I.

Importance of Research in nursing

1. Research is an important tool for the continual development of a relevant body of
knowledge in nursing.
2. Research generates information from nursing investigations which help define the
unique role of nursing as a profession.
3. Professional accountability of nurses to their clients is demonstrated when nurses
incorporate research evidence into their clinical decisions.
4. Research facilitates evaluation of the efficacy of nurses; practice which may
articulate their role in the delivery of health services.
5. Another reason for nurses to engage in research involves the spiraling costs of
health care and the cost-containment practices being instituted in health care
facilities. With research, costly trial-an-error and even unsafe interventions are
avoided.
6. Research may allow nurses to make more informed decisions as each phase of the
nursing process is clarified through research.
Research also enables nurses to
7. understand a particular nursing situation about which little is known,
8. assess the need for an intervention,
9. identify factors that must be considered in planning nursing care,
10.predict the probable outcomes of certain nursing decisions,
11.control the occurrence of undesired outcomes,
12. provide advice to enhance client health, and
13. initiate activities to promote appropriate client behavior.

II. Main difference between quanti and quali research

Similarity:

Both methodologies require researcher expertise, involve rigor in conducting the study,
and generate scientific knowledge for nursing practice.

Differences:

1. In terms of their philosophical underpinnings, quantitative research is based on

logical positivism while qualitative research is naturalistic, interpretive, and
humanistic
2. In terms of focus, quantitative research is objective, concise, and reductionist,
while
qualitative research is broad, subjective, and holistic.
3. In terms of reasoning, quantitative research is logistic and deductive while
qualitative research is dialectic and inductive.
4. In terms of their basis of knowing, quantitative research is based on discovering
cause-and-effect relationships while qualitative research is based on meaning,
discovery, and understanding.
5. In terms of their theoretical focus, quantitative research tests theorywhile
qualitative research develops theory
 6. In terms of their basic element of analysis, quantitative research uses numbers,
while qualitative research uses words
7. Quantitative research utilizes statistics to make generalization while qualitative
research looks into individual interpretation to find the uniqueness of a
phenomenon.

III. Major steps in quantitative research

Phase I: The conceptual Phase

1. Formulating and delimiting the problem

Example:
“Do women who attend structured antenatal classes have higher scores in the
labor and delivery knowledge test and experience less pain in labor?”

2. Next step will be to review related literatures

A. Identify key words/phrases
Pregnancy
Primigravid woman
Antenatal care and existing programs
Stages of Labor and delivery process
Labor pains
Gate control theory of pain
Learning theories
B. Identify possible resources
A. Maternal and child health nursing books
B. Surf the net Pubmed/Medline, Cochrane Library
C. Library search for relevant journals such as The American Journal of
Obstetric and Gynecology Nursing, Nursing Research Journal, Public
Health Nursing Journal
3. Interview clinicians (OB-GYNe nurses, doctors, public health nurses) do
benchmarking
4. Explore theory of reasoned action, or the health belief model if these can support
proposed study.
5. Hypotheses: “Women who attend structured antenatal classes obtain higher
test scores in the labor and delivery knowledge test than women who
do not attend.”
“Women who attend structured antenatal classes throughout
pregnancy request less analgesia during the first stage of labor.”
“There is no significant difference in the test scores from a labor and
delivery knowledge test between women who attend and those
who do not attend structured antenatal classes.”

“There is no significant difference in the number of requests for

analgesia during the first stage of labor between women who attended and
those who did not attend structured antenatal classes.”
Phase II: The design and planning phase

6. Choose a nonequivalent group pretest and post test quasi-experimental

design. Since it is difficult to determine the population of all primigravid women in
Dumaguete City or the province of Negros Oriental, it is not very feasible to come
up with a sampling frame where actual subjects will be drawn. A modified sampling
design where the decision to which group will the first qualified subject should
belong will be done through simple random sampling by tossing a coin.
7. A well structured antenatal care class program will be designed. It shall include the
following topics and activities:
Normal physiology of pregnancy, labor and delivery
The psychological aspects of pregnancy, labor and delivery
Discomforts experienced during labor and how to manage them.
Prenatal exercises in preparation of the labor and delivery process
Factors that may affect pain experience during labor and delivery.
8. The population is all primigravid women on their second trimester of pregnancy
who are residing in the barangays of the randomly chosen towns and cities of
Negros oriental at the time of program implementation.
9. Cluster sampling will be used. Clusters will be the basis starting with towns and
cities, two towns and two cities will be chosen at random. From these towns and
cities will be drawn the barangays included in the study. A total of four barangays
(2 urban and 2 rural) will be drawn from each of these barangays. All primigravid
mothers will be recruited from each of these barangays. To prevent contamination,
all women from the barangays that are randomly assigned to the control group will
be tested first. After the post test has been conducted for the control group,
women of the barangays randomly assigned to the experimental group will be
exposed to the structured antenatal care program after the pretest and then a post
test will also be given.
10. A 20-item knowledge test will be developed which will be used for the pre and post
test measure on knowledge. To measure number of analgesia, a monitoring
scheme will be devised which will be used to record number of askings for
analgesics indicating frequency, dosage, response and person administering the
intervention.
11. An informed consent will be secured from each participant. A set of inclusion
criteria will also be specified. Recruitment of subjects should be without any form
of coercion or threat. Women of both groups will continue to attend usual prenatal
check-ups at their barangay health stations.
12. Trainings for program facilitators and data collectors will be done at least a month
prior to actual conduct of the study. Prepared data gathering tools will be
submitted for expert scrutiny through Delphi technique. Knowledge test measure
will be submitted for item analysis and content validity with some experts.

Phase III: The empirical phase

 13. A Pilot test will be done in a barangay with similar characteristics with those
included in the study. After refining all processes and protocols a Gantt chart will be
shared with all study facilitators.
14.Actual data gathering, then data processing and analysis preparation will be done

Phase IV: The Analytic Phase

15.Data analysis using descriptive and inferential statistics

16.Interpreting results

Phase V: the Dissemination Phase

17. Present findings in proper fora

18.Utilizing findings in practice.

IV. Steps in Conducting Literature Review

A literature review is a summary of previous research on a topic. Some questions to think about
as one develops the literature review:

*What is known about the subject?

*Are there any gaps in the knowledge of the subject?
*Have areas of further study been identified by other researchers that I may want to consider?
*Who are the significant research personalities in this area?
* Is there consensus about the topic?
* What aspects have generated significant debate on the topic?
*What methods or problems were identified by others studying in the field and how might they
impact my research?
*What is the most productive methodology for my research based on the literature I have
reviewed?
* What is the current status of research in this area?
*What sources of information or data were identified that might be useful to my study?

How to do a literature Review

Steps to take:

1. Define the topic - In order to begin my literature review I must first define my research
question.
What is the purpose? What does it mean? What are the key words? Are there
other words which could be used, such as synonyms, variations in spelling? What do I
already know about the topic? What is the scope? Do I need everything ever
written in English on this topic, or just the last ten years?

2. Develop a search strategy

Compiling a list of keywords - Before beginning a search for information, it is
important to develop a search strategy that will most effectively locate useful, relevant
information. This will often involve breaking down the research question into:
keywords or phrases; entering thesearch; and evaluating results to determine
whether Ineed to employ various strategies to broaden, narrow or otherwise modify
myresearch.
 Analyzing the topic of a research topic usually involves making a list of keywords or
phrases. I will need to include all the key concepts or ideas contained within the
researchquestion. It might be useful to include alternative ways of phrasing and
expressing concepts and ideas. I will think about both general terms and very specific
terms for broadening and narrowing mysearch. The keyword or phrase is the basic unit of
any search. Imay find it helpful to consult subject dictionaries and encyclopedias, or a
textbook glossary for the common terminology of the subject area. I may also consider
the use of an index and/or thesaurus which isalso advisable to establish the useful terms.

3. Identify resources
Information is available in a number offormats. It is important for me to understand the
significance of various formats so that I will know what will best suit my information
requirements.
*Books *Indexes/Abstracts Printed (e.g. CINAHL)
*Reference Materials *Electronic Databases
* Journals *Government publications
*Conference Papers * Internet (Medline, Cochrane Library)
* Dissertations * Theses

V. Examples of a statement of a problem and research questions:

Examples of a problem statement:
A. “Patients’ concerns about reporting pain and using analgesics… are
barriers to adequate pain management…Despite extensive attention
to issues of pain management…few studies have been conducted
testing impact of intervention on cancer pain…”
B. “Current policy at most hospitals requires the use of routine
flushing of heparin locks after administration of medication or
flushing heparin locks every 8 hours when not being used for
medication administration. However, there is disagreement on
whether flushes of low doses of heparin are necessary to maintain
the patency of heparin locks....”
C. “Nursing studies have shown that nursing care delivery changes
affect staff and organizational outcomes, but the effects on client
outcomes have not been studied sufficiently” (Blegen, Goode, &
Reed, 1998).

Examples of Research questions:

A. What is the relationship between reported depressive symptoms

and rate of return to work for patients following cardiac surgery?
B. What is the relationship of anxiety and compliance with medications
and follow-up appointments for patients following cardiac surgery?
Examples of a problem statement and related research questions:
The Problem:
“Patients’ concerns about reporting pain and using analgesics… are
barriers to adequate pain management…Despite extensive attention
 to issues of pain management…few studies have been conducted
testing impact of intervention on cancer pain…”
Research Questions:
1. What is the effect of a PRN pain medication protocol in
the Cancer patients’ reported pain relief concerns?
2. What is the effect of a round-the-clock analgesic use
protocol in the cancer patients’ reported pain relief
concerns?
3. Is there is a significant difference in pain relief between
cancer patients receiving PRN pain medication and cancer
patients receiving round-the-clock pain medication?

VI. Determining Appropriate Research Design

Appropriateness of a design considers several factors. These factors include

the following:
1. To set up a situation that maximizes the possibilities of obtaining valid
answers to research questions or hypotheses.
2. To achieve greater control, and thus improve the validity of the study in
examining research problem
3. The design selected must be:
Appropriate to the purpose of the study
describe...
determine differences between groups...
examine relationships among...
determine the effect of...
- Appropriateness to the research question
a. Whether the design does the possible job of providing trustworthy
answers to the research questions.
b. A given research question can be addressed with a number of
different designs.
c. Many designs are completely unsuitable for dealing with certain
research problems
d. There are many research questions of interest to nurses for which
highly structured designs are unsuitable.
- Lack of Bias (The lack of unwanted influences that can produce a
distortion in the results of a study.)
The goals of experimental research can be summarized by four Major
questions:
• What is the strength of the evidence that a relationship exists
between two variables?
• If a relationship exists, what is the strength of the evidence that
the independent variable of interest (e.g. an intervention),
rather than extraneous variables, caused the outcome?
• If the relationship is plausibly causal, what are the theoretical
constructs underlying the related variables?
 • If the relationship is plausibly causal, what is the strength of
evidence that the relationship is generalizable across people,
settings, and time?
4. Feasible given realistic constraints
5. Effective in reducing threats to validity.
Elements of a good research design:
• Use of Comparison groups
- Comparison between 2 or more groups
e.g. study the emotional consequences of having an abortion, to do
this, we might compare the emotional status of women
who had an abortion with that of women with an unintended
pregnancy who delivered the baby.
- Comparison of one group’s status at two or more points in time
e.g. we might want to assess patient’s level of stress before and
after introducing a new procedure to reduce
preoperative stress.
- Comparison of one group’s status under different circumstances.
e.g. compare people’s heart rates during two different types of
exercise.
- Comparison based on relative rankings.
e.g. we hypothesized a relationship between level of pain of
cancer patients and their degree of hopefulness.
• Use of methods to control extraneous variables.
* Random Sampling
-increases the probability that subjects with various levels of an
extraneous variable are included and are randomly dispersed
throughout the groups within the study.
-this strategy is particularly important for controlling unidentified
extraneous variables.
* Random Assignment
-enhances the probability subjects with various levels of extraneous
variables are equally dispersed in treatment and control groups.
* Homogeneity
- In this, the researcher limits the subjects to only one level of an
extraneous variable to reduce its impact on the study findings.
- to use this strategy, the researcher must have previously
identified the extraneous variables.
- this strategy, the researcher might choose to include subjects with
only one level of an extraneous variable in the study.
Example of homogeneity:
the study of breast cancer patients who have been diagnosed
within one month, at a particular stage of disease, and are receiving
a specific treatment of cancer
* Blocking
-the researcher includes subjects with various levels of an
extraneous variable in the sample but controls the numbers of subjects
at each level of the variable and their random assignment to groups
within the study.
-designs using blocking are referred to as randomized block
designs.
 -the extraneous variable is then used as an independent variable in
the data analysis.
* Matching
-is used when a subject in the experimental group is randomly
selected and then a subject similar in relation to important extraneous
variables is randomly selected for the control group.
• Timing of data collection – is it longitudinal or cross-sectional
• Study site and setting – is it conducted in laboratory setting or in its
natural setting?
• Intervention or the presence or absence of a treatment
VII. Strengths and Weaknesses of the different designs
1. True Experimental Designs:
Some researchers believe that this is the most powerful research
design as it gives us cause and effect relationships.
Strengths: More Controls: in the design and conduct of study
Increased internal validity: decreased threats to design
validity
Fewer Rival Hypotheses
More Practical: Ease of implementation
More Feasible: resources, subjects, time, setting
More Generalizable: Comparable to practice
Weaknesses:
-There are a number of variables of interest that are
not amenable to manipulation. For instance we
cannot randomly confer upon infants their weight
at birth to observe the effect of birth weight on
subsequent morbidity.
- Ethical considerations may prevent the manipulation
of the independent variable. - You would not inflict
pain for the sake of an experiment.
- Artificial circumstances may affect the results.
Laboratory designs take place in an artificial
setting. Easier to control for external variables but
is not as generalizable because it constrains
the human experience.
- Many variables of interest in nursing cannot be
manipulated; difficult or impractical to perform in
field settings; the act of being studied influences
results of a study.
- The Hawthorne Effect: effect of being in the study
group may be sufficient to cause people to change
their behaviors. This is the reason that double blind
studies are conducted. In which neither subject
nor those who administer the treatment knows
which is the experimental or control group.
Quasi-Experimental Designs
STRENGTHS:
More Practical: Ease of implementation
More Feasible: resources, subjects, time, setting
More Generalizable: Comparable to practice
 used frequently because they are practical, feasible, and
generalizable.
WEAKNESS/DISADVANTAGE – involve mainly the inability to make clear
cause- and-effect statements.
Can be remedied by controlling extraneous variables
(alternative events that could explain the findings) a priori
(before initiating the intervention) by design.
Descriptive Survey Design
STRENGTHS:
Data are gathered from a more natural setting.
Large amount of data can be gathered at fairly reasonable
cost.
Surveys using the questionnaire are likely to cover a wide
geographical area, reach many people, insure
respondents’ anonymity, and require less skill to
administer.
DISADVANTAGES
It only collects self reports where selective recall may
introduce bias.
Some respondents may not be willing to express attitudes
and beliefs on sensitive topics.
There may be no chance to observe the study participants
directly unless done with interview (which is more
expensive).
Correlational and Ex-post-facto Research
ADVANTAGES:
Both designs have the advantage of examining the results
of factors that could not be studied because of ethical
constraints.
Ex-post-facto research can have the researcher examines
the effect, search among the processes of the
past to identify a possible agent whose presence
is correlated with the effect.
DISADVANTAGE:
The disadvantage of ex-post-facto research is the loss of
control-both manipulation and randomization.
The disadvantage of the correlational design is the
researcher’s tendency to attribute causality to
descriptive relationships.

VIII. How to conduct probability sampling

According to the types:
Simple random sampling
Objective: Select n units out of N such that every NCn has an
equal chance.
Procedure: Use table of random numbers, computer random
number generator or mechanical device.
Can sample with or without replacement.
f=n/N is the sampling fraction.
Stratified sampling
 Objective: Population of N units divided into nonoverlapping
strata N1, N2, N3, ... Ni such that N1 + N2 + ... + Ni
= N; then do simple random sample of n/N in each strata.
Example:

Proportionate: If sampling fraction is equal for each stratum

Disproportionate: Unequal sampling fraction in each stratum
Needed to enable better representation of smaller (minority
groups)

Systematic sampling
Procedure:
Number units in population from 1 to N.
Decide on the n that you want or need.
N/n=k the interval size.
Randomly select a number from 1 to k.
Take every kth unit.

Cluster (area) sampling

Procedure:
Divide population into clusters.
Randomly sample clusters.
Measure all units within sampled clusters.

Multistage sampling
Cluster (area) random sampling can be multi-stage.
Any combinations of single-stage methods.
Example: Choosing students from schools
• Select all schools; then sample within schools.
• Sample schools; then measure all students.
• Sample schools; then sample students.

IX. Steps in conducting Random Assignment in experimental research:

Example: In a study of primigravid women attending structured
antenatal classes, random assignment could be done as follows:
1. Prepare a list of the names of all primigravid women who qualify to
participate in the study.
2. Write each name on pieces of papers. Roll all the pieces of papers
and place in a box or jar. Shake the box thoroughly.
3. Make a decision whether to assign the first drawn name to
experimental or control or toss a coin to make this decision e.g.
Head to experimental group and tail to control group.
4. Draw the first name. After noting the name, replace the rolled paper
inside the box or jar (random with replacement).
5. Draw the next name and toss the coin again. After noting to which
group that name belong replace the rolled paper inside the box or
jar.
 6. Continue the steps 4 and 5 until all names are assigned to either of
the two groups.
NB: If a name is picked more than once just replace it but take first
assignment as final.

X. A comparison of descriptive and inferential statistics:

Descriptive statistics, such as the mean, summarize research data
from a sample, while inferential statistics use the data from
randomly drawn samples, both to infer characteristics of the
population from which the samples was drawn and to test statistical
hypotheses. Descriptive statistics may be used whether or not
random sampling has been used, but inferential statistics requires
random sampling and other processes based on the principles of
probability.
Descriptive Statistics are used to present quantitative descriptions in
a manageable form. This method works by reducing lots of data into
a simpler summary. While of basic importance, such findings are
usually limited to the sample under study, unless the process of
random sampling has been used.
Descriptive statistics are used to describe and synthesize data
obtained from empirical observations and measurements while
Inferential statistics allows the researcher to go beyond the
description and summary of data.
Inferential statistics are based on the laws of probability and on the
assumption that the sample/s was/were randomly selected.
There are two purposes of inferential statistics:
1. Estimating population parameter from sample data
2. Testing hypothesis about a population
XI. Difference between parametric and non-parametric statistical tests
Parametric tests are statistical tests based on assumptions that the
sample is representative of the population and that the scores are
normally distributed.
Parametric Tests are characterized by three attributes:
1. They involve the estimation of a parameter
2. They require measurements on at least an interval scale
3. They involve several assumptions, such as the assumption that the
variables are normally distributed in the population
Nonparametric tests by contrast do not estimate parameters; they are
used when the data are nominal or ordinal or when a normal
distribution cannot be assumed. This means data need not be
quantitative measurements but could be in the form of qualitative responses
such “yes” or “no”, “present” or “absent”. They are called distribution-
free statistics. Their use is encumbered with less restrictive assumptions
compared with their parametric counterparts. Their computation is also
usually quick and easy.

XII. Ethical Principles

The ultimate consideration is protection of the rights of people
who participate in nursing research.
Ethical concerns are especially prominent in the field of nursing
because the line of demarcation between what constitutes the
 expected practice of nursing and the collection of research
information has become less distinct as research by nurses increases.
Ethics poses particular problems to nurse researchers in some
situations because ethical requirements sometimes conflict with
methodologic considerations.

Three primary ethical principles:

1. Principle of beneficence: Above all, do no harm.
a. Freedom from harm
*research should be conducted only by qualified people.
*Researcher must be prepared at any time during the study to
terminate the research if there is reason
to suspect that continuation would result in injury,
disability, undue distress, or death.
How to remedy:
-test new medical procedures or drug with animals or tissue
cultures before proceeding to test with humans.
-conduct debriefing sessions that permit participants to ask
questions after their participation and by providing
participants with written information on how they may
later contact the researchers.
b. Freedom from exploitation
Participants need to be assured that their participation, or the
information they might provide to the
researcher will not be used against them in any way.
e.g. subject reporting drug abuse should not fear exposure
to criminal authorities.
c. Benefits from research
Benefits from research should accrue to society in general or to
other individuals.
d. Risk/Benefit ratio
The degree of risk to be taken by those participating in the
research should never exceed the potential
humanitarian benefits of the knowledge to be gained.

2. The principle of respect for human dignity

a. The right to self-determination
This means that prospective participants have the right to
decide voluntarily whether to participate in a study, without
the risk of incurring any penalties or prejudicial treatment.
This also means that people have the right to decide at any
point to terminate their participation, to refuse to give
information, or to ask for clarification about the purpose of the
study or specific study procedures.
b. The right to full disclosure
Full disclosure means that the researcher has fully described
the nature of the study, the participants’ right to refuse
participation, the researcher’s responsibilities, and the likely
risks and benefits that would be incurred.
*Informed consent is based on the right to self-determination and
the right to full disclosure
 3. The principle of justice
a. Right to fair treatment
Study participants have the right to fair and equitable
treatment, both before, during, and after their participation
in the study.
b. Right to privacy
Study participants have the right to expect that any
information collected during the course of a study will be kept
in strictest confidence.

XIII. Ways to collect data

1. Data could be gathered in three ways:
 Self Reports
A researcher collecting structured self-report data for a
quantitative study almost always uses a formal, written, instrument:
a. Interview Schedule – the instrument used is an interview schedule
when the questions are asked orally in either face-to-face or
telephone interviews. Interviews
a. Advantages outweigh those of questionnaires in terms of
response rates, audience, clarity, depth of questioning,
missing information, order of questions, sample control,
supplementary data
b. Questionnaire or SAQ – this is the instrument when respondents
complete the instrument themselves, usually in a paper-and-pencil
format
a. Self-administered questionnaires can be distributed in person,
by mail, or over the internet
b. Advantages: less costly and require less time and energy to
administer, offer the possibility of complete anonymity, and
absence of interviewer ensures no interviewer bias
 Observation
Unstructured Observations
Structured Observations
○ Category Systems
○ Checklists
○ Rating Scales
 Biophysiologic Measures
○ Physical Measurement Methods Chemical/biochemical
EKG, BP, I & O Pulse Oximetry
○ Microbiological Blood glucose
Smears PKU
Cultures Sensitivities
 Scales
Rating Scales Semantic Differentials
Likert Scales Visual Analog Scales
XIV. Ensuring validity of the study and validity of the research tool
What is validity?
The best available approximation to the truth or falsity of a given
inference, proposition, or conclusion
A set of standards by which research can be judged.
Conclusion validity - The extent to which the research design is
sufficiently precise or powerful enough for the detection of effects on
the operationalized variable should they exist
Elements of conclusion validity:
Sufficient power
Reasonable evidence to find that the cause and effect covary
Significant covariation
Threats to conclusion validity:
Low statistical power
Violated assumptions of statistical tests
Fishing and the Error Rate problem
Low reliability of measures
Poor reliability of treatment implementation
Random irrelevancies in the setting
Random heterogeneity of respondents
Improving Conclusion Validity:Specific Suggestions
Pretest and posttest on same scales
Match before or after random assignment (but not in place of
random assignment)
Use covariates
Increase reliability, especially of dependent measures
Adjust raw scores for unreliability
Estimate desired effect magnitude in advance
Each person as own control
Present effect and standard error
Select homogeneous samples
 Internal Validity - this refers to the degree to which it can be
inferred that the experimental treatment (IV), rather than
uncontrolled extraneous variables, is responsible for observed
effects.
– This addresses the question: “Given a statistical relationship
between the IV and the DV, is there evidence that one causes
the other?”
– Extraneous variables present threats to internal validity
because they offer competing explanations for the observed
relationships between the IV and the DV; that is, they
interfere with cause-and-effect inferences.
– True experiments have a high degree of internal validity
because of the controlling properties of randomization and
control groups. Types include:
1. History – refers to the occurrence of external events that take
place
concurrently with the IV that can affect the DV. Example: If
we study the differential effect of two forms of exercise on
knee extensor strength, history effects may include some
 subjects’ participation in other athletic activities or other
therapies that affect knee extensor strength.
2. Maturation – This refers to processes occurring within
the subjects during the course of the study as a result of
the passage of time rather than as a result of a
treatment or IV.
– Maturation effects may cause subjects to respond
differently on a second measurement because they have
grown older, stronger, healthier, tired or bored since the first
measurement.
– Maturation is a relevant consideration in many areas of
nursing research. Maturation does not refer to aging or
development exclusively but rather to any change that
occurs as a function of time. Thus wound healing, postop
recovery, and many bodily changes that can occur with little
or no nursing or medical intervention must be considered as
an explanation based on the effects of the IV.
3. Testing – This refers to the effects of taking a pre-test on
subjects’ performance on a post- test.
- The mere act of collecting data changes the response that is
being measured particularly in those that deal with
opinions and attitudes.
- In true experiments, testing may not be a problem
because its effects would be expected to be about equal
in all groups.
- The Solomon four-group design could be used if
researchers wanted to isolate intervention effects from
pre-test effects.
4. Selection – This encompasses biases resulting from
pre-existing differences between groups.
- When individuals are not assigned randomly to groups. There
is always a possibility that the groups are non-equivalent.
- They may differ in ways that are subtle and difficult to
detect.
- If the groups are non-equivalent, differences on outcomes
may result from initial differences rather than from the effect of the IV.
5. Mortality – Also called attrition, refers to the differential loss of
subjects from comparison groups; that is dropouts occur for
specific reasons related to the experimental situation.
- The loss of subjects during the course of a study may differ
from one group to another because of a priori differences in interest,
motivation, health, etc.
- The risk of attrition is especially great when the length of
time between points of data collection is long.
- If attrition is random (i.e. those dropping out of a study are
similar to those remaining in it with respect to extraneous
characteristics), then there would not be bias.
- In general, the higher the rate of attrition, the greater the
likelihood of bias.
 6. Instrumentation – This is concerned with the reliability of
measurement.
- This bias reflects changes in measuring instruments or
methods of measurement between two points of data collection.

Ruling out threats to internal validity

Many threats such as history, maturation, selection, statistical
regression, testing, instrumentation and selection interactions, can be ruled
out by the use of random assignment and control groups.
Random assignment cannot rule out the effects of attrition, imitating
treatments, or compensatory reactions.
Blinding subjects and investigators will control many of these effects.
 Construct Validity - Construct validity of causes and effects
concerns the theoretical conceptualizations of the
intervention and response variables and whether these have
been developed sufficiently to allow reasonable
interpretation and generalization of their relationship
(Portney & Watkins, 2000).
– This addresses the question: “Given that a cause-and-effect
relationship is probable, to what theoretical constructs can
the results be generalized?”
a. Operational definition of the variables – threats to construct
validity are related to how variables are operationally
defined within a study and to potential biases introduced
into a study by subjects or experimenters.
– These threats were originally defined by Campbell and
Stanley under the category of External Validity. These are
now subdivided by Cook and Campbell into construct validity
and external validity.
– When studies incorporate only one form of measurement or
examine only one form of treatment, the results will apply
only to a limited aspect of the construct. Therefore, if a
study addresses only one form of treatment op one form of
measurement, generalization of the results of that study is
limited.
Example: Construct of pain which is multidimensional

Suppose pain is treated with relaxation exercises or

transcutaneous electrical nerve stimulation (TENS), measures
of success may vary depending on whether we assess pain by
using a visual analogue scale (VAS), by measuring range of
motion of involved joints, or by observing he efficiency of
functional tasks.

VAS – reflects the patient’s subjective and relative

feelings of pain intensity

ROM test reflects physiological concomitants of pain

Functional evaluation is influenced by personality,

attitude, motivation, and lifestyle.
 Each of these assessments measures a different aspect of pain
that reflects components of the total construct of pain.

b. Time frame within operational definitions

The element of time cannot be ignored in defining the
construct of treatment, and testing may need to be done at
various intervals to determine the range necessary to achieve
maximal effectiveness.

For example: If we study the effect of TENS over a 2-

week period, we cannot generalize outcomes to events
that might occur over a longer period of treatment. If treatment
shows no effect within this time frame, we would be inaccurate
to conclude that TENS does not work..

c. Hawthorne Effect – subjects nay behave in a particular

manner largely because they are aware of their participation
of a study.
Subjects often try their best to fulfil the researcher’s
expectations or to present themselves in the best
way possible, so that responses are no longer
representative of the natural behavior.

d. Experimenter Effects – Subjects’ behavior ay be affected by

characteristics of the researchers.
The investigators may react more positively to
subjects in the experimental group or give less attention to
those in the control group, because of an emotional or
intellectual investment in their hypothesis. If this is the case,
the results in the original study might be difficult to replicate in
a more neutral situation.

This threat to construct validity can be avoided by employing

testers who are blinded to subject assignment and the research
hypothesis.

 External Validity – this refers to the extent to which the results

of a study can be generalized beyond the internal
specifications of the study sample.
- Addresses the question: “Can the results be generalized to
persons, settings, and times that are different from
those employed in the experimental situation?”
a. Expectancy Effects- includes placebo effect and nocebo effect

Placebo effect – this occurs when subjects administered a

pesudointervention show changes or
improvements. That same placebo might not have any benefits
when not administered in the context of a study.
 Nocebo effect - this involves adverse side effects experienced
by those receiving the placebo.

b. Novelty Effects – When treatment is new, subjects and

researchers alike might alter their behavior in various
ways.
- Results mat reflect reactions to the novelty rather than to
the intrinsic nature of an intervention; once the treatment is
more familiar, results may be different.
c. Interaction of history and treatment effects – this concerns the
ability to generalize results to different periods of time in the
past or future.
Example: If we look at the results of nutritional studies for
reducing cholesterol in the diet, results may be
quite different today from results obtained 20 years ago,
when knowledge about the effect of diet and exercise on CV
fitness was less developed, and when society and
the media were less involved in promoting fitness
and health.

d. Measurement Effects – Researchers collect a considerable

amt of data in most studies, such as pretest
information, background data, and so forth. The results may not apply
to another group of people who are not also exposed
to the same data collection (attention-giving)
procedures.

Other threats to external validity:

1. Interaction of selection and treatment – When samples

areconfined to certain types of subjects it is not reasonable
to generalize results to those who do not have these
characteristics.
2. Interaction of setting and treatment – If we demonstrate a causal
relationship between an exercise program and functional
improvement using patients in a rehabilitation hospital, can
we generalize these findings to a nursing home or to home
care? This question can only be answered by replicating
effects in different settings.

Ensuring validity and reliability of research tools

Validity – the degree to which an instrument measures what it is
supposed to measure.
1. Face validity refers to whether the instrument looks as though
it is measuring the appropriate construct
2. Content validity – concerns with the degree to which an
instrument has an appropriate sample of items for the
construct being measured.
3. Criterion-related validity- The degree to which scores on an
instrument are correlated with some external criterion.
 Predictive validity – the adequacy of an instrument
in differentiating between people’s
performance on some future criterion.
Concurrent validity – refers to an instrument’s
ability to distinguish individuals who differ on
a present criterion.
1. Construct validity – The degree to which an instrument
measures the construct under investigation.
Multitrait-multimethod matrix method (MTMM) - a
method of establishing the construct validity of an instrument
that involves the use of multiple measures for a set of
subjects; the target instrument is valid to the extent that
there is a strong relationship between it and other measures
purporting to measure the same attribute(convergence) and a
weak relationship between it and other measures purporting
to measure a different attribute (discriminability)
Convergent validity – An approach to construct
validation that involves assessing the
degree to which two methods of measuring a
construct are similar.
Discriminant validity – an approach to construct
validation that involves assessing the degree to
which a single method of measuring two
constructs yields different results.

Students’ Attitudes toward Four-day class week

Instruction: Please place a check mark on the space opposite the question
under the column of your choice of answer. Please answer as
honestly as possible. Thank you.
 Item RESPONSES

SA A ? D SD

1. A four-day class week is a cost cutting

strategy for the school.
2. Many students can work to earn for
their schooling on the extra day weekend.
3. The best way to make students work is
to include the extra day weekend for
service-learning credits
4. Many students can benefit from the
extra day training in service learning
centers if they do not need the extra day to
work.
5. There should be an expanded effort to
disseminate information about extra day
weekend to parents.
6. Because many families are financially
challenged a four-day class week will save
them the cost of the one day less a week
for fare and student allowance.
7. A four-day class week also gives time to
teachers to find extra work on the added
day off.
8. A four-day work week may help curb
incidence of truancy among students.
9. Students need to be trained to be self-
sufficient and the one day off may give
them time to get a job.
10. School work is becoming heavy and a
one day added off will prevent students
from getting burnout.

Critiquing

Nature of evidence-based nursing

Evidence-based practice – A practice that involves making clinical
decisions on the best available evidence, with an emphasis on evidence
from disciplined research.
 According to Polit And Beck EBP is a major paradigm shift for health care
education and practice. With EBP, a skillful clinician can no longer rely on
a repository of memorized information, but rather must be adept in
accessing, evaluating, synthesizing, and using new research evidence
(2008).
Best evidence refers generally to findings from research that are
methodologically appropriate, rigorous, and clinically relevant for
answering pressing questions-questions not only about efficacy, safety,
and cost-effectiveness, but also about the reliability of nursing
assessment measures, the determinants of health and well-being, the
meaning of health or illness. (2008, p.32)
The practice of evidence-based nursing involves the following steps:
1. formulation of an answerable question to address a specific patient problem or situation
2. systematic searching for the research evidence that could be used to answer the
question
3. appraisal of the validity, relevance and applicability of the research evidence
4. integration of the research evidence with other information that might influence the
management of the patient's problems
5. clinical expertise, patient preference for alternative forms of care, and available
resources
6. implementation of the evidence-based practice decision
7. and finally, evaluation of the outcome of the decision.