GHS5841 Research and Evidence for Practice
Workbook: Supplementary Assessment
Due Date: November 13, 2015, 23.55hrs
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This paper consists of 104 marks and constitutes 20% of your grade for this unit.
QUESTION 1 (3 marks)
a) Locate, and give the reference for, one article that represents the highest evidence available relating to the changing of intravenous administration sets.
b) According to the JBI evidence hierarchy (effectiveness domain), what level of evidence is this article?
c) What is the evidence regarding the frequency of administration set changes?
QUESTION 2 (10 marks)
a) Identify the appropriate measurement scale for the following:
Variable Measurement Scale
Time of day (Night, Dawn, Noon, Afternoon, Evening)
Ranking of journals in a category according to impact factor
Presence or absence of infection
b) You construct a survey and create categories for age – what scale is this? Identify one advantage and one disadvantage of measuring the variable in this way.
QUESTION 3 (2 marks)
The lifespan of light bulbs is normally distributed, with a mean life of 850 hours, and a standard deviation of 20 hours.
a) What would be the expected lifespan of approximately 99% of the light bulbs?
b) What percentage of light bulbs should last for at least 830 hours?
QUESTION 4 (8 marks)
Nursing staff in a surgical ward are interested in acupressure in treating postoperative nausea and vomiting. They decide to carry out a study comparing its effectiveness with that of standard treatment. Patients must consent to the study to be included.
a) Explain the difference between internal and external validity in studies such as this [2 marks]
b) Identify 3 threats to internal validity in this study and suggest strategies by which they could be prevented or reduced [6 marks]
QUESTION 5 (6 marks)
A class of 30 students received the following marks (expressed as percentages) for their overall assessment.
Student Mark Student Mark Student Mark
Grace 50 Sunil 62 Ahmed 67
Jianxia 76 Louisa 90 Tracey 72
Mark 82 David 72 Lian 62
Herlina 52 Jennifer 54 Abdul 20
James 64 Matilda 69 Melanie 65
Bianca 77 Elise 43 James 59
Mishal 35 Ramon 75 Jehan 67
Nawal 85 Caroline 62 Diana 58
Chris 78 Zara 70 Peter 68
Simon 60 Sunit 56 Rebecca 53
a) Calculate: [3 marks]
i) The mean
ii) The median
iii) The mode
b) You wish to know whether there is a difference between the marks obtained by male and female students. How would you examine the association between these two variables? [1 mark]
c) What statistical test would you perform to examine the significance of this association? [1 mark]
d) You are also interested to know whether there is an association between the marks obtained for this subject, and those obtained for another unit which all of the students have taken. To compare the marks you calculate Pearson’s correlation coefficient, and obtain a result of -0.334. What can you conclude about the relationship between the two sets of marks? [1 mark]
QUESTION 6 (3 marks)
The graph below indicates the distribution of the memory test scores of 123 people. What inference can you make about the distribution of scores? [1 mark]
c) For this dataset, what would be the most appropriate measure of: [2 marks]
i) central tendency
QUESTION 7 (15 marks)
Julia works in a general medical ward where the majority of patients have intravenous infusions. She is concerned about the incidence of phlebitis around the cannulation site and wonders whether it is related to the type of dressing used to secure the cannula. Currently all cannulae are secured with adhesive tape. After examining a variety of available products, Julia and her team decide to try a transparent, non-occlusive dressing to see if the incidence of phlebitis is affected.
a) Generate a null hypothesis and an alternate (non-directional) hypothesis for Julia’s study [2 marks]
Julia and her team commence a study to test this hypothesis. For the first 6 months of the study, all enrolled patients have their IV cannulae managed with the standard dressing. The incidence of phlebitis is documented and all other relevant data is collected. For the next six months, all enrolled patients have their cannulae managed with the new dressing. The same data is collected as previously.
b) What is the name of this research design? What level of evidence (according to the JBI hierarchy) will it generate? [2 marks]
c) What design could be used to provide a higher level of evidence? Why is this second design considered superior? [2 marks]
d) Give three (3) reasons why Julia’s team might have chosen the first design over the second [3 marks]
e) For this study, identify [2 marks]:
i) the independent variable
ii) the dependent variable
f) How will Julia’s team examine the association between the independent and dependent variables? [1 mark]
g) What statistical test would be appropriate to test the hypothesis? [1 mark]
h) The test is performed and the result generated is p=0.004. Interpret the p-value. [1 mark]
i) What decision would you expect the researchers to make with respect to the null hypothesis? [1 mark]
QUESTION 8 (7 marks)
Researchers are interested in comparing the effectiveness of a non-pharmacological method of managing pain compared with pharmacological management in patients with arthritis. They decide to conduct a systematic review.
They perform the systematic review and find 4 studies have been conducted. All have measured patients’ self-reported pain using a visual analog scale (1-10), and have compared the mean pain score for the experimental and control groups. The researchers are able to combine the findings from these studies in a meta-analysis, testing the null hypothesis that there will be no difference in the pain scores between the two treatments. These findings are displayed graphically in the Figure in Appendix 1.
a) What does the figure indicate about the outcomes of the 4 individual studies? [2 marks]
b). Comment on the width of the confidence intervals for the various studies. What is the likeliest reason for the difference? [2 marks]
c) When the findings from the 4 studies are combined, the difference between the mean pain scores is 0.4, with 95% confidence intervals of -0.4 and 1.2. Interpret these confidence intervals [2 marks]
d) What conclusion will the researchers make regarding the null hypothesis? [1 mark]
QUESTION 9 (21 marks)
Jane is a new graduate coordinator at a hospital where she manages the transition to practice of new graduates employed at the hospital. She has introduced a mentorship program on two of the wards where she provides primary mentorship to 10 graduates and wishes to conduct qualitative research to explore the new graduates’ perspectives on their transition experience in these wards, and compare it to other support programs in the hospital.
a) Identify an appropriate methodology for this study and provide a rationale for its use. Include at least one reference specific to the methodology. Identify the paradigm with which this methodology is aligned. [6 marks]
b) Identify and provide the rationale for a suitable sampling strategy for this methodology. [3 marks]
c) What data collection strategy/strategies would be most appropriate for this methodology? Give reasons. [3 marks]
d) Describe, and provide a rationale for, an appropriate method of data analysis for this methodology. [3 marks]
e) Identify three (3) elements of research rigor relevant to this methodology and provide a specific example of how each could be achieved in this study. [6 marks]
QUESTION 10 (16 marks)
a) With respect to the study in the Question 9, identify specific ethical problems which this study raises, and the ethical principle which is threatened in each case. What specific strategies could Jane adopt in her research procedures to overcome these ethical problems? [6 marks]
b) Provide an example of each of the following ethical review categories, and give reasons why the type of study would be categorised in this way [8 marks]
i) a type of study requiring approval by the full Human Research Ethics Committee (HREC)
ii) a type of study that could be approved by the Chair of the HREC alone
iii) a type of project that could be exempted from ethical review
iv) a type of study that would not require approval by any external body or committee
c) In the study in Question 9, what type of consent would you expect participants to provide? Why? [2 marks]
QUESTION 11 (13 marks)
In the appendix at the end of this document you will find extracts from interview transcripts from a study examining the experiences of lecturers at a UK university. “Rachel” and “Fern” are pseudonyms for two of the study participants. The specific question addressed in these extracts is “What are lecturers’ experiences of teaching various types of students?”
a) What type of interview are these examples of? [1 mark]
b) Written transcripts contain only the words spoken by the participants. What other data is available during the actual interview, and is important to take into account when considering their answers to the questions? As a researcher, how would you collect this type of data? [4 marks]
c) From the data, identify two (2) themes that could contribute to answering the research question. Provide 3 examples of data (ie, quotes from the interviews) that would contribute to each theme. [8 marks]
Figure: Findings of 4 studies, showing the difference between the mean pain score (central square) for the experimental (non-pharmacologic management) and control (pharmacologic management) groups. 95% confidence intervals are shown by the lines. The final diamond shows the combined difference between mean scores (mean score for experimental group minus mean score for control group) and 95% confidence intervals (ie meta-analysis of the 4 individual studies).
Extract 1: Fern
Interviewer: Okay, we are now going to focus on students. A question about the attendance and motivation of students.
Fern: I think that’s difficult, I think now we’re treating the preliminary degree as a career grade it’s becoming a bit like school. In a sense you’ve got some kids who love to be there and other kids who can’t be bothered because they’re just going through the motions. And there used to be about 5–10% of people went to university so I imagine you were effectively teaching that minority who really want to be there. But now you have some who are not too bothered; they’re here to get a qualification and get on with their lives, and they’re quite instrumental with that. But people don’t attend because they’re working, they don’t come in because as soon as they know what the assessment is they go to do it and don’t want to learn. They’re not particularly interested in learning they just want to get the assessment and that’s it. So I think to a certain extent that I understand that’s instrumental to students doing reasonably well. They don’t have a breadth of education but they can technically get though the assignment. So I just let them get on with it and concentrate on those who really want to do it, you know. So really it’s like the old university group inside the mass really, so you know I just focus – that’s not true, I don’t just focus on those who are interested. But if a minority, like lectures aren’t compulsory, we don’t take down registers so there might be people not there. But we do take registers in seminars so we have more people there. If I find some people haven’t turned up to class I don’t worry about it because I teach those that are there and those who are there by definition are the most interested. So attendance is a problem, that cynicism of ‘oh let’s get through this’, ‘oh we’ve got to do this degree, let’s get through it’. There’s still loads of interested students but, if they’re not there, then they’re either working or not interested.
Interviewer: Okay, what is your experience of teaching mature students?
Fern: Oh it used to be fabulous, in the good old days when there were grants we had loads and loads of mature students and sometimes up to a third of a course were made up of mature students. And there would be all sorts of people, we had vicars, we had retired miners – all sorts of people coming in. And lots of women who had returned to work after having children. And several of them struggled with it but some of them were really fabulous. In fact we had a couple of mature students just recently on the course; I wouldn’t say more so than other students, but they were here because they wanted to be here. And they were desperate to learn and desperate to know, some of the brightest students we had were the mature students. And I thought it was marvellous taking somebody who had no chance of education and suddenly had the confidence to realise that they could come to learn and I think it’s fabulous. I really, really enjoyed that, you don’t have that now because of course they can’t afford to take the loans out, mature students, they have to work. You know, no government grants, there’s no support for them so they’ve all gone, nearly all gone.
Interviewer: Have you noticed this change since it became a university or just the whole…
Fern: It’s the loss of the grant. I don’t think it’s got anything to do with turning into a university; I suppose there’s also the whole strict admissions and this kind of thing. But I don’t think that’s got to do with being a university because I think traditional universities used to take in more mature students all the time so I don’t think it’s got anything to do with being a university. I think that it’s just to do with increased bureaucracy and the loss of grants.
Interviewer: Have you noticed any differences between the way that students like to be taught? Like more traditional students liking it one way and mature students a different way or?
Fern: I don’t know…
Interviewer: A difference in methods of teaching?
Fern: I don’t think there’s a difference in methods of teaching. I think all students now need the information, they want to know what the assessment is; they want to know what they need to do because they want to know how to get the marks. They really are quite instrumental, whereas the mature students never were here just to get the qualification – that was the icing on the cake. They were here to learn and to enjoy the process. I’m not sure that students enjoy the process any more; I don’t know if students get a kick out of learning anymore, they do it because they have to do it otherwise they won’t get the jobs they want. So whether it’s to do with style of teaching, it’s got to do with the content and the seminars, the attitude is just very, very different – take the information.
Interviewer: What is your experience of overseas students?
Fern: Loads of it through the years. Again, it’s about the same; there was a stage where the international students were quite exceptional: they had quite a struggle to get here and wanted to learn as much as possible. Whereas now we get loads of international students being sent by their government to get trained up, to get qualifications, and therefore they haven’t got a hunger to learn. Well, that’s not true, some of them do. But their priority is to get that qualification in the time scale because otherwise they’ll have to pay the money back or lose their job so people are under that very instrumental pressure, so not doing it for the love of it. I think it’s much the same; I don’t think it’s to do with being an international student but I think it’s to do with being put through the grinder to get the qualifications. And I think that makes it difficult, but many of them are a delight to teach, very interesting, obviously they bring new experiences and different perspectives.
Interviewer: And what about language barriers?
Fern: That’s very difficult because, if people just aren’t experienced, they may not understand what you’re saying. I have quite a fast delivery so I don’t probably teach in a style that students would find useful. I work with PowerPoint but then I explain things and I think that I do that quite quickly, and therefore, if the language isn’t there, I think that to pick up the meaning of what I am saying may be quite difficult. So I do try to repeat things rather than say it slowly, I try to say things two or three times. But yes, I think people seem to learn quite quickly when they get here and have to learn another language. But I know students who can barely speak and still manage to get through it somehow. I think a combination of low motivation, not really being very on top of a subject and not being able to speak – when you’ve got that combination it’s pretty difficult, but I haven’t often seen those combinations all together. For instance I have very able, very polite international students who barely speak English but, as I say, they can still get over it. It’s a mixture really.
Extract 2: Rachel
Interviewer: Okay, we’re going to move on now to student diversity. What is your experience of teaching mature students?
Rachel: I taught a lot of mature students in my previous job, but in this post at the moment I’m teaching predominately undergraduates.
Interviewer: And have you noticed any differences between traditional and mature students?
Rachel: No, nothing huge.
Interviewer: What about in terms of preferred teaching methods?
Rachel: With mature students you can probably be a bit more flexible with your teaching methods and you can also expect them to read. They’ll probably take it quite seriously so, for instance, when I was teaching some mature students in my last job, if you asked them to read something, they would come back having made notes. So I think they tend to take studying more seriously while traditional undergraduates are less likely to read. So you have to rely on different teaching methods so in that respect, yes there is a difference. Mature students are also more likely to bring their work to you for guidance. This may be just a lack of confidence because they haven’t been in higher education before or for a long time or just because they feel more committed to the course they’re doing.
Interviewer: And do you get more satisfaction from teaching mature students as opposed to traditional students or vice versa?
Rachel: I like to teach them all: it’s different and there’s great satisfaction if you have a good traditional student sitting there and they’ve read something because they’re interested in it after you’ve given the lecture about it. If they hadn’t thought about something before, but now they are reading about it, then the satisfaction is immense. On the other hand, it’s quite demoralising when you feel that you’ve given your heart and soul to a lecture and then the students come along to a seminar and are just not interested – it’s quite demoralising. It’s also frustrating because you can’t actually make people do work for seminars.
Interviewer: Okay, have you got any experience of teaching overseas students?
Rachel: No, not really, no.
Interviewer: We’re going to look at teaching now. What’s your experience of teaching using lectures?
Rachel: In the terms of the response you get or how you feel about it?
Rachel: I don’t mind big lectures now; I used to be terrified and used to find it really hard to stand up in front of lots of people. But now I think I feel a bit more confident about that. I think it’s frustrating when you write a lecture and you know people are talking and I think it happens more these days; it’s hard to keep good order in your lecture theatres because there are lots of students. I think some of the two-hour lectures are too long but I still think it’s a really good way of imparting knowledge – providing a structure to a subject area.
Interviewer: Do you like to give lectures?
Rachel: Yes, I don’t mind now. I can’t believe I’m saying that, but I don’t mind!
Interviewer: And how about seminars?
Rachel: I don’t mind seminars either. I think the old-fashioned way of expecting students to work for seminars has gone and that’s the hardest thing, you can’t go to a seminar and expect all the students to have prepared. So seminars can actually be really hard work, perhaps harder than lectures.
Interviewer: And are you involved in any other sorts of teaching?
Rachel: I do try and do different things; I have a module where I do try and take the students out on field trips, which I really enjoy and I think that’s really, really useful. And I’d like to see more of that, I’d like to see more students getting out and about – they’re studying the world, they should get out and be more interactive with the community that’s around us.
Interviewer: How about workshops?
Rachel: To be honest I can’t see the difference between a workshop and a seminar. I do try to do things differently and use film and try to get them to act out things as well. We try to get the student to imagine they are in a particular situation and how that would feel, so I don’t know if some people would call that a workshop rather than a seminar.
Interviewer: Okay, if you personally need advice or guidance, where does that come from?
Rachel: I don’t know. Probably colleagues – it would probably be informal amongst my colleagues.
Interviewer: So what would you say your preferred method of teaching would be?
Rachel: I think a combination really. I think lectures are good, but it’s quite good to break lectures up, if you can, into activities. But if you have a large number of students then you’re limited. I just think that a combination of different things – film, lecture, activities or sometimes you get students to think about things. We’ve got a debate in one of our seminars so we get them to split up into two camps, and one’s got to argue for and one against. I think a whole host of things because if you use the same thing over and over again it’s boring for you and it’s boring for them so it’s as much of a varied approach as possible.
Interviewer: And how do you find fitting everything in, with your time management and juggling everything?
Rachel: Stressful and hard at the moment, but you do. I think some people probably do it by not being available to students and that’s hard because then the students know that you are available and you’re the sort of person that they want to go and talk to – they’ll come and see you and not see anyone else. So in a sense if students see you as being student-centred and student-friendly then all your appointments will be filled up and you’ll have a constantly full diary. But people who aren’t like that have a lot more time and I think that is really hard for you to gauge in higher education. A lot of the people who students don’t go and see are perhaps the ones who are seen as the leaders within the subject areas; students go to see the workers, the teachers, and obviously they have more contact with students and so students go and see them, so I think it’s quite difficult.
Interviewer: And what do you think about student motivation and participation?
Rachel: It varies; you’ve got some students who are fantastic and they’ll attend everything and, if they’re not going to attend, they’ll let you know. Then you’ve got some who you don’t even know, and you couldn’t even put a name to a face if they turned up. I think higher education as a whole needs to think about what we want to do in terms of attendance of students because it’s something which is going to get worse. You’re now in a position where students could be sitting exams having attended no lectures or seminars and they might pass but they might not pass so I do think there needs to be a central approach to the whole faculty.
Interviewer: Do you think that’s got anything to do with students working?
Rachel: Yeah I think it’s a lot to do with students working, but I think it’s also because some don’t take it that seriously, and also because they see it as something they’re paying for, so if they don’t go it’s up to them. And I think that there is a real shift from the time when I was at university when you went to everything – you attended. But if you hadn’t read you didn’t attend because you didn’t dare go to a seminar – you hadn’t read and you’d be picked on to say something so you’d rather not go to the seminar. I think there’s a real change that has occurred in the last ten years.
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