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
NR 505 Week 4 Discussion: Qualitative Design and Sampling
With the focus on qualitative design and sampling, this is a great opportunity to compare and contrast quantitative and qualitative research approaches. For each of the following areas, apply information that considers one advantage and one disadvantage regarding
• control over study conditions with the quantitative research approach;
• control over study conditions with the qualitative research approach;
• extending or generalizing results from a sample to a larger group or population with the quantitative research approach; and
• extending or generalizing results from a sample to a larger group or population with the qualitative research approach.
Be sure to include scholarly references to support your information.
ANSWER
There are two main approaches to research: qualitative and quantitative. Qualitative methods to explore the phenomenon and understand the participants’ different constructions of their life experiences, followed by a quantitative method for the measurement and generalization of the findings based on the collection of data on large samples.
Quantitative methods have traditionally been considered more rigorous than qualitative methods, with randomized controlled trials (RCTs) and systematic reviews being the 'gold standard' for determining evidence. There is an established ranking or hierarchy of evidence for assessing the quality and robustness of methodological approaches (Hoe & Hoare, 2012).
RCTs are experimental studies that are used to test the effectiveness of interventions between two or more groups, usually an intervention and a control group (Hoe & Hoare, 2012). Participants are randomly allocated to a group and the intervention is delivered under tightly controlled conditions to avoid systematic errors (bias) and random errors (chance). The study participants and/or those undertaking the research assessments may be blinded (single-blind where either the participant or the researcher is unaware to which group the participant has been randomly allocated, or double-blind where the participant and researcher are unaware of the allocation), where information about who is and who is not receiving the intervention is concealed until the trial is complete. Data are usually collected before and after the intervention and differences in outcome examined between the groups (McKeon & McKeon, 2016).
Qualitative research approach, which is based on grounded theory, operates almost in a reverse fashion; rather than starting with a hypothesis, it begins by data collection in the form of text (narrative) using in-depth interviews, FGD, observations, etc. The data analysis steps include extraction of key points from the text or the narrative which are marked as codes. The codes are then summarized into similar concepts in order to make the extensive text data more comprehensible. From the concepts, categories are formed.
According to Setia (2017), Qualitative research is often criticized for its lack of scientific analysis considerations. In particular, the criticisms of qualitative research relate to issues of representativeness and generalizability of the findings, reliability, and validity. Analytical concepts for qualitative research are defined, and suggestions based on the literature are given to enhance trustworthiness of focus group data and reporting (Setia, 2017).
For basic research (quantitative), generalizability is sacrificed for control in order to show specific underlying mechanisms. No matter how well-defined the population, there are so many inherent individual differences that investigators cannot account for all of these. To some readers, this may seem sloppy and neglectful to those all-critical steps to producing good research (McKeon & McKeon, 2016).
For epidemiological research (qualitative), control is sacrificed for generalizability (the ability to state, with confidence, universal conclusions that are common to the greater population). This research, while low on the control side, is critically important to elucidating the trends that affect the population at large, which can generate important scientific inquiry (McKeon & McKeon, 2016).
Both methods have limits in the quality of their results: for both, any change of context changes the meaning and the interpretation of the results, and for both, the quality of the inferences is limited in that the result is merely situated (QUAL) or in that the generalization does not deepen our knowledge of the specific context (QUANT). According to an ecological perspective, both methods can be lacking in value in that the transformative perspective has not been taken into consideration (McKeon & McKeon, 2016).
References:
Medina McKeon, J. M., & McKeon, P. O. (2016). A Balancing Act Between Control and Generalizability. International Journal of Athletic Therapy & Training, 21(2), 1-3. doi:10.1123/ijatt.2016-0010
Hoe, J., & Hoare, Z. (2012). Understanding quantitative research: part 1. Nursing Standard, 27(15-17), 52-57.
Setia, M. S. (2017). Methodology Series Module 10: Qualitative Health Research. Indian Journal of Dermatology, 62(4), 367-370. doi:10.4103/ijd.IJD_290_17
Response to Prof
One author I once read argued that quantitative and qualitative research do not exist as a dichotomy but rather on a continuum where the "best" approach is based on that research question. What are your thoughts?
Dr. Pat,
Your statement regarding the non-existent of the quantitative versus qualitative dichotomy is very interesting, for healthscience researches have recently gravitate toward using the “mixed” method. Quantitative and qualitative approaches sometimes are picked up and embedded one in the other to provide new insights required in public health. For example, in a randomized controlled trial, which was conducted to compare two doses (high and low) of a nurse- led psycho educational intervention to assist oncology outpatients to effectively manage their pain, qualitative data was collected in the form of audiotapes of the intervention sessions with nurse and patient for exploring the issues, strategies, and interactions experienced during the intervention. The study provided evaluation of the processes along with the outcomes of the intervention.
Mixed method approach helps in having a more comprehensive understanding of the structure and functioning of society at large. Mixed method research intentionally integrates quantitative and qualitative methods rigorously to draw on the strengths of each other to ensure that the results of a study are more close to reality.
Reference;
Kaur, M. (2016). Application of Mixed Method Approach in Public Health Research. Indian Journal Of Community Medicine, 41(2), 93-97. doi:10.4103/0970-0218.173495
Response to Peer:
Thank you Luisa, class several of you have brought up the potential bias in qualitative research. As you read studies, look to see if the researcher addresses this potential limitation to the study.
Hello Luisa,
I enjoyed reading your post, for your layout was very easy to understand. I agree with the biases as limitations or disadvantages, though not only in qualitative design, but also in quantitative as well.
According to Malone, Nicholl & Tracey (2014), it is not possible to completely remove systematic bias or to have a complete awareness of all possible types of systematic bias. Thus, on-going awareness of the potential presence of bias in the research process ensures that systematic bias may be kept to a minimum. Such awareness also facilitates a more meaningful critical scrutiny of research results and conclusions prior to submission for publication. When attempting to eliminate one type of systematic bias, a researcher may inadvertently introduce another form of bias. A researcher’s goal should be to identify potential bias in the study design and implementation, to minimize identified potential bias where feasible and, where this is not possible, present study findings in a way that informs the reader of the degree to which any residual bias exists. The extent of bias should be described, as it may be of sufficient importance to exercise caution when deriving conclusions from the study findings and translating them into clinical practice.
Reference:
Malone, H., Nicholl, H., & Tracey, C. (2014). Awareness and minimization of systematic bias in research. British Journal of Nursing, 23(5), 279-282. [Show Less]