Nursing Research

QUALITATIVE RESEARCH 1. Phenomenological Studies a. “Lived experience” b. Examines human experiences through descriptions provided by the people involved c. Bracketing • The researcher releases expectations and biases prior to doing the research. d. End purpose • To determine themes and patterns of behavior, etc. 2. Ethnographic Studies a. Collection and analysis of data about cultural groups. b. End purpose • To develop cultural theories. c. Method • Participant observation and interviews with “key informants” 3. Grounded Theory Studies a. Data are collected and analyzed and then a theory is developed that is grounded on the data. b. Method • Purposeful sampling, done in field or naturalistic setting. c. Concerned with generation rather than testing the hypothesis. 4. Historical Studies a. Identification, location, evaluation, and synthesis of data of the past b. End purpose • To relate the past to the present and the future. c. Sources of data for historical research 1. Documents a. Oral history, written research, diaries, eyewitness accounts, pictorial services. 2. Relics and artifacts a. Physical evidence. d. Classification of sources can be: 1. Primary a. An account of the event from the person himself. 2. Secondary a. Summarized or retold by another. e. Evaluation or Critism of the data 1. External a. Authentically or genuineness of the source 2. Internal a. Accuracy of the data in the source. 5. Case study • In-depth examination of people.

QUANTITATIVE RESEARCH Steps: 1. Identify the problem a. Broad topic, narrowed down b. May be the most difficult and will take the most amount of time c. Sources of study problems i. Personal experiences ii. Literature sources iii. Previous research iv. Testing of theories d. Characteristics of a good problem statement i. Stated as a question ii. Specifies the population and the variables 1. One-variable studies • Also called Univariate. • Eg. What is the primary motivation of student nurses in preparing the Licensure examination? 2. Two-variable studies • Also Bivariate. • Can be cause and effect in experimental studies. But in a correlational study, the two variables are not “cause and effect” but may be two variables that are compared or contrasted. 3. Multiple-variable studies. • Also called Multivariate • Eg. Why do nursing students fail on NLE? iii. Emphirically testable • Hearing, sight, taste, touch, smell. 1. Ethicai and value issues, “right or wrong”, are not empirically testable but can be measured based on their effect to a subject . • Eg. Should patients be allowed an unlimited number of visitors during their stay in the hospital?” can be measured if “Is there a difference in the comfort level of hospitalized patients who receive an unlimited number of visitors compared to those limited to two visitors compared to those limited to two visitors per day?” 2. Avoid words like “cause” and “effect”. e. Is there a significant difference in the average weight of school age children who eat fast food twice a week than those who eat fast food once a week? f. Problem Statement Format: i. Correlational statement: Is there a correlation between X and Y in the population?

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Comparative statement: Is there a difference in Y between people in the population with X characteristics and those who do not have X characteristics. iii. Experimental study: Is there a difference in Y between group A who received X treatment and group B who did not receive X treatment. g. Research problem considerations: i. ii. iii. iv. v.

Ethical issues Significance to nursing Personal motivation Researcher qualifications Feasibility of the study 1. Time 2. Cost 3. Equipment and Supplies 4. Administrative support 5. Peer support 6. Availability of Subjects 2. Determine the purpose of the study a. Define why the study ids being made (often mistakenly interchanged with problem statement). b. Must state the significance and use of the study results in order to get approval. c. Eg. To develop a better understanding of the significance of consumption of fast food in the growing number of cases of obesity and overweight among school aged children. 3. Review of Related Literature a. Purpose i. To determine what knowledge already exist on the topic to be studied. ii. To develop a conceptual and theoretical framework for the study. iii. To help the researcher plan the study methods (eg. Instrument and tools). b. Primary vs. Secondary sources i.

Written by the original researcher  (eg. The Thesis itself, or the article written by the researcher).  Seen in Nursing Journals. ii. Secondary source  Summary of the research as written by someone other than the researcher. c. Review of related literature must be done on a continuous basis so as to ensure that researcher’s informations are up to date. 4. Develop a Theoretical/Conceptual Framework.

To assist in the selection of the study variables and in defining them.  Research without a theory provides a set of isolated facts.  Definition of terms: i. Theory  Set of related statements that describes or explains phenomena in a systematic way.  Eg. Newton’s Theories of motion, Callista Roy Adaptation Theory. ii. Concept a. A word picture or mental idea of phenomenon. b. Maybe concrete or abstract. c. The building blocks of theory d. Eg. Thermometer, Hate, Anger iii. Construct  Highly abstract, complex phenomenon.  Cannot be directly observed by, must be inferred by certain concrete or less abstract indicators.  Eg. Wellness, Mental health, Self esteem, Assertiveness. iv. Proposition  Statement of assertion of the relationship between anger concept.  Eg. Bacteria causes disease. There is a relationship between anger and increase in BP”. v. Empirical Generalization When a similar pattern of events is found in the empirical data of a number of different studies. Eg. Women are likely to pass the board exams than men. vi. Hypothesis  Researcher’s expectations about the study. vii. Model  Symbolic representation of some phenomenon or phenomena.  Eg. Flowchart or diagram.  Conceptual Models – made of concepts and propositions that state the relationship between the concepts. 

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d. Theoretical vs. Conceptual framework i.

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Theoretical framework  Broad, general explanation of the relationships between concept of interest in a research study.  Based on the existing theory. Conceptual framework

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Explains relationship between concept but links concepts selected from several theories, from previous research results, and from the researcher’s own experience. • Eg. Maslows Hierarchy of Needs Theory and Job satisfaction theory. e. Theory Generation and Development i. Deductive reasoning • Proceeds form general to specific. • Eg. Maslow’s Hierarchy of needs – job satisfaction scale. • Theory -> Propositional statement -> Hypothesis -> Empirical data. ii. Inductive reasoning  Proceeds from specific to general  Empirical date -> Empirical Generalization -> Propositional statement -> theory.  Eg. Observed that workers who receive low salaries have poor work performance – job satisfaction theory. f. Two types of theories i. Grand theory  Address a broad range of phenomena in the environment or humanity. ii. Middle-range theory  Concerned only with a small area of the environment or human experiences.  Middle range theories have been found to be more valuable to nursing research than grand theories. 5. Identify the Study Assumption  Assumptions o Beliefs that are held to be true but have not necessary been proven. o Eg. Fast food makes you fat.  Three types of assumptions: i. Universal assumptions  Beliefs assumed to be true by a large percentage of society.  Eg. “Fast food makes you fat”. ii. Assumptions based on theory or research findings  Using another research finding assumptions as the basis of one’s study.  Eg. An existing research finding may have stated an assumption that children who eat fast food twice a week tend to be twice more likely to become overweight than children who eat only once a week. iii. Assumptions that are necessary to carry out the study  In the mentioned research, the assumption that children who study in elementary schools are of “school-age”.

6. Acknowledge the Limitation of the study a. Limitations  Uncontrolled variables that may affect the study results and limit the generalizability of the findings.  Extraneous Variables  Also called Confounding or uncontrolled  Variables over which the researcher either has no control or chooses not to exercise control.  Eg. The attitudes and beliefs of parents of children involved in the study is not being something that the researcher can control. 

In experimental studies, uncontrolled variables are referred to as threats to internal and external validity. b. Delimitations  Limitations placed on the research by the researcher himself. c. Scope 

The extent to which the study will be made.

7. Formulate the Hypothesis 

Hypothesis o Predicts the relationship between two or more variables. o Problem statements ask the question, hypothesis gives a predicted answer.

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Characteristics of a hypothesis

i. ii. iii. iv. v.

Declarative form Written in present tense Reflects the problem statement Contains the population and the variables Must be testable or empirically verifiable

c. Two main types of variables: a. Independent – the cause b. Dependent – the effect  i.

Classification of Hypothesis

Simple vs. Complex 

Simple

a. Relationship between one independent and one dependent variable.

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 Complex Relationship between two or more independent or dependent variables. An interaction effect would concern the action of two variables in conjunction with each other. ii.

Null vs. Research

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 Null No relationship exists between two variables.

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 Research There is a relationship, states the expected relationship.

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Nondirectional vs. Directional

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 Nondirectional Mere prediction that a relationship exists.

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 Directional Researcher further predicts the type of relationship. 

Which types of research require hypothesis?

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Experimental, correlationa, comparative studies, require hypothesis. 1. Eg. Children who eat fast sood twice a week are morelikely to be overweight that those who eat fast food only once a month.

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Descriptive studies, exploratory studies 1. Do not necessarily require hypothesis. 2. Eg. A description of the lifestyles, customs and practices of indigent Manobos from Central Mindanao.

8. Define Study Variables and terms 

Importance o To make the meaning of terminologies and variables clearer to the researcher and the reader. o To allow for replication of the study.

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Types of Research Definitions:

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Operational definitions o Indicates hoow a variable will be observed or measured.

o Eg. Weight – can be measured in kilograms or pounds.   

Dictionary definitions or Theoretical definitions Obtained from literature sources Eg. School-age-child – any child from age 7 to 12. Fast food – any food that is consumed in eating establishments that are served within a considerably short period of time.

9. Select the Research Design a. Research design i. The PLAN for how the study will be conducted. b.Will it examine cause-and-effect or will it only describe existing situations.  Two major types i. ii.

Qualitative Quantitative

a. Can be Experimental and non-experimental 

Experimental vs. Non-experimental studies

a. Experimental  Concerned with cause and effect relationships.  Highly respected in the scientific world.  Must have: Manipulation or control of independent variable, random selection of subjects, measurement of independent and dependent variable.  More control can be exercised over extraneous variables.  In nursing experimental, a nursing intervention is usually introduced. i.

Validity of Experimental Design. Extraneous variables (confounding or intervening or study limitations).  Those which the researcher cannot control or chooses not to control. 

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Internal validity o Degree to which changes in dependent variable can be directly attributed to the independent variable. o Can have the following as threats to validity:

Selection Bias o Results are due to subject differences before the independent variables was manipulated.

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History o Some event other than the experimental treatment occurs during the study that influenced the dependent variable.

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Maturation o Changes that occur within the subjects during an experiment study influences the study results.

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Instrumentation Change o Difference between the pretest and the post test measurement caused by a change in the accuracy of the instrument of the judge’s ratings. o Avoided by trial runs, or training sessions for judges prior to rating.

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Mortality o Subject dropout rate is different between the experimental and comprison group.  External Validity Degree to which the study results can be generalized to other people and other settings. Threats include: i. Hawthrone effect 1. Study participants respond in a certain manner because there are aware that they are being observed.

i. ii.

ii. Experimenter effect Researcher characteristics or behavior influence subject behavior. In non-experimental research, this is called the Rosenthal Effect. iii. Reactive effects of the pre-test (measurement effect) 1. Subjects have already been sensitized by the pre-test and may affect post-test results. 

Types of Experimental Designs a. True Experimental  Researcher has great deal of control over the research situation.  3 criteria: Manipulation of variables; One experimental and one comparison group (control group).  Subjects are randomly assigned

i. Pretest-Posttest Control Group Design R O1 X O2 (experimental group) R O1 O2 (control group) i. Subjects are randomly assigned to groups ii. Pretest given to both groups iii. Experimental groups receives treatment, control group the usual or no treatment iv. Posttest given to both groups. ii.

Posttest only Control Group Design

R X O1 (Experimental Group) R O1 (Control Group) a. Subjects are randomly assigned to groups b. Experimental group receives treatment, control group the usual or no treatment. c. Posttest given to both groups. b. Quasiexperimental  Missing one criteria for true experimental design. 

Non-equivalent control group design o Similar to pretest posttest control group design but there is no random assignments of subjects. o Biggest threat: Selection bias.

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Time-series designs Researchers periodically observes measures the subjects. Experimental treatment is administered between two of the observations. 01 02 03 X 04 05 06.

c. Pre-experimental design  Weak researcher has little control over the research. i.

One-shot case study  Single group is exposed to an experimental treatment and observed after the treatment.  TX X O

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One-group pretest-posttest design

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Provides a comparison between a group of subjects before and after the experimental treatment. 01 X 02

g. Types of Non-experimental Research design i. 

Correlational Studies Researcher extent to which one variable (X) is related to another variable.

1. Correlation Coefficient  Researcher extent to which one variable (X) is related to another variable. a. + Relationship  Also called Direct  As the value of one variable increases, the value of the other variable also increases. b. – Relationship  Also called Inverse  As the variable of one value increase, the value of the other variable decreases. ii.  iii.

Survey studies Self report data are collected from samples with purpose of describing populations on some variables of interest. Comparative studies

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Examine the differences between intact groups on some dependent variable of interest. Almost similar to experimental but has no manipulation of variables. Experiemental studies are rarely done in nursing research since this will usually involve experimentation with human beings, and are thus perceived as having ethical issues. Eg. In the case of making the research on the weight gain of school age children who frequently eat fast food, we cannot conduct experimental study since doing so can endanger the health of the subjects. 1. Retrospective studies

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Dependent variable identified in the present, and the independent variable that occurred in the past is determined.

2. Prospective studies  Independent variable is identified at the present time, and the subjects are followed in the future to observe the dependent variable  Eg. Fast food and weight gain. 3. Ex post facto studies  Data are collected “after the fact” variations in the independent study are studied after the variations have occurred, rather than at the time of the occurrence. iv.

Methodological Studies  Concerned with the development, testing, and evaluation of research instruments and methods.  Eg. Post partum depression screening scale.

10. Identify the population a. Population  Complete set of individuals or objects the posses some common characteristics that is of interest to the researcher. i. Target population  Also called Universe.  The group of people or objects to which the researcher wishes to generalize the findings of the study. ii.Accessible population  That group which is actually available for the study. iii.

The accessible population must posses the characteristics similar to the target population, and vice versa.

11. Select the sample a. Sample 

A subgroup chosen to represent the population and used to make generalizations about the population.

b. Two major types of sampling i. Probability

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Everyone in the population has the chance of being selected.

1. Sample Random Sampling  Ensures that each element of the population has an equal and independent chance of being chosesn.  

Identify the sample population and list all the elements of the population (sampling frame). Table of random numbers.

2.Stratified Random Sampling  Population is divided into subgroups or strata, according to some variable/s of importance. After this, a simple random sample is taken from each of the subgroups. a. Proportional stratified b. Disproportional stratified 3. Cluster Random Sampling  Large groups or samples become the sampling units.  Eg. Geographical area, school, etc. 4. Systematic Random Sampling a. Sample is taken from every kth element of the population. b. Eg. 1,000 population and researcher needs 100 samples, then: (k interval = N/n) 1,000/100 = 10. Every 10th person in the list will be taken as sample. ii. Non-probability Sampling Methods  Sample elements are chosen from the population by non-random methods. More likely to produce biased samples.

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1. Convenience sampling Accidental or incidental. Choosing readily available people or objects for a study. Snowball sampling o Study subjects help refer additional subjects. 2. Quota Sampling  Similar to stratified random but selection not random.  Basis of stratification is determined by the researcher.  Eg. 50% females, 50% male. 3. Purposive sampling

a. Judgmental sampling b. Handpicking of subjects. c. Time frame for studying the sample i. Longitudinal study  Follows the subject over a period of time (6 months or more).  More accurate study of changes that occur over time 1. Cohort study  Persons are studied who have been born during a particular time period. ii. Cross-sectional study  Examines the subjects at one point in time.  Less expensive and easier to conduct  Eg. Use of marijuana in high school freshmen vs. seniors, etc. 12. Conduct a pilot study 

Maniature, trial version of the planned study. Can prevent a researcher from conducting a large-scale study that might be an expensive disaster.

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Objectives  To examine issues related to the design, sample size, data collection procedures and data analysis approaches.

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Can be used to test an instrument, evaluate the study phenomenon. Etc.

13. Collect the data a.

Data  Pieces of information or facts that are collected in scientific investigations.

b.

What data will be collected? Who will collect the data? Where will the data be collected? When will the data be collected? How will the data be collected? (Why, is answered by the purpose of the study or the research design, and is not part of this).

c.

The choice of data collection method is determined by the study hypothesis or research question of the study.

d.

Criteria for selection of data collection instrument

Practicality of the instrument Reliability of the instrument • Consistency and stability  Validity of the instrument Ability to gather data that is intended to gather. Concerns that content of the instrument. Will the instrument gather data that is needed in the research.  

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e. Data collection methods i. Questionnaires  Paper and pencil, self-report instrument.  Contains questions the respondents are asked to answer in writing. 1. Guidelines in wording questions i. ii. iii. iv. v.

Affirmative rather than negative (never say never). Avoid ambiguous questions (many, generally, few, often) Avoid double negative questions Neutral wording Double-barreled questions

2. Types of questions a. Demographic  Data on the characteristics of the subjects.  Demographic or attribute variables.  Age, educational background, religion.

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b. Open-ended questions Essay, fill-in-the-blank c. Closed-ended questions Respondent is asked to choose from given alternatives. Must be collectively exhaustive (all possible answer provided) and mutually exclusive ( no overlap between categories) d. Contingency questions  Items that is relevant for some respondents and not for others.  Eg. If yes.. e. Filler questions

a. Items in which the researcher has no direct interest but are included in a questionnaire to reduce the emphasis on the specific purpose of other questions. ii. Interviews b. Interviewer obtains responses from a subject in a face-to-face encounter or through a telephone call. 1. Unstructured interview c. Interviewer given a great deal of freedom to direct the course of the interview. d. Conducted more like a normal conversation. Probes o Additional prompting questions that encourage the respondent to elaborate on the topic.

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2. Structured interviews  Asking the same questions in the same order and in the same manner of all respondents in the study.  Even subtle changes in the wording of the interview may not be permitted. 3. Semi-structured interview 

Interviewers are generally required to ask a certain number of specific questions but additional probing questions are allowed or even encouraged.

iii. Observation method  Gathering data through visual observations.  Can be psychomotor skills, habits, non-verbal communication. 1. Structured vs. Unstructured Observations a. Structured  Carried out when the researcher has prior knowledge about the phenomenon of interest.  Uses a checklist. b. Unstructured  Researcher attempts to describe events or behaviors as they occur, with no preconceived idea of what will be seen. 2. Event sampling vs. Time sampling

a. Event  Observation of an entire event.  Eg. Bed making techniques of student nurses. b. Time  Observation of events or behaviors during specified times.  Eg. Appetite of patients during scheduled meals. 3. Relationship between observer and subjects a. Non-participant observer-overt  Observer openly identifies himself and provides subjects with information about the types of data that will be collected. b. Non-participant observer-covert  Generally not ethical.  Observer does not let participant know of his activity.  Eg. Public behavior (can be ethical) c. Participant observer-overt  Involved with the subjects openly and subjects know that they are being observed by the same.  Eg. Immersion with families while observing their day-today lifestyle. d. Participant observer-covert  “Plant”, “Spy”  Observer interacts with the subjects and observes their behavior without their knowledge. Rarely ethical. iv. Physiological Measures  Involve in the collection of physical data from the subjects.  Generally more objective and accurate than many of the other data collection methods. v. Attitude scales  Self-report, data collection instruments that ask respondents to report their attitudes or feelings on a continuum. 1. Likert Scale  Uses five or seven responses for each item ranging from Strongly Agree (5) to strongly disagree (1).  Negatively worded questions are rated scored reverse.

2. Semantic Differential Scales  Asks subjects to indicate their position or attitude about some concept along a continuum between two adjectives. vi. Psychological Tests 1. Personality Inventories  Self-report measures used to assess the differences in personality traits, needs, or values of people. 2. Projective Techniques  Subject is presented with an ambiguous stimuli, subject describes what the stimuli appear to represent.  Eg. Rorschach Inkblot Test. vii. Delphi Technique  Uses several rounds of questions to seek a consensus on a particular topic from a group of experts.  To obtain group consensus without a face-to-face meeting. viii. Visual Analogue Scale ix. Preexisting Data  Use of existing information that has not been collected for research purposes.  Eg. Patient’s chart 14. Organize the Data for Analysis a. Tabulation and evaluation b. Plans for organizing the data should be made prior to data collection. Plans for analyzing the data should be made prior to data collection. c. Determine if questionnaires have been completed correctly. What to do with missing data. Audio tapes transcribed. 15. Analyze the data – statistical concepts i. Frequency distribution  Simply counting the occurrence of values or scores represented in the data.  Appropriate for tabulating all types of data (nominal, ordinal, interval, ratio).  If range of score is less than 20, each score can be listed individually, when the range is large you can group them into “class intervals” ii. Graphic Presentations

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Have visual appeal that may cause readers to analyze the data more closely.

1. Bar graph  Used to represent frequency distribution with nominal data or some type of ordinal data.  May be horizontal or vertical. 2. Histogram  Uses bars to represent the frequency distribution of a variable that is measured at the ordinal, interval, or ratio level.  Has X and Y axis. 3. Frequency polygon  Graph that uses dots connected with straight lines to represent the frequency distribution or ordinal, interval, or ratio data.  The class intervals are on the horizontal axis, the frequency on the vertical axis. iii.

Percentages  Represents the proportion of a subgroup to a total group.  Minimum number for the computation of percentages should be atleast 20.

b. Measures of Central Tendency  Statistics that describe the average, typical, or most common value for a group of data. i. Mode   

Category or value that occurs most often in a set of data under consideration. If the data gathered are nominal this is referred to as “nominal class”. Maybe unimodal, bimodal, multimodal.

ii. Median  Middle score or value in a group of data.  If number of values is even, the midpoint between the two middle values is the median. If the number of values is uneven, then the median is the middle value. iii. Mean  The average sum of a set of values found by adding all values and dividing by the total number of values.  X = Total of all values or number of values.

c. Measures of Variability  Measures how spread out values are in a distribution of values. i. Range  

Distance between the highest and lowest value in a group of values or scores. Eg. Highest 60, lowest 40, the range is 20.

ii. Percentile  A datum point below which lies a certain percentage of the values in a frequency distribution.  Eg. NCEE Score, Weight for Age charts in Pediatrics. iii. Standard Deviation  Most widely used when interval or ratio data are obtained.  Indicates the average deviation or variation of all values in a set of values from the mean values of those data. iv. Variance  Standard deviation squared. v. Z-score d. Measures of Relationships  Measures the correlation between variables. i. Correlation Coefficients  Pairing the value of each subjects on one variable with the value on another variable.  Eg. Athletic ability vs. IQ level. Anxiety level vs. pulse rates. ii. Scatter Plots  Scatter diagram or scattergram  Graphic representation of the relationship between two variables (X and Y axis). 16. Interpret the findings a. Made in light of the study hypothesis or research question and the theoretical framework. 17. Communicate the findings

a. The final step in the research process and yet the most important one for nursing. No matter how significant the findings may be, they are of little value to the nursing profession if not communicated to other collegues. b. Best method to reach a large number of nurses is the publication in research journals. c. May also be done through oral presentations. Poster sessions. Books. Research seminars.