Purpose
The purpose of this discussion is for you to demonstrate an understanding and ability to search the library for quantitative research related to the practice problem. Use the focus of the Global Burden of Disease and National Practice Problems to guide your search for a quantitative article. From what you have learned from the Explore section choose a quantitative research article about one of the National Practice Problems. These eight National Practice Problems include: COPD, mental illness, addiction, heart disease, diabetes, cancer, obesity, and safety. You will successfully demonstrate your library search skills to identify evidence. PLEASE CHOOSE “SUBSTANCE ABUSE AND HEART FAILURE”.
Instructions
Follow these guidelines when completing the assignment. Contact your course faculty if you have any questions.
- Conduct a search of the library to find one quantitative research article related to one of the National Practice Problems. PLEASE FIND A RESOURCE ON SUBSTANCE ABUSE AND HEART FAILURE. You will use the quantitative article you have selected for your paper. The DNP-prepared nurse uses the most recent (within 5 years) evidence available.
- The quantitative source of evidence you select must be a single source of evidence. Systematic reviews and/or mixed-methods are not permitted for this assignment.
- Present the written reference and the permalink to the article you chose.
- Attach your completed Johns Hopkins Appraisal Tool to your response. (SEE LINK W/I IN THE LESSON)
- Describe what you found most interesting or concerning in the study you selected.
REQUIRED TEXTBOOK:
Gray, J., & Grove, S. (2021) Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Springer.
- Read Chapters 1, 3
White, K., Dudley-Brown, S, & Terhaar, M. (2021). Translation of evidence into nursing and healthcare (3rd ed.). Springer.
- Read Chapter 16
Zaccagnini, M. E., & Pechacek, J. M. (2021). The Doctor of Nursing Practice essentials: A new model for advanced practice (4th ed.). Jones & Bartlett.
- Read Chapters 1, 3
REQUIRED ARTICLE:
Cathala, X., & Moorely, C. (2018). How to appraise quantitative literature.Links to an external site. Evidence Based Nursing, 21(4), 99-101. http://dx.doi.org/10.1136/eb-2018-102996
Rutberg, S., & Bouikidis, C. D. (2018). Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research.Links to an external site. Nephrology Nursing Journal, 45(2), 209- 212.
ADDITIONAL RESOURCES:
Review the following additional resources for further exploration of the weekly topics/concepts:
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice.Links to an external site. https://www.aacnnursing.org/DNP/DNP-Essentials
Astroth, K., & Chung, S. (2018). Exploring the evidence: Focusing on the fundamentals: Reading quantitative research with a critical eye.Links to an external site. Nephrology Nursing Journal, 45(3), 283-286.
Farghaly, A. (2018). Comparing and contrasting quantitative and qualitative research approaches in education: The peculiar situation of medical education.Links to an external site. Education in Medicine Journal, 10(1), 3-11. https://doi:10.21315/eimj2018.10.1.2
Greenlaugh, T. (2019). How to read a paper: The basics of evidence-based medicine and healthcareLinks to an external site. (6th ed.). Wiley.
Ingham-Broomfield, R. (2016). A nurses’ guide to the hierarchy of research designs and evidence.Links to an external site. Australian Journal of Advanced Nursing, 33(3), 38. https://www.ajan.com.au/archive/Vol33/Issue3/5Broomfield.pdf
Kerry, M. J., & Huber, M. (2018). Quantitative methods in interprofessional education research: Some critical reflections and ideas to improving rigor.Links to an external site. Journal of Interprofessional Care, 32(3), 25-256. https://org.doi.10.1080/13561820.2018.1426267
National Institutes of Health. (n.d.). The Nuremberg Code.Links to an external site. https://history.nih.gov/display/history/Nuremburg+Code
Resnik, D. B. (2015). Glossary of commonly used terms in research ethics.Links to an external site. https://www.niehs.nih.gov/research/resources/bioethics/glossary/index.cfm
Roth, W. M., & von Unger, H. (2018). Current perspectives on research ethics in qualitative research.Links to an external site. Forum: Qualitative Social Research, 19(3). http://dx.doi.org/10.17169/fqs-19.3.3155.
U.S. Department of Health & Human Services. (1979, April 18). The Belmont Report.Links to an external site. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html
U.S. Department of Health & Human Services. (2017, October 25). Part 3 – The Belmont Report: Basic ethical principles and their application [Video]. https://youtu.be/M6AKIIhoFn4 (Note: This 26-minute video captures the core principles for researchers as they conduct research using human subjects.)
U.S. Department of Health & Human Services. (2018, July 19). OHRP code of federal regulations: HHS Regulation 45 CFR part 46.Links to an external site. https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html
LESSON:
CHECK IN: Welcome to the third week of our educational journey together! In previous weeks, we learned the DNP-prepared nurse will possess a unique skillset to apply evidence to address patient care problems and improve outcomes. This expertise is guided using nursing science and theory—the scientific underpinnings of nursing practice. This week, we will discuss and contrast the two paradigms of research: quantitative and qualitative research. In addition, we will review the ethics that must be observed in research with human subjects.
The explosion of information available in the literature can make it feel overwhelming to filter through the relevant literature and find research on a clinical topic. Honing your skills in the search for research evidence is vital to evidence-based practice and will have a direct impact on your ability to influence patient care outcomes. On this leg of the journey, we will also focus on quantitative methodology and design and discuss how we level the quality of evidence. There are many resources available that will make searching for reliable information in the library much easier and faster than ever before.
Understanding the philosophical foundation of nursing science and theory, the values, beliefs, and ideas that inform the decisions and actions of the DNP-prepared nurse is essential to effective advanced nursing practice. How will you use these scientific foundations differently than other healthcare providers?
Lesson 1
Scientific Underpinnings for Practice—Nursing Research
Paradigms of Research
Nursing’s knowledge development through theory and research are underpinned by two philosophical orientations: positivism (quantitative) and the naturalistic, humanistic approach (qualitative). Importantly, both types of research are valid. The two types of research generate different types of nursing knowledge through selected research methods (Gray & Grove, 2021). The DNP-prepared nurse uses both types of research. Gaining an understanding and learning to critique the different types of research is integral to the work of the DNP-prepared nurse. As you consider the Global Burden of Disease and National Practice Problems, your search for recent research will allow you to focus on an area of interest related to a practice problem.
As you gain knowledge about these equally important ways to conduct research, you will learn to discern quantitative (positivism, empirics) and qualitative (interpretive human science) research paradigms. As you consider these two paradigms of nursing research, you will have a better understanding of the different types of research in the manuscripts you are critiquing. You will use the Johns Hopkins Appraisal Tool as a step-by-step process to discern the quality of what you are reading. Knowing how to use this tool to discern the level (I, II, III, or IV) and quality (A, B, and C) of the evidence, will be a foundational competency for the DNP-prepared nurse. Mastery of these skills will provide the foundation for building the required research to support your future work as a DNP-prepared nurse.
Johns Hopkins Appraisal Tool and Summary Tool
The Johns Hopkins Appraisal Tool and Summary Tool are found in the Resources section of your course as well as at the following link:
- Link (Word doc): Johns Hopkins Research Appraisal ToolLinks to an external site.
- Link (Word doc): Johns Hopkins Individual Evidence Summary ToolLinks to an external site.
This appraisal tool is used to critically appraise individual research studies. This tool will be used in future courses to appraise systematic reviews, meta-analysis, and meta-synthesis also. The summary tool combines the individual appraisals.
Click on the following tabs to learn more about quantitative and qualitative research:
Quantitative research is a systematic inquiry that tests a hypothesis, determines cause and effect relationship between variables, and makes predictions. Quantitative research determines the relationship between one variable (an independent variable) and another (a dependent or outcome variable) within a population. When you review a quantitative research article you will see the use of numbers, statistical analysis, measurement using valid tools, and an objective approach by the researcher. There are four types of quantitative research you will recognize as you search the literature:
- Experimental
- Quasi-experimental
- Correlational
- Nonexperimental (descriptive etc.)
In contrast, qualitative research is used to gather meaning and understanding about a phenomenon. In qualitative research, we discover knowledge emerging within the social and historical contexts. As you discover qualitative research, you will encounter designs such as phenomenology, grounded theory, case study, and ethnography. The findings of qualitative research can serve to provide meaning about a population, setting, or other context. Regardless of the paradigm of research, the DNP-prepared nurse benefits from the growing body of scientific knowledge and translates this knowledge into practice.
The following table shows differences between the two types of research.
| Characteristic | Quantitative Research | Qualitative Research |
| Philosophy | Empirics, logic | Interpretive, humanistic |
| Basis of research | Cause/effect | Discovery of meaning, experience |
| Theoretical focus | Tests theory | Creates theory |
| Data source | Numbers | Words, observations, pictures |
| Analysis | Statistics | Researcher Interpretation |
| Sample | N= X, large, 100-1000’s | Small expected, <20 normal |
| Researcher role | Objective | Subjective |
| Validity measures | Methods, systematic testing, valid tools | Trustworthiness |
Check your understanding by dragging the characteristics to the correct type of research study.
Qualitative
- Lived experience
- Small sample size
- Deductive
- Ethnography
- Phenomenology
- Grounded Theory
- Case Study
- Historical
Quantitative
- Comparison
- Prediction
- Hypothesis
- Experimental
- Quasi-Experimental
- Correlational Studies
- Nonexperimental (descriptive, case study, survey)
Ethical Considerations for the DNP-Prepared Nurse
Each National Practice Problem is informed by published research. As a DNP-prepared nurse, you will lead practice change as you translate research to practice, influencing outcomes.
The review and critical appraisal of individual research articles includes reviewing the researcher’s plan and process for protecting the individuals who served as subjects in each study. As you learn to critique the articles you are selecting, you will want to pay attention to the ethical principles that subjects are afforded while a study participant. There should be a section in each research study where the researcher shares the processes undertaken to protect the subjects.
Lesson 2
What Is Quantitative Inquiry?
Characteristics of Quantitative Research
In Week 3 you were introduced to the two overarching paradigms of qualitative and quantitative research methodologies. You will see quantitative and qualitative used individually in many research studies. This week we will focus on quantitative research. Quantitative research is a formal, objective, and systematic process, which results in numerical data emerging from the comparison of two or more variables. Variables are the name we give to each phenomenon we are comparing in a study. The dependent variable is the variable being tested and the independent variable is the treatment or intervention provided. An example would be to measure if adding a therapy (the independent variable) influences depression (the dependent variable) in postpartum depression. Statistical measures such as values, confidence intervals, means, modes, and chi-square are some of the statistical tests used to measure outcomes in quantitative research designs. It is important to understand the outcomes and findings as you locate credible quantitative research to address practice problems.
Quantitative Research Designs
A researcher determines the type of research design based on the focus of their inquiry or research question. Research designs include experimental, non-experimental, descriptive, and correlational designs. The researcher selects the type of research design based on the research question or hypothesis.
View the following activity to investigate research variables.
Variables can be characterized in several different ways that have implications for how researchers analyze data. One distinction relates to independent and dependent variables. An independent variable is the variable that’s changed or controlled in a scientific experiment to test the effects on the dependent variable. A dependent variable is the variable being tested and measured in a scientific experiment. The dependent variable is dependent on the independent variable. As the researchers change the independent variable, the effects on the dependent variable are observed and recorded. In the research question, does a low cholesterol diet reduce the risk of heart disease, the independent variable is the amount of cholesterol in a person’s diet, and the dependent variable is heart disease. Cholesterol level is a variable because people consume different amounts of it, and heart disease is a variable because not everyone has this disease. The research question is whether variation in the independent variable causes or influences variation in the dependent variable.
The DNP-prepared nurse needs to understand the different types of research designs. The four major designs are the following:
- Experimental
- Non-experimental
- Descriptive
- Correlational
Types of Research Designs Image Description
The design chosen is based on the hypothesis or question asked. The strongest of the quantitative research designs is the experimental design, often found as a randomized control trial and perhaps what you associate with research. Each of the designs is presented in the following interactive along with an exemplar and how to consider presenting these findings.
Click on the left navigation tabs or the uppermost/bottommost arrows to explore each type of design. Within each tab is a detailed slide show about the particular design. Click on the bars or the Forward button to advance through the slides.
A true-experimental design is considered the strongest or most rigorous for establishing causal effects and internal validity. Internal validity is where the researcher controls factors within the study that might influence the outcomes. As you search for a true experimental design,, you will review and find the research typically uses random assignment, manipulation of an independent variable(s), and strict controls. These characteristics provide increased confidence in cause-and-effect relationships. review and find the research typically uses random assignment, manipulation of an independent variable(s), and strict controls. These characteristics provide increased confidence in cause-and-effect relationships.
The discovery of solutions to practice problems are often published in this type of research. Review the next slide for an exemplar on a study of vulnerable elders needing vaccinations (safety) using a randomized control trial research design.
The quasi-experimental design is also used to examine causality. A quasi-experimental design is chosen when the researcher does not have one of the key aspects of the rigorously designed experimental research (e.g., a random assignment of participants, a control group, a strictly implemented intervention, or careful control for validity). Quasi-experimental study designs were developed to provide an alternative means of examining causality about a topic of study where the situation is not conducive to experimental controls. Although the quasi-experimental design is less powerful than the experimental design, the quasi-experimental design provides knowledge that contributes to solutions for practice problems. Again, these studies can reveal important interventions to improve health and preventive care. Review the next slide for an exemplar on a study using a quasi- experimental design with a focus on improving positive health behaviors and decreasing smoking in older adults.
Descriptive studies seek to describe the current status of a variable or phenomenon when little is known about the phenomenon. Descriptive research is another nonexperimental research design that provides important information. Using descriptive designs, the researcher does not begin with a hypothesis. Rather, the researcher simply studies the phenomenon of interest as it exists naturally. The purpose of a simple descriptive design is to describe the phenomenon of interest and other variables within one single group of participants.
There is no manipulation of variables and often these findings are used in future correlational research. Often you will discover descriptive research conducted to share characteristics of a regional or local population related to a National Practice Problem such as diabetes. For the DNP-prepared nurse, this can provide new meaning, incidence, prevalence, and significance with key information about the said population and practice problems such as diabetes or cancer.
Correlational designs explore the relationship between variables using statistical analyses but do not show cause and effect like experimental research. Correlational designs are used to collect data about a topic and are considered an observational study. Correlational studies look at the relationship between specific variables. Correlational research is conducted to establish the direction and the strength of relationships between or among variables. There are three major types of correlational research:
- Descriptive correlational design
- Predictive correlational design
- Model-testing design
Experimental Design
Slide 1
AB comparison test AB comparison test. Computer and feedback, research and planning, vector illustration Research stock vectorexperimental design, you will review and find the research typically uses random assignment, manipulation of an independent variable(s), and strict controls. These characteristics provide increased confidence in cause-and-effect relationships. review and find the research typically uses random assignment, manipulation of an independent variable(s), and strict controls. These characteristics provide increased confidence in cause-and-effect relationships.
The discovery of solutions to practice problems are often published in this type of research. Review the next slide for an exemplar on a study of vulnerable elders needing vaccinations (safety) using a randomized control trial research design.
Slide 2
A randomized control trial was conducted by Ho et al. (2019) to evaluate a point of care intervention within general practice clinics. The intervention was designed to improve vaccination rates among elderly patients. Twenty-two private general practitioner clinics were randomly assigned in a cross-over design. The outcomes from the study were positive with an increase in vaccination rates for influenza (5.9% vs 4.8%; p = .047) and pneumococcal (5.7% vs 3.7%. p = .001). The evaluation was conducted using selective, de-identified information from the electronic medical record, comparing differences among the control group and intervention group for an increase in vaccination rates. This experimental study and evaluation strategy can be translated to practice by the DNP-prepared nurse.
Ho, H., Tan, Y., Cook, A. R., Koh, G., Yean, T., Answar, G., Chiang, G., Lwin, M., & Chen, M. (2019). Increasing influenza and pneumococcal vaccination uptake in seniors using point-of-care informational interventions in primary care in Singapore: A pragmatic, cluster-randomized crossover trial. American Journal of Public Health, 109(12). 1776-1783. https://org.doi:10.2105/AJPH.2019.305328
Slide 3
Terms that may indicate an experimental study: Random assignment of participants, random sampling, control group, power, independent and dependent variables, manipulation of a variable, and predicted relationship between variables, statistical results
Nonexperimental Research: Quasi-Experimental
Slide 1
The quasi-experimental design is also used to examine causality. A quasi-experimental design is chosen when the researcher does not have one of the key aspects of the rigorously designed experimental research (e.g., a random assignment of participants, a control group, a strictly implemented intervention, or careful control for validity). Quasi-experimental study designs were developed to provide an alternative means of examining causality about a topic of study where the situation is not conducive to experimental controls. Although the quasi-experimental design is less powerful than the experimental design, the quasi-experimental design provides knowledge that contributes to solutions for practice problems. Again, these studies can reveal important interventions to improve health and preventive care. Review the next slide for an exemplar on a study using a quasi- experimental design with a focus on improving positive health behaviors and decreasing smoking in older adults.
Slide 2
A quasi-experimental study was conducted by Marcus-Varwiik et al. (2020) over one year to determine the impact of a nurse-led intervention to improve health outcomes. The Community Health Consultation Offices for Seniors was the setting used to counsel older participants. The nurses used motivational interviewing on specific health-related topics with a group comprised of people greater than 60 years old in the Netherlands. Outcomes of the study showed no significant increase in health-related behaviors or a decrease in smoking in the participants. Limitations included a lack of randomization or blinding of the nurses involved in the interviews. Another limitation reported by the researchers was that there was a strong primary care health system in place in the Netherlands. The study used valid instruments that could be used in future research.
Marcus-Varwiik, A., Peters, L., Visscher, T., Smiths, C., Ranchor, A., & Slaets, J. (2020). Impact of a nurse-led health promotion intervention in an aging population: Results from a quasi-experimental study on the “Community Health Consultation Offices for Seniors.” Journal of Aging & Health, 32(1), 83-94. https://doi.org.10.1177/0898264318804946
Slide 3
Terms that may indicate a quasi-experimental study: Quasi-experimental, non- experimental, quantitative, alternate means to examine cause and effect, possibly missing random assignment, control group, validity, or rigorous intervention, statistical results
Correlational Designs
Slide 1
Growth barchart Gradient and transparent effect used. Bar Graph stock vectorCorrelational designs explore the relationship between variables using statistical analyses but do not show cause and effect like experimental research. Correlational designs are used to collect data about a topic and are considered an observational study. Correlational studies look at the relationship between specific variables. Correlational research is conducted to establish the direction and the strength of relationships between or among variables. There are three major types of correlational research:
- Descriptive correlational design
- Predictive correlational design
- Model-testing design
Slide 2
There is no manipulation of variables as the researcher is seeking to understand the relationship between two variables. Correlational research provides keen information for practice for the DNP-prepared nurse. One key concept to remember is that correlation does not prove causation.
Outcomes in correlation are reported as the strength of the relationship of variables. A correlation of –1 indicates a perfect negative correlation while a correlation of +1 indicates a perfect positive correlation. A zero correlation would indicate no difference in correlation of the variables tested.
Correlational research measures the relationship between two variables. Note that in correlational research the number of participants (n=) in each group can be different in size. Let’s review the correlation study provided.
Slide 3
A correlational research study was conducted using secondary analysis from the Breast Cancer Integrative Oncology Study (Eunjun et al., 2019). This correlational study sought to detect a difference between receivers of adjuvant therapy (n = 372) and intentional non-receivers (n = 46). Two validated survey tools, the Treatment Decision Making (TDM) and Health-Related Quality of Life were used to measure the difference between groups. The two groups, intentional non-receivers (no adjuvant therapy after breast cancer surgery) and receivers (who had various treatments), completed the surveys. Findings revealed intentional non-receivers, in general, were “very involved” in TDM, and experienced better physical, general health, and vitality than receivers. It was concluded this may be related to the adjuvant therapies used by the non-receiver group.
Eunjung K., Andersen, R. M., & Standish, L. J. (2019). Comparison of health-related quality of life between adjuvant breast cancer treatment groups. Oncology Nursing Forum, 46(1) 59-70. https://doi.org.10.1188/19.ONF.59-70
Slide 4
Terms that may indicate a correlational study: Correlation, non-experimental, positive correlation +1.0, negative correlation -1.0. variables, no manipulation of variables, correlation does not prove causation, relationship between
Descriptive Designs
Slide 1
Descriptive studies seek to describe the current status of a variable or phenomenon when little is known about the phenomenon. Descriptive research is another nonexperimental research design that provides important information. Using descriptive designs, the researcher does not begin with a hypothesis. Rather, the researcher simply studies the phenomenon of interest as it exists naturally. The purpose of a simple descriptive design is to describe the phenomenon of interest and other variables within one single group of participants. There is no manipulation of variables and often these findings are used in future correlational research. Often you will discover descriptive research conducted to share characteristics of a regional or local population related to a National Practice Problem such as diabetes. For the DNP-prepared nurse, this can provide new meaning, incidence, prevalence, and significance with key information about the said population and practice problems such as diabetes or cancer.
Slide 2
The objective of the descriptive study conducted by Lord et al. (2020) was to investigate clusters of pre-diabetes and diabetes risk in Florida and to identify significant predictors of the conditions. The researchers used existing data from the 2013 Behavioral Risk Factor Surveillance System to identify clusters of pre-diabetes and diabetes. The study results showed a high prevalence of prediabetics and diabetes in different counties in Florida confirming geographic disparities. More diabetes cases were in rural areas versus urban areas. Also, pre-diabetes clusters were found in urban and rural areas. This study supported the association between income level, educational attainment, and comorbidities like arthritis with diabetes. The descriptive findings can be used to focus on healthcare funding within identified clusters of diabetes in Florida. The descriptive study replicated previous research findings.
Lord, J., Roberson, S., & Odoi, A. (2020). Investigation of geographic disparities of pre-diabetes and diabetes in Florida. Bio Med Central Public Health, 20(2), 1-15. https://org.doi.10.1186/s12889-020-09311-2
Slide 3
Terms that may indicate a descriptive study: Descriptive statistics, population, incidence, prevalence, local, regional, and state statistics and percentages, non-experimental, used with surveys
Lesson 3
Searching for Evidence to Improve Nursing Outcomes
Selecting Evidence and Information Resources
Honing literary search skills is an ongoing learning process. When you have mastered the literature search, you will have both the confidence and the ability to identify appropriate research evidence related to your practice problem. Credible sources of research evidence come from many resources, and the DNP-prepared nurse must be familiar with these resources. Searching in only one database limits your ability to locate the most current evidence. The DNP student must possess a toolbox of skills to learn search techniques and to critically appraise evidence. These skills include an understanding of what constitutes the best research evidence and knowledge of where to find it.
You may already be somewhat familiar with library databases. These databases provide an electronic search index of a collection of literature. Examples of databases to inform evidence-based practice include the following:
- Cumulative Index to Nursing and Allied Health Literature (CINAHL)
- Medical Literature Online (MEDLINE)
- Health and Psychosocial Instruments (HaPI)
As you continue learning search techniques, you will find there are also specific sources for evidence-based research and systematic reviews in the Joanna Briggs Institute and the Cochrane Library.
You will begin your search this week. You will discover the importance of choosing specific keywords related to a practice problem you would like to explore. For example, you may be thinking about the need to improve care related to screening for postpartum depression. Your search terms might include one of the following combinations:
- Postpartum depression AND Research
- Postpartum depression AND Screening
You will also learn how to use the limiters to help you find the most recent, relevant, peer-reviewed research.
COACH WRAP UP: Let’s recap what you learned this week. Philosophical orientation for research evolved over time, and we see both research paradigms conducted in nursing. You were able to learn and gain an understanding of the two research paradigms. We continued our dialogue about research designs by examining quantitative research and how quantitative data is presented. You appraised a quantitative research study using the Johns Hopkins Appraisal Tool as you learned to glean important findings from the quantitative study. Importantly, you are learning how practice problem interventions are likely already published in an experimental study! I know you have gained an understanding of how the research question drives the selection and appraisal of the quantitative research design. The results of each research design provide the DNP-prepared nurse with various types of data to support practice change. Also, you explored how quantitative data can be used by the DNP-prepared nurse who judges the value of the quantitative findings to influence patient outcomes.
