Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing

mHealth resources for asthma and pregnancy care: Methodological issues and social media recruitment. A discussion paper

AIMS

A discussion of methodological issues and social media recruitment to a feasibility study to investigate mHealth resources for asthma and pregnancy care.

BACKGROUND

Pregnant women with asthma are reported to be poorly supported according to an international research. We sought to establish if a mHealth intervention might be feasible and acceptable to them.

DESIGN

A Phase I or modelling study.

METHODS

A project team designed an intervention to address UK national guidelines for the management of asthma during pregnancy, using other resources already accessible on the web. This was made available on a project website optimized for mobile phone usage. Links were Tweeted and advertised on Facebook, asking participants to access the project website, which included links to the resources and before- and after-use questionnaires to establish baseline symptom data and participant views of the resources.

RESULTS

Despite 55,700 Twitter impressions in a 76-day period over winter 2016-2017, this recruitment strategy garnered 402 engagements but only seven respondents for questionnaire 1 and zero respondents for questionnaire 2.

CONCLUSIONS

We could not recruit to this study despite believing that social media recruitment would be effective and we recommend that social media recruitment be used cautiously. Apparently, we did not sufficiently address the theoretical aspects of communications theory and were not clear enough about our key messages. Publication bias may exist about the non-publication of other failed telemedicine studies using social media; this goes largely unreported in some systematic reviews and may influence researchers' decision-making about social media recruitment.

Repeated sleep-quality assessment and use of sleep-promoting interventions in ICU

To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep-promoting interventions has not been widely reported. An observational study was conducted in a 58-bed adult intensive care unit. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep-promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open-ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep-promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards-Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards-Campbell Sleep Questionnaire was used on repeated occasions, and sleep-promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards-Campbell Sleep Questionnaire for the subjective self-assessment of sleep quality in intensive care unit patients and the implementation of simple-promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.

Cardboard versus sterile containers: more nitrite-positive urinalysis results?

Urinalysis is a frequently performed test that provides valuable information as to the health of individuals. The presence of nitrites in the urine may indicate infection. Antibiotic therapy is commonly started following the results of dipstick urine taken from non-sterile urine samples. This is especially prevalent in men who are immobile, because sterile containers large enough to hold a full bladder of urine are not available (at the author's trust). Urine samples were taken from 25 male A&E patients in a sterile container. Half of each sample was decanted into an ordinary cardboard urine bottle and both samples were then tested using dipstick urinalysis after 1 minute and after 10 minutes to see if there was a difference in the presence of nitrites between the two container types. After 10 minutes, 21 of the 25 samples showed a positive nitrite dipstick in the cardboard container while it remained negative when the urine remained in the sterile container. These results demonstrate that care needs to be taken when collecting urine samples, and the results of dipstick urinalysis should be used with caution depending on the collection method.

Randomizing research participants: promoting balance and concealment in small samples

Randomization is central to rigorous scientific trials. An effective but underutilized approach is urn randomization. To test the ability of urn randomization versus simple randomization to produce balanced groups with small sample sizes, we conducted simulated randomizations: 10 times under sample size scenarios of 20, 40, 60 (group sizes of 10, 20, and 30, respectively), for 30 trials in total. For groups of 20-30, urn surpassed simple randomization in the equal distribution of confounding variables between groups, leading to effects of these variables that were both smaller on average and more consistently close to zero over multiple trials. The urn method is easy to implement and has the advantages of unpredictability of assignment and decreased susceptibility to investigator bias.

Tensions and contradictions in nurses' perspectives of evidence-based practice

AIM

To explore nurses' understanding and interpretation of evidence-based practice (EBP).

BACKGROUND

EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.

METHODS

All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.

RESULTS

Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.

CONCLUSIONS

The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.

IMPLICATIONS FOR NURSING MANAGEMENT

Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.

[Scientific production of Brazilian nurses on blood pressure measurement]

In the previous issue of this journal the authors celebrated in an article the discovery of the Korotkoff sounds, in 1905, and presented the historical facts that determined the important role of the University of São Paulo's Nursing School (EEUSP) in the development of the oldest blood pressure research line in Brazilian Nursing: "Cuff Width Influence in Blood Pressure Measurement." This new article presents the scientific production derived from the studies carried out by nurses with a PhD from EEUSP during and after their doctoral programs in the area. The path each researcher followed in his/her group and laboratory is emphasized. The data presented is aimed at offering a number of qualitative and quantitative indicators that make possible to evaluate the impact of the research that they have carried out, as well as the development of knowledge in the area.

The reporting of statistics in medical educational studies: an observational study

BACKGROUND

There is confusion in the medical literature as to whether statistics should be reported in survey studies that query an entire population, as is often done in educational studies. Our objective was to determine how often statistical tests have been reported in such articles in two prominent journals that publish these types of studies.

METHODS

For this observational study, we used electronic searching to identify all survey studies published in Academic Medicine and the Journal of General Internal Medicine in which an entire population was studied. We tallied whether inferential statistics were used and whether p-values were reported.

RESULTS

Eighty-four articles were found: 62 in Academic Medicine and 22 in the Journal of General Internal Medicine. Overall, 38 (45%) of the articles reported or stated that they calculated statistics: 35% in Academic Medicine and 73% in the Journal of General Internal Medicine.

CONCLUSION

Educational enumeration surveys frequently report statistical tests. Until a better case can be made for doing so, a simple rule can be proffered to researchers. When studying an entire population (e.g., all program directors, all deans, and all medical schools) for factual information, do not perform statistical tests. Reporting percentages is sufficient and proper.

Use of factor analysis in Journal of Advanced Nursing: literature review

AIM

This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing.

BACKGROUND

Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable.

METHOD

Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study.

RESULTS

One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used.

CONCLUSIONS

Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.

Room for improvement? Reporting response rates and recruitment in nursing research in the past decade

AIMS

This paper reports an analysis of recruitment and response rates in published nursing research in three peer reviewed nursing journals in 2002. We wished to establish if the deficits in reporting nursing research identified a decade earlier had been addressed.

BACKGROUND

This analysis was informed by our personal experiences of research which produced widely differing response rates. An examination of the literature revealed a lack of consensus on desirable response rates in nursing research. Previous analyses have shown deficits in describing participants, sampling methods and reporting recruitment.

METHODS

Papers reporting empirical research in three nursing journals in 2002 were reviewed in terms of a number of variables including research methodology, respondent type, recruitment method, response rate, location, and data collection method. Nominal coding was used as necessary. Data were analysed using the Statistical Package for Social Sciences and a variety of descriptive statistics were employed.

RESULTS

Half of the papers did not report a response rate. Of those which did, over three-quarters of both qualitative and quantitative studies had response rates of 60% or more. Research conducted in hospital and educational settings produced higher response rates than those in community settings. Studies with response rates of less than 60% did not always refer to their rates in the study limitations, and low response rates do not appear to be a barrier to publication.

CONCLUSION

Reporting of sampling, recruitment and response rates in nursing research must be improved to support nursings' claim to be an evidence-based profession and to underpin clinical governance requirements. Only through improvements in the quality of nursing research publications can knowledge be extended and a better-informed research community be created.

Developing Lecturer Practitioner roles using action research

BACKGROUND

Lecturer Practitioner roles are well established in the United Kingdom. The national literature demonstrates that these staff are valuable to National Health Service trusts and universities however, their roles are busy and demanding, with conflicting expectations from the two employers. In addition, their role in addressing the theory-practice gap - a major reason for their establishment - is at best unclear. Although a number of qualitative studies have explored the topic, there have been no systematic attempts to develop the role or to quantify the effects on postholders.

AIM

This paper reports a study that aimed to develop aspects of Lecturer Practitioners' work roles, examine the effects of this on individuals at one English university, and to quantify Lecturer Practitioners' occupational stress and burnout.

METHODS

A flexible, 'spiral' action research framework and 'collaborative group approach' were used, with mixed methods of data collection. Data were collected through focus groups, meetings and participant feedback, and participants' reflective diaries. A questionnaire using previously validated psychological attitude rating scales was also used to measure occupational stress and burnout, the extent to which the project influenced these, and the influence of Lecturer Practitioners' experience and qualifications. Six null hypotheses were constructed to measure these ideas. Findings from qualitative and quantitative perspectives were triangulated to give depth to the analysis.

FINDINGS

Five themes emerged from the focus groups: personal motivation, workload pressures, role clarity, preparation and support, and gains from the role. Specific policies and documentation were developed as a result of this initial project planning work. The findings from the questionnaire indicated that Lecturer Practitioners were no more stressed or burnt out than comparable workers. Synthesis of findings indicated, broadly speaking, that these LPs were 'thriving rather than just surviving'.

CONCLUSION

Action research was an effective methodology for uncovering new knowledge, and bringing about organizational change in this project.