Week 2

Guide:

• Black text- textbook (main info)

• blue text- powerpoint additions

• green text- professor added

• orange text- personal info I added to help understand

Critical Thinking

• The rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, beliefs, statements, and actions

• Involves disciplined, self-directed thinking

• Includes the display of mastered intellectual skills and abilities, such as applying research critique criteria

Critical Thinker

• Consciously thinking about their own thoughts: what they say, write, read, or do, and what others say, write, or do

• Questioning the appropriateness of the content, applying standards or criteria

• Evaluating the arguments or overall position of the author

Critical Reading

• An active, intellectually engaging process in which the reader participates in an inner dialogue with the writer

• A critical reader can enter the point of view of the writer

• Both critical thinking and critical reading are developed by learning the research process

Critical Reading Process

1. Preliminary: familiarize yourself with the content

   • skim the article

   • identify concepts

   • clarify unfamiliar terms

2. Comprehensive: understand the researcher’s purpose or intent

   • identify main theme

   • identify main steps of the research design

   • continue to clarify unfamiliar terms

3. Analytical: understand the parts of the study and begin developing a critique

   • assess the study’s value for your needs

   • critically evaluate the validity and applicability to practice

4. Synthesis: understand the whole article and how it fits with the larger body of knowledge

   • understand the whole article and each step in the research process

   • use your own words to describe

   • identify the articles strengths and weaknesses

Tips for Critical Reading Strategies

Levels of Evidence

1. Level 1: meta-analysis, systematic review of several randomized control trials (the strongest)

2. Level 2: a well-designed RCT (at least)

3. Level 3: quasiexperimental study

   • controlled trial without randomization

4. Level 4: single nonexperimental study

   • case control, correlational, cohort studies

5. Level 5: systematic reviews of descriptive and qualitive studies

6. Level 6: single descriptive of qualitive study

7. Level 7: evidence from the the opinion of authorities or reports of expert committees.

(Triangle image)

Research articles: format & style

Published articles:

• Guidelines for manuscript

• A shortened version of the complete work

How to present information:

• A journal’s space limitations

• A journal’s author guidelines

• The type or nature of the study

• An individual researcher’s evaluation of the most important component of the study

Components of a Research Report

• Title

• Abstract

• Introduction

• Literature review

  • Purpose

  • Question or hypothesis

• Theoretical/conceptual frameworks

• Methods

  • Design

  • sample

  • procedures

  • instruments

  • ethics

• Results

  • Data analysis (Statistical data, interview data analysis)

• Discussion

• Conclusions and implications

• References

A. Title

What’s in a title?

A good title tells you everything you need to know about the content of the paper in as few words as possible

A title should:

1. Describe the content of the paper

2. Distinguish the paper from others on a similar topic

3. Catch the reader’s attention and interest

4. Match search queries so people will find your paper (and cite it)-keywords

Critique the Title

Criteria:

• Tell what the article is about

• Be as brief as possible; (10-12 words)

• Be concise yet complete (convey the topic)

  • concise statement of the main topic

• Be interesting

Example Title: Sleep Quality and Stress Levels in Nurses Working Night Shifts: A Cross-Sectional Study

• Identify the actual variables or theoretical issues under investigation:

• Relationship between variables:

Example Title: A Multifaceted In-depth Look at the Experiences of People Working in the Health Care Sector During Times of Transition and Various Circumstances

• What the article is about:

• Be as brief as possible; 10-12 words:

• Be concise yet complete (convey the topic):

• Concise statement of the main topic:

Example Title: A Multifaceted In-depth Look at the Experiences of People Working in the Health Care Sector During Times of Transition and Various Circumstances

• Be interesting:

• Identify the actual variables or theoretical issues under investigation:

• Relationship between variables:

B. Abstract

Critique the Abstract

Criteria:

• A brief, comprehensive summary of the contents of the article

• 100-120 words; maximal 250 words (50-250); 960 characters; six short sentences

• Usually a single paragraph (traditional)

• Chap. 3, p. 47

Two Formats of Abstract

Unstructured; Structured

Structured:

• means the use of subheadings, whereas unstructured is simply text without subheadings (usually a paragraph).

• The headings might be "Objective", "Method", "Outcomes", and "Conclusion".

• They are bolded and the text usually directly follows the heading.

• Structured abstracts appear to be favored by medically-relevant publications

Structured Abstract (outline format) Example:

• Purpose: To examine dimensions of the psychosocial work environment that influence the psychological health of new-generation nurses.

• Background: While much work has been done concerning the health of nurses in general, research on the relationship between the nursing work environment and the psychological well-being of new-generation nurses at the start of their careers is limited.

• Design: A correlational descriptive design was used for this quantitative study. Survey data were collected from new nurses (N=309) whose names were obtained from a provincial licensing registry in Quebec, Canada.

• Findings: Among new nurses, 43.4% stated that they have a high level of psychological distress. These nurses were significantly more likely to perceive an imbalance between effort expended on the job and rewards received, low decisional latitude, high psychological demands, high job strain, as well as low social support from colleagues and superiors (p ≤ 0.05).

• Conclusions: Understanding the relationship between the work environment and health as experienced by new-generation nurses is imperative for creating interventions to successfully recruit and retain these young nurses.

• Clinical Relevance: Generation Y nurses in Quebec, faced with high levels of psychological distress because of their exposure to difficult nursing work environments, might leave the profession thereby exacerbating an already salient nursing shortage.

• [Key words: administration, quantitative, work environment/working conditions]

Unstructured:

Unstructured Abstract (outline format) Example:

Kravits et al., Self-care strategies for nurses: A psycho-educational intervention for stress reduction and the prevention of burnout

Abstract

• The purpose of this project is to develop and evaluate a psycho-educational program that assists nurses to develop stress management plans. Discussion of nursing-specific risk factors, practice with relaxation techniques, and exploration via art are used as interventions. Quantitative and qualitative measures of stress and burnout are conducted pre- and postcourse using the Maslach Burnout Inventory, Draw-a-Person in-the-Rain Art Assessment, and wellness plans. Descriptive statistics are used, and preliminary analysis indicates that the course is useful in impacting levels of emotional exhaustion. There are opportunities for evolving the program so that more enduring change in selfcare is generated.

Abstract Elements:

• Background/ introduction: importance or purpose of the study

• Objectives

• Methods: the setting, study population; selection of subjects for the study; research design; period of time; data collection procedure; analytical techniques and statical tests if possible

• Results: summarize the key findings with significant level precision in data

• Conclusion/ implication: state whether the hypothesis was proven

• Highlight the importance of the work in word

Critique the Abstract:

Good Abstract:

• accurate

• self-contained

• concise and specific

• non-evaluative, just report

• coherent and readable

C. The Research Problem (Problem Statement)

• Usually stated in the introduction section

• Refined by the researcher from an idea to something that can be studied; the question that is to be answered by the research

• Arises from practice, theory, or gaps in the literature and from previous research

• In the first part of the paper, but may not be well defined

• A concise, interrogative statement written in the present tense and including one or more variables/concepts.

• A research problem statement is a short (a paragraph or two) description of a specific research area or issue that you intend to address, why an explanation of why that area/ issue needs to be addressed, why addressing this area/issue is of importance, and what overall benefit (i.e., to society as a whole or to other researcher) addressing the issue may provide.

D. Research Questions

A concise, interrogative statement written in the present tense and including one or more variables/concepts.

• Research questions focus on

  • describing variables/concepts.

  • specifying the population being studied.

  • examining testable relationships among variables.

Designing an Answerable Question:

• A well built clinical question should have 4 components. The PICO model (for Quantitative) (SPIDER for Qualitative) is a helpful took that assists you in organizing and focusing your question to a searchable query.

• Dividing into the PICO elements helps identify search terms/concepts to use in your research of the literature.

Designing an Answerable Question:

• Clinical Scenario 1:

  • Our patient is a 45-year old female who is experiencing moderate depression. After surfing the web, she believes St. John’s Wort will cure her symptoms with less risk than conventional antidepressant medications.

• Clinical Question 1:

  • In female patients 45 years old and above (P), what is the effect of St John’s Wort (I) on depression (O), in comparison to conventional antidepressant medication (C)?

• Clinical Scenario 2:

  • On morning rounds in the Oncology unit, a first-year student turns to you for consultation. She wants to discuss options for managing moderate nausea and vomiting that result following chemotherapy. She shares an experience a relative had taking ginger when prochlorperazine didn’t provide effective relief and asks for your input.

• Clinical Question 2:

  • In cancer patients undergoing chemotherapy (P), what is the effect of ginger (I) in managing moderate nausea, in comparison to prochlorperazine (C) in providing effect relief of symptoms (O)?

Examples of nursing research questions formatted using the PICOT structure:

• In adult patients with Type 2 Diabetes (P), how does a lifestyle intervention program involving diet and exercise (I) compared to standard care (C) affect HbA1c levels (O) over a period of 6 months (T)?

• In elderly patients recovering from hip surgery (P), does the implementation of a fall prevention program (I) compared to standard care (C) reduce the incidence of falls (O) within the first year after surgery (T)?

• In patients with chronic obstructive pulmonary disease (COPD) (P), does the use of a home-based pulmonary rehabilitation program (I) compared to conventional hospital based rehabilitation (C) improve quality of life (O) over a 12 month period (T)?

• In adults undergoing chemotherapy (P), does the use of guided imagery and relaxation techniques (I) compared to standard care (C) better manage chemotherapy-induced nausea and vomiting (O) during the treatment period (T)?

E. Research Problem

• A concise, interrogative statement written in the present tense and including one or more variables/concepts

• A research problem statement is a short (a paragraph or two) description of a specific research area or issue that you intend to address, with an explanation of why that area/issue needs to be addressed, why addressing this area/issue is of importance, and what overall benefit (i.e, to society as a whole or to other researchers) addressing the issue may provide.

In a research paper, the research problem typically comes first, followed by the research question.

Research Problem Statement Example:

According to the York University mission statement, the university seeks to provide students with a safe, healthy learning environment. Dormitories are one important aspect of that learning environment, since 55% of York students live in campus dorms and most of these students spend a significant amount of time working in their dorm rooms.

However, students living in dorms A B C, and D currently do not have air conditioning units, and during the hot seasons, it is common for room temperatures to exceed 80 degrees F. Many students report that they are unable to do homework in their dorm rooms. Others report having problems sleeping because of the humidity and temperature. The rooms are not only unhealthy, but they inhibit student productivity and academic achievement.

Concepts:

• Concepts: abstractions of particular aspects of human behavior or characteristics (e.g., pain, weight)

• Constructs: slightly more complex abstractions (e.g., self-care)

Concept

• A concept is an image or symbolic representation of an abstract idea (e.g., pain). Chinn and Kramer (1999) define a concept as a “complex mental formulation of experience”.

• Concepts are the major components of theory and convey the abstract ideas within a theory.

• While the theoretical framework is the theory on which the study is based, the conceptual framework is the operationalization of the theory.

Conceptual framework

• It is like a process that involves mapping out or visualizing these theoretical threads to form some diagrammatic representation of interrelatedness

• is the researcher’s own position on the problem and gives direction to the study.

• Aside from showing the direction of the study, through the conceptual framework, the researcher can be able to show the relationships of the different constructs that he wants to investigate.

Developing a Theoretical or Conceptual Context

Theory:

• Theory is a human-invented in order to explain, predict and master phenomena (e.g. relationships, events, or the behavior).

• Theory is a set of interrelated concepts that systematically explains the relationship between phenomena.

• A theory is like a blueprint or a written or diagrammatic depiction of both the concepts that compose a theory and how they are related.

Variable:

• The property that is being studied.

• A characteristic or quality that takes on different values, that is, something that varies from one person to the next, e.g.,

  • height

  • weight

  • religion

  • ventilation

  • health

  • illness

• Researchers often conduct studies to understand how changes in one variable relate to changes in another variable (e.g., gender and mental health).

• Independent or dependent/outcome

  • Direction of influence or causal link

Types of Variables #1:

• Continuous (e.g., height)

• Discrete (e.g., number of children)

• Categorical (e.g., marital status)

• Dichotomous (e.g., gender)

• Attribute variable versus active variable

Types of Variables #2:

• Independent variable (IV)—the presumed cause (of a dependent variable)

• Dependent variable (DV)—the presumed effect (of an independent variable)

• Example: Smoking (IV) → Lung cancer (DV)

Definitions of Concepts and Variables

• Conceptual definition: the abstract or theoretical meaning of a concept being studied

• Operational definition: the operations (measurements) a researcher must perform to collect the desired information

• Data(singular = datum): the pieces of information researchers collect in a study

  • Quantitative: researchers collect numeric (quantitative) data.

  • Qualitative: researchers collect narrative (verbal) data.

Hypothesis

• Is a statement predicting the relationship of two or more variables

• Used in quantitative studies

• Used when have sufficient previous evidence on which to build empirical testing of theory through hypotheses testing.

• Formal statement of expected relationship between 2 variables in a specified sample.

  • Predict answers to a query, eg

    • The research question “What is the relationship between sexual risk taking and substance abuse among teenage mothers in Jamaica?”

    • Teenage mothers who are substances abusers are more likely to high levels of sexual risk-taking behavior

• Testable hypotheses

  • State the expected relationship between the independent variable and the dependent variable in a population

    • Adolescents and young mothers who do not take sexual risks and are substances abusers are more likely to be knowledgeable about AIDS, compared to those who take risks…

• Statistical analyses used to either support or not support hypotheses (never ‘prove’).

• Null or statistical (Ho ) vs. Research or alternate [alternative; scientific; theoretical] (H1 or Ha ).

• Simple vs. complex.

• Directional or non-directional.

Types of Hypothesis:

• SIMPLE HYPOTHESIS – predicts the relationship between a single IV and a single DV

• COMPLEX HYPOTHSIS – predicts the relationship between 2 or more IV or 2 or more DV

• DIRECTIONAL HYPOTHESIS- specifies not only the existence but the expected direction of the relationship between the variables

  • eg: incontinent patients who receive Two-hourly change in position are less likely to develop decubitus ulcers compared to those receiving daily position change

• NON DIRECTIONAL HYPOTHESIS - Does not say the direction of the relationship

  • eg: Frequency of change in position of incontinent patients is related to the development of decubitus ulcers

• NULL HYPOTHESIS (statistical hypothesis)-

  • E.g.: incontinent patients who receive two-hourly change in position are just as likely to develop decubitus ulcers as those receiving 4-hourly position change

• RESEARCH HYPOTHESIS (scientific hypotheses)

  • E.g. incontinent patients who receive two-hourly change in position are less likely to develop decubitus ulcers compared to those receiving daily position change

  • Frequency of change in position of incontinent patients is related to the development of decubitus ulcers

Hypothesis Testing:

• Hypotheses are tested through statistical analysis

• Hypotheses are never proved, they are accepted or supported − They are increasingly supported with more evidence

  • There will be no difference in pain reduction levels across 3 types of analgesia - music, therapeutic touch, and morphine - in patients who are 24-48 hours post abdominal surgery for non-cancer conditions.

  • Recently bereaved parents who receive weekly1-hour sessions of grief counselling for 12 weeks will have a greater decrease in grief levels compared with recently bereaved parents who do not receive grief counselling.