NR 505 Week 3 Discussion: Elements of Quantitative Research: Design and Sampling
The focus of the Week 3 discussion is on two important elements of
... [Show More] quantitative research studies- design and sampling. The approach or design, quantitative or qualitative, also applies to EBP projects. Both quantitative and qualitative have diFerent designs or traditions that fall under these two broad categories.
Select a single-study quantitative research study article related to your specialty track and provide the permalink to the article. Then discuss each of the following items.
• Identify whether the research study design is experimental, quasiexperimental, or nonexperimental. Provide the rationale for your answer.
• Identify the appropriate representation for the research study article you selected using the nomenclature of X for intervention, O for observation and data collection, and R for random a assignment to a research study group.
• Identify the type of sampling (probability vs. nonprobability) that was used in the research study article you selected.
• Identify one advantage and one disadvantage to the sampling type used (probability vs. nonprobability).
• Identify whether there was random assignment to research study groups in the research study article you have selected.
• If random assignment to groups was used, how does this strengthen the research study design?
Answer
A major issue for the HMH’s organ transplant unit is the surge in incidences of surgical site infections (SSI), especially in the post renal transplant patients in the months of June and July, 2017. It is highly unusual for this inpatient transplant unit to have 12 out of 38 post renal transplant patients being re-admitted after their discharges following the transplant surgery. Prior to this cluster of infections, their infection rate was less than 2% in the last 3 years. Thus, the inpatient transplant team is partnering up with infection and quality control teams to investigate the incidences for their root causes, and to recommend evidence-based practices for implementation. For this paper’s purpose, the independent variable/intervention will be frequency of chlorhexidine bath or shower on the evening of admission, then once again on morning of surgery. For those patients who are total care, chlorhexidine wipes will be done by the RN and patient care assistant at same intervals.
The objective is to provide adequate prophylactic protection against organisms that could cause morbidities and negative outcomes for the post renal transplanted patients. Thus, the hypothesis is that increased in frequency of chlorhexidine gluconate baths will decrease the rate of post-surgical sites infections.
The research question for the study is: “Does increase in frequency of HCG baths affect the rate of post-surgical site infection in the post renal transplanted patients? In PICOT form it is:
P – Adults patients in the 2 transplant units
I – HCG baths X2 in 8 hours increments
C – HCG bath only on morning of surgery
O – Decrease rate of infection
T – 6 months post-operative monitoring
Per Graling & Vasaly (2013), the University of Virginia in 2011 conducted a single institution, quasiexperimental study in general surgical patients (N=3,209 operations) looking at clinical outcomes associated with 3 separate skin-prepping regimens using a sequential (6 month) implementation design:
• (X): (regimen A) 10% povidone-iodine scrub combination with an isopropyl alcohol application between steps; (regimen B) 2% CHG + 70% isopropyl alcohol; and (regimen C) 0.7% iodine povacrylex + 74% isopropyl alcohol.
• (R): patients were randomly assigned to regimen A, B or C in chronological orders, without prejudice.
• (O): patients were followed for 30 days postoperatively. The primary outcome was overall rate of SSIs by 6 months performed in an intent-to-treat manner.
In order to make sure the study has validity I believe the selection sample that would be best used is the probability sampling method. The probability sampling method I would choose is a random sampling of the patients in the hospital. I would pick random sampling because every person in the hospital has an equal chance of being chosen (Setia, 2016). However, in the article by Hicks (2015), most studies designated one to two units within a hospital system to pilot the required changes.
References:
Graling, P. R., & Vasaly, F. W. (2013). Effectiveness of 2% CHG Cloth Bathing for Reducing Surgical Site Infections. AORN Journal, 97(5), 547-551. doi:10.1016/j.aorn.2013.02.009
Hastings, C. & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing Management, 9 12. doi:10.1097/01.NUMA.0000452006.79838.67)
Setia, M. S. (2016). Methodology series module 5: sampling strategies. Indian Journal of Dermatology, 61(5), 505-509. doi:10.4103/0019-5154.190118
PEER:
Hi Sharon,
I appreciate your discussion about a CLABSI, a clinical problem I face consistently at work is preventing central line acquired blood stream infections (CLABSI’s) in the post-surgical patient population. I work on a post-surgical Transplant Intermediate Medical Unit that receives patient’s either straight from the operating room (OR) or from the intensive care unit (ICU) who have received an organ transplant and often require a central line. Being as this patient population is immunosuppressed they are more susceptible to infections, especially CLABSI’s. Research by Graling and Vasaly (2013) concluded that using 2% Chlorhexidine Gluconate (CHG) wipes to bathe patients within three hours before receiving surgery decreased the rates of surgical site infections (p. 549). With this being proven, one could hypothesize that giving a post-surgical patient with a central line a CHG bath daily could decrease CLABSI rates as well. In this study, the independent variable would be daily CHG baths, while the dependent variable would be the rate of CLABSI’s.
References
Graling, P. R., & Vasaly, F. W. (2013). Effectiveness of 2% CHG Cloth Bathing for Reducing Surgical Site Infections. AORN Journal, 97(5), 547-551. doi:10.1016/j.aorn.2013.02.009. Retrieved from CINAHL Complete.
Response to Prof:
Prior to deciding on undertaking any project, an organization’s leaderships or quality officers must have evidence that a problem or process exists that hinders the effectiveness of providing care to all patients. Since the onset and eventual advancement of the information system in healthcare, chances are that there had been multiple researches or quality improvement projects regarding the topic in question had been done. A search and review of the evidence from a system-wide research to evaluate strengths and weaknesses, and organizational readiness for changes.
In the last 10 years, evidence-based practices (EBP) are readily recognized as tried and true researches of best practices, and are implemented by every healthcare institution globally. EHR systems, such as Epic, can pull EBPs into individual patient’s record based on the list of diagnoses. Though evidence-based practices were born of quality improvement initiatives and researches that resulted in significant or positive outcomes. Hence, project management and evidence-based practices are interrelated, as one may precedes the other and vice-versa.
Reference:
Carter, E. J., Mastro, K., Vose, C., Rivera, R., & Larson, E. L. (2017). Clarifying the Conundrum: Evidence-Based Practice, Quality Improvement, or Research? The Clinical Scholarship Continuum. Journal Of Nursing Administration, 47(5), 266-270. doi:10.1097/NNA.0000000000000477 [Show Less]