reporting or publishing them Falsification ○ Distorting research procedures, changing or omitting data Plagiarism ○ Using someone else’s ideas without giving them credit Conflict of interest ○ E.g., if you knew the interviewee personally Failure to comply with government regulations ○ E.g., TCPS  Claiming improper authorship Using confidential information without permission 26. Provide guidelines for critiquing research ethics Usually not possible to identify research ethics transgressions Could be caught in the peer review process Often reference only to REB review and informed consent What were the risks and benefits? Were privacy and confidentiality breached? Was there coercion or deception? Were vulnerable participants involved? Were groups unjustifiably omitted? 27. Explain the challenges in the literature related to theories/models/frameworks and some pragmatic strategies for dealing with these challenges. Challenges: ○ Theories/models/frameworks (TMFs) can be overwhelming ○ “Theory Adverse Syndrome” or “Framework Adverse Syndrome” in the authors experience: Many people feel anxious about using these tools May not know about them May not appreciate how helpful they can be Embrace TMFs and recognize that these tools organize and provide direction for research Note that there is overlap between the terms and the inconsistency in use of the terms ○ **Just have a general overview and know how to apply it Strategies: ○ You may find it helpful to learn definitions to guide your choice of language ○ It will be less stressful for you to not focus on labels, especially if the authors of an article you are reading called something a theory but you think it really fits the definition of a model instead ○ Focus not on the label but on the concepts and relationships within the theory, model or framework so you can understand what was done or planned 28. Provide guidelines for critiquing use of theories/models/frameworks in research studies. Did the research report have a stated theoretical framework? Did the report adequately describe the theory or theoretical framework? Is there a model? Is the theory and model appropriate for addressing the problem? Did the framework guide the study methods? Was it appropriate? Were the findings of the study tied back to the framework? 29. Explain causality and effect in relation to Quant research*** Quantitative research often involves determining effect (causality) ○ E.g., does one variable, the independent variable, cause (exposure) an effect on another variable, the dependent variable?  Criteria for causality include: ○ Cause must precede an effect (temporal) ○ There must be an association between cause and effect If it was found there was no difference it would be problematic ○ The relationship cannot be explained by a third variable (why it is important to control for confounding variables) 30. Explain what determines the choice of design in a research study. Design is primarily determined by the question and or statement of purpose To figure out the design, move beyond the abstract and assess what the researchers actually did It should be able to answer the research question or meet the purpose of the research Goal: Provide the most valid, unbiased, and interpretable evidence possible 31. List factors that should be considered when choosing a Quant design Will there be intervention? (experimental research) What type of comparison will be made? (same people at different points in time; different person) ○ E.g., pre post design ○ E.g., looking at different groups of people (people with dementia) How will confounding variables be controlled? (Variables extraneous to the research) ○ Classification of people ○ Can do be randomization Will blinding be used? ○ Will information about the study be hidden from data collectors and participants Where and how often will data be collected? 32. Identify the three properties needed for an experimental design 1: Intervention ○ Something is done to the participants; intervention or treatment ○ Independent variable is manipulated ○ Effect on the dependent is assessed 2: Control ○ Use of a control group that does not receive the intervention ○ Used to rule out extraneous variables 3: Randomization ○ Random assignment to control or experimental group (groups are comparable) ○ Equal chance of being assigned to the experimental group or control group ○ Not random sampling ○ **Experimental designs (Random assignment) 33. Identify the requirements for treatment and control conditions Treatment must be of sufficient intensity and duration to have an effect Control condition: ○ No treatment ○ Alternative treatment ○ Placebo ○ Standard treatment (routine care) ○ Lower dose or only part of a treatment  ○ Delayed treatment Blinding of participants to the condition - double or single 34. Identify the advantages and disadvantages of quasi-experimental designs Practical when not feasible to conduct a true experiment People are not always willing to be randomized Cause and effect may be more difficult to infer. There are more plausible explanations, for example, is it plausible that some other factor causes the effect? Not as strong 35. Identify the advantages and disadvantages of non-experimental (descriptive) designs Used to study problems not conducive to experimentation Cannot presume causality Pre Existing group differences may be plausible explanation for any differences observed Cannot determine the direction of the influence 36. Explain how extraneous variables can be controlled in a research study** Use a laboratory setting Restrict data collection to one setting (e.g., participants home) Use a consistent time for data collection (e.g., morning or afternoon, summer or winter) Keep communication constant (e.g., same instruments to all participants about the study purpose, instruments, intervention) 37. Explain statistical conclusion validity Extent to which statistical tests will detect a true relationship Based on statistical power and sample size ○ A small sample results in low statistical power and could result in failure to detect a relationship or change that actually exists Maximize the difference between the two groups on the independent variable Ensure integrity of the treatment 38. Explain internal validity*** Truth within the study The strength of the evidence indication that the independent variable, not an extraneous variable, caused or influenced the outcome (dependent variable) Strategies: reliable and valid tools, temporal relationship, training or assessors, loss of participants (attrition) 39. Identify threats to internal validity*** Temporal ambiguity ○ The cause and effect, the temporal, is unclear History ○ Events that occur at the same time as the independent variable and that can affect the dependent variable (one group before and after designs and time-series are particularly vulnerable) Misclassification bias Information bias Reliability and validity of instruments Retention of participants in the study 40. Explain external validity Generalizability of the findings to other people (groups) and settings Studies are rarely done with the intention of applicability to just the sample examined Hawthorne effect (awareness of being in a study) has an impact on findings Placebo effect (expectation of a benefit, regardless of the actual intervention) Experimental blinding can reduce placebo effect ○ If people do not know they are receiving the intervention