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Fundamentals of Nursing Research: evaluation of the evidence for nursing practice Essay

1.How do nurses and doctors interact in acute settings?

In this study, I would like to use ethnography. When compared to other qualitative methods like ;phenomenology or grounded theory,ethnography is a systematic approach,which includes observing,detailing,describing,and analyzing the patterns of culture(Leininger,1985).The key feature of ethnography as a qualitative research methodology is that, it involves long term study of a group by the researcher who becomes both the observer and participant in the group this is often termed as participant observation(Ellis 2010)They don’t always take a participant role,sometimes they are non-participant observers.

Access to a group for study may involve the researcher in seeking the help of a gate keeper(Ellis 2010). In this study a gate keeper can be the HOD of acute care unit who allows to access the group of doctors and nurses and also to introduce them. However there are some ethical issues this approach like an informed concent of colleagues(Ellis 2010) Convenience sampling is apt for this study as the researcher cannot predict the situation.It might be very difficult to get enough number of sample at a stretch,observation during a period of one week with different staff at different shifts,would be great to get maximum number of sample of 40 .

Data collection methods include observation and interview .There are mainly three broad types of information are usually saught by ethnographer ie;: the cultural behaviour(which means what members of the culture do) Cultural artifacts : What members of the culture make or use Cultural speech(What people say)

This implies that ethnographers rely on a wide variety of data sources including observations indepth interviews records charts and other type of physical evidence(Diary letter) (Polit and Beck 2010)

Observation is not unique to research and can be considered as part of every day life(Benner and Fian,2008) . Adler and Adler (1994) noted ;

“For as long as people have been interested in studying the social and natural world around them observation has served as bedrock of source of human knowledge”(P 377)

Often the key objective of using observation is to check weather what people say that they do is the same as what they actually do. As Hammersley (1990) suggested to rely on what people say about what they belive and do, without also observing what they do, is to neglect the complex relationship between attitudes behaviour( p 597)

There are many other reasons for using observation as the data collection method :

• It helps us to inform about the influence of the physical environment • Captures sense of the context of the and whole social settings in which people function • Helps to illustrate the whole picture (Benner and Fian,2008). Some phenomena lent themselves well to observation(Polit and Hangler 1995) including characteristic and conditions of individuals, verbal and no verbal communication behaviour, activities, skill attainment and performance and the characteristics of an environment.(Benner and Fian,2008)

Observation can be considered as an approach ,in which the aspects of the phenomenon to be observed are operationally defined and decided in advance(Benner and Fian,2008)

It’s actually a skill to interview in qualitative research and this can be acquired through practice. (Ellis 2010) ethnographic interviews are unstructured- here i would like to use descriptive questions to ask participants about there experiences in there own language and are the backbone of ethnographic interviews(Polit and Beck, 2008) however study participants will not share much information with interviewers if they do not trust them close rapport with respondence provides access to richer information and to personal or intimate details. And audio taping equipment batteries tapes notepads and pens are essentials. Tape recorded interviews should be listened to and checked for audibility and completeness soon after the interview is over.

The analysis mainly based on the patterns in the behaviour and thoughts of the participants comparing one pattern against another and analyzing many patterns simultaneously(Felterman 1989) Spradly’s 1979) /In an ethnographic study,research sequence is often used for data analysis .(Polit and Beck, 2008).On the other hand Spradely believes that language is the primary means that relates cultural meaning in a culture. His sequence of 12 steps, which includes both data collection and data analysis, and the analysis part includes making a domain analysis which are units of cultural knowledge and making a taxonomic analysis asking contrast questions making componential analysis discovering cultural themes and the last step is writing the ethnography. (Polit and Beck 2008)

On the contrary ,it is very challenging method when it compares to other quantitative methods for there are no universal rules for analyzing data( Polit and Beck 2008).

2 – Do weekly counseling sessions decrease stress levels of carers of people with Alzheimer’s disease?

This study can better done by the experimental method, to be more specific a randomized controlled trial is apt for this particular study. The genuineness of true experiments give us greater confidence that they depict the causal relationships under controlled settings of study (Polit and
Beck,2008)

Randomized controlled trials are able to answer a very specific question or related questions,because it uses specific manner ( Ellis 2010). RCT use techniques to find out the relationships between to variables. Moreover it holds direct control over many other factors that may effect the validity and reliability of the findings( Ellis 2010). Here Independent variables is weekly counseling sessions and dependent variable is stress levels of carers of people with Alzheimer’s disease.

RCT’s are characterized by the following properties

✓ Manipulation – The experimenter does something to some subjects or some type of interventions. ✓ Control – The experimenter introduces controls into the study, including devising good approximation of counter factual – usually a controlled group that does not receive the intervention. ✓ Randomization – The experimenter assigns subjects to a controlled or experimental conditions on a random basis. (Polit and Beck 2010)

It was pointed out earlier that the RCT involves the random allocation of participants(Carer of people with Alzheimer’s disease) between experimental groups, whose members receive the treatment (in this study weekly counseling sessions) and control group who is devoid of or receive no intervention (in this study intervention means counseling sessions)

I think a continuous 8 weeks counseling sessions that includes psychological and physical retreat of carers of Alzheimer’s patient can decrease stress levels of participants. In this particular study ,we should make sure that all meet the demands of inclusion criteria( Ellis 2010). In this study inclusion criteria involves carers who suffer from stress related to their work experience with Alzheimer’s patient.

After sampling ,the researcher divides the entire sample into two different groups so that each group portrays the similar characters and even in terms of variables. ( Ellis 2010).

Researchers manipulate independent variable by administrating the intervention to some subjects while withholding it from others. To illustrate participants in the experimental groups are subjected to counseling sessions through out the period where as those in the controlled group gets the usual care and treatment .

Firstly, researcher have to do a pretest that involves the observation of dependent variable before the counseling session. This design permits us to examine what changes in stress levels were caused by the 8 week counseling session because only some people were subjected to it, providing an important comparison (Polit and Beck 2010)

There are mainly two methods for data collection namely clinical or non clinical. Here it is a non clinical method we can use questionnaires for the data collection.( Ellis 2010).A crucial part of good research design concerns making sure that the questionnaire design addresses the needs of the research.To put this another way; somehow we need to ensure that the questions asked are the right ones.(iss.leeds.ac.uk › home › resources › tutorial documents › surveys). Reliability and validity are the two important aspect about the tool.The consistency in measuring is reliability .If the device produces the same or similar results when it uses under same circumstances,it is reliable. Whereas validity defined as, whether a tool measures or examines what it claims to measure or examine./(www.holah.karoo.net/reliabilityandvalidity.htm)‎

Outcome data should be collected in the same way and with the same figures for all the study group to facilitate this where possible participants may remain unaware of the intervention being received(Gerrish and Lacey 2010).Here the researcher can use blinding in order to reduce the risk of biases.(http;//www.ajronline.org/doi/full)It means the participants in the trial doesn’t know which intervention is given to each individual.

A comparison of both group after the counseling session can be done by a post test. Despite the benefits of experimental research this has some
limitations, first of all there are often constrains that make an experimental approach impractical or impossible(Polit and Beck 2008)

3: What are the factors that influence women’s smoking behaviour during pregnancy?

This study has got social relevance. The grounded theory tradition which has its roots in sociology, seeks to describe and understand the social psychological and structural processes that occur in a social setting.(Polit and Beck 2008).It’s procedures are not specific to a particular discipline or method of data collection.(Holloway and Wheeler,2002)

Grounded Theory research is used to generate theories about practice and understanding from many different areas of health care(Ellis 2010) so in this study grounded theory is very apt because it deals with a practice or a habit and we can gain insights into how pregnant ladies changes there smoking behaviour during pregnancy

Of the qualitative approaches to research grounded theory is perhaps the most systematic in its approach. Grounded theory systematically applies procedural steps to explore social phenomenon and derive a theory that explains people’s understanding of those phenomenon .According to Strauss & Corbin, grounded theory emerges inductively from the research study.It undergoes very systematic process, data collection and analysis of data are the two major aspects of the study,so that the theory or the phenomena derives from the reciprocal relationship with each other.(Strauss & Corbin,1990)

The starting point for grounded theory is that to select a homogeneous sample ,which means a sample portrays same kind of experience and with same process . A broader sample enables the researcher to draw on the experience of people to come to some conclusion of their experience (Ellis 2010)

Samples for qualitative studies are generally much smaller than those used in
quantitative studies.(www.qualitative-research.net › Home › Vol 11, No 3 (2010))The sampling in this study is theoretical sampling. I would like to select the samples from antenatal clinics or GP’s. The sample needs to be broad enough to enable the researcher to draw on the experiences enough people to come to some conclusion (Ellis 2010).But usually Grounded research typically done with 20 to 30 people.(Polit and Beck,2008).The sample size is determined by the theory being generated from the qualitative data.

The data analysis can be done in two ways.Firstly, grounded theory may be used as a technique for analyzing data, which includes the process of constant comparison. The theory suggests that categories and properties are concepts that are identified by the researcher and evolve from the constant comparing of the data. (epress.anu.edu.au/info_systems/mobile_devices/ch04s03.html)

Constant comparative analysis can be explained as the continuous comparison of data obtained from different participants so that the researcher analyses the difference or similarity among them.(www.rangahau.co.nz/analysis/83/‎)

Methods used in data collection include, interviews ,documentary evidence, case studies and participant observations. Here i would like to use interview as my data collection method.It would be so helpful when we can maintain the field notes throughout the process of data collection.Certain occurrences in the setting or ideas from participants that seem of vital interest are recorded either during or after data collection.They remind the researcher of the events and interactions and trigger thinking process.(Holloway and Wheeler,2004).

As mentioned above the analysis of Grounded theory can be done by two major methods; Firstly, the Glaser and Strauss’s Grounded theory method, and the second one is Strauss and Corbin’s approach.(Polit and Beck,2008). In this study i would like to use Strauss and Corbin’s approach. Main three types of coding includes ; Open axial and selective coding the out come of the Strauss and Corbin’s approach is a full conceptual description that explains how a basic social problem that emerged from the data is processed in a
social setting (Polit and Beck 2008)….

When compared to other ways of qualitative analysis, It provides researchers with a unique tool for theoretical development.On contrary to the conventional path Grounded Theory works inductive . A researcher affords the luxury of maintaining an open mind and allowing the data to inform the discovery of theory. Natural phenomena is best represented by the emergent findings avoiding preconceived ideas. (ro.uow.edu.au/cgi/viewcontent.cgi)

4: What is the effect of hydrotherapy on the pain levels of people with osteo-arthritis?

This study is Quantitive study. The true experimental designs are those in which the researcher has a great deal of control over the research situation.(Nieswiadomy,2008).There are three criteria for a true experimental design.Firstly, the researcher manipulates the experimental variable(s).Second one is at least one experimental and one comparison group are included in the study.Last criteria is that subjects are randomly assigned to either the experimental or the comparison group. (Nieswiadomy,2008).

Using manipulation, researcher consciously vary the independent variable and observe its effect on dependent variable. Researcher manipulate the independent variable by administering an experimental treatment(intervention) to some subjects while withholding it from others. Here dependent variable is pain level an independent variable is hydrotherapy(Polit and Beck 2010)

Randomization or random assignment to study groups involves distribution of subject to either the experimental or control group on purely random or chance basis(Schneider and et al 2003)

Sampling is the process of selecting a portion of the population to represent the entire population. It is subset of population elements. Simple random sampling can be used for this study. The members of the population
are numbered and a number of them are selected using random numbers without replacing them. With this method each population member has equal chance of selection (Bowling 2009)

Factors affecting sample size includes homogeneity of the population effect size cooperation and sensitivity of the measures. Quantitative researchers need to pay careful attention to the number of participants needed to achieve statistical conclusion validity. A procedure known power analysis(Cohen 1988) can be used to estimate sample size needs (Polit and Beck 2008). The sample size, effect size and the alpha level are the three major factors which determine the power.It can be defined as the capability to figure-out the statistically significant difference when the null hypothesis is in fact false,which means, power is your ability to find a difference when a real difference exists(psych.wisc.edu/henriques/power.html)

Large samples are no assurance of accuracy however. There can be practical constraints such as subject availability cooperation level of participants time and resources can limit the sample size so that many studies are based on relatively small samples (Polit and Beck 2008)

Data collection in experimental study dependents on the exact questions being investigated. The data collected can include data about the independent variable and data on a phenomenon(Ellis 2010). Interviews,physical examination or biological samples are the main data collection methods, researcher can also collect data from existing records. (Ellis 2010).Here a personal interview using a structured questionnaire can be used for the data collection.

In this study we should do a pre test and post test. Pre test should be conducted before the intervention and a post test to assess the effect of hydrotherapy

A major strength experiments is that they are practical in the real world it may be difficult if not impossible to conduct true experiments. In current era of healthcare consumerism patients are not always willing to
relinquish control over there treatment condition. Another drawback of experiments is that unwillingness of people.( Gross and Fogg 2001)

REFERENCES

Ellis P.(2010),Understanding research for nursing students,Exeter;Learning matters Polit D. F and Beck C.T(2010),Essentials of Nursing Research:Appraising Evidence for Nursing Practice,7th edn;Lippincott Williams & Wikins. Nieswiadomy RS(2008), Foundations of nursing research, 5TH edn; new jersey: Pearson Leininger(1985), Qualitative research methods in nursing; W.B Sanders Company. Inc Holloway I & Wheeler(2002), Qualitative research in nursing, 2nd Edition, oxford Blackwell Science LTD Gerrish K and Lacey A (2010), The research process in nursing 6th edn, UK, Wiley-Blackwell Bowling A 2009, Research methods in Health;investigating health and health services, 3rd Edn, England, open university press Polit D.F and Beck C T(2008); Nursing research;Generating and assessing evidence for nursing Practice 8th Edn; Lippioncott, Williams & Wilkins Watson R, Mckenna H, Cowman S & Keady J (2008); Nursing research; Designs and method; Churchill Livingstone: Elsevier Schneider Z,Elliot D,Lobiondo-Wood G & Haber J (2003); Nursing Research: Methods critical appraisal and utilisation 2nd edn, Australia: Elsevier Pty Ltd University of Leeds: (iss.leeds.ac.uk › home › resources › tutorial documents › surveys). (No date)(Accessed on 25thof June,2013) University of Wisconsin-Madison:(psych.wisc.edu/henriques/power.html) (no date)(Accessed on 25thof June,2013)

13.University of Wollongong:(ro.uow.edu.au/cgi/viewcontent.cgi) (no date)(Accessed on 25thof June,2013)
Dr Leonie Pihama, Māori and Indigenous Analysis Ltd:(www.rangahau.co.nz/analysis/83/‎)(no date)(accessed on 25thJune). nformation Systems Foundations: Constructing and Criticising:(epress.anu.edu.au/info_systems/mobile_devices/ch04s03.html) (no date)(Accessed on 25thof June,2013)

16. M Mason -(www.qualitative-research.net › Home › Vol 11, No 3 (2010)
(2010)(Accessed on 25thof June,2013)


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