HSON MSN Blended Program

Rafic Hariri School of Nursing Nursing Administration and Management Track

NURS 530:
Statistical
Reasoning and
Applications in
Nursing Research

Rafic Hariri School of Nursing

Lecture 1
Souha Fares, PhD

MSN Nursing Administration Blended Program HSON

Rafic Hariri School of Nursing
 Chapter 1
Introduction
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 Introduction to Statistics and Basic Vocabulary

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 Learning Objectives

After studying this lecture you should be able to:

▪ Describe the importance and role of statistics in nursing research

▪ Define basic biostatistical terms, sampling methods and study designs
▪ Recognize different types of data that arise in health care studies
▪ Distinguish between population parameters and sample statistics
▪ Distinguish between different areas of statistics

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 Why Statistics in Nursing?

▪ Statistics intrudes itself into the life of every nurse and health care worker at the
community and individual patient levels

▪ At the community level, it is used to monitor and assess the health situation and trends,
or to predict the likely outcome of an intervention program

▪ At the patient level, it is used to arrive at the most likely diagnosis, to predict the
prognostic course and to evaluate the relative efficacy of various modes of treatment

▪ Knowledge of statistics is an important part of the competence of every nurse

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 Why Statistics in Nursing?

▪ It is essential for the nurse to critically understand the medical

literature

▪ Ex: Shin et al., Journal of Nursing Research, 2009

▪ Study to assess the effects of two alternative treatments, compared with
no treatment, on menstrual symptom severity in Korean women

▪ Authors state that “post-treatment symptom severity differed

significantly among women in the three groups (F1,22 = 124.6, p <
0.001)”

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 Why Statistics in Nursing?

▪ Statistical principles are essential if the nurse wishes to

undertake an investigation that involves collecting, analyzing
and interpreting data of his/her own

▪ Ex: you wish to investigate whether

▪ We can use our hospital beds more effectively
▪ Those who have their hip replaced using keyhole surgery have, on
average, a shorter stay in the hospital than those using traditional
methods
▪ Good health and exercise are closely connected

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 Statistics and EBP

▪ Statistics provide essential tools in the

development of evidence-based practice (EBP)

▪ Health care practitioners need to have a sound

grasp of statistics and use them with confidence

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 What Do I Need to Understand Statistics?

In this class
▪ You won’t need advanced (if any) mathematical skills
to understand statistics

▪ You need your logical thinking ability, AND

▪ A computer that has SPSS installed on it!

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 What is Statistics?

▪ Statistics is the study of “making sense of data”

▪ Statistics is the science of

entering and analyzing and

cleaning the interpreting data reporting the
data describing or results of the
collecting summarizing data (deriving and
data (into a statistical communicating analysis
software) meaningful
conclusions)

in order to help people make decisions when faced with uncertainty

▪ Biostatistics: data related to the medical and health fields

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 Population and Sample

▪ Population is the collection of all subjects of interest

Ex. All Lebanese males 50 years of age with coronary heart disease

▪ Sample is a subset of the population of interest

Ex. 100 randomly selected Lebanese males 50
years of age with coronary heart disease

https://www.omniconvert.com/what-is/sample-size/

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 Population and Sample

▪ Usually populations are so large that a researcher cannot examine the entire
group. Therefore, a sample is selected to represent the population in a research
study

▪ The goal is to use the results obtained from the sample to help answer
questions about the population

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 From the Sample to the Population
Population
All individuals of interest

Results are generalized

from the sample Sample is selected
to the population from the population

Sample
The individuals selected
to participate in the study
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 Variables and Data

▪ Variable is the characteristic measured on each subject (it is something that

varies from one person to the next)
Ex. Systolic blood pressure in mmHg

▪ Measurements are called data

Ex. (140, 160, 110,…)

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 Population Parameters and Sample Statistics

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 Population Parameters vs. Sample Statistics

▪ Populations are characterized by unknown parameters which we estimate with

sample statistics

▪ Parameter: A numerical value summarizing the data of an entire population

▪ Statistic: A numerical value summarizing the sample data

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 Population Parameters vs. Sample Statistics

Population are characterized by unknown parameters which we estimate with sample statistics

Parameter (a descriptor of the Statistic (a descriptor of the

population)
μ = population mean
σ = population standard deviation
ρ = population correlation coefficient
π = population proportion
sample)
X= sample mean
S = sample standard deviation
r = sample correlation coefficient
p = sample proportion

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 Ex: Study of a Cholesterol Reducing Drug

Population Sample

Men age ≥ 18 with elevated cholesterol Random sample of n = 100 men

(≥ 200 mg/dl) age ≥ 18, with cholesterol ≥ 200

Parameter Sample Statistics

μ = mean cholesterol level

X = mean cholesterol observed
in the sample (252mg/dL)

π = proportion with ≥ 10% change from

baseline level p = proportion of men in the sample who
have ≥ 10% changes from baseline (25%)

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 Ex: Age of Registered Nurses

Ex: A nursing director is interested in learning about the average age of registered
nurses in Lebanon. Identify the basic terms in this situation

▪ The population is all registered nurses in Lebanon

▪ A sample is any subset of that population. For Ex., we might select 50registered
nurses at AUBMC and determine their age
▪ The variable is the “age” of each registered nurse
▪ The data would be the set of ages in the sample
▪ The parameter of interest is the “average” age of all registered nurses in Lebanon
▪ The statistic is the “average” age for all registered nurses in the sample

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 Types of Variables, Types of Data, and Basic Sampling Methods

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 Independent and Dependent Variables

▪ The independent variable (or exposure, predictor) is the hypothesized cause of,
or influence on, the dependent variable (or outcome, response)

▪ Does a low-cholesterol diet reduce the risk of heart disease?

▪ The independent variable (IV) is the amount of cholesterol in a person’s diet
▪ The dependent variable (DV) is heart disease

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 Independent and Dependent Variables

▪ Do coronary angioplasty patients have more symptoms of psychologic stress than

coronary artery bypass patients 1 month after treatment?
▪ IV: Procedure (coronary angioplasty/artery bypass)
▪ DV: Symptoms of psychologic stress

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 Confounding Variables

▪ Other potentially interfering variables

IV DV

▪ Additional factor that is both:

▪ Associated with the IV; and
▪ Independently affects the outcome you plan to measure

▪ In the coronary angioplasty Ex. (IV = Procedure, DV = Symptoms of psychologic

stress) can you suggest a potential confounding variable?

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 Confounding Variables

▪ Can lead to the observation of differences when they do not exist, or the
observation of no differences when they do exist

▪ Can be “controlled” by various methods, including randomization, matching,

restriction, stratification, and multivariable analysis
▪ Randomization, matching, restriction and stratification will be discussed in NURS502
▪ Multivariable analysis will be introduced in lecture 7

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 Sampling Methods

▪ Probability sampling: every element in the population has a chance of being

selected
▪ A complete list of the population is available (Sampling frame)
▪ Ex: Random sample

▪ Non-probability sampling: not every element in the population has a chance of

being selected
▪ Ex: convenience, systematic

▪ Sampling methods are described in details in NURS502

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 Study Designs – Experimental Studies

Experimental studies (randomized experiments) – brief description:

▪ In an experiment, one variable is manipulated (i.e participants are assigned randomly to a treatment
or condition by the investigator) to create treatment conditions. A second variable is observed and
measured to obtain scores for individuals in each of the treatment conditions

▪ The manipulated variable is the IV and the observed variable is the DV

▪ The measurements are then compared to see if there are differences between treatment conditions
(all other variables are controlled to prevent them from influencing the results)

▪ The goal of an experiment is to demonstrate a cause-and-effect relationship between two variables

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 Study Designs – Observational Studies

Observational studies (non experimental) – brief description

▪ Similar to experiments because they also compare groups of scores

▪ Observe but cannot manipulate/control the independent variable

▪ Participants may receive interventions (which can include medical products such
as drugs or devices) or procedures as part of their routine medical care, but
participants are not assigned to specific interventions by the investigator

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 Study Designs

Ex: suppose researchers want to study whether people lose more weight by exercising
or by limiting their fat intake.

▪ Is an observational study appropriate to answer this research question? If so describe

▪ Is an experimental study appropriate to answer this research question? If so describe

▪ All study designs are described in details in NURS502

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 Types of Data (Levels of Measurement)

Level of Measurement: A system of classification with four types of measurement

rules that affect the kind of statistical analysis that is appropriate:

 Nominal
Categorical
 Ordinal

 Interval
 Ratio
Continuous or quantitative

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 Continuous (Quantitative) Data

▪ Continuous(quantitative): numerical data. May take any value within a defined

range. Also called interval data
Ex.
▪ Blood pressure, mmHg
▪ Weight, pounds (kilograms, ounces, etc.)
▪ Height, feet (centimeters, inches, etc.)
▪ Age, years (months)
▪ Income, dollars/year (Euro/year, etc.)

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 Categorical Data

▪ Categorical (discrete): take on a limited number of observations or categories

▪ Ex. Gender, marital status, symptom severity

▪ Assign numbers to classify characteristics into categories

▪ Categorical data can be Nominal or Ordinal

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 Categorical Data – Nominal

▪ Nominal: names describe the categories, no order

▪ Ex. Gender (Male, Female), marital status (Married, Divorced, Widowed, Never Married)

▪ The numbers assigned have NO quantitative meaning

▪ I can code males as 1 and females as 2 or
▪ Males as 2 and females as 1

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 Nominal Data

▪ Nominal measures must have categories that are mutually exclusive and
exhaustive

▪ Each individual must be classifiable into one and only one category

▪ Ex: marital status as: 1 = married, 2 = separated or divorced, 3 = widowed, 4 =

single

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 Categorical Data – Ordinal

▪ Ordinal: Ordered categories, ranking

▪ Ex. Socio-economic status; 1 = Low, 2 = Medium, 3 = High

▪ Ex. Histologic stage of the disease; 1 = Minimal, 2 = Moderate, 3 = Severe

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 Ex: Data on MI Patients

Data for selected baseline variables for a sample of 100 patients

Patient ID Vital Status Gender Age BMI Hospital

(1 = Dead 0=M (years) admission
0 = Alive) 1= F date

11 1 0 40 21.78971 22-Jul-95
12 1 1 73 28.43344 11-Oct-95
13 0 0 83 24.66175 26-May-95
14 1 1 64 27.46412 21-May-95
15 1 0 58 29.83756 14-Dec-95
Nominal Nominal Nominal Interval Interval Date

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 Types of Data

▪ You can transform data from continuous to categorical

Ex:

▪ BMI: continuous
▪ If we collapse BMI values in three categories then it
becomes categorical
▪ BMI ≤ 20  group1
▪ 20 < BMI ≤ 30  group2
▪ BMI > 30  group3

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 Types of Data

It is important to determine the nature of the variable under investigation, as the

selection of the appropriate technique to summarize it and make inferences
depends on whether the variable is continuous or categorical

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 Areas of Statistics

▪ Descriptive Statistics: methods of presenting, summarizing and describing a set

of data
Ex. Frequency tables, graphs, numerical
summaries

▪ Inferential statistics: allows us to make conclusions and generalize from the

sample of data to the population of subjects
Ex. Confidence intervals, tests of hypotheses

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 Areas of Statistics

▪ Univariate statistics: involves one variable at a time

▪ What is the rate of death after COVID-19 infection in Lebanon?

▪ Bivariate (bivariable) statistics: involves two variables

▪ Is gender associated with death after COVID-19 infection in Lebanon?

▪ Multivariable statistics: involves three or more variables

▪ Mutlivariable: Are age and gender and history of heart disease associated death after COVID-19 infection
in Lebanon?

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