Chapter 1 Introduction to Nursing Research in an Evidence-Based Practice Environment

COMMENTS ON THE CRITICAL THINKING ACTIVITIES IN CHAPTER 1 Example 1: Depression and anxiety in women with breast cancer and their partners. 1. (#1) Badger and colleagues (2007) study evaluated whether there were psychological benefits associated with two alternative interventions that were delivered by nurses over the telephone to women who had breast cancer, and their partners. Given the importance of nurses role in educating and supporting patients and their caregivers, the potentially beneficial effects of the interventions are of direct relevance to nursing practice. By directly comparing two alternative interventions, the research team was able to gather information about whether one was superior to the other in reducing anxiety and depression. The research was innovative in its inclusion of partners in both the intervention and in the assessment of outcomes. The study falls within the first priority area identified by Sigmat Theta Tau International, namely health promotion. (#2) The research as reported in this article is clearly quantitative. The effects of the interventions on patient and partner outcomes were assessed by using formal measures of psychological outcomes (anxiety and depression). The researchers sought to determine whether the telephone interventions caused improvements in these outcomesan aim solidly within a positivist framework. (#3) The study probably had a number of purposes, including quantitative description (What happens to anxiety and depression in cancer patients and their partners over time when they interact with nurses by telephone?). The research could also be called cause-probing in that the researchers sought to determine if the intervention could cause improvements in anxiety. Prediction and control were undoubtedly a purpose. Based on the findings (especially if the results are replicated in other studies), we could predict decreases in anxiety among women and partners exposed to the interventions. This, in turn, allows some control: by instituting the intervention, nurses could partially control anxiety. The study in itself does not elucidate an explanation, (i.e., the results do not explain why the interventions reduced anxiety), although the researchers did provide some interpretation of possible underlying mechanisms in their article. In terms of EBP-related purposes, this study is clearly an example of intervention or treatment research.

2.

a. As you will learn as you progress through this book, quantitative research almost always

involves some type of comparison. If Badger and colleagues had administered the interventions to all of the study participants, they would have learned that there were changes in anxiety and depression over time, but they would not have known if changes were caused by the interventions per se or, for example, the result of the natural progression of these emotions over time. By comparing patients who received the interventions with others who received only brief telephone contact, they were able to make the inference that it was indeed the interventions that caused reductions in anxiety over the 10 week study period. b. The control group members received brief weekly contact with nurses by telephone to help rule out that it was contact by nurses, rather than the actual content of the interventions, that led to improved psychological outcomes. There is a technical term for a control group that deliberately is given a modest degree of interaction with researchersit is called an attention control group, and this is the term the researchers used in describing their study. An attention control group typically is used when researchers want to rule out the possibility that intervention effects are caused by the special attention given to the people receiving the intervention, rather than by the actual content of the treatment. The idea is to try to separate the active ingredients of the treatment from the inactive ingredients of special attention. c. This research could not have been undertaken as a qualitative study. Badger and her co-researchers were interested in describing measurable phenomena, testing whether the interventions had measurable effects on those outcomes, and examining how those effects transpired over time. However, the researchers could have studied additional related questions that would lend themselves to qualitative inquiry. Here are some examples of the kinds of questions that could be asked in a related qualitative inquiry: What was it like for the participants to experience the interventions? What were the conversations between patients and partners like during the course of the intervention? What kinds of anxieties did the patients and their partners experience?

Example 2: Living with risk: Mothering a child with food-induced anaphylaxis 1. (#1) The emotional and educational needs of mothers who have children with health risks are very relevant to clinical nursing practice. The ongoing stress of having a child with a potentially lifethreatening condition requires sensitive treatment by health care professionals, and studies such as this one can help nurses to better formulate and implement appropriate care.

(#2) The naturalistic paradigm provided the underpinnings for this research, and the methods used were qualitative. The researchers realized that the dynamics of parenting a child at-risk of FIA are complex and poorly understood. To gain insights into the social and psychological dynamics of the parents experiences, it was essential to talk to the mothers directly, and to probe deeply into the emotions, fears, and concerns associated with their experiences. It was important for the researchers to understand the experience holistically, without imposing any controls or constraints on the research situation. (#3) Like many qualitative studies, this study can be described as exploratory. When a new area is being researched, an exploratory study can provide insights into the full nature and meaning of the phenomenon of interest. An exploratory study can lay the groundwork for more focused research. In terms of EBP purposes, this study clearly concerns the meaning of a phenomenon, i.e., parenting a highrisk child. 2. a. The researchers audiotaped and transcribed their in depth interviews with study participants so

that their data would be of the highest possible accuracy and thoroughness. These verbatim transcripts provided a sound basis for their analysis of the interviews. Interviews in qualitative research tend to be long, complex, and filled with many rich details and examples of the topic under study. It is impossible for a researcher to remember all the information shared by a participant during an interview, so it is an excellent strategy to audiotape and then later transcribe the interviews in their entirety. b. It would not have been appropriate (or even feasible) for the researchers to conduct this study using quantitative methods. The researchers aims of describing and exploring the meaning of an experience could only be investigated with qualitative methods. The experiences under investigation do not lend themselves to measurementalthough aspects of the process possibly could be quantified on the basis of the findings from this study.

Example 3: Anger, Anxiety, and Blood Pressure in Children 1. (#1) Studies that focus on factors linked to potential health problems ( risk factors for poor health) are of great relevance to nurses. In this case, the researchers were exploring risk factors in children for a lifelong health concern, namely high blood pressure. Studies such as this can be useful in understanding the need for and dimensions of early interventions for youth. This study is readily viewed

as falling within the parameters of the first priority area identified by Sigma Theta Tau in 2005i.e., health promotion and disease prevention. (#2) This research is quantitative. Howell and her colleagues were interested in studying relationships among measurable phenomena, such as childrens blood pressure on the one hand and anger and anxiety on the other. (#3) The underlying purpose of the study could perhaps best be described as explorationthe researchers wanted to explore the relationship between factors that have been identified as associated with high blood pressure in adults. Prediction was also likely a goalidentifying risk factors that could predict high blood pressure in school-aged children. In terms of EBP purposes, this study is an example of Harm and Etiology. The researchers sought to identify factors that might be associated with (and perhaps cause) a harmful health condition, high blood pressure. 2. a. The researchers present existing evidence from the literature about the relationships among blood pressure on the one hand, and anger and anxiety on the other, but most research has been done with adults. As they noted in the second paragraph, much less research has been done with children. That is the gap the researchers were seeking to address. b. This study could best be described as basic. The researchers sought to understand some basic linkages between childrens blood pressure and other characteristics, including both psychosocial factors (anger and anxiety) and biological factors (gender, height, and weight The study did not aim to solve a particular, immediate problem--although findings from this study and replications of it could perhaps contribute to interventions for children with high blood pressure. c. Qualitative methods would not have been appropriate in this study. All of the phenomena in which the researchers were interested were measurable phenomena that could be quantified. It would, however, be possible for researchers to conduct qualitative studies that are conceptually related. For example, questions that could be addressed in a qualitative study might be: What is it like for children to experience high levels of anger or anxiety? What is it like for children to have high blood pressure? d. According to information at the end of the report, the research was supported by grants from the College of Health Sciences, Georgia State University.

Example 4: Anniversary of Birth Trauma 1. (#1) Investigating birth trauma and its sequelae is extremely relevant to the practice of nursing because there are potentially devastating long-term effects that can include mother-infant attachment difficulties, parenting problems, and adverse psychological consequences. This research problem is relevant for a number of clinical specialty areas such as obstetrics, psychiatry, and pediatrics. (#2) Becks study of the anniversary of birth trauma is qualitative. Her research emphasized understanding the mothers experience of reliving a traumatic birth through the collection and analysis of mothers stories. In her findings Beck captured the individual and holistic aspects of the anniversary of the birth trauma within the context of the women who had experienced this phenomenon. The womens real-life experiences during labor and delivery provided first-hand knowledge of the phenomenon. (#3) As indicated by Beck, description was the underlying purpose of this study--the purpose was to describe the essence of the womens experiences of the anniversary of a birth trauma. This is an appropriate purpose inasmuch as birth trauma and re-experiencing the trauma on an anniversary are phenomena about which little is known. Within the set of EBP-related purposes described in the book, the purpose of the study was to elucidate the meaning of a health-related phenomenon. 2. a. Becks literature review revealed very few studies on birth trauma or on the resulting post-traumatic stress. What little research had been done were primarily quantitative ones that focused on identifying risk factors that could predict a traumatic birth. There was a gap in knowledge about the meaning of the experience of a traumatic birth for women, and there were no studies at all relating to the anniversary. b. Becks study was conducted within the naturalistic paradigm. The voices of the women in Becks study were key to understanding the experience of birth trauma and the anniversary of the event. Beck sought to identify patterns in the narrative stories written by the mothers.