Research Critique of Quantitative Research on Nursing Practice

Research Critique of Quantitative Research on Nursing Practice Nurses are expected to provide the best standards of care possible for their patients and clients, and in order to do this, they are required to provide evidence-based practice wherever possible. Part of this process of providing care based on the best available evidence involves appraising primary research (Elliott, 2001, p 555). If nurses are to improve their practice, and apply evidence to improve their clinical and theoretical knowledge and skills, they must be able to assess the quality of the available research which is relevant to their practice (Freshwater and Bishop, 2003k p23; Hek, 2000, p 19). According to Hek (2000 p 19-21), evidence based practice incorporates professional expertise, patient need and preference, and the best available evidence. But in order to identify this best evidence, the nurse must undertake an evaluation and critical review of research studies, to see if the research is useful and of sufficient quality to be applied to their practice (Fink, 2005). This essay evaluates a quantitative research article which has relevance to nursing practice, because it deals with a chronic condition and one which is prevalent in worldwide populations. The author will review Tangkawanich et al (2008 p 216) Causal model of health: health-related quality of life in people living with HIV/AIDS in the northern region of Thailand. This article is published in a reputable journal, The Journal of Nursing and Health Sciences which addresses issues of interest and concern to nurses internationally, and as such, offers specific insight into HIV/AIDS and nursing within a global context. There are a number of appraisal tools available to healthcare practitioners to assist them in analysing and critiquing primary research articles. Such models are developed over time in relation to standardised conceptualisations of what constitutes quality and rigour in research and in its reporting. For the purposes of this essay, the primary tool used is that proposed by Cormack (2000), but the author will make reference to other critiquing guides and information, including the popular CASP tool (PHRU, 2009, online) Discussion 1. Title The title is concise (Cormack, 2000) and describes the focus of the research itself. While it clearly indicates what the purpose of the study was (Cormack, 2000), it could be clearer and more indicative of the nature of the study. While the nature of the research in setting out to examine the causal relationships between age, antriretroviral treatment, social support, symptom experience, self-care strategies and health related quality of life (Tangkawanich et al, 2008 p 216) in the chosen sample and population, is apparent in the abstract, there is little indication of these particular variables in the title, although the description of the causal model (Tangkawanich et al, 2008 p 216) does indicate the nature of the research. The use of the word causal (Tangkawanich et al, 2008 p 216) also suggests that this is a quantitative research article. It does not clearly indicate the research approach used (Cormack, 2000). To the less research-aware reader, it would be difficult to divine t his information from the title alone, and it could be argued that it would be better to include in this title a clearer indication of the nature of the study. This would then help the reader to identify if this is the type of research study that would be applicable to their own practice or learning. 2. Authors The authors qualifications are provided, and they all are registered nurses, all of which have postgraduate degrees, and two of which have doctorates. They all work within nursing education within a University context. This would suggest that they have the research skills and expertise to carry out such a study. However, there is no indication in the author list whether or not any of them have the statistical expertise for the study. 3. Abstract Tangkawanich et al, (2008 p 216) provide an abstract, which is identified by Cormack (2000) as an important introduction to the article. The study effectively summarises the research, by identifying the variables being tested. The authors do not, however, present the hypothesis in the abstract (Cormack, 2000). The abstract contains a summary of the study sample, and also identifies the research tools that have been used. They include the results and a summary of conclusions from these findings. As such, the abstract does represent the article itself (PHRU, 2009, online), and for the reader, it does make it easy to identify whether or not the article is relevant to their interest. In particular, it does indicate clearly that it is a quantitative paper which uses recognisable data collection tools. 4. Introduction and Literature Review Although Cormack (2000) separates these two into distinct subheadings, within this article, the introduction and literature review are contiguous. The author has noted that this is often the case in the reporting of such studies, but this may simply be a convention of the publication itself, and not the preference of the authors of the study. The authors use the introduction to contextualise the problem in relation to published research, stating the importance of health-related quality of life (HRQL) for people living with HIV/AIDS (PLWHA), because of the impact of the disease on these individuals daily lives (Tangkawanich et al, 2008 p 216). They discuss changes and advances in treatment options for this condition, and relate this to HRQL, and then discuss the disease itself, and how these impact upon HRQL (Tangkawanich et al, 2008 p 216). They summarise some research about this topic, and also look at self-care strategies, symptom management and treatment (Tangkawanich et al, 2008 p 216). There is some exploration of HRQL and its relationship to nursing and to existing literature on this topic, which aids understanding of the concept prior to reading the rest of the article. They highlight some important topics in relation to the focus of the article, including treatment, social support, and other issues (Tangkawanich et al, 2008 p 216). Although the introduction/literature review contextualises and introduces this study, this author believes that a more detailed critical analysis of the literature would be warranted here. It is not enough to cite previous research as a means of establishing the credentials of the study, as it were. A wider range of research could have been included Gerrish and Lacey, 2006, 38; Fontana, 2004, p 93), and this research could have been evaluated to identify its quality. It is left to the reader to pursue this matter and determine the quality of the research upon which they base the premise and justification for this study. This could be considered a limitation in the reporting of this research. 5. The Hypothesis The authors do not state a hypothesis (Cormack, 2000), as such, but instead present a research question. The purpose of this study was to examine the causal relationships between age, antiretroviral treatment, social support, symptom experience, self-care strategies, and the HRQL in Thai PLWHA (Tangkawanich et al, 2008 p 217). The nature of this statement would suggest that it is not an experimental study, but that it is within a quantitative research paradigm. 6. Operational definitions Cormack (2000) suggests that people appraising research question whether operational definitions are clearly presented. In this study, operational definitions are explained within the introduction but in language that would make it inaccessible to the less experienced or less knowledgeable reader. 7. Methodology The methodology section does not clearly state or discuss the choice of a quantitative approach (Cormack, 2000). The focus of the section on Methods is rather on the instruments that are being used. The quality of this study seems to rest in the choice of a quantitative approach, and the choice of data collection instruments. Quantitative research approaches offer a better standards of evidence, with generally greater ability for replication and greater rigour (Kitson et al, 2000 p 149; Duffy, 2005, p 233). As far as research for healthcare practice is concerned, quantitative studies hold better status than those based with a qualitative paradigm (Hek, 2000 p 19; Newman et al, 1998 p 231; Pepler et al, 2006, p 23). There is however no real discussion of the underpinning principles of quantitative research (Parahoo, 2006). It is good that the research instruments are explained in such detail, because it helps overcome one of the limitations of quantitative research, that of not asking the right questions to elicit answers that relate to person al experience (Johnson and Onwuegbuzie, 2004 p 14). 8. Subjects There is very limited detail given of sample selection, save stating that eight hospitals were randomly selected using a lottery method without replacement and that the 422 participants were randomly sampled (Tangkawanich et al, 2008 p 217). This could constitute a limitation of this research, as it is not possible to identify if there was any sampling bias, how participants were recruited, who recruited them, and any ethical issues in relation to participant recruitment (Hek, 2000, p 20; PHRU, 2009, online, Bowling, 2002). This author would argue that this is a weakness of the study, as these are crucial elements of quality measurement in primary research within healthcare (Austin, 2001 p 1; Cooper, 2006, p 439; Nuremberg Code, 1949, online). 9. Sample selection Sample selection is not discussed in any detail, which could be a weakness of the study, as mentioned above (Cormack, 2000). Sample size is stated, but it is not stated whether this was statistically determined, which could also be considered a weakness, as achieving a statistically sound sample size is important within quantitative research (Daggett et al, 2005, p 255; Donovan, 2002). 10. Data Collection Data collection procedures are not adequately described in this study (Cormack, 2000). This would be problematic for replication and for rigour. There is no indication who administered the questionnaires, whether or not they were self-report in the participants own time and convenience, or whether a researcher was present at the time of completion. This could be considered a weakness of this studys reporting. The issue of researcher bias is important in the completion of data collection tools, and while questionnaires may be considered a way of avoiding this, if they are remotely administered, it is not always possible to check they are full, or honest, or completed by the intended target (Gillham, 2000, p 48). Having the researcher present, however, could introduce bias or influence of some kind, particularly in vulnerable people (Bowling, 2001). As these are vulnerable adults attending clinics for their chronic condition, not discussion how the data was collected from them is a ser ious failing and may also constitute an ethical issue. However, a strength of this study could be considered to be the use of multiple data collection instruments, and the detail with which they are described, and their provenance accounted for. They have used the Social Support Questionniare, the Symptom Experience Questionnaire, the Self-Care Strategies Questionnaire, and the Health-Related Quality of Life Questionnaire (Tangkawanich et al, 2008 p 217). These are described in detail, and where they are based on previously developed research or derived directly from previous studies, this is also described. As these are established research data collection tools, this would suggest they have been previously validated, which adds to the quality of the research (Yu and Cooper, 1983 p 36; Oppenheim, 1992; McDowell and Newell, 1996; McColl et al, 2001 p 1). The demographics of the sample are addressed to some extent, and the use of multiple tools also helps to address potential confounding variables or factors (PHRU, 2009, online). 11. Ethical Considerations It is clearly stated within the study that ethical approval was derived from an appropriate body, and that informed consent was achieved, both of which signify good ethical consideration here (Cormack, 2000). However, there is no explanation of what information was given to the participants, how informed consent was achieved, or if there was any issue with communication or accessibility for people with different communication needs. It does not specifically address issues of anonymity and confidentiality (Cormack, 2000), but instead seems to focus on safety (Tangkawanich et al, 2008 p 218). 12. Results The results of this study are presented in tables, diagrams, and in great detail within the text of the paper. The key results and demographic issues are presented, but data presentation is summarised in a results section and then in more detail in the discussion. The findings are not very accessible, but p values are clearly stated, which is important in a study of this kind. PHRU (2009, online), within the CASP tool, poses the question of do you believe the results?. This is an important question. The results seem plausible, and relate to established statistical analysis procedures (see below). But because of the lack of detail about the sample, and the selection method, it is not possible to eradicate the doubts about these findings, in relation to potential bias. But in the context of the authors wider knowledge and understanding about people living with HIV/AIDS, the results seem believable. However, the issue of bias cannot be overlooked. More transparency in reporting of key e lements of this study would have made it easier to determine whether these results constitute good evidence for practice (Rosswurm and Larrabee, 1999 p 317; Pepler et al, 2006, p 23). 12. Data analysis The authors carried out the statistical analyses using SPSS, which is an established statistical programme, and LISREL, which is not a programme this author is familiar with. They describe generating descriptive statistics for each of the variables under consideration, but do not present these in any detail (Tangkawanich et al, 2008 p 218). They then describe the use of multivariate analysis for specific model development, and using other tests, some of which are familiar to the author, some of which are not. While the multivariate analysis and X2 tests are acceptable tests of inference or relationships between variables (Duff, 2005 p 234), anyone who does not have the specialist knowledge of the other tests would find it hard to determine their appropriateness here. The level of specialist statistical knowledge required to understand this would be significant. More transparency could have been achieved by including an explanation of these tests. 13. Discussion The discussion appears quite balanced (Cormack, 2000), and is very detailed, which is good, given the complexity of this study, involving as it does multiple data collection instruments. The study relates the findings back to a wide range of other research studies, which is a strength of this part of the report, showing congruence with many other findings in relation to quality of life, age, socioeconomic status, social support, antiretroviral treatment, symptoms, and self-care (Tangkawanich et al, 2008 p 219). Limitations of the study are also acknowledged (Cormack, 2000). However, the implications for practice are presented in a separate section. 14. Conclusions The conclusion supports the results obtained (Cormack, 2000), although it is not a very detailed summation of the complexity of the findings. However, this is referred to in the Implications and Recommendations section. (Tangkawanich et al, 2008 p 217). 15. Recommendations The authors of this study suggest that social support would have the strongest effect on HRQL(Tangkawanich et al, 2008 p 220). They recommend a wide range of strategies to support this, and also look at all the other factors, making recommendations for improving care for this patient population. These are all consistent with the study. However, the only recommendation for future research is that it should be longitudinal rather than cross-sectional (Tangkawanich et al, 2008 p 217). Conclusion It is apparent from this study that social and other factors have a serious impact upon the lived experience and quality of life of the target population. It is also apparent that social factors may outweigh medical factors, other than in the provision of antiretroviral therapies for these patients. It would appear, therefore, that understanding these factors and the relationships between them could improve nursing and healthcare practice for people living with HIV/AIDS. However, this author would also conclude that because of some methodological and reporting weaknesses in this study, it would be better to find other research confirming these findings before using it as evidence for practice.

Legal and Ethical Implications for Classroom Management Essay

Today’s classrooms are more dynamic than ever before. Educational needs of students are changing at breakneck speeds, along with the demands being placed on their teachers. There are associated legal and ethical implications that are evolving as rapidly as the technology that is driving a lot of the change. In order to have a chance to meet the needs of students and legal/ethical obligations, educators must have well developed classroom management techniques. These can get tricky quite often and require balancing the increasingly diverse needs of many different people. To be an effective teacher today is extremely difficult for these reasons. This essay will examine some of the current issues that teachers are exposed to in today’s classrooms by summarizing four journal articles and responding to them. The specific issues will be free speech and what it means in a school setting, cell phones in classrooms, bullying (specifically of students with disabilities), and gender specific dress codes. Freedom of Speech The issue addressed in the first article summary is freedom of speech and how it is interpreted in a public school setting in relation to the distribution of religious materials. This is really not a new topic of debate. Current precedents have been set in court cases dating as far back as1969 and the Tinker vs. Desmoines case. In that case, the court decision reads that, in order to prohibit any students’ expression of opinion, the school must provide evidence to support the fact that the actions being suppressed would be significantly disruptive (Essex, 2006). Because it is an issue of ongoing debate there are cases still being heard all over the country. This article is specifically in response to a case in the New York Supreme Court, where a student was prohibited from distributing religious fliers on school property. The question is, why was the student prevented from expressing her opinion in the first place. According to Essex (2006), one of the requirements placed on schools is that they remain viewpoint neutral. This means that if the literature was suppressed because it was religious in nature, the suppression violated her First Amendment rights, even in the school setting. In all court cases, the real message has been that schools are responsible for making sure parents and students are aware that the schools are merely sending messages indiscriminately from religious and non-secular sources and that they are not in support of any of them (Essex, 2006). Really the essence of the article is that sound policies must be in place, well documented, and consistently followed for a school to be able to regulate what a student says or distributes and there must be no endorsement of any particular ideas from any group or student. Cell phones The next topic of discussion is cell phones in classrooms. The article being summarized is entitled The Only Thing We Have to Fear is†¦120 Characters. In this article, Kevin Thomas and Christy McGee (2012) make arguments for the use of cellphones in classrooms in spite of the fact that 69% have banned them. This paper responds to the many reasons for disallowing their use, and then it goes on to highlight some ideas about why cell phones should be used as educational tools. Both sides of the discussion certainly make valid points. If 69% schools have taken students cell phones away, there must be some reasons. Thomas & Mcgee (2012) identified and responded to four commonly offered rationales, including misuse for cheating, replacing Standard English with textese, sexting, and cyberbulling. It seems rather obvious that these are negative side effects of the technology, however there are also positive results that can be attributed to the use of cell phones. Today, they are relatively affordable and powerful miniature computers. When used properly, the possibilities for better use of time are astonishing. According to Thomas and McGee (2012), teachers need to be modeling appropriate behavior with their portable electronic devices and taking advantage of the benefits because the technology is not the cause of the problems. The problems being associated with cell phones all existed in some form, long before modern technology. Thomas Diamates (2010) reports that courts have supported schools in their efforts to ban cell phone use as long as the school follow established procedures. Bullying The third topic has to do with bullying, specifically students with disabilities. These students stand out in the classroom, as they are â€Å"different† and so they are subjects of increased abuse from fellow students (Eckes and Gibbs, 2012). Schools and teachers have an obligation to provide students with disabilities a free appropriate public education (FAPE) in the least restrictive environment according to the Individuals with Disabilities Education Act (2004). This paper looks at the findings in several court cases to establish what is required of teachers in situations where students with disabilities are being bullied. What this article shows is that there are an increasing number of suits against school where disabled children are being bullied. The interpretation of what is considered an appropriate education, and whether or not the school took proper preventative/disciplinary steps in light of the bullying are the reasons for these suits. The findings of this study provide evidence that the courts will generally side with schools that have taken and documented actions to alleviate the harassment. In Brown vs. Monroe County Board of Education (1999), the Supreme Court ruled that for a school to be liable, it must receive federal funds, it must have been aware of and acted â€Å"deliberately indifferent† to the harassment, and the bullying must have been severe enough to deprive educational opportunity (Eckes and Gibbs, 2012). Basically, schools must make an adequate effort to alleviate the harassment in order to limit their liability, and this has been upheld by the courts in cases like Werth v. Board of Directors (2007), and Biggs v. Board of Education (2002). Dress codes The last article on the list takes a look at how and why public schools can or cannot implement gender based dress codes. Proponents of dress codes list reasons including less distractions, less pressure to dress right, safety, and lower cost to families. Opponents say that dress codes take away students expressive rights, which are already severely limited in school settings. In this particular case, Ceara Sturgis had her picture and name removed from her senior yearbook because she is a lesbian who was more comfortable wearing the school prescribed male outfit. The current question is whether or not this is in violation of her civil liberties. Historically the courts have upheld the rights of schools to implement dress codes with very few exceptions. In Blau v. Fort Thomas Public School District (2005), a father brought suit against the school for violating 1st and 14th amendment rights with their dress code. The court found no violation of rights since â€Å"it is not related to suppression of the content of expression, it furthers a substantial government interest, and it does not burden substantially more speech than is necessary to further that interest† (Dowling-Sender, p. 34, 2005). On the other side of the coin, in United States vs. Virginia (1996), schools were required to show a â€Å"legitimate and important† reason for any gender based restrictions (Smith, 2012). In Ceara’s case, the school is going to have to show that it meets all these criteria, and the outcome has some potentially far reaching consequences. What all this means is that teaching in todays classrooms must be dynamic. Teachers need to be aware of their ever-changing legal and ethical obligations as educators. Decisions must be based on sound judgment and carefully documented observations. Teachers, students, and parents must work together and communicate with each other to create the best possible learning environment for everyone.

Project Management Body of Knowledge Essay

The PMBOK is an IEEE standard pioneered by PMI that provides the essentials of project management to successfully complete the project. Out of the nine knowledge areas I think these three areas are the most important and if these are managed well the trade show would be very effective. 1. Project Time Management A project is considered winning only if it is delivered on time and in that case only, it earns proper attention in terms of business and visitors. A project needs to be divided into various small tasks and each task must be linked together using two strategies of logical relationship between the tasks and the estimated time. Furthermore the sequence of flow of the tasks defining dependency of tasks on each other is important in this regard. The priority of tasks must also be considered while time managing the project. Milestones must be set to follow the time management properly; these milestones may include the following:  · The start and finish of a project  · Completion of major deliverables  · Formal reviews  · Key events such as presentations If this area of PMBOK is missed then the project would not be delivered on time and would definitely lose its value and if it is still delivered the quality of the trade show would definitely have been deteriorated. 2. Project Human Resource Management To manage most projects, another most important area is human resource management. To organize a trade show a number of people having expertise in various areas are needed and effectively managing them so that maximum output form the employed people is taken is a key to a successful project. The frustrated project managers are usually found saying that they need more resources, but even with more resources the problem doesn’t get solved, adding more resources may even complicate the problem. The key to it is to systematically analyze the project human resource requirement, which in turn make possible effective project completion in a timely and neatly manner (Meredith & Mantel, 2008). Key practices to improve the human resource management are  · List the people with the tasks (in a Gantt chart)  · Find out If the same person is listed as the owner of the most of the tasks  · Find out if The same person is listed as owner of the same parallel tasks  · Find out if The any person has been barely listed  · Find out if The Many tasks are stacked up in parallel  · Find out if Those tasks which don’t have owners If the proper HRM is not a practice, Firstly Cost of project would be increased and secondly rift between the several members of the team may result leading to the total failure of the project. 3. Project Communications Management To organize an effective event the communication between the various members of the team need to have effective communication between them. Large projects such as tradeshow generate a large amount of communication. Proactively determining the mode of communication between the team members and how often would that communication takes place would be an important time saver, some teams agree to use email for formal and non urgent matters and voice mail/ phone call for urgent matters. Another way is to give responsibility to someone who would be responsible for communicating information to the senior managers. Trade show, like all other projects, needs to establish its own communication strategy depending upon the people involved and the cost (Kerzner, H. (2005). Ineffective communication would incur considerable increase in cost to the project and things would happen but in a haphazard manner with often conflicts occurring within the team and same tasks done repeatedly by several members resulting in wastage of time.

Philosophy Deontology vs. Utilinarianism Essay - 761 Words

The word deontology comes from the Greek word â€Å"deontos† which means duty (Adams, 2011). Deontology can be defined as doing what is morally correct regardless of the final results as long as they abide by the moral principles. Certain actions, like lying, are never allowed regardless if its outcomes benefit the purpose and no harm is caused. The theory states that whether an action is ethical and follows the moral rules, depends on the intentions behind the decisions (Pieper, 2008). So for an action to be â€Å"good† and morally right, it must have been performed at goodwill and abide to moral values. Immanuel Kant was a renowned philosopher known for his theories and his deontological way of thinking. Deontology was also known as kantianism†¦show more content†¦It’s the nurses duty to advocate for her patient and to make sure that the patient understands and ask questions if necessary. Overall, deontology is based upon not just by following universal rules or performing what is ought to do, but by respecting human beings as rational beings as well. Deontology judges the ethical motive of an action not by its consequences, merely by the reasoning behind it. Utilitarianism Utilitarianism, in the contrary, is based on the principle of utility or usefulness. Utility is what encourages an agent to act in a particular way (Tuckett, 1998). Utility can be explained as maximizing the good like pleasure and happiness and minimizing the bad like pain and evil, all leading to the greater good for all parties involved. It weights the consequences of the actions equally between the ones involved, and the ethical solution would be to follow the greater good for most if not all the parties involved. Jeremy Bentham and John Stuart Mill are known for their theories about utilitarianism. Both of them agree that the ethical right thing to do would be to maximize utility in any given situation. Yet, both of them disagree when it came to defninig pleasure. Bentham’s theory generalizes pleasure as just the same type of emotion felt by anyone and in any situation. Mill’s theory on the other hand stated that there are two different types of pleasure: the higher intellectual pleasure and the lower physical pleasure