nursing research 2 lecture

7/29/2019 Nursing Research 2 Lecture

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Measurement

What is measurement?

Measurement involves rules for assigning number to qualities of object to

designate the quantity of the attribute. Attributes do not inherently have numeric values;

human invent rules to measure attributes. Many quantitative researchers concur with a

statement by early American psychology L. L. Thurstone: ―Whatever exists, exists in

some amount and can be measured. ― attributes are not constant; they vary from day to

day, from situation to situation, or from one person to another. This variability is capable

of a numeric expression that signifies how much of an attribute is present.

Measurement requires number to be assigned to object according to rules. Rulesfor measurement temperature, weight, and other physical attributes are familiar to us.

Rules for measurement many variables for nursing studies, however, have to be

created. Whether data are collected by observation, self-report, or some other method,

researchers must specify the criteria according to which number are to be assigned.

Levels of measurement

Normal measurement- the lowest level, involves using number simply to

categorize attributes. Examples of variables that are normally measured include gender

and blood type. The number used in normal measurement do not have quantitative

meaning. If we coded males as 1 and females as 2, the number would not have

quantitative implication __ the number 2 does not mean ―more than‖ 1 nominal

measurement provides information only about categorical equivalence and

nonequivalence and so the number cannot be treated mathematically. It is nonsensical,

for example, to compute the average gender of the sample by adding the numeric

values of the codes and dividing by the number of participants.

Ordinal measurement- ranks object on their relative standing on an attribute. If

a researcher orders people from heaviest to lightest, this is ordinal measurement. As

another example, consider this ordinal coding scheme for measuring ability to perform

activity of daily living : 1= completely dependent ; 2= need another person‘s assistance;

3= needs mechanical assistance and 4= completely independent in twice as good as

needing mechanical assistance. As with nominal measures, the mathematic operations

permissible with ordinal-level data restricted.

Interval measurement-occurs when researchers can specify the ranking of

object on an attribute and the distance between those object. Most educational and



psychological test yield interval-level measures. For examples, the Stanford-Binet

intelligence scale—a standardized intelligence (IQ) test used in mant countries—is an

interval measure, a scire of 140 on the Stanford-Binet is higher than a score of

120,which, in turn, is higher than 100. Moreover, the difference between 140 and 120 is

presumed to be equivalent to the difference between 120 and 100. Interval scales

expand analytic possibilities: interval level data can be averaged meaningfully for

example. Many sophisticated statistical procedure require interval measurements.

Ratio measurement is the highest level-. Ratio scales, unlike interval scales,

have a rational, meaningful zero and therefore provide information about the absolute

magnitude of the attribute. The Fahrenheit scale for measuring temperature(interval

measurement) has an arbitrary zero point. Zero on the thermometer does not signify the

absence of heat; it would not be appropriate to sat that 60 F is twice as hot as 30 F.

many physical measures, however, are ratio measures with a real zero. A person

weight, for example, is a ratio measure. Ir is acceptable to say that someone who

weight 200pounds is twice as heavy as someone who weight 100 pounds. Statistical

procedure suitable for interval data are also appropriate for ratio-level-data.

Researchers usually strive to use the highest levels of measurement possible—

especially fpr their dependent variables—because higher levels yield more information

and are amenable to more powerful analyses than lower levels.

Advantages of measurement

a major strength of measurement is that it removes guesswork and ambigulity in

gathering data communicating information. Consider how handicapped health careprofessionals would be in the absence of measurement of body temperature, blood

pressure , and so on. Without such measures, subjective evaluations of clinical

outcomes would have to be used. Because measurement is based on explicit rules

resulting information tends to be objective, that is, it can be independently verified. Two

people measuring the weight of a person using the same scale would likely get identical

results. Not all measures are completely objective, but most incorporate mechanisms

for minimizing subjectivity.

Measurement also makes it possible to obtain reasonably precise information

instead of describing Nathan as ―tall,‖ we can depict him as being 6 feet 3 inches tall if necessary, we could achieve even greater precision, such precision allows researchers

to make fine distinctions among people with different degrees of an attribute.

Finally, measurement is a language of communication. Numbers are less vague

than words and can thus communicate information more clearly. If researcher reported

that the average oral temperature of a sample of patients was ―somewhat high‖ different

readers might develop different conceptions about the sample‘s physiological state. If



the researcher reported an average temperature of 99.6 F however, there is no

ambiguity.

Reliability

Ratability is the consistency with which an instrument measures the attribute. If a scale weighed a person at 120 pounds one minute and 150 pounds the next, we

would consider it unreliable. The less variation an instrument produces in repeated

measurement, the higher its reliability.

Reliability also concerns a measure‘s accuracy. An instrument is reliable to the

extent that its measures reflect true scores—that is, to the extent that measurement

errors are absent from obtained scores. A reliable instrument maximized the true score

component and minimizes the error component of an obtained score.

Three aspect of reliability are of interest ot quantitative researchers: stability,

internal consistency and equivalence.

Stability

The stability of an instrument is the extent to which similar results are obtained

on two separate accasions. The reliability estimate focuses on the instrument‘s

susceptibility to extraneous influences over time, such as participant fatigue

assessments of stability are made through test-retest reliability procedures.

Researchers administer the same measure to a saple twice and then campare the

score.

Fictitious data for test-retest reliability of self-esteem scale

Subject number Time1 Time 2

1 55 57

2 49 46

3 78 74

4 37 35

5 44 46

6 50 56

7 58 55

8 62 669 48 50

10 67 63

r=.95

Suppose, for example, we were interested in the stability of a self-report scale that

measured self-esteem. Because self-esteem is a fairly stable attribute that does not



change much from one day to another, we would expect a reliability measure of it to

yield consistent scores on two different days. As a checj on the instrument‘s stability, we

administer the scale 2 weeks apart to a sample of 10 people. Fictitious data for this

example are presented in table 14.1.

The score on the two tests are not identical but, on the whole, differences are not large.Researchers compute a reliability coefficient, a numeric index that quantifies an

instrument reliability, to objectively determine how small the differences are. Reliability

coefficients (designated as r) range from .00 to 1.00.* the higher the value, the more

reliable (stable) is the measuring instrument. In the example shown in table 14.1 the

reliability coefficient is .95, which is quite high.

Internal consistency

Scales and test that involve summing item scores are most always evaluated for their

internal consistency. Ideally \, scale are composed of items that all measure the oneunitary attribute and nothing else. On a scale to measure nurses‘ empathy, it would be

inappropriate to include an item that measures diagnostic competence. An instrument

may be said to be internally consistent to the extent that its items measure the same

trait.

Internal consistency reliability is the most widely used reliability approach among nurse

researchers. This approach is the best means of assessing an especially importance

source of measurement error in psychosocial instruments, sampling of items . internal

consistency is usually evaluated by calculating coefficient alpha (or cronbach’s

alpha).the normal range of values for coefficient , the more accurate (internallyconsistent) the measure.

Equivalence

Equivalence in the content of reliability assessment, primarily concerns the degree to

which two or more independent observers or coders agree about the scoring on an

instrument. With a high level of agreement, the assumptions is that measurement errors

have been minimized.

The degree of error can be assessed through interrater( or interobserver) reliability

procedures, which involve having two or more trained observers or coders. Makesimultaneous, independent observations. An index of equivalence or agreement is then

calculated with these data to evaluate the strength of the relationship between the

ratings. When two independent observers score some phenomenon congruently, the

score are likely to accurate and reliable.

Validity



Validity is the degree to which an instrument measures what it is supposed to measure.

When researcher develops an instrument to measures hopelessness, how can they be

sure that resulting scores validity reflect this construct and not something else, such as

depressions?

Reliability and validity are not totally independent qualities of an instrument. Ameasuring device that is unreliable cannot possibly be valid. An instrument cannot

validly measure an attribute if it is erratic and inaccurate. An instrument can, however,

be reliable without being valid. Suppose we wanted to assess patients‘ anxiety be

measuring the circumference, but such measures would not be valid indicators of

anxiety. Thus, the high reliability of an instrument provides no evidence of its validity;

low reliability of a measure is evidence of low validity.

Content validity

Content validity concerns the degree to which an instrument has appropriate sampleof items for the construct being measured and adequately covers the construct domain.

Content validity is crucial for test of knowledge, where the content validity question is

:‖how representative are the questions on this test of the universe of questions on this

topic?‖

Content validity is also relevant in measures of complex psychosocial traits.

Researchers designing a new instrument should begin whit a thorough

conceptualization of the construct so the instrument can capture the full content domain.

Such a conceptualization might came from rich first hand knowledge, an exhaustive

literature review, or findings from a qualitative inquiry.

An instrument‘s content validity is necessarily based on judgment. No totally objective

methods exist for ensuring the adequate content coverage of an instrument, but it is

increasingly common to use a panel of substantive experts to evaluate the content

validity of new instrument. Researchers typically calculate a content validity index

(CVI) that indicates the extent of expert agreement. We have suggested a CVI value of

.90 as the standard for establishing excellence in a scale‘s content validity.(polit &beck,

2006)

Criterion-related validity

In criterion-related validity assessments, researchers seek to establish a relationship

between scores on an instrument and some external criterion. The instrument, whatever

abstract attribute it is measuring is said to be valid if its score correspond strongly with

score on the criterion.



After a criterion is establish, validity can be estimated easily. A validity coefficient is

computed by using a mathematic formula that correlates scores on the instrument with

cores on the criterion variable. The coefficients (r) range between .00 and 1.00, with

higher values indicating greater criterion-related validity. Coefficients of .70 or higher are

desirable.

Sometimes a distinction is made between two types of criterion-related validity.

Predictive validity refers to an instrument‘s ability to differentiate between people‘s

performances or behaviors on a future criterion. When a school of nursing correlates

students‘ incoming high school grades with their subsequent grades-points averages,

the predictive validity of high school grades for nursing school performance is being

evaluated. Concurrent validity refers to an instrument‘s ability to distinguish among

people who differ in their present status on some criterion. For example, a psychological

test to differentiate between patients in a mental institution who could and could not be

relased could be correlated predictive and concurrent validity, and then is the difference

in the timing of obtaining measurement on a criterion.

Construct validity

Construct validity construct validity is a key criterion for assessing the quality of a study,

and construct validity has most aften been linked to measurement issues. The key

construct validity questions with regards to measurement are: ‗what is this instrument

really measuring?‘ and ―does it validly measure the abstract concept of interest?‖

Construct validity is essentially a hypothesis-testing endeavor, typically linked to a

theoretical perspective about the construct.

Construct validation can be approached is several ways, but it always involves logical

analysis and testing relationship predicted on the basic of firmly grounded

conceptualization.

One approach to construct validation is the known-groups technique. In this procedure,

groups that are expected to differ on the target attribute are administered the

instrument, and group scores are compared.

Another method involves examining relationship based on theoretical predition.

Researchers might reasons as follows: according to theory, construct X is related toconstruct Y; scales are related to each pther, as predicted by the theory ; therefore, it is

inferent that A and B are valid measures of X and Y. this logical analysis is fallible, but it

does offer supporting evidence.

Another approach to construct validation employs a statistical procedure known as

factor analysis, which is method for identifinf clusters of related items on a scale.



Sensitivity and specificity

Reliability and validity are two most important criteria for evaluationg quantitative

instrument, but researchers sometimes need to consider other qualities. In particular, for

sscreening and diagnostic instruement—be they self-report, observational or

biophysiologic—sensitivity and specificity need to be evaluated.

Sensitivity is the ability of measure to identify a case correctky,that is, to screen is or

diagnosis a condition correctly. A measure‘s sensitivity is its rate of yielding ‗thru

positive.‖ Specificity is the measure‘s ability to identify noncases correctly thaht is to

screen out those without the condition.

The uses of data analysis

Once the researcher variables have been measured the resulting queantitative data can

be analyzed in a variety of ways, and the analyses can serve many different purposes.

The purposes can be categorized and illustrated along three difference dimensions, as

discuseed in the next sections.

Analyses for description versus inference

One of the most basic distinctions in statistical analysis is the difference between

descriptive statistics and inferential statistics.

Descriptive statistic al researchers want, at a minimum, to describe their data in a

convenient and informative manner.

Descriptive statistics which are used by researchers to describe and summarize data,

help to make data readily comprehensible.

Descriptive statistics can be communicated in three ways: in a narrative fashion, in a

graph, or in a table.

Inferential statistics Researchers typically derive their data by obtaining measurements

from a sample, that is, from a relatively small group of people with characteristics thatare relevant to the researcher question. However, researchers are almost always

interested in answering research questions about a population—the entire group of

people with the relevant characteristics —rather than about the particular individuals

compressing the sample.



Inferential statistics use the laws of probability to help researchers draw conclusions

about population characteristics, based on information from samples. Most researcher

use statistics based on sample to address questions about a population, and thus

inferential statistics are widely used in research.

Inferential statistics are sometimes used to draw conclusions about a single populationvalue.

More frequently, inferential statistics are used to draw conclusions about the

relationship between variables in the population. A relationship is a bond or

association between variables. For example, the researcher might want determine

whether the average birth weight of aids babies is lower than the birth weight of other

babies. The relationship in question concerns birth weight(the dependent variable) in

relation to the infants‘ AIDS status(the independent variable).

Univariate, bivariate, and multivariate statistics

Univariate statistics involve two variable at a time. Example include the percentage of

men and women in the sample, or the average heart rate of the sample members.

Bivariate statictics involve two variables examined simultaneously. If the researcher

compared the average heart rate of men versus women, bivariate statistical procedure

would be used.

Multivariate statistics when tree or more variables ate included in the same analysis.

For example a researcher might use gender, weight, and amount of exercise to better

understand variations in heart rate.

Analyses for different purposes

A third dimensions for characterizing quantitative analysis concerns the role that the

analysis palys in the research process. Statistical analysis is typeically used for many

more purposes than simply to answer the researcher‘s substantive questions.here are a

few examples of different purposes for using statistical analysis:

1. Data cleaning. Typically, one of the firth things that a researcher does with a data

set(we are assuming that the researcher is using a computer for data analysis )

is to determine if the data are ―clean‖. Before the more substantive analyses canbegin, the researcher must have confidence that the number and codes entered

in the computer file are accurate.

2. Sample description. Researcher almost always want to learn the main

characteristics of their sample.



3. Assessment of bias. Researcher often perform statistical analyses to determine if

there might be systematic biases that need to be taken into consideration in

interpreting the results of the substantive.

4. Evaluation of measuring tools in mant studies, the researcher undertakes

analyses designed to examine whether the measuring instrument used to collect

the data are reliable and valid.

5. Evaluation of the need for transformations. Data that are gathered by the

researcher often need to be transformed or altered before the substantive

analyses can proceed, and the use of descriptive statistics comes to the

researcher‘s assistance. The term missing values refers to the absence of

information for a specific variable for some of the subject, as a result of errors,

refusals, misunderstanding, and so on.

6. Addressing research questions. Finally, statistical analyses are used to directly

address the substantive research questions.

The data analysis plan

The prudent researcher endeavors to develop a realistic data analysis plan that guided

progress toward the goal of answering the researcher questions and interpreting the

results.

Introduction

The final phases of the research process entail decisions about communicating and

utilizing a study‘s findings. This chapter focuses on communicating research findings;

the research utilization process is described in chapter 17. Communicating a study‘sfindings—even findings from small-scale practice-based studies—is important for

several reasons. First and foremost, communicating research is the first step to

research utilization and evidence-based practice. Evidence-based practice is dependent

on researchers ―getting the word out‖ and making their study findings public so that they

can be evaluated as part of the body of evidence for practice decisions. In other words,

research-based evidence needs to be accessible in order to influence nursing practice.

Communicating research findings is important for another reason, in a vert real sense,

research is a public or community enterprise and all researchers have an obligation to

their sponsors, study participants and colleagues to share their findings. When aresearcher fails to communicate a study‘s findings, the time and talent of many people

are disregarded, trust can be undermined, and knowledge that could benefit patients,

nurses, the nursing profession, and society in lost. Most study‘s consent forms advice

potential participants that, while they may not benefit directly from study participation.

The knowledge gained will help others. This statement is frequently extended as a study

benefit to balance even minor risk such as discomfort, in convenience, and invasion of



privacy. In a vert real sense, this statement constitutes an implicit contract that study

findings will be communicated. With this in mind, failure to communicate a study‘s

findings gas bees labeled a form of scientific misconduct (Winslow, 1996).

Finally, communicating a study‘s findings helps to make a project worthwhile. It provides

an opportunity to interact with other researchers and clinicians who are interested in thestudy problem and receive feedback on the study‘s methods and interpretation of

finding. Other researcher interested in the same problem will be able to reference your

work, learn from experience, and further extend the knowledge base about a problem

without reinventing the wheel.

Despite the importance of communicating study findings, in too many instances sudty

findings remain hidden and private. In fact, in 1995 hicks estimated that dewer than 3%

of nurse researchers actually communicate their study‘s findings in any sort of formal

way. Whole more recent data about nurses‘ publication activities are not available, it is

interesting to speculate whether this number has changed. Reasons documented byhicks for not communicating a study‘s findings still seem valid: lack of time. Lacks of

confidence in the quality of their study, lack of confidence in the ability publish or

present findings and lack of knowledge about opportunity and opinions for

communication study finding. This chapter addresses these barriers. The chapter

particulatly focuses on communicating findings from small-scale practice-based studies,

since these are the type of studies in which most baccalaureate-prepared nurses are

involed. Since nurses can—do—conduct these types of studies, they need to know how

to communicate their findings.

This chapter begins by considering some of the decisions that need to be made beforepackaging a study‘s findings. Next, steps in publishing a report of study findings,

presenting study findings and creating a research poster are described. The chapter

closes by sharing strategies for success that apply to any research communication

strategy.

Decision and options

Decisions about the focus of a report, intended audience, and most appropriate outlet

are interrelated and need to mesh with one another in order to effectively communicate

research findings and achieve the desired impact. Decision about the report‘s focushave implications for the appropriate audience and both of these decisions have

implications for the most effective communication outlet.

Decision #1 what to tell the first step in the research communication process is to

determine the report‘s focus. The decision affects both who w\to tell and how best to

reach them. When deciding on the focus of a research report, it is important to think of

research findings in the broadest since of the wood and consider sharing information



about a study‘s processes and method, problem encountered and solution, as well as to

influence public knowledge, attitude, opinions, and policy. Additionally, information

about successful (and unsuccessful) research process contributes to the development

of scientific rigor in research and influence future nursing research endeavors. In other

words, a single research project contains many types of findings and offers many

opportunities to influence nursing and health care. In fact, most research projects can

generate at least three different types of reports: a summary of the problem background

and literature review, a report of study methods and lessons learned, and a report of the

study‘s results and their interpretation. decideing in the focus of a communication

project can be facilitated by identifying your goal or agenda for communication a study‘s

findings: do you want to create awareness of a situation, influence a change in practice,

stimulate debate and discussion, argue for a policy change, or share study findings for

the purpose of achieving personal recantation or reward of some sort?

In many studies, more data are collected than can be communicated in a single

report. A researcher will decide to develop a separate report for each research question.

If a study includes both quantitative and qualitative findings, these also will sometimes

be reported separately. To some extent this strategy makes sense , as different findings

may be of interest to different audeiences. It is important, however,to void simply

repackaging the same findings and communicating them in outlets. This practice, which

is referred to as self-plagiarsm, limits the number of different studies that can be made

available in scare journal and presentation space. In is considered unethical to

simultaneously submit essentially the same report to multiple journals. Some journals

will not accepts reports that have been presented at a widely attended national

conference. It is acceptable, however, to develop a multi-prong approach to sharingmultiple findings from a singke research study. For example a study‘s methodology

could be the focus of a report for nurse researchers and published in a journals such as

nursing research.in addiction, aposter or newsletter artcle could be developed for

clinicians or healrhcare consumers,and relevant findinfs could be reported in the form of

a letter or white paper tp policy makers

Decision#2 who to tell the decision about the intended audience for a research report

is influenced by the focus or content of the report: different stories are suited for

different groups. Choosing the riht(or best) audience for specific study findings involves

considering(1) who wants to know and (2) who need to know about a particular study‘sfindings. Consider the potential benefits of targeting research communication effort

toward the following audiences:

Clinicians can use information about research a outcomes to develop evidence-

based practice patterns.



Nurse‘s researchers can use information about research method and study

results to conduct further research and add to the body of knowledge about a

problem area.

Nurses educators and administrations are potentially powerful agent for

research-driven changes in practice because of their responsibly for educating

nurses and managing nursing care delivery system.

Provides in other disciplines such as medicine and social work can use nursing

research finding to develop evidence-based practice patterns in ther own field

which facilitates interdisciplinary continuity of care for parents.

Consumers mat be motivated by nursing research findings to change behaviors

nursing research finding also can help consumers develop further understanding

about their illness and its management.

Consumers and legislators can use findings from nursing research to influence

health-related public policy.

Decisions#3 how to tell

Research findings can be communicated in written publications, as oral presentations,

or as poster presentations. The focus of a report and its intended audience has

implications for which strategy will be most effective. Written report, such as journal

articles, has the advantage of being accessible to the broadest audience. For nurses

working in academic settings, publishing findings in a journal, particularly a peer-

reviewed or refereed journal is considered the most prestigious and influential

communications strategy. Disadvantage of written reports, particularly reports submitted

to professional journals, include the lag time between study completion and publication

of findings(which often stretches to two years) and the fact that preparing a manuscript

for publication can be a very time-consuming process. Additionally, publishing in

professional journals in a competitive endeavor and there is simply not enough journal

manuscript development, there really are no costs associated with publishing findings

as written report.

Authorship issues

Since many nursing research project involve a team approach, nurse researchers oftenfind themselves facing issues related to authorship: specifically, who count as an author

and in what order multiple authors should be recognized .although authorship issues

can also arise with conference and poster presentations, they tend to be most apparent

and problematic when study‘s findings are being communicated(published) in written

form.



Project planning

Once decisions have been made about the focus of the study report the intended

audience, appropriate communication outlet, and authorship issues, project planning

can commence. Project planning begins by assembling all of the materials that will be

needed to develop the manuscript, presentation, or poster.resources and artiles thatwere used to develob the resacrh problem and its background, data collection

instrument,consent forms,irb approval letters, interview transcripts, and computer

printouts of study results should be garhered and organized in the order in which they

will be used to develop the research report. For example,the first folder of materials

might be vopies of key articles that were used to develop the study;s problem statement

and literarure review, sice these are the firt section of an articles(or presentation or

poster). The second folder might be copies of data collection instruments and consent

form for the resus section, and so on. Int also is essential to secure the author

guidelines provided by the selected journals or presentation guidelines provided by

conference organizers so that the report can ve developed in the appropriate format.

Introduction

The overall purpose of nursing research is to generate knowledge that can be used to

guide nursing practice. This means that nurses must read critique, synthesize, and

replicate research finding, as well as apply and test the effectiveness of those findings

in practice. indeed, unless research findings are used to guide nursing practice research

is little more than a costly and time-consuming intellectual exercise. Understanding the

research process in the first step toward having an evidence-based practice and has

been the focus of this test book so far. This step is necessary so that you can identifyquality research studies and credible research findings. concesistent with the

expectation that baccalaureate –prepared nurses can ―apply research findings from

nursing and other disciplines in their clinical practice ―this chapter describes the

research unitization process. When research findings—rather than tradition, authority

,trial and error, or only logical thinking—are used to guide nursing decisions, the results

are higher quality care, improved patients outcomes, and decreased healthcare costs.

Patients and their families, healthcare agencies their practice. An evidence-based

practice also enhances the nursing profession‘s visibility and credibility bt demonstrating

its scientific based.

Like other activities in the research process, applying research findings to practice

settings requires critical thinking and careful decision making. The importance of critical

thinking in making a decision about a study‘s quality and implications of a proposed

innovation, the application of research findings can be inappropriate and ineffective—as

well as costly and even dangerous(settler, 2001). This chapter is intended to help you

develop the critical thinking skill that is foundational to research utilization.



The chapter begins by comparing research utilization and evidence-based practice.

Next, the continuum of activities that comprise research utilization is described. The

next section of the chapter briefly summarizes three recognized and widely cited models

for research utilization. These models are then synthesized and widely cited models for

research utilization is presented. The chapter closes by describing barriers to research

utilization and suggesting strategies for developing a culture of research utilization.

Research utilization and evidence-based practice

Resech utilization refers to using research knowledge to change an existing clinical

practice or professional situation. Occasionally the knowledge may be from a single

isolated study; more typically, however, it is derived from a set a related studies (melnyk

& fineout-overholt, 2005). The knowledge is reviewed, disseminated, and applied to

specific practice problem or issue. In many instances, the impetus for a research

utilization project is suggestions made by a researcher in a research article‘s

discussions section (e.g., implications for practice).typical products of research

utilization project are new policies, procedure, or programs, or changes in routine

practice (melnyk & fineout-overholt, 2005).

Evidence-based practice differs from reseach utilization in that evidence from source

other than reserch studies is considered in the decision making process. In addition to

research findings, evidence based practice recognizes clinical experience expert

opinion,parients vales and preferences and clinical resources as valid and important

sources of evidence for evidence,skills beyod those needed to critique a single research

studt are required.

The research utilization continuum

Research can influence nursing practice directly my providing the impetus for making a

change in practice, or indirectly influencing personal understanding and approach to

patient interaction or serving as a catalyst for evaluation of a current practice. These

influences on clinical practice reflect instrumental, conceptual and symbolic utilization of

research findings.

Instrumental utilization

Instrumental utilization of research finding refers to the concrete application of research

findings, such as adopting an intervention that is described in the research literature

(settler, 1985). In other words, instrument utilization is an action-oriented application of

study finding to a cynical situation; it is a discrete and clearly identifiable attempt to base



specific actions on research findings. Instrumental utilization includes the direct

application of a research-based intervention.

Conceptual utilization

Conceptual utilization refers to a research to a research-based change in one‘sunderstanding of a practice situation (settler, 1985). Conceptual utilization is the

cognitive application of research findings to one‘s personal clinical practice. Conceptual

utilization can be thought of as research-based enlightenment or change in

understanding or a new perspective that may lead to a change in one‘s personal

response pattern to a situation. Example of conceptual utilization includes the following:

Increased awareness of clinical problem, such as the incidence of a specific

condition or a treatment side effect, which could alter personal observation and

assessment practices.

Increased understanding of a subjectively experienced event or phenomenon,such as prenatal loss, a chronic illness, or being a victim of violence, which could

alter interactions with patients.

Increased awareness of environmental changes as well as new trends and

healthcare issues, such as the prevalence of MRSA (methicillin-resistant

staphylococcus aureus) infections, which could affect safely precautions taken in

personal practice.

Symbolc utilization

Symbolic utilization refers to using research findings to legitimize or call attention

to a current practice (settler,1985). More specifically, symbolic utilization means

using research findings as the basis for. Continuing current practices or as a catalyst

for evaluating current policies and practice. Symbolic utilization also can entail using

findings from a qualitative study to augment, validate, or illustrate quantitative

research in providing newborn care after taking part in a prenatal support program

might be used as a supplemental piece of evidence for a decision about continuing

the program.

Knowledge creep (settler, 1985) refers to the evolution or percolation of ideas for a

practice change.

Decision accretion refers to momentum for a change that evolves over time as

results of gaining additional information.



Major steps in a quantitative study

In quantitative studies, researchers move from the beginning point of a study(the posing

og a question) to the end point( the obtaining of an answer) in a reasonable linear

sequence of steps that is broadly similar across studies.

Phase1 the conceptual phase

The early steps in a quantitative research project typically involve activities with a strong

conceptual or intellectual element. During this phase, researchers call on such skills as

creativity, deductive reasoning, and a grounding in existing research evidence on the

topic of interest.

Step 1:Formulating and delimiting the problem

Quantitative researchers begin by identifying an interesting, significant research

problem and formulating good research questions. In developing research questions,nurse researchers must pay close attention to substantive issues (in this research

question important, given the evidence base?)Theoretic issues (is there a conceptual

context for enhancing understanding of this problem?) clinical issues(could study

findings be useful in clinical practice?)methodologic issues(how can this question best

to answered to yield high-quality evidence? And ethical issues (can this question be

rigorously addressed in an ethical manner?).

Step 2: Reviewing the related literature

Quantitative research in typically conducted within the context of previous knowledge.

Quantitative researchers typically strive to understand what is already known about a

topic by undertaking a thorough literature review before any data are collected.

Step3: Undertaking clinical fieldwork

Researchers embarking on a clinical study often benefit from spending time in

appropriate clinical settings, discussing the topic with clinical fieldwork can provide

perspective on recent clinical trends, current diagnostic procedures‘, and relevant health

care deliver models; in can also help researchers better understanding clients‘

perspective and the settings in which care is provided.

Step 4: Difining the framework and developing conceptual definitions

When quantitative research is performed within the context of a conceptual framework,

the findings may have broader significance and utility even when the research question

is not embedded in a theory, researchers must have a conceptual rationale and a clear

vision of the concepts under study.



Step 5: Formulationg hypotheses

Hypothesis state researchers expectations about relationship among study variavle.

Hypotheses are predictions of expected outcomes; they state the relationship

researchers expect to observe in the study data. The research question identifies the

concepts under investigation and asks how the concepts might are designed to testhypotheses through statistical analysis.

Phase 2: the design and planning phase

In the second major phase of a quantitative study, researchers make decisions about

the study site and about the methods and procedures to be used to address the

research question. Researchers typically have considerable flexibility in designing a

studt and make many methodological decisions. These decisions have crucial

complications for the integrity and generalizability of the study findings.

Step 6: Selecting a research design

The research design is the overall plan for obtaining answers to the questions being

studied and for handling various challenges to the worth of the study‘s evidence. In

designing the study, researchers decide which specific design will be adopted and what

they will do to minimize bias and enhance the interpretability of results, in quantitative

studies, research design tend to be highly structured and controlled. Research designs

also indicare other aspects of the research—for example, how often data will be

collected, what type of comparisons will be made, and where the study will take place .

the research design is the architectural backbone of the study.

Step 7: developing protocols for the intervention

In experimental research, researchers create the independent variable, which means

that participants are exposed to different treatment or conditions. An intervention

protocol for the study‘s would need to be developed, specifying exactly what the

intervention will entail(e.g who would administer it, how frequently and over how long a

period the treatment would last, and so on) and what the alternative condition would be.

The goal of well-articulated protocols is to have all subjects in each group treated in the

same way. In no experimental research, of course, this step is not necessary.

Step8: identifying the population

Quantitative researchers need to know what characteristics the study participants

should possess, and clarify the group to whom study results can be generalized – that is

they must identify the population to be studied. A population is all the individual or

objects with common defining characteristics. For example, the population of interest

might be all adult male patients undergoing chemotherapy in Dallas.



Step 9: designing the sample plan

Researchers typically collect data from a sample, which is a subset of the population.

Using sample is clearly more practical and less costly than collecting data from an entire

population, but the risk is that the sample might not adequately reflect the population‘s

traits. In a quantitative study , a sample‘s adequacy is assessed by the criterion of representativeness ( I,e., how typical or representative the sample is of the population).

The sampling plan specifies in advance how the sample will be selected and how

many subjects there will be.

Step 10: specifying methods to measure variables

Quantitative researchers must develop or borrow methods to measure the research

variables as accurately as possible. Based on the conceptual definitions, researchers

select or design methods to operationalize the variable and collect their data. A variety

of quantitative data collection approaches exit; the primary methods are self reports(e.g., interview) observations(eg., observing children‘s behavior), and

biophysiologic measurements. The task of measuring research variables and

developing a data collection plan is a complex and challenging process.

Step 11: developing methods to safeguard human/animal rights

Most nursing research involves human subjects, although some involve animal. In either

case, procedure need to be developed to ensure that the study adheres to ethical

principles. Each aspect of the study plan needs to be scrutinized to determine whether

the rights of subjects have been adequately protected.

Step 12: Reviewing and finalizing the research plan

Before actually collecting data, researchers often perform a number of ―tests‖ to ensure

that procedures will work smoothly. For example, they may evaluate the tradability of

written materials to determine if participants with low reading skills can comprehend

them, or they may pretest their measuring instruments to assess their adequacy.

Researchers usually have their research plan critiqued ny reviewers to obtain

substantive, clinical, or methodologic feedback before implementing the plan.

Researchers seeking financial support submit a proposal to a funding source, and

reviers usually suggest improvements.

Phase 3 : The empirical phase

The empirical portion of quantitative studies involves collecting research data and

preparing the data analysis. The empirical phase is often the most time consuming part

of the study. Data collection may require months of work.



Step 13: Collecting the data

The actual collection of data in a quantitative study often proceeds according to a

reestablished plan. The researcher‘s plan typically articulates procedure for training

data collection staff, describing the study to participants, the actual collection of

data(e.g, where and when the data will be gathered), and recording information.

Step 14: Preparing the data for analysis

Data collected in a quantitative study are rarely amenable to direct analysis. Preliminary

steps are needed. One such step is coding, which is the process of translating verbal

data into numeric form(e.g., coding gender information as ―1‖ for females and ―2‖ for

males). Another preliminary step involves transferring the data from written documents

onto computer files for analysis.

Phase 4: The analytic phase

Quantitative data gathered in the empirical phase are not reported as a mass of

numbers. They are subjected to analysis and interpretation, which occurs in the fourth

major phase of a project.

Step 15: Analyzing the Data

To answer research questions and test hypotheses, researchers need to analyzed their

data in an orderly, coherent fashion. Quantitative information in analyze though

statistical analyses, which include some simple procedure (e.g., computing an

average) as well as complex and sophisticated methods.

Step 16: The Dissemination phase

In the analytic phase, researchers come full circle: the questions posed at the outset are

answered. The researcher‘s job is not completed, however; until study results are

disseminated.

Step 17: Communicating the findings

A study cannot contribute evidence to nursing practice if the results are not

communicated. Another —and often final—task of a research project, therefore, is the

preparation of a research report that can be shared with others. We discuss research

reports in the next chapter.

Step 18: Putting the evidence into practice

Ideally, the concluding step of high-quality studies is to plan its use in practice settings.

Although nurse researchers may not themselves be in opposition to implement a plan



for utilizing research findings, they can contribute to the process by developing

recommendations regarding how the evidence could be incorporated into nursing

practice, by ensuring that adequate information has been provided for a meta-analysis,

and by vigorously pursuing opportunities to disseminate the findings to practicing

nurses.

nursing research 2 lecture

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