Surgical Nursing lecture notes

8/11/2019 Surgical Nursing lecture notes

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Research methods

Lecturer: Isaac Amankwaa


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Course ObjectivesBy the end of the course the studentwill:

Define research

Describe various types of research

Describe the research process

Carry out a simple research


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Course outlineDefinitionTypes of researchIdentifying research problemObjectives of the researchStatement of hypothesisOperational definitionLiterature review

MethodologyResearch setting and populationSampling methodData collection, tools/methods, limitationsDissemination of research report


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What is Research?Research means

to search again orcarefully examine

(Langford 2001)


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Research definedResearch is systematic inquiry that uses

disciplined methods to answer questions or

solve problems.

(Polit and Beck, 2010).


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Characteristics of nursing researchIt demands a clear statement of the problem

It requires a plan, order and controlIt builds on existing data

Based on theory of empiricism

Generalisation


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Purpose of conducting researchDescription

Exploration

Explanation

Prediction


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Types of research1. Basic2. Applied research.


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Basic research Also called Fundamental or pure research

Studies are designed to seek knowledge

without specifying application of the

knowledgeEx: examining xtics of a cell.


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Applied researchConcerned with using knowledge to solve

immediate problems facing an organization.

Ex. Using to solve patient care difficulties,

educational concerns and administrative issues.

The nurse investigator contribute to some

modification of the present practices


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Quantitative Research

Originated in the natural sciences such as

biology, chemistry, physics, geologyThis is that is concerned with investigating

things which we could observe and measure in

some way .


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Qualitative researchOrigin: social sciences like psychology &

nursing.

Involves study of human behaviour & the

social world inhabited by human beings;

Answers the why and how questions.


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Definition of nursing researchNursing research is the systematic inquiry

designed to develop knowledge about issues of

importance to the nursing profession, including

nursing practice, education, administration, and

informatics.

(Polit and Beck, 2010)


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Importance of Nursing Research1. To promote evidence-based nursing practice:

nursing care must be based on accurate

knowledge.2. To ensure credibility of the nursing

profession3. Provide accountability for nursing practice4. Document the Cost Effectiveness of Nursing

Care:


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Sources of nursing knowledgeTradition

AuthorityTrial and errorLogical reasoning: comprises inductiveand deductive reasoningScientific research


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The research process1. Review of existing literature

2. Research questions

3. Method

4. Analysis

5. Presenting our findings


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Chapter Two

Selecting a Research TopicChapter objectives Enumerate the sources of nursing

research problems List the various steps required to

select a research topic

Describe the criteria for prioritising aresearch problem

Select their own research topic thatis relevant to nursing


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Introduction

What is a problem?

A situation that lends itself tobe addressed throughapplication of the researchprocess


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Sources of research problemExperience from clinical practice

Nursing literature

Ideas from external sources

colleagues


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Procedure for identifying research

problemSelect a broad topic of interest

Refine/narrow down

Evaluate significance of topic


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Identifying research problemSelect broad topic area

Write down general area of interestE.g. cancer patients in pain


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Selecting Research ProblemRefine/narrow down the topic

Ask questionsReview literatureTalk to people


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Is your topic significant? A research topic must meet the following

conditions1. The should be perceived difference between what

exist and the ideal or planned situation

2. The reason(s) for the difference shd be unclear

3. There should be more than one possible answer

to the question or solution to the problem.


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Prioritising Research: Criteria1. Significance of the problem:

Is the problem an important one?Will patients, nurses etc. benefit from theevidence that will be produced?Will the results lead to practical

applications?Will the study help to alter nursingpractices or policies?


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Prioritising Research: Criteria2. Researchability of the problem

Not all problems are amenable to aresearch through a scientific studyExample include problems that relate tomoral or ethical nature

Ex. Observing how often couples usecondoms during sexual intercourse


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Prioritising Research: Criteria3. Feasibility

Time and Timing

Availability of study participantsCooperation of others (e.g. seeking the consentof parents if children)Interest to the researcher

Avoidance of duplication Applicability of possible research findingsEthical acceptability


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Characteristics of a good

research topic1. Interesting2. Researchable3. Significant4. Manageable5.

Ethical

Ch Th


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Chapter Three Analysing & Stating Research

ProblemLearning objectives

Use the problem analysis diagram to analysis a

research problemDescribe the importance of a clear statement of aproblemEnumerate the points that should be included inthe statement of a problem

Analyse and state their own research problem


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Introduction

Adequately analysing theproblem will help you includeall possible contributory factorsfrom different sectors


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Analysing the problem Analysis focus on:

Factors that may have contributed to theproblemThe relationship between the problem andthe contributing factors


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Analysing the problemContributing factors grouped into:

Service- related factors: e.g. distance to

clinicDisease related factors e.g. seriousness ofpatients conditionSocio- cultural factors e.g. occupation &marital status


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Analysing the problemSTEPS IN PROBLEM ANALYSIS

Identify and write down the core problem

Identify possible contributing factorsDetermine relationship between the problemand the contributing factorsRegroup the contributing factors into broadcategories where appropriateDecide on the focus and scope of the research


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Stating the Research ProblemProblem statement is an expression of

the dilemma or disturbing situation thatneeds investigation.


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Stating the Research ProblemIt has six components:1. Problem identification : what is wrong with the current

situation?

2. Background: what is the nature of the problem, thecontext of the situation that readers need to understand?3. Scope of the problem: how big a problem is it; how

many people are affected?4. Consequences of the problem: what is the cost of not

fixing of not fixing the problem?5. Knowledge gaps: what information about the problem is

lacking?6. Proposed solution: what is the basis that the proposed

study would contribute to the solution of the problem?


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CHAPTER FOUR

Study Purpose, Aim or Objectives At the end of the lesson, studentsshould be able to

Explain the relationship between theterms: purpose, aims and objectiveDifferentiate between general and specific

objectivesFormulate specific objectives


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Study purpose, aims and objectives are

synonymous terms and are thereforeused interchangeably


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Study purpose, aims &

Objective Assumed to mean the same thing

It answers the question what does theresearcher wish to achieve?

It is the overall impact of the study


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Statement of objectivesResearch objectives are the steps you are going

to take to answer your research questions or

a specific list of tasks needed to accomplish the

goals of the project.

While aims are broad in nature, objectives

are focused and practical.


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Statement of objectivesDefine the focus of your studyClearly identify variables to be measured

Indicate the various steps to be involvedEstablish the limits of the study

Avoid collection of any data that is not strictly

necessary


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General ObjectivesThese are normally the aims/goals ofthe study,

Are broad statements of what is to beachieved by the study.That is, what is the purpose ofresearch?


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Specific ObjectivesThese are measurable statements on the

specific questions to be answered.

They are more specific and are related to the

problem situation

Refer to example 4.1 in lecture notes


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How to state the objectives Research objectives should:

cover different aspects of the problem and its

contributing factorsbe clearly expressed in measurable terms be realistic considering local conditionsmeet the purpose of the study

use action verbs that are specific enough to bemeasured


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Characteristics of Objectives

(SMART)Specific

be precise about what you are going to do

Measurable you will know when you have reached your goal

Achievable dont attempt too much.

Realistic do you have the necessary resources to achievethe objective?

TimeConstraint

determine when each stage needs to becompleted.


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Examples of strong verbs for

objectivesTo determineTo compare

To verifyTo describeTo establishTo produceTo revise

To find outTo collect

To constructTo classifyTo developTo deviseTo measureTo selectTo synthesise


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Avoid the use of weak, vague non-

action verbs such as: To appreciate,To consider,To enquire,To learn,To know,To understand,be aware ofto listen,to perceive

Chapter Five


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Chapter FiveResearch Questions, Hypothesis &

Variables At the end of this lesson, the studentshould be able to:

Explain the need for developing a researchquestion and hypothesisFormulate research questions and hypothesis.Differentiate between dependent & independent

variablesExplain the need for operationalizing variablesState operational definition of variables


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Introduction After deciding on your research topic,the next thing to do is to state a

research question that will help focusyour research study.This will be followed by the making a

scientific guess as to the possibleoutcome of the research study.


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What is Research Question?This is a clear, focused, concise, complexand arguable question around which you

centre your research.

The question provides a path through the

research and writing process.


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Characteristics of research questionsClearFocusedComplex i.e., should not be answerablewith a simple yes or no or by easily -found facts.Refer to examples 5.1 & 5.2


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Research questions, rather thanhypothesis, are normally used in

qualitative research and in descriptive-survey studies.


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Variables-what youre measuring

A variable is a characteristic that varies betweenindividuals and can be measured , such as weight,age and gender.

Refers to Qualities , properties, or characteristicsof persons, things, or situations that change or

vary

(Burns & Grove, 2007, p.125).


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Types of variablesFive main types

1. Dependent variable2. Independent variable3. Demographic variable4. Descriptive variable5. Extraneous variables


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Dependent vs. Independent variablesNursing researchers may be interested inanswering the following questions

Does a nursing intervention causeimprovements in patient outcome?Does smoking cause lung cancer ?

The presumed cause is the independent

variable, and the presumed effect is thedependent variable


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Dependent vs. Independent variables

Independent variable Dependent variable

intervention, influence orexposure

outcome


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Activity-determine the variables1. A researcher wants to know whether a

hospitalised childs anxiety level during painfulprocedure would lessened if a parent werepresent during the procedure.

2. You are interested in the effect of daily exerciseon glucose levels in adolescents with type Idiabetes


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Activity-determine the variables2. A researcher asked: What is the effect of heart

failure self-management education on apatients knowledge level and readmission rateto the hospital?

3. For term, stable infants, is there a relationship*between immediate skin-to-skin contact afterbirth and exclusive breastfeeding at 2 months ofage?


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Demographic variablesThese are attributes or characteristics ofthe subjects in a study. Examples:

AgeGenderDiagnosis

Socioeconomic information


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Extraneous Variables Also called nuisance variables.Not usually of primary interest but are believed to berelated to the independent and/or dependentvariables.Their effects need to be controlled in order to obtainmeaningful results.Examples include:

TransportationLiteracy

In doing a research, you need to identify and controlthem if possible.


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Hypothesis A hypothesis attempts to answer aquestion which has emerged from a

research problem.They are scientifically reasonablepredictions that go further than a

research question and predict anoutcome.


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Hypothesis

A hypothesis states the relationship

between two or more variables thatsuggest an answer to the research

question.


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Simple VS. complex hypothesis

Simple hypothesisexpresses an expected relationship btn one

independent and one dependent variable.Complex hypothesis

Expresses a relationship btn two (or more)

independent variables and/or two (ormore) dependent variables.


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Directional vs. Non-directional Hypothesis

Directional hypothesis: specifies not onlythe existence but the expected direction of therelationship between variables.Example

The risk of falling increases with the age ofthe patient .

In the above example, there is an explicitprediction that older patients are atgreater risk of falling than younger ones.


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Directional vs. Non-directional Hypothesis

Non-directional hypothesis : does notstipulate the direction of the relationship.

Example:There is a relationship between the age of apatient and the risk of falling.

This hypothesis do not stipulate whether the

researcher thinks that older patients or youngerones are at greater risk.


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Alternate VS. Null Hypothesis Alternative hypotheses (H I )

This hypothesis normally suggests a relationshipand a potential outcome in a research study.

can be directional or non-directionalExample:

Children with high IQ will exhibit more anxietythan children with low IQ -directionalThere is a difference in the anxiety level of thechildren of high IQ and those of low IQ- non-directional


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Alternate VS. Null Hypothesis A null hypothesis (H O)

is a statement that there is no actual relationshipbetween variables.

predicts no difference between the groups ofevents or observations under study.

Example:

There is no significant difference in the anxietylevel of children of High IQ and those of low IQ.There is no relationship between age ofadolescents and occurrence of unwantedpregnancy.


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Refer to examples in the handout


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Chapter 5Literature Review

Learning objective After reading this chapter, student should beable to:

Describe the reasons for reviewing availableliteratureDescribe the literature resources that are availablefor carrying out reviewSystematically review a literature on a given topic


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Introduction A literature review

summarises, interprets, and critically

evaluates existing "literature"establish current knowledge of a subjectestablish what knowledge and ideas havebeen established on a specific topic


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Purpose of literature reviewRefer to lecture notes


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Types of literaturePrimary literature e.g. articles published inreputable journals.Secondary literature e.g. textbooks andreview articles.Grey literature e.g. government reports,conference proceedings and theses.

Web sites : sites other than those associatedwith mainstream academic literature.


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Steps in the review of literatureInitial search

a cursory examination of available publicationSecondary search

in-depth & critical evaluation of publicationsInvolves:

Electronic searching

Manual searching


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Steps in the review of literatureElectronic searching

Databases contain large quantities of informationExamples of databases:

Cochrane libraryWeb of scienceGoogle scholar

CINAHLPubMed/Medline


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Steps in the review of literatureManual Searching

not all journals are available on databases;important information may be missed.Ideal to combine manual and computerisedsearch. This include:

Hand searching journals

Searching reference list Author searching


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Keeping Record A systematic method for recording importantinformation and the search strategy:

prevent duplicating effort by doing the samesearch twicemissing out a significant and relevant sector ofliterature

Information such as authors name, date ofpublication, title of article and name of journal orbook can be entered on a separate card


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Writing the reviewFinal task: organise and report thematerial covered

Outlinean introduction,a body,

a conclusion


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Writing the review Your review should:

well-organized and critical summary of current stateof knowledgeStudies with comparable findings often can besummarised together.in your own words.point out both consistencies and contradictions inthe literature as well as offer possible explanationsfor the inconsistencies.

CHAPTER SEVEN


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CHAPTER SEVEN Research Methods

Learning objective After completing this chapter, the studentshould be able to:

Differentiate between quantitative and qualitativeresearch methodsDescribe and understand the various componentsof the methods section in a research proposalExplain the cyclical nature of the different steps indesigning the methodology


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IntroductionNot all research methods can be used to answerevery research questionsE.g.

a nurse interested in the accuracy ofthermometers in assessing fever will use aquantitativea nurse interested in the experience of fever from

the patients perspective will use a qualitativeapproach


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DefinitionsResearch Methodology is the science of studyinghow research is done scientifically.Research methods are generalized and established

ways of approaching research questions (e.g.,qualitative vs. quantitative methods).Research Design involves determining how a chosenmethod (qualitative or quantitative) will be applied to

answer your research question.Includes methodology, sample selection, data collectionprocess, instruments


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Quantitative Research Design

Based on the measurement ofquantity or amount.Results can be:

a number or a set of numbers

presented in tables and graphs.


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Types of quantitative researchTwo main types

Interventional (experimental) research

Non-interventional (non-experimental)research


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Types of quantitative research1. Interventional (experimental) research

The researcher manipulates objects

He then measures the outcome of hismanipulation.Two main types:

experimental and quasi-experimental studies .


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Types of quantitative researchNon-interventional (non-experimental)research:

the researcher just describes oranalyses variables without interveningin anyway.The main types are

correlational studies and descriptive

studies .


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Interventional Research: Experimental

The researcher provides a specifictreatment to one group and withholds it

from the other.He then determines how both groupsscored on an outcome.


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Interventional Research: Experimental

Characteristics of experimental designManipulation: involves doing something to studyparticipants.Control: the experimenter introduces controlsover the experimental situation, including the useof a control groupRandomization: the experimenter assignssubjects to a control or experimental group on arandom basis.


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Interventional ResearchQuasi-experimental

Undertaken when randomization not possible.

The design introduces some form of treatment or

manipulation but does not utilize

randomization or control group.

Quasi-experimental therefore lack eitherrandomisation or a control group


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Non-interventional research

Non-interventional researchGenerally present-oriented.describe what exist.variables are not deliberatelymanipulated,the setting controlled


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Examples1. Explorative studies :

explores new phenomena to enhance theresearchers understanding.normally of short duration and carried out onsmall scale.


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Examples2. Descriptive studies

description of phenomena in real life situation.It is designed to provide an accurate account ofcharacteristics of particular individuals,situations or groups.

It answers the question: what is? e.g. whatfactors influence mother-infant bonding ?


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Non-interventional researchExamples

4. Correlational studiesinvestigates relationship btnx or amongvariables.

5. Surveysprovides a quantitative description of

trends, attitudes, or opinions of a populationby studying a sample of that population.It can either be cross-sectional orlongitudinal.


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Qualitative research design

Quali is a way of looking at the world fromthe point of view of people.

It enquires about what people feel, think,understand and believe.It is more concern with describing andunderstanding human experiences from thepoint of view of the people who have had, orare having, the experience.


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Qualitative researchE.g. a patients who are experiencing chronicpain.

Quantitative research would be concernedwith the level of pain patient experiencethat these people were experiencing, andQualitative research would be concernedwith what it means to be living withchronic pain .


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Examples of qualitative Grounded theory,action research,

historical,ethnographic,philosophical andphenomenological


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Selecting a research method

Refer to section 7.6

CHAPTER EIGHT


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CHAPTER EIGHT Data Collection

Learning objective After completing this chapter, the studentshould be able to:

Define key terms used in data collectionMention the data collection techniques and toolsDifferentiate between data collection techniques

and toolsMention the characteristics of a good interviewDesign and administer a questionnaire for a simplestudy


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Definition and types of data

Datapieces of information obtained in a

studyIt can exist as:

Numeric values Quantitative

Narrative descriptions Qualitative


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Types of dataPrimary data

collected afresh & for the first time

original in character.Secondary data

data collected by someone else & already

been passed through the statisticalprocess.


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Data Collection TechniquesData are collected using the ff means:

Interviewing

Administering questionnaireObserving participantsusing existing data

using focus group discussionsHistorical data and records


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Data collection toolsThese are the recording forms. consistsof :

observation scheduleinterview guide,interview schedule,

questionnaire,rating scale,check list etc.,

Data collection technique Data collection tool


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Using existing data Checklist, data collection

forms Observing Eyes and other senses, pen

and paper, watch, scales etc

Interviewing Interview schedule,

questionnaire, tape reorder

Administering written

questionnaire questionnaire


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InterviewDefinition

it is a data-collection technique that

involves oral questioningit is a two way systematic conversationbetween an investigator and an informant


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Interview: characteristics1. Interviewer and respondent are strangers; proper

introduction needed.2. The relationship btnx participants and interviewer

must have a fixed beginning and termination points.3. Interview is conversation with a specific purpose4. Interview needs not to be face-to-face only5. Although interview is usually a conversation

between two persons, it need not be limited to asingle respondent.


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Advantages of interviews improves the percentage of responses & quality ofinformation received than other methodsupplemental information like economic level, living

conditions etc. can be gatheredThe accuracy and dependability of the answers givenby the respondent can be checked by observationand probing.

Interview is flexible and adaptable to individualsituations.


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Disadvantages of interviews1. Results are often adversely affected by interviewer's

mode of asking questions & interactions2. Certain types of personal and financial information

may be refused in face-to-face interview3. Interview poses the problem of recording

information obtained from the respondents4. Lack of training for the person who conduct

interview.5. Interview is costly both in terms of money and

time.


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Types of interview1. Structured or directive interview

same questions put to all the respondents and inthe same order.

Each question is asked in the same way in eachinterview.

2. Unstructured or non-directive interviewRespondent encouraged to talk freely about agiven topic with a minimum of prompting orguidance.


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Interview process

1. Preparation e.g.Prepare interview schedule

2. Researcher properly introduces self

3. Establish rapport with respondent

4. Carrying the interview forward by asking

questions5. Recording the interview

6. Closing the interview


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QuestionnaireDefinition

Consist of a number of questions printed or

typed in a definite order on a form or setof forms .


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DisadvantagesQuestionnaire

prevents personal contact with

respondents.does not allow respondents to qualifyambiguous questionsPoorly worded or direct questions mightarouse antagonism or inhibitions on thepart of respondents


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Types of questionnaires

Three basic types of questionnaire:closed-ended;open-ended;combination of both


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Types of questionnairesClosed-ended questionnaires

used to generate statistics in quantitative research.Questionnaires follow a set format

Open-ended questionnairesContain blank section for the respondent to write inan answer.

E.g. closed-ended questionnaires might be used to findout how many people use a service , open-endedquestionnaires might be used to find out what peoplethink about a service .


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Types of questionnairesCombination of both

Combination of open-ended and close-ended

questionsMany questionnaires begin with a series ofclosed questions, with boxes to tick or scales torank, and then finish with a section of open-questions for more detailed response.


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Refer to example of questionnaire


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Designing effective questionnaire

Questionnaire design go through:Planning

Composing a draft questionnaireSequencing questionnaireFormatting the questionnairePiloting and revising the questionnaire


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Planningmake a list of research objectives/variablesdetermine information required to achieveobjectivesMake a list of all the questions that could go intothe questionnaire.The best way to do this is to turn the objectives toquestions.Review literature to identify tested questionnaires.


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Designing effective questionnaireComposing a draft question; POINTS TO NOTE!.

Avoid leading questions: questions should not beworded in such a way that it lead the respondent

into an answer. E.g . Wouldnt you say that,Isnt it fair to say


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Composing a draft question; POINTS TONOTE!.

Be specific. Avoid words like regularly, often, or locally as everyones idea ofwhat is regular, often or local will bedifferent.


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Composing a draft question; POINTS TO NOTE!Keep your questions short & simple as possible.

Avoid multiple ideas or two questions in one willconfuse and be misunderstoodE.g. How many cups of coffee or tea do you drinkin a day? To make the question simple, separatethe it into two:

How many cups of coffee do you drink during atypical day?How many cups of tea do you drink during atypical day?


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Composing a draft question; POINTS TO NOTE!Encourage the respondent to consider each possibleresponse to avoid the uncertainty of whether a missingitem may represent either an answer that does notapply or an overlooked item.Example: Which one of the following do you thinkincreases a persons chance of having a heart attack

the most? (Check one.) [ ] Smoking [ ] Being overweight [ ] StressSee solution on next page


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Composing a draft question; POINTS TO NOTE!

Solution:

Which of the following increases the chance ofhaving a heart attack?Smoking: [ ] Yes [ ] No [ ] Dont know Being overweight: [ ] Yes [ ] No [ ] Dont know Stress: [ ] Yes [ ] No [ ] Dont know


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Composing a draft question; POINTS TO NOTE! Avoid branching as much as possible to avoidconfusing respondents.

Example :( 1) Do you currently have a life insurancepolicy? (Circle: Yes or No)If no, go to question 3.

(2) How much is your annual life insurancepremium?


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Composing a draft question; POINTS TO NOTE!Solution: If possible, write as one question.

How much did you spend last year for lifeinsurance? (Write 0 if none).


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Desensitise questions by using responsebands.

Questions which ask women about their ageare best presented as a range of responsebands.Example

instead of asking the respondent to write downher age, you can give a range of ages such as

20-29, 30-39 etc.


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Do not use jargon or specialist language Avoid questions which require participants toperform calculations

Avoid offensive questions or insensitive questionswhich could cause embarrassment

Avoid asking difficult questions, e.g. where therespondent may struggle to answer (people hateto look stupid by not knowing the answer).


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Sequencing of questionnaire

Three major sections in aquestionnaire:

The basic information soughtThe socio-demographic information usefulin obtaining the profile of the respondentThe identification sections to be used bythe interviewer


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Points to considerPut the most important items in first half of

questionnaire.Dont start with awkward or embarrassingquestions respondents may just give up.Start with easy and non-threateningquestions.Go from the general to the particular.


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Points to considerGo from factual to abstract questions.

Go from closed to open questions.Leave demographic and personal questionsuntil last

Arrange questions in logical order. Suddenchanges in subject confuse the respondentand cause indecision.


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Formatting the questionnaire Appearance of your questionnaire matters!

The questionnaire should be clear and easy toread. It should be easy for the interviewer to navigatearound.Provide adequate space for respondents to answeropen-ended questions .


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Formatting the questionnaireUse clear headings and numbering ifappropriate.Questionnaire should be legibleIt is important not to split the question, orquestion and response categories between twopages.

Questions must be numbered (1,2,etc) and sub-sections clearly labelled (e.g. 1a, 1b, etc).


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Piloting & revising the questionnairePre-testing

administering questionnaire to a limited number ofpotential respondents

Helps identify potential problemsRespondents should be informed that they arebeing interviewed for a pilot study


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How to administer the questionnaire

ways of administering questionnaires:

self-administered (sent by post, email,

or electronically online).

Interview administered ( administered

by telephone, skype or face to face

Advantages of self-administered


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Advantages of self-administeredquestionnaires

1. Cheap and easy to administer

2. Preserve confidentiality

3. Can be completed at respondents

convenience

4. Can be administered in a standard manner

Advantages of interview administered


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Advantages of interview administeredquestionnaires

Allow participation by illiterate people. Allow clarification of ambiguity


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Participant observationthe researcher is involved in thesituation being measured;

E.g., a nurse who would be washinghis or her hands, along with the otherstaff.

The nurse researcher might do this covertly (secretly )- ethical concerns


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Non-participant observationThe researcher is not involved directly in thepractice being measured.

Both participant and non-participant observationcan raise concerns about something called theHawthorne effect (or sometimes performancebias).The Hawthorne effect is where the behaviour of

those being watched changes because they knowthey are being watched.


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Using existing dataIt is also possible to take existing data andsubject those data to analysis.E.g. use of existing hospital records.It would be a waste of time collecting new datawhen existing data are available.

An important and relatively new way of using

existing data is in the meta-analysis associatedwith systematic reviews.

CHAPTER NINESAMPLING A POPULATION


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SAMPLING A POPULATION

Learning objectiveAfter completing this chapter, the student should be able to: Define common concepts used insamplingExplain the term sampling Enumerate the steps involved in thedevelopment of a sample designDescribe the two main types of samplingdesigns

DefinitionsR h tti


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Research setting

The environment in which research is carried out.E.g. laboratory or a 'real' setting such as hospital

A research population/Target populationa large collection of individuals or objects that is the mainfocus of a scientific query.

Study PopulationThis is the population from which the sample actuallywas drawn.Subset of target population


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Reasons for Sampling

Less costs


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Less costs

Less field timeMore accuracy

When its impossible to study thewhole population

Steps involved in sample design1 Define target population


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1. Define target population

2. Decide on the Sampling Unit e.g.geographical area such as a village3. Decide on the sampling frame (list of units

from which the sample is to be selected)4. Determine the sample size.5. Decide on sampling Procedure


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Probability (random) sampling


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Each member has an equal chance of

being selected.It ensures representativeness

Types1. Simple random,2. Stratified random,

3. Cluster sampling4. Systematic sampling.

Simple random sampling


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Individuals have an equal andindependent chance of being selected for

the sample.Used when the population is uniform or

has similar characteristics in all cases.

Refer to examples in the handbook

Stratified samplingApplied to a population that is not homogeneous


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Applied to a population that is not homogeneousThe population is divided into several sub-

populations that are individually morehomogeneous these sub populations are called strata

A simple random sample is then taken from eachgroup.Example, dividing the population into males and

females and then doing a simple random samplingof each strata

Cluster/multistage sampling

Used for large-scale surveys, when the population


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g y , p prepresents broad geographic areas or large numbers of

people.The process of sampling moves through stages until thefinal sample has been selected.

E.g. to sample all nursing students in the Ghana, youwould proceed as follows:Prepare a list of regions and draw a random sample.Prepare a list of nursing schools in those selectedregions and take a random sample of the schools.Then prepare a list of students from these schoolsand make a random selection of a sample of

students

Systematic samplingInvolves the selection of every kth case from a list or

h 10 h i li


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group, such as every 10th person on a patient list.

Procedure;1. Establish the desired sample size (n)2. Determine the size of the population (N).3. Calculate the sampling interval (K) = N/n4. E.g. a sample of 200 from a population of 40,000,then

our sampling interval would be as followsK=40,000/200 = 200

5. Every 200th element on the list would be sampled.6. The first element should be selected randomly7. If number 73 is selected from a table. The people

corresponding to numbers 73, 273, 473, 673, and soforth would be sampled.

Non-probability (non-random)


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Each member does not have an equal chance of being selected as a participant in the study.Units of the sample are chosen on the basis of

personal judgment or convenience.

Other name: deliberate sampling, purposivesampling and judgment sampling .Advantages

ease of recruitment,easier monitoring and follow-up,higher response rates

Non-probability samplingConvenience sampling


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p g

Researcher includes whoever happens to be available or participants that are easiestto obtain.It is also called accidental orhaphazard sampling.Example: distributing questionnaires tonursing students in a classDisadvantage: available subjects might beatypical of the population of interest

Snowball sampling


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also called network sampling or chain sampling

Its a variant of convenience sampling.

Researcher ask participants to suggest or refer

someone else who might be eligible

Snowball samples are useful when certain people

are hard to contact, for example a person trying to

contact drug users might use a snowball sample

Purposive/Judgmental sampling

B d th b li f th t h


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Based on the belief that researchers

knowledge about the population can beused to hand-pick sample members.subjects sampled may be:

typical of the population or particularly knowledgeable about the

issues under study


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Samplingmethods

Probabilitysampling

Simplerandom

Systematic cluster stratified

Non-probability

convenience Snow

-ballingPurposive quota

Quota SamplingThe researcher identifies population


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The researcher identifies population

strata and determines how many participants are needed from eachstratum.

Ensures the inclusion of representativesfrom certain elements in the population.For example ensuring that all tribes arerepresented in a study.


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DATA PROCESSINGAND ANALYSIS

Isaac Amankwaa

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Key topics


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y pData processing Tabulation of data

Analysing quantitative data the student should be able to:

Mention the processes involve in processingresearch dataMention the importance of tabulating data

Explain how quantitative data is analysed

Editing Data


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g

It is a process of examining the collectedraw data to detect errors and omissionsand to correct these when possible .

It involves a careful scrutiny of thecompleted questionnaires.

Editing Data


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g

Purpose of editingFor consistency between and amongresponses.

For completeness in responseTo better utilize questions answered out oforder.

To facilitate the coding process .

Data Processing


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g

Types of EditingField Editing

Done on the same day as the interview to

catch technical omissions, check legibilityof handwriting, and clarify responses

Office Editing

Performed by a central office staff; often donemore rigorously than field editing

Coding of data


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g

It involves assigning of numbers to eachresponse of the question.Purpose

to translate raw data into numerical data , whichmay be counted and tabulated.

E.g. the variable sex can be represented as:1 = Male2 = Female.

Missing values can be entered as a code 9or 99 or 999instead of entering it as blank.

Coding of data


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Pre-codingThis is when codes are entered on thequestionnaires (or checklists) themselves.

For each questionnaire a box is inserted inthe right margin of the page.These boxes should not be used by theinterviewer.They are only filled in afterwards during dataprocessing.

Summarizing (classification) of data


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Data can be summarized using:Data master sheets;

manual compilation orcompilation by computer



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Data Master Sheets All the answers from individual

respondents are entered by handonto the data master sheet.



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Data Master SheetsIn a study carried out by students of a nursingschool about the smoking habits of theinhabitants of their town.The questionnaire had only 17 questions, ofwhich 9 were asked of everyone, 4 exclusivelyto smokers and 4 exclusively to non-smokers.The data was processed by hand as seen in

the next slide


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Summarizing (classification) ofdata


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Compilation by hand (withoutusing master sheets)

Used for a small sample (e.g.< 30)This can be done by

manual sorting

tally counting



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Compilation by hand (contd)Manual Sorting (Procedure)

Take one question at a time, for example, use of

health facility,Sort the questionnaires into different pilesrepresenting the various responses to the question,(e.g., hospital/ health centre/ traditional practitioners)

then count the number in each pile



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Compilation by hand (contd)Tally counting (Procedure)

One member of the compiling team reads out the

information while the other records it in the formof a tally (e.g., /// representing 3 subjects, ////representing 4 subjects who present a particularanswer).

After tally counting, add the tallies and record thenumber of subjects in each group.



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Compilation by hand (contd) After doing either manual or tally

counting, check the total number ofsubjects/responses in eachquestion to make sure that there

has been no omission or doublecount.

Computer Compilation


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The computer should not be usedFor small samplesif data is mainly generated by open questions

(qualitative data)The larger the sample, the more beneficial ingeneral the use of a computer will be.

Computer Compilation


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Steps in ComputerChoosing an appropriate computer program(e.g. STATA, SPSS, ect)

Data entryVerification or validation of the dataProgramming (if necessary)

Computer outputs/prints

Computer Compilation-steps


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1. Choosing an appropriate computerprogram

You need to identify an appropriate statisticalpackageExamples include Epi Info, SPSS, STATA, etc.

2. Data entryFirst develop a data entry format

This is followed by coding of information on thedata collection instrumente.g., Male: M or 1, Female: F or 2



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3. VerificationThis is done to correct mistakes that occurredduring data entry

E.g. of mistakes that can seen on a print outincluded

exceptionally long or short lines,blanks that should not be there,alphabetic codes where numbers are expected.



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4. Programming A certain amount of basic knowledge ofcomputer programming is needed to give the

appropriate commands.



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5. Computer outputsThis involves printing the analysis

generated by the computerThis is followed by a careful scrutinyof the individual tables, graphs, and

statistical tests to ensure they makesense

Classification of data


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This involves putting the collected datainto groups that have common featuresThis helps convey a meaning to the

researcher.Classification is done in two ways:1. Classification according to attributes.2. Classification according to the class intervals

Classification according theattributes


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Data is classified on the basis ofcommon characteristics that can

be:Descriptive e.g. sex, marital statusNumeral e.g. weight and height

Classification on the basis ofthe interval


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The numerical feature such asincome, age and weight can be

measured quantitatively classifiedby way of intervals.

Tabulation of Data


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Tabulation is the process ofsummarizing raw data and displayingit in the form of statistical table forfurther analysisThis can be done manually (smallstudy) or by the use of computers(large numbers)

Advantages of Tabulation


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It simplifies complex data.It facilitates comparison and summarisation.It facilitates computation.

It presents facts in minimum possible space.Facilitates detection of errors and omissionsTabulated data are good for references and

they make it easier to present the informationin the form of graphs and diagrams.

Basic Principles of Tabulation


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1. Tables should be clear, concise & adequately titled.2. Every table should be distinctly numbered for easy

reference.3. Column headings & row headings of the table should

be clear & brief.4. Units of measurement should be specified at

appropriate places.5. Explanatory footnotes concerning the table should be

placed at appropriate places.6.

Source of information of data should be clearlyindicated.7. Abbreviations should be avoided.

Analyzing Quantitative Data


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Quantitative studies normally producenumbers In quantitative study, data that describe both

the characteristics of the participants andthe findings of the study.This can be presented in two main ways:

Descriptive analysisInferential analysis

Descriptive Analysis


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Descriptive analysis describes the maincharacteristics of a collection of data.Four main areas of descriptive statistics

are:FrequenciesAverages

ChartsVariability

Descriptive AnalysisF t


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Frequency counts An enumeration of how often a certainmeasurement or a certain answer to a specificquestion occurs.Example, asking 100 nurses working in SDAhospital whether they had experienced any backpain in the past six months. Responses to begiven include:

Severe,Minor andNone .


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Diagnosis Frequency %

A d h d h ll 1 4 2

FREQUENCIES OF TYPES OF LEARNING DISABILITIES


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Arrested hydrocephally 1 4.2

Brain trauma 3 12.5Brain damage 2 8.3 Brain damage (RTA) 1 4.2 Cerebral palsy 1 4.2

Chicken pox encephalitis

1 4.2 Congenital abnormality 1 4.2 Downs syndrome 6 25.0 Dysgenic features 1 4.2 Microcephaly 2 8.3

Multiple handicap birth 1 4.2 Not recorded 1 4.2 Williams syndrome 3 12.5 total 24 100.0

Descriptive Analysis


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Percentages Allow us to quickly summarize and putsome meaning behind our findings.

In percentage terms, 25 per cent of oursample has been diagnosed with Downssyndrome .

Averages/ Measures of CentralTendencies


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It give the reader a good idea of someof the central, or average, values of aset of data.The three types of averages are

Mean

modemedian

E.g. a nurse consultant interested in howlong patients are seen at the OPD

Possible answer Frequency of


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q y

answer 10 minutes 3 patients 20 minutes 1 patient 30 minutes 40 minutes

50 minutes 60 minutes 1 patient


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Bar chart


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Mainly used for categorical-type data

Frequ enciesof variablesappear here

Variablesappear here

Pie ChartThis is a circular chart divided into segments


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This is a circular chart divided into segments,

illustrating the different frequencies,proportional to the size of the frequency to allthe other frequencies.

Discussing your ResearchFinding


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Key topicsInterpreting the findings Contextualising the findings Evaluating the study and making

recommendations After reading this topic, the student must be ableto:

offer a good interpretation of research resultsdiscuss research findings in relation to existingliteraturemake recommendations based on study findings

Introduction


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This is the most difficult part of theresearch process. It involves:

interpreting your results and what theymeanLooking for opportunities to point out theimportance of your findingsPointing out the issues that arose out ofyour study

Introduction


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Discussion therefore involvesinterpreting the findings,

contextualising the findings and thestudy in relation to the literature,evaluating the study and making

recommendations .

Interpretation of Results


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Provide a brief summary of the findingsdo not repeat the statistics norrepeat verbatim quotes in the results section

anddo not come up with new findings not alreadycovered in the results.

Explain why certain trends were obtained .

Contextualising the findings and thestudy in relation to the literature

Cl l d fi h h h d fi


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Clearly define whether the data confirm yourhypotheses (quantitative study) or whether a newtheory has been generated (qualitative studies).If a hypothesis was not supported by the data,

are there any alternative ideas for further re-search and further hypotheses?Could any anomalous findings in a quantitativestudy lead to an exploratory qualitative study totry to explain such anomalies?

Contextualising the findings and thestudy in relation to the literature


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It is essential that you providesuggestions for future studies in thearea

Provide proposals for more effectivedesigns and alternative methods ofanalysis.

Mention the limitations.

Evaluating the study and makingrecommendations

Summarise the general strengths andli it ti f th t d k


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limitations of the study so you can makeclearer to the reader the main points you aretrying to convey.Provide recommendations that might apply to:

developments in policy,changes to nursing practicesfuture recommendations for researchers to furtherstudy in this area.

Finally there should be one or two sentencesthat summarise your overall findings and mainconclusion.

Reporting/Disseminating ResearchFinding

Findings of research must be communicated


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Findings of research must be communicatedespecially if they have the potential toimpact nursing practice and patient care.Common forums for communication of studyfindings include

publication in various nursing journals,oral and

poster presentations at professionalmeetings/conferences, and/or in the workplace.

Research Reports


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A research report should have the ff sections:

An abstract or summary

An introduction Methodology or method

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Surgical Nursing lecture notes

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