Chapter 1: Discovering the World of Nursing Research Test Bank, Exams of Nursing

Download Chapter 1: Discovering the World of Nursing Research Test Bank and more Exams Nursing in PDF only on Docsity! | MULTIPLE CHOICE 1. Nurses with a bachelor’s degree in nursing can participate in the implementation of evidence- based protocols in practice. This means that the BSN nurse a. Develops evidence-based guidelines b. Designs research studies, on which protocols may be based c. Evaluates and revises evidence-based protocols d. Contributes practice wisdom when applying protocols in patient settings e. Mentors PhD researchers in the clinical setting during protocol development ANS: D Nurses with a BSN degree have knowledge of the research process and skills in reading and critically appraising studies. They assist with the implementation of evidence-based guidelines, protocols, algorithms, and policies in practice. This implies that nurses provide their point of view, from the clinician’s vantage, when new protocols are being put into practice, and continue to provide feedback, regarding the positive and negative aspects of those protocols. DIF: Cognitive Level: Analysis REF: Page 4 Research is designed to test the idea of providing companion dogs to elders in a major hospital, in order to determine the effect upon the elders’ level of orientation. (The dogs’ level of orientation will not be a focus of the research.) This type of study can do which of the following? a. Control b. Describe ec. Explain d. Predict ANS: A Control is the ability to manipulate the situation to produce the desired outcome. Description involves identifying and understanding the nature of nursing phenomena and, sometimes, the relationships among them. Explanation clarifies the relationships among phenomena and identifies the reasons why certain events occur. The ability to estimate the probability of a specific outcome in a given situation in nursing practice is known as prediction. The researcher’s focus is on predicting what is likely. DIF: Cognitive Level: Application REF: Page 13 A researcher wants to find out whether children with autism who are hospitalized on a pediatric ward will require more hours of nursing care than average children when the parents or caregivers are not present. What type of research outcome does this provide? a. Control b. Description ec. Explantation d. Prediction | 6. ANS: D Control is the ability to manipulate the situation to produce the desired outcome. Description involves identifying and understanding the nature of nursing phenomena and, sometimes, the relationships among them. Explanation clarifies the relationships among phenomena and identifies the reasons why certain events occur. The ability to estimate the probability of a specific outcome in a given situation in nursing practice is known as prediction. The researcher’s focus is on predicting what is likely. DIF: Cognitive Level: Application REF: Page 16 A researcher who desires to determine the cause-and-effect relationship between requiring that all children under the age of 8 will ride in special care harnesses and the subsequent rate of children’s spinal cord injury will consequently utilize which form of nursing research? a. Descriptive research b. Outcomes research ¢. Qualitative research d. Quantitative research ANS: D Quantitative research, the most frequently used method, is a formal, objective, systematic methodology to describe variables, test relationships, and examine cause-and-effect interactions. Quantitative research includes experimental research, which is the method for testing cause-and-effect relationships between and among specific variables. Qualitative research methods are used for explaining meanings and describing experiences in context. Descriptive research involves identifying and understanding the nature of phenomena and, sometimes, the relationships among them. Outcomes research examines the end result of care in huge populations, most often retrospectively, using a database. DIF: Cognitive Level: Application REF: Page 3 Despite the presence of an intraventricular drain, the intracranial pressure of an ICU neuro patient remains increased. The nurse recalibrates the machine, makes sure the monitor is on the same level as the drain, checks all connections, and then notifies the physician, who comes to the unit and inserts a new drain. What type of reasoning prompts the nurse to recalibrate, ensure proper placement, and check connections? a. Abstract reasoning b. Concrete thinking c. Logistic reasoning d. Reality testing ANS: C Logistic reasoning is used to break a whole into parts that can be carefully examined. Concrete thinking is oriented toward and limited by tangible things or by events that are observed and experienced in reality. Abstract reasoning is oriented toward the development of an idea without application to, or association with, a particular instance. Reality testing is used to validate what is observed in the empirical world. DIF: Cognitive Level: Application REF: Page 6 A nurse with considerable clinical expertise develops a policy for managing agitated patients in the emergency department. The resultant policy emanates from Because reality can vary with perception, and because the facts can be relative, nurses do not impose their views on patients. Rather, nurses help patients seek health from within the patients’ worldviews. This is a critical component of evidence-based practice. The nurse’s individual wisdom is based upon the nurse’s actual practice, over time. DIF: Cognitive Level: Analysis REF: Page 11 In nursing mentorship, as opposed to authority, the novice nurse fills which of the following roles? (Select all that apply.) a. Counselor b. Student c. Sponsor d. Disciplinarian e. Teacher f. Questioner g. Apprentice ANS: B, F, G An intense form of role-modeling is mentorship. In a mentorship, the expert nurse—or mentor —-serves as a teacher, sponsor, guide, exemplar, and counselor for the novice nurse. Over time, the relationship morphs into a colleague relationship in which both mentor and mentee share information and exchange ideas in a cooperative spirit. DIF: Cognitive Level: Analysis REF: Page 10 How are dialectic reasoning and holistic practice similar? (Select all that apply.) They are both based on intuition, not facts. They both consider the whole, rather than one part of the picture. Dialectic reasoning emphasizes truth and holistic practice accepts untruth. They both ignore the main idea or diagnosis and concentrate on different entities. They both honor context and the interactions among ideas and people. They both break down concepts into understandable parts. Dialectic reasoning can be used to validate a study design, whereas holistic practice does not contribute to research. emeasge ANS: B, E, F Dialectic reasoning involves looking at situations in a holistic way. A dialectic thinker believes that the whole is greater than the sum of the parts and that the whole organizes the parts. DIF: Cognitive Level: Synthesis REF: Page 6 Which of the following statements synopsize the relationship between research and practice? (Select all that apply.) a. Practice limits nursing research to issues that are client-centered. b. Research participation helps nurses to meet re-licensure requirements for evidence- based practice. c. Research knowledge, combined with experiential wisdom, constitutes the base for d. Research emphasizes what can be done in practice, rather than what has been done in practice. | 6. e. Practice does not affect research: research affects practice. f. Practice provides inspiration for meaningful nursing research. g. Practice helps a nurse differentiate between rigorous, well-designed research and useless research. ANS: C, F Evidence-based practice in nursing requires a strong body of research knowledge that nurses must synthesize and use to promote quality care for their patients. Research is a way to test reality and generate the best evidence to guide nursing practice. Practice problems inspire meaningful clinical research. Evidence-based practice evolves from the integration of the best research evidence with clinical expertise and patient needs and values. DIF: Cognitive Level: Evaluation REF: Page 3 Realistically, what might be done in a situation in which a nurse does not know the appropriate way to use a new ultrasonic bladder scanner (a non-invasive, painless procedure) but has an order to scan? (Select all that apply.) Refuse to carry out the order. Ask a co-worker who has used the equipment for help. Access the instructions on the company’s web site. Try to scan the bladder and see if the value obtained makes sense. Notify the manager that a formal inservice is needed. Read the instruction booklet. mepoge ANS: B, C, D, F Trial and error is an approach with unknown outcomes that is used in a situation of uncertainty, when other sources of knowledge are unavailable. The profession evolved through a great deal of trial and error before knowledge of effective practices was codified in textbooks and journals. The trial-and-error way of acquiring knowledge can be time- consuming, because multiple interventions might be implemented before one is found to be effective. DIF: Cognitive Level: Application REF: Page 9 Which of the following sources generates new knowledge for nurses? (Select all that apply.) Editorials in nursing journals Qualitative research Adhering to hospital policies Research that tests a new sling scale for safety of patients and nurses Quantitative research Comparison of two different insulin dosing protocols ANS: B, D,E Nursing research is defined as a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences the delivery of evidence-based nursing. Nurses use a variety of research methods to test their reality and generate nursing knowledge, including quantitative research, qualitative research, outcomes research, and intervention research. mepoege DIF: Cognitive Level: Application REF: Page 2 | 8. Which of these are suitable focuses for a nursing research study? (Select all that apply.) a. How clinical nurse specialists contribute to patient outcomes b. Which elements of a nursing school curriculum remain useful for current practice after students graduate c. Whether requiring nurse managers to supervise more than four units is cost- effective d. What styles of physician teaching produce better diabetic compliance Whether patients with exacerbation of CHF are best managed with inpatient treatment or with outpatient treatment f. What the personality characteristics are of nurses in various inpatient areas ANS: A,B,C, F Many nurses hold the view that nursing research should focus on acquiring knowledge that can be directly implemented in clinical practice, which is sometimes referred to as applied research or practical research. However, another view is that nursing research should include studies of nursing education, nursing administration, health services, and nurses’ characteristics and roles, as well as clinical situations, education, practice, and service. Research is needed to identify teaching-learning strategies to promote nurses’ management of practice. Thus, nurse researchers are involved in building a science for nursing education so that the teaching-learning strategies used are evidence-based. Nurse administrators are involved in research to enhance nursing leadership and the delivery of quality, cost-effective patient care. DIF: Cognitive Level: Application REF: Page | 9. What might a nursing research study address? (Select all that apply.) a. Whether having a nurse practitioner manage care is effective in decreasing length- of-stay b. Whether students learn better in an online course format or by actual lecture attendance c. Comparing four types of leadership used by nurse managers and comparing their employees’ job satisfaction, absenteeism rates, and error rates d. Different common surgical procedures and the mortality rate of each e. Learning specific things about the liver failure patient that can be applied to nursing practice ANS: A, B,C,E Many nurses hold the view that nursing research should focus on acquiring knowledge that can be directly implemented in clinical practice, which is sometimes referred to as applied research or practical research. However, another view is that nursing research should include studies of nursing education, nursing administration, health services, and nurses’ characteristics and roles, as well as clinical situations, education, practice, and service. Research is needed to identify teaching-learning strategies to promote nurses’ management of practice. Thus, nurse researchers are involved in building a science for nursing education so that the teaching-learning strategies used are evidence-based. Nurse administrators are involved in research to enhance nursing leadership and the delivery of quality, cost-effective patient care. DIF: Cognitive Level: Application REF: Page | | 6. Quantitative research formal, objective, systematic process in which numerical data are used to obtain information about the world. Qualitative research is also systematic, but it is a holistic, interactive, and subjective approach to describe life experiences and identify their meaning. Both types of research have a purpose statement and can use a survey instrument; however, neither depends on surveys for data. Both can contain suggestions for practice. Qualitative research results are presented as a narrative, without statistical analysis. Outcomes research examines the results of care and measures the changes in health status of patients. Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting. DIF: Cognitive Level: Application REF: Page 23 A newly employed nurse administrator wants to know more about the employees on the units the administrator supervises. The manager accesses the managerial database and gathers data about all of the current employees on the unit, including work shift, number of years employed, age, gender, educational preparation, certifications, work history, and professional accomplishments. What type of research is this? a. Descriptive research b. Correlational research ¢. Quasi-experimental research d. Experimental research ANS: A The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This is a research study, even though it depends upon existent data, collected by another manager. Its purpose is to describe the employees. DIF: Cognitive Level: Analysis REF: Page 26 A human resources employee performs research focusing on the professional lifespan within the institution of nurses, and trying to discover whether their choice of work area is connected with the number of years they work in the institution. What type of research is this? a. Descriptive research b. Correlational research ¢. Quasi-experimental research d. Experimental research ANS: B The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This study investigates the connection or association between work area and length of time worked. DIF: Cognitive Level: Analysis REF: Page 26 | 8. 10. In an attempt to whether selection of a same-gender psychiatrist leads to better mental health outcomes, clients newly referred for mental health services are told they may choose their mental health physicians. Later, measures of mental health are performed. What type of research is this? a. Descriptive research b. Correlational research ¢. Quasi-experimental research d. Experimental research ANS: C The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This research study is designed to test an intervention but does not include random assignment. DIF: Cognitive Level: Analysis REF: Page 26 In a rehabilitation unit, patients are randomly assigned to high fiber diets versus ordinary fiber diets, in order to measure the effect on constipation. What type of research is this? a. Descriptive research b. Correlational research ¢. Quasi-experimental research d. Experimental research ANS: D The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks either a control group or random assignment, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment. DIF: Cognitive Level: Analysis REF: Page 26 A researcher uses interviews with two or three open-ended questions to study women in the staging phase of breast cancer treatment, in order to understand their experiences and the meanings they attribute to those experiences. What type of research is this? a. Phenomenologic research b. Grounded theory research c. Ethnographic research d. Historicism ANS: A | 12. Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest. DIF: Cognitive Level: Analysis REF: Page 27 A researcher uses interviews with eight open-ended questions to study women in a new staging phase of breast cancer treatment, which includes serial biopsies and necessitates weekly closed biopsy, in order to understand more about social factors that impinge upon their experience. What type of research is this? a. Phenomenologic research b. Grounded theory research c. Ethnographic research d. Historicism ANS: B Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest. DIF: Cognitive Level: Analysis REF: Page 27 A researcher conducts many interviews, over a one-year period, with women in the treatment phase of breast cancer, all of whom are attending a breast cancer support group, in order to understand what happens in the support group, how the members are affected by membership, and how the members contribute to the group. The researcher herself is also in treatment for breast cancer and is a member of the group. What type of research is this? a. Phenomenologic research b. Grounded theory research c. Ethnographic research | e. Qualitative research does not contain or imply a research question. f. Qualitative research is ill-defined and vague. g. Qualitative research has no practical use. ANS: B, C Qualitative researchers use observations, interviews, and focus groups to gather data. The interactions are guided but not controlled in the way that quantitative data collection is controlled. For example, the researcher may ask subjects to share their experiences of powerlessness in the health care system. Qualitative researchers would begin interpreting the subjective data during data collection, recognizing that their interpretation is influenced by their own perceptions and beliefs. Qualitative data take the form of words and are analyzed according to the qualitative approach that is being used. The intent of the analysis is to organize the data into a meaningful, individualized interpretation, framework, or theory that describes the phenomenon studied. The findings from a qualitative study are unique to that study, and it is not the researcher’s intent to generalize the findings to a larger population. Qualitative researchers are encouraged to question generalizations and to interpret meaning based on individual study participants’ perceptions and realities. DIF: Cognitive Level: Analysis REF: Page 25 4. Which is true of quantitative research? (Select all that apply.) It addresses human responses by measuring or counting them. It presents information by clustering it or counting it. It yields a data set that can be analyzed by statistics. It operates systematically. It states or implies a research question. It operates in a concrete realm. It can always be generalized. ANS: A,B, C, D, E, F The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. Quantitative research requires the use of structured interviews, questionnaires, or observations, scales, or physiological measures that generate numerical data. Statistical analyses are conducted to reduce and organize data, describe variables, examine relationships, and determine differences among groups. Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized. Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn. Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples. Bmeas ge DIF: Cognitive Level: Analysis REF: Page 24 5. Ethnographic research might focus upon which of the following topics? (Select all that apply.) Bacterial cultures Cultural beliefs of the ancient Romans How children in Alaska play during the winter Twenty-year abstinence members of Alcoholics Anonymous The mentoring process in a labor-delivery unit Conversational Spanish mepoge | 6. ANS: C, D,E Ethnographic research was developed by anthropologists to investigate cultures through an in- depth study of the members of the culture. The culture may be an actual culture, a loosely connected group of people who share a common characteristic, or a work or recreational group. The ethnographic research process is the systematic collection, description, and analysis of data to develop a description of cultural behavior. The researcher (ethnographer) actually lives in or becomes a part of the cultural setting to gather the data. DIF: Cognitive Level: Analysis REF: Page 24 A researcher is operating from the point of view of logical positivism. Which of the following research methods would the logical positivist use? (Select all that apply.) Grounded theory research Correlational research Historical research Quasi-experimental research Quantitative descriptive research Exploratory descriptive qualitative research ANS: B, D, E The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. The quantitative research methods are classified into four categories: (1) descriptive, (2) correlational, (3) quasi-experimental, and (4) experimental. The qualitative research methods included in this textbook are (1) phenomenological research, (2) grounded theory research, (3) ethnographic research, (4) exploratory-descriptive qualitative research, and (5) historical research. mepoege DIF: Cognitive Level: Analysis REF: Page 27 Which of the follow potential studies would fall within the Agency for Healthcare Research and Quality’s future research goals? (Select all that apply.) a. Performing a synthesis of research evidence regarding skin-to-skin contact of mothers and newborns b. Enacting a quantitative research project measuring bacterial count on nurses’ uniforms at the beginning and the end of 12-hour work shifts c. Performing a qualitative research project to explain sources of student nurses’ stress d. Enacting a public education Internet commercial encouraging smokers to read the statistics regarding sequelae of cigarette smoking e. Trialing clean-and-sober support groups that are based in community shopping centers ANS: A, D,E | The Agency for Healthcare Research and Quality partners with public and private sectors to improve the quality and safety of patient care by promoting the use of the best research evidence available in practice. Its three future goals are focused on the following: “Safety and quality: Reduce the risk of harm by promoting delivery of the best possible health care; Effectiveness: Improve healthcare outcomes by encouraging the use of evidence to make informed healthcare decisions; and Efficiency: Transform research into practice to facilitate wider access to effective healthcare services and reduce unnecessary costs.” DIF: Cognitive Level: Analysis REF: Page 22 8. Early nursing research by Nightingale focused on improving patient outcomes. What were the principal topics for the next wave of nursing research, in the first half of the 20th century? (Select all that apply.) a. Evidence-based practice Primary nursing’s advantages in hospitals Nursing education, as opposed to nurse training The nursing process and nursing diagnosis Staffing, patient assignments, and type of care ANS: C, E From 1900 to 1950, research activities in nursing were limited, but a few studies advanced nursing education. Based on recommendations of the Goldmark Report, more schools of nursing were established in university settings. A research trend that started in the 1940s and continued in the 1950s focused on the organization and delivery of nursing services. Studies were conducted on the numbers and kinds of nursing personnel, staffing patterns, patient classification systems, patient and nurse satisfaction, and unit arrangement. Types of care such as comprehensive care, home care, and progressive patient care were evaluated. In the 1970s, the nursing process became the focus of many studies, with the investigations of assessment techniques, nursing diagnoses classification, goal-setting methods, and specific nursing interventions. Primary nursing care, which involves the delivery of patient care predominantly by registered nurses (RNs), was the trend for the 1970s. The vision for nursing research in the twenty-first century includes conducting quality studies using a variety of methodologies, synthesizing the study findings into the best research evidence, and using this research evidence to guide practice. The focus on EBP has become stronger over the last decade. eaes DIF: Cognitive Level: Synthesis REF: Page 19 9. Which of the following is true of the Cochrane Center and Cochrane Collaboration, begun in the 1970s by Professor Archie Cochrane? (Select all that apply.) a. It was originally called the Walter Reed Army Institute of Research. It developed the original master’s degrees in nursing practice. It serves as a repository for evidence-based practice guidelines. It was the first association to publish a nursing research journal. It is the online library resource for research literature reviews. ANS: C, E Cochrane advocated the provision of health care based on research to improve the quality of care and patient outcomes. To facilitate the use of research evidence in practice, the Cochrane Center was established in 1992 and the Cochrane Collaboration in 1993. The Cochrane Collaboration and Library house numerous resources to promote EBP, such as systematic reviews of research and evidence-based guidelines for practice. eae | Control occurs when the researcher imposes “tules” to decrease the possibility of error and thus increases the probability that the study’s findings are an accurate reflection of reality. Descriptive and correlational studies are usually conducted with minimal control of the study design, because subjects are examined as they exist. In experimental research, the independent and dependent variables are highly controlled, the researcher exerts high control over the planning and implementation of the study, and often these studies are conducted in a laboratory setting on animals or objects. If a research study randomly assigns subjects to two different groups, applies an intervention to one of the groups, and then measures both groups and compares them, it is experimental design. DIF: Cognitive Level: Analysis REF: Page 36 Use the following information to answer Questions 3 through 7: A research study contains the following in its Introduction section: “This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia .Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. The claim that massage increases total hours of sleep has been inadequately researched. ...... Does massage increase the total number of hours of daily sleep?...... It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day. The study’s causational explanation was based on the physiologic matrix of McCarthy, which includes effects of endorphins on sleep, learning ability, pain, digestive function, and cardiac output It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed.” 3. What is the research problem? a. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia. b. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day. c. It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed. d. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. ANS: D A research problem is an area of concern or phenomenon of interest about which there is a gap in the knowledge base needed for nursing practice. The problem identifies an area of concern or phenomenon of interest for a particular population and often indicates the concepts to be studied. DIF: Cognitive Level: Analysis REF: Page 39 4. What is the research framework? | 6. a. It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed. b. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. ¢. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day. d. The study’s causational explanation was based on the physiologic matrix of McCarthy, which includes effects of endorphins on sleep, learning ability, pain, digestive function, and cardiac output. ANS: D A framework is the abstract, logical structure of meaning that will guide the development of a study and enable the researcher to link the findings to the body of nursing knowledge. In quantitative research, the framework is often a testable midrange theory that has been developed in nursing or in another discipline, such as psychology, physiology, or sociology. DIF: Cognitive Level: Analysis REF: Page 41 What is the research assumption? a. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia. b. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day. c. It was taken as established fact that massage is pleasant, that research subjects getting fewer than 7 hours of sleep per night were sleep-deprived, and that endorphins mediated the changes observed. d. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. The claim that massage increases total hours of sleep has been inadequately researched. ANS: C Assumptions are statements that are taken for granted or that are considered true, even though they have not been scientifically tested. Assumptions are often embedded (unrecognized) in thinking and behavior, and uncovering them requires introspection. Sources of assumptions include universally accepted truths, theories, previous research, and nursing practice. DIF: Cognitive Level: Analysis REF: Page 41 What is the research purpose? a. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia. b. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day. c. Presumably by increasing endorphin levels, massage seems to provide an | immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. The claim that massage increases total hours of sleep has been inadequately researched. d. The study’s causational explanation was based on the physiologic matrix of McCarthy, which includes effects of endorphins on sleep, learning ability, pain, digestive function, and cardiac output. ANS: A The research purpose is generated from the problem and identifies the specific focus or aim of the study. The focus of the study might be to identify, describe, explain, or predict a solution to a situation. The purpose often indicates the type of study to be conducted (descriptive, correlational, quasi-experimental, or experimental) and usually includes the variables, population, and setting for the study. DIF: Cognitive Level: Analysis REF: Page 41 7. What is the research question? a. This study was undertaken to explore the effect of massage on total hours of sleep per 24-hour day, in persons averaging fewer than 7 hours of sleep per night, attributable to insomnia. b. It was posited that provision of daily late-morning massage would affect total hours of sleep per 24-hour day. c. Does massage increase the total number of hours of daily sleep? d. Presumably by increasing endorphin levels, massage seems to provide an immediate relaxation and an ability to sleep immediately following the session, but it is unclear whether these benefits actually extend to total sleep, despite anecdotal support. ANS: C Research objectives, questions, and hypotheses bridge the gap between the more abstractly stated research problem and purpose and the study design and plan for data collection and analysis. Objectives, questions, and hypotheses are narrower in focus than the research purpose and often (1) specify only one or two research variables, (2) identify the relationship between the variables, and (3) indicate the population to be studied. A research question is a concise, interrogative statement that is worded in the present tense and includes one or more variables (or concepts). DIF: Cognitive Level: Analysis REF: Page 39 8. A researcher conducting a study to examine linkages among age, gender, driver’s license suspension, and zip code poverty, educational level, and income, sourced from the records of the State Department of Motor Vehicles, is using which of the following types of research? a. Descriptive research b. Correlational research c. Problem solving d. Triangulation ANS: B | 16. chosen from that population. d. A population is usually larger than a sample. ANS: D The population is all the elements (individuals, objects, or substances) that meet certain criteria for inclusion in a given universe. The researcher must determine which population is accessible and can be best represented by the study sample. A sample is a subset of the population that is selected for a particular study. Being a subset, the sample is either smaller than the population or, very occasionally, equal in size to it; it cannot be larger. DIF: Cognitive Level: Analysis REF: Page 44 What does a quantitative research instrument measure? a. The level of measurement b. A statistical test c. Itself, for validity d. A study variable ANS: D When conducting a quantitative study, the researcher attempts to use the most precise instruments available to measure the study variables. DIF: Cognitive Level: Comprehension REF: Page 37 Which is the highest form of measurement? a. Interval b. Nominal ec. Ordinal d. Ratio ANS: D An instrument is selected to measure a specific variable in a study. Data generated with an instrument are at the nominal, ordinal, interval, or ratio level of measurement. The level of measurement, with nominal being the lowest form of measurement and ratio being the highest, determines the type of statistical analyses that you can perform on the data. DIF: Cognitive Level: Comprehension REF: Page 45 The researcher believes that adults can remember details about the first time they were taken on a camping trip, as 7-year-olds, and that the experiences of a first camping trip are life- altering. What is a research term for these beliefs? a. Applications b. Assumptions c. Limitations d. Variables ANS: B | 17. 18. Assumptions are statements that are taken for granted or are considered true, even though they have not been scientifically tested. Assumptions are often embedded (unrecognized) in thinking and behavior, and uncovering them requires introspection. Sources of assumptions include universally accepted truths (e.g., all humans are rational beings), theories, previous research, and nursing practice. In studies, assumptions are embedded in the philosophical base of the framework, study design, and interpretation of findings. Theories and instruments are developed on the basis of assumptions that the researcher may or may not recognize. These assumptions influence the development and implementation of the research process. Since researchers’ assumptions influence the logic of the study, their recognition leads to more rigorous study development. DIF: Cognitive Level: Application REF: Page 41 Which of the following items is different when comparing probability sampling and nonprobability sampling? The type of descriptive statistics applied to the sample The size of the sample The relative chance of being selected as a study participant Whether or not the findings can be generalized S aes ANS: C Sampling is a process of selecting subjects, events, behaviors, or elements for participation in a study. Random sampling methods usually provide a sample that is representative of a population, because each member of the population has a probability greater than zero of being selected for a study. This is not true of nonrandom sampling methods, in which not every member of the population has an opportunity for selection to the sample. Descriptive statistics applied to the sample are identical. The size of the sample doesn’t vary depending on type of sample chosen. Generalization of the findings is possible under either condition. DIF: Cognitive Level: Analysis REF: Page 37 A correlational researcher reports that the strength of the relationship between X and Y is near 0 (r= 10.03). What does this mean, relative to prediction? a. If X is present, Y is only somewhat likely to be present. b. If Y is absent, X will also be absent. c. If X is present, there is no guarantee at all that Y will be present. d. If Y is absent, X will always be present. ANS: C Correlational research examines a linear relationship between two or more variables and determines the type (positive or negative) and degree (strength) of the relationship. The strength of a relationship varies from —1 (perfect negative correlation) to +1 (perfect positive correlation), with 0 indicating no relationship. The positive relationship indicates that the variables vary together—that is, the two variables either increase or decrease together. The negative or inverse relationship indicates that the variables vary in opposite directions; thus, as one variable increases, the other variable decreases. DIF: Cognitive Level: Application REF: Page 49 MULTIPLE RESPONSE | 1. How is a researcher who exemplifies rigor similar to the best technical nurse on her shift in a cardiovascular intensive care unit? (Select all that apply.) a. They are both rigid and inflexible in details such as timelines and doing things the way they want to do them. They are both aggressive in acquiring and recording data. They both strive for excellence. They both communicate well with others. They both are disciplined in the way they conduct their jobs. They both are passionate about accuracy and attending to details. ANS: C, E, F Rigor is striving for excellence in research and involves discipline, scrupulous adherence to detail, and strict accuracy. A rigorous quantitative researcher constantly strives for more precise measurement methods, structured treatment, representative samples, and tightly controlled study designs. Characteristics valued in these researchers include critical examination of reasoning and attention to precision. meaos DIF: Cognitive Level: Synthesis REF: Page 49 A researcher undertakes a research study on the danger of bears in Yosemite Valley. What determines the researcher’s selection of a research design? (Select all that apply.) The mentor the researcher chooses to support the study Whether or not the researcher intends to generalize the findings The researcher’s expertise and comfort with the research process c! Whether the National Park Systems are funding the research The study purpose and its anticipated outcomes The body of research already present on bear danger mepoege ANS: B, C, E, F A research design is a blueprint for maximizing control over factors that could interfere with a study’s desired outcome. The choice of research design depends on the researcher’s expertise, the problem and purpose for the study, and the desire to generalize the findings. This means that other research in the area must be taken into consideration as well. DIF: Cognitive Level: Application REF: Page 43 A researcher performs a study of how many nurses are assigned to a nursing floor on the basis of total square feet of the unit, correlating this with injury, fatigue, patient assignment, patient acuity, and length of employment. Which of the following are true regarding the type of quantitative data analysis used by the researcher? (Select all that apply.) a. The type of quantitative data analysis guides the study objectives and hypotheses. b. The type of quantitative data analysis is determined by the level of measurement of data. The type of quantitative data analysis determines the research design. d. The type of quantitative data analysis should include some sort of numerical analysis. e. The kind of data that will be collected is determined by the type of analysis chosen. ° ANS: B,D | d. To prove a theory e. To disprove a hypothesis f. To determine the strength of the relationship between the independent variable and the dependent variable ANS: B, F A research design is a blueprint for maximizing control over factors that could interfere with a study’s desired outcome. The choice of research design depends on the researcher’s expertise, the problem and purpose for the study, and the desire to generalize the findings. This means that other research in the area must be taken into consideration as well. DIF: Cognitive Level: Application REF: Page 43 The director of a major hospital complex conducts a study to discover the types of critical incidents that have occurred in this hospital and its sister hospital over the past five years. She makes a list of every critical incident that has occurred over this period. Choose the true statements about this list. (Select all that apply.) a. The list is the dependent variable. b. The list represents the hospital director’s assumptions. c. The list is an extraneous variable. d. The list represents the sample. e. If the two hospitals have been in operation only five years, the list represents the population. ANS: A The population is all the elements (individuals, objects, or substances) that meet certain criteria for inclusion in a given universe. The researcher must determine which population is accessible and can be best represented by the study sample. A sample is a subset of the population that is selected for a particular study. Being a subset, the sample is either smaller than the population or, very occasionally, equal in size to it; it cannot be larger. DIF: Cognitive Level: Application REF: Page Chapter 4: Introduction to Qualitative Research Test Bank Se MULTIPLE CHOICE 1. What does the “grounded” in grounded theory mean? Small pieces of data are “ground up” in the analysis process. The theory that emerges is “grounded” in real-world data. No theory is groundless. All data must be “on the ground” and written out fully. Be rF ANS: B Grounded theory research is an inductive research technique developed by Glaser and Strauss through their study of the experience of dying. The method’s name means the findings are grounded in the concrete world as experienced by the participants and are interpreted at a more abstract theoretical level. | DIF: Cognitive Level: Analysis REF: Page 62 2. An ethnographic researcher plans to study organizations and how they promote or suppress individual effort. What type of ethnography will the researcher select? a. Classical ethnography b. Systematic ethnography c. Interpretive ethnography d. Critical ethnography ANS: B Four schools of thought within ethnography have emerged from different philosophical , systematic, interpretive, and critical ethnography. 1 ethnography seeks to provide a comprehensive holistic description of a culture. In contrast, systematic ethnography explores and describes the structures of the culture with an increased focus on groups, patterns of social interaction, organizations, and institutions. Interpretive ethnography has as its goal understanding the values and thinking that result in the behaviors and symbols of the people being studied. Critical ethnography has a political purpose of relieving oppression and empowering a group of people to take action on their own behalf. It is not ethnography’s focus to construct theories. DIF: Cognitive Level: Application REF: Page 64 3. Why is the Sunshine Model of ethnonursing more specific to health than other ethnography models? a. It was created by a nurse. b. It values the point of view of the individual. c. It focuses on factors that impact health. d. It explains how various levels of culture interact. ANS: C Madeline Leininger (1970) brought ethnography into nursing science by writing the first book linking nursing with anthropology. Leininger was first a nurse and then earned her doctoral degree in anthropology. In the 1950s, she began developing a framework for culture care that became the Sunshine Model (Clarke, McFarland, Andrews, & Leininger, 2009). The Sunshine Model identifies factors that affect health and illness, such as religion, income, kinship, education, values, and beliefs. Chapter 7 contains more information about the Theory of Culture Care developed by Leininger, so this section focuses on the qualitative method that she developed to be consistent with ethnonursing. Multiple levels of factors affect the culture and, consequently, the care expressions of the people. A person who is a member of the only Vietnamese family in a small rural community in Georgia may have different care practices than if he or she were living in New York City in a predominantly Vietnamese community. DIF: Cognitive Level: Analysis REF: Page 65 4. A researcher investigates the fact that women with chronic pain are more apt to be treated for depression than are men with chronic pain. Which qualitative strategy will most likely be used to study this topic? a. Grounded theory b. Exploratory-descriptive qualitative research c. Phenomenology d. Critical research | ANS: D Critical ethnography has a political purpose of relieving oppression and empowering a group of people to take action on their own behalf. DIF: Cognitive Level: Analysis REF: Page 64 MULTIPLE RESPONSE 1. A research study about holiday celebrations is based on a philosophy or philosophical perspective. In the analysis, the authors state that they reflected upon the data for several weeks, reading and re-reading interviews, in order to capture their meaning. Aside from descriptive statistics addressing the sample, the results are all presented in narrative form. Which of the following statements are true? (Select all that apply.) The philosophy for the study is logical positivism. The sample size was decided upon using power analysis. In this method, meaning emerges from the data. The data analysis process seems to be inductive. The method was shaped by the authors’ philosophical perspectives. eae re ANS: C, D,E Quantitative studies are based primarily on the philosophy of logical positivism that values logic, empirical data, and tightly controlled methods. Power analysis is a quantitative method of setting the sample size. Inductive thinking involves perceptually putting insights and pieces of information together and identifying abstract themes or working from the bottom up. From this inductive process, meanings emerge. In qualitative research, the philosophy directs the research questions and the collection and interpretation of the data. DIF: Cognitive Level: Application REF: Page 57 Which statements best describes the differences between Heideggerian and Husserlian phenomenology? (Select all that apply.) a. Husserl proposed that the researcher could identify and set aside his or her own private attitudes and opinions before data analysis. b. Heidegger postulated that a person interacted with the world only through his or her physical body. Heideggerians believe that the past has no influence on present thought. d. Heideggerian phenomenologists posit that the person is situated in a specific context and time that shape his or her experiences, paradoxically freeing and constraining the person’s ability to establish meanings through language, culture, history, purposes, and values. e. Husserl developed his ideas as a method for understanding and avoiding conflict between psychology and the basic sciences. ° ANS: A,B, D,E | Ethnographic research provides a framework for studying cultures. The word ethnography is derived by combining the Greek roots of “ethno” (folk or people) and “graphy” (picture or portrait). Ethnographies are the written reports of a culture from the perspectives of insiders. These reports were initially the products of anthropologists who studied primitive, foreign, or remote cultures. Now, however, a number of other disciplines, including social psychology, sociology, political science, education, and nursing, promote cultural research. Anthropologists seek to understand people: their ways of living, believing, acquiring information, transforming knowledge, and socializing the next generation. Studying a culture begins with the philosophical values of respecting, appreciating, and seeking to preserve the values and ways of life of the culture. The philosophical bases of ethnography are naturalism and respect for others. The purpose of anthropological research is to describe a culture and explore “the meanings of social actions within cultures.” DIF: Cognitive Level: Synthesis REF: Page 63 8. Which of the following are the general purposes of phenomenological research? (Select all that apply.) a. To generate theory To describe the lived experience To observe and document interactions within an existent culture To determine the meaning that an experience has for the individual To describe the single reality expressed by a group of participants ANS: B, D The purpose of phenomenological research is to describe experiences (or phenomena) as they are lived—in phenomenological terms, to capture the “lived experience” of study participants. During the process of data collection, the meaning the participants attach to their experience is revealed. All phenomenologists agree that there is not a single reality: each individual has his or her own reality. While phenomenology can be used indirectly in the development of a theory, grounded theory is the method intended to generate theory. Observing and documenting interactions within a culture describes ethnographic research. eaes DIF: Cognitive Level: Comprehension REF: Page 60 9. Acertain qualitative method takes the position that there is no single reality. Because of this, the reality experienced by each participant is unique. Because experience is subjective, the experienced reality is reality. The method does not perform reality checks in order to determine whether a participant’s story is “true” or not. What is this qualitative method? (Select all that apply.) a. Husserlian phenomenology b. Ethnography c. Historicism d. Heideggerian phenomenology e. Grounded theory ANS: A,D The purpose of phenomenological research is to describe experiences (or phenomena) as they are lived—in phenomenological terms, to capture the “lived experience” of study participants. All phenomenologists agree that there is not a single reality; each individual has his or her own reality. Reality is considered subjective, and as a result, unique to the individual. | 10. DIF: Cognitive Level: Analysis REF: Page 60 What are the general truths of symbolic interaction theory, as utilized in grounded theory research? (Select all that apply.) a. Perceptions of one’s interactions with others shape one’s self-view. Perceptions of one’s interactions with others shape subsequent interactions. A person is “embodied” and experiences the world within that body. The culture determines behavior; the persons comprise the culture. Persons within a social structure share symbols that have meaning for them. ANS: A,B, E Heideggerian phenomenologists believe that the person is a self within a body, which is referred to as a person being embodied. Symbolic interaction theory explores how perceptions of interactions with others shape one’s view of self and subsequent interactions. In social life, groups share meanings. They communicate these shared meanings to others through socialization processes. Ethnography does not require travel to another country or region; however, it requires spending considerable time in the setting observing and gathering data. eae DIF: Cognitive Level: Analysis REF: Page 60 Which of the following are the characteristics of grounded theory research? (Select all that apply.) a. It focuses on experiences and processes, against the backdrop of society. b. It scrutinizes phenomena, past the capabilities of quantitative research. c. It always develops theory. d. It provides a cohesive description of a phenomenon, fostering understanding. e. Itis able to be used effectively in a considerable variety of settings. ANS: A,B, D,E Grounded theory research is an inductive research technique developed by Glaser and Strauss through their study of the experience of dying. The method’s name means the findings are grounded in the concrete world as experienced by the participants and are interpreted at a more abstract theoretical level. The desired outcome of grounded theory studies is a middle range or substantive theory. Grounded theory researchers have contributed to our understanding of the patient experience across a wide range of settings. Grounded theory research examines experiences and processes with a breadth and depth not usually possible with quantitative research. The reader can intuitively verify these findings through her or his own experiences. The contribution to nursing science is that a clear, cohesive description of the phenomenon allows greater understanding. DIF: Cognitive Level: Synthes Chapter 5: Research Problem and Purpose Test Bank Se MULTIPLE CHOICE 1. A researcher has conducted 9 clinical studies, some quantitative and others qualitative, all of which focus on depression’s relationship to perceived abandonment. “Depression’s relationship to perceived abandonment” is an example of which of the following? a. Research problem | b. Research topic c. Research purpose d. Problem statement ANS: B Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. A research problem is an area of concern where there is a gap in the knowledge base needed for nursing practice. Research topics contain numerous potential research problems, and each problem provides the basis for developing many research purposes. The problem statement identifies the specific gap in the knowledge needed for practice. A nursing situation often includes a variety of research topics or concepts. DIF: Cognitive Level: Application REF: Page 73 2. Why is replicating a research study essential for knowledge development? a. Each time a study is replicated, its probability of error decreases. b. Reproducing a study decreases theoretical knowledge, increasing real knowledge. ¢. Replication helps confirm that the initial results were not reached in error. d. Replication studies represent the majority of published nursing literature. ANS: C Replication involves reproducing or repeating a study to determine if similar findings will be obtained. Replication is essential for knowledge development because it (1) establishes the credibility of the findings, (2) extends the generalizability of the findings over a range of instances and contexts, (3) reduces the number of type I and type II errors, (4) corrects the limitations in studies’ methodologies, (5) supports theory development, and (6) lessens the acceptance of erroneous results. Some researchers replicate studies because they agree with the findings and wonder if the findings will hold up in different settings with different subjects over time. Others want to challenge the findings or interpretations of prior investigators. However, the number of nursing studies replicated continues to be limited. DIF: Cognitive Level: Synthesis REF: Page 77 3. A nurse researcher working in a subacute orthopedic hospital floor. She notes that her elders with knee replacements sleep as many as 16 hours a day, waking only for physical therapy and meals, but she also notices that those with many visitors sleep fewer hours and seem to experience more pain. She wonders whether sleep in elders after knee replacement prevents pain, or whether elders select the coping strategy of sleeping more, in response to pain, and begins to attempt to identify the relationship between the two. A literature search reveals only three descriptive studies on this topic, one quantitative and two qualitative. What is “the relationship between elders’ hours of sleep following knee replacement and its relationship with report of pain”? a. The research aim b. The research purpose c. The research problem d. The research topic ANS: C the research 5 b. Research topics contain numerous potential research problems, and each problem provides the basis for developing many purposes. c. The research topic and the research problem are identical. d. The research topic specifies setting and population, but the problem does not. ANS: A Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. Research topics contain numerous potential research problems, and each problem provides the basis for developing many purposes. Thus, the identification of a relevant research topic and a challenging, significant problem can facilitate the development of numerous study purposes to direct a lifetime program of research, DIF: Cognitive Level: Analysis REF: Page 73 9. Which of the following is the practicing nurse’s most important source of researchable problems? a. The nurse’s own clinical practice b. Review of the literature c. Nursing theories d. Administrative mandates to conduct clinical research on every hospital unit ANS: A The practice of nursing must be based on knowledge or evidence generated through research. Thus, clinical practice is an extremely important source for research problems. Problems can evolve from clinical observations. A review of patient records, treatment plans, and procedure manuals might reveal concerns or raise questions about practice that could be the basis for research problems. DIF: Cognitive Level: Analysis REF: Page 75 MULTIPLE RESPONSE 1. Which of the following are considered evidence-generating? (Select all that apply.) Replication of previous research Identification of research topics, followed by basic research Applied research studies that examine clinical response to interventions Reviews of the literature Qualitative research examining responses to diagnosis ANS: A, B,C,E eae re | Research topics are concepts, phenomena of interest, or broad problem areas that researchers can focus on to enhance evidence-based nursing. However, the lack of replication studies severely limits the generation of sound research findings needed for evidence-based practice in nursing. Basic, or pure, research is a scientific investigation that involves the pursuit of “knowledge for knowledge’s sake,” or for the pleasure of learning and finding truth. The purpose of basic research is to generate and refine theory and build constructs; thus, the findings are frequently not directly useful in practice. Replication of previously conducted research is essential for knowledge development. By questioning and reviewing the literature, researchers begin to recognize a specific area of concern and the knowledge gap that surrounds it; however, review of the literature does not generate knowledge—it reviews previous knowledge. Questions focusing on investigating new techniques to improve existing skills, patient responses to techniques, or ways to educate patients and families to perform techniques. . . could add to knowledge needed for evidence-based practice. DIF: Cognitive Level: Analysis REF: Page 73 2. Reasons to conduct an exact replication include which of the following? (Select all that apply.) a. A different sample is used in the replication, because subjects seldom elect to undergo the same surgical procedure twice. The same site is again used, in order to decrease variation. Sample size was adequate, the design was strong, and measurements were robust. Validation of the truthfulness of the original subjects’ responses is desired. A similar population is used, in order to verify the findings. ANS: B, C, D Four different types of replication are important in generating sound scientific knowledge for nursing: (1) exact, (2) approximate, (3) concurrent, and (4) systematic extension. An exact (or identical) replication involves duplicating the initial researcher’s study to confirm the original findings. All conditions of the original study must be maintained. Exact replications might be thought of as ideal to confirm original study findings, but these are frequently not attainable. In addition, one would not want to replicate the errors in an original study, such as small sample size, weak design, or poor-quality measurement methods. ene DIF: Cognitive Level: Analysis REF: Page 77 3. The American Association of Critical Care Nurses (AACN) funds various research projects that focus on its research priorities. A master’s student wants to initiate research to study the relative accuracy of new computer-assisted assessment device that painlessly measures blood glucose values through a probe just distal to the insertion hub of a central line, in patients on insulin drips with hourly Accu-Chek readings. Does this pertain to any of the organization’s research priorities, listed here? (Select all that apply.) a. Technology use to achieve patient as ment, Management, or outcomes Prevention and management of complications Processes and systems that foster the optimal contribution of critical care nurses Creation of a healing, humane environment Development of processes and systems that foster the optimal contribution of critical care nurses eae ANS: A,D | The American Association of Critical Care Nurses (AACN) determined initial research priorities for this specialty in the early 1980s and revised these priorities based on patients needs and the changes in health care. The current AACN (2011) research priorities are identified on this organization’s website as (1) effective and appropriate use of technology to achieve optimal patient assessment, management, or outcomes; (2) creation of a healing, humane environment; (3) processes and systems that foster the optimal contribution of critical care nurses; (4) effective approaches to symptom management; and (5) prevention and management of complications. This research study uses technology. Also, it saves the patient from interruptions in sleep, as the nurse flushes a line and draws blood hourly, or performs hourly Accu-Cheks, if the line will not draw. DIF: Cognitive Level: Synthesis REF: Page 79 4. “The purpose of the research will be, most likely, to document how admirable charitable efforts by The Children of the Land were terminated by the well-meaning Los Angeles Police Force.” What is incorrect about this wording? (Select all that apply.) a. A police organization cannot be named in a research purpose. A purpose should specify methodology. The terms admirable and well-meaning are both subjective. The purpose must identify the goal of the study, not the “most likely” goal. The purpose should be stated as “was” or “is” but not “will be.” ANS: C, D,E The purpose is generated from the problem, identifies the goal or goals of the study, and directs the development of the study. In the research process, the purpose is usually stated after the problem, because the problem identifies the gap in knowledge in a selected area and the purpose clarifies the knowledge to be generated by the study. The research purpose must be stated objectively, that is, in a way that does not reflect particular biases or values of the researcher. Investigators who do not recognize their values might include their biases in the research. This can lead them to generate the answers they want or believe to be true and might add inaccurate information to a discipline’s body of knowledge. eae DIF: Cognitive Level: Evaluation REF: Page 83 5. Children in publicly funded school breakfast programs often have learning delays. These are not readily attributable to single causes. Research on learning delays has revealed that family literacy, measured by parental reading level and comprehension scores, is the most powerful predictor of delay in the primary grades. On the other hand, repeated exposure to eyes-on reading, in the company of a trusted non-parent adult, has been shown to over-ride family literacy as a predictor. No research, however, has studied institution of a reading-and-breakfast program, delivered five days a week before school, intended to over-ride the variable of family literacy. Given this problem statement, which of these purposes would be appropriate for the study? (Select all that apply.) a. The purpose of the study was to determine whether providing volunteer readers during school breakfasts for all kindergarten and first-grade children would result in fewer than anticipated learning delays. b. The purpose of the study was to determine the lived experience of children with learning delays, against the context of school and home, and to examine the children’s peer relationships. c. The purpose of the study was to determine whether a buddy system of one sixth- | 10. A research problem is an area of concern where there is a gap in the knowledge based needed for nursing practice. A research problem includes significance, background, and a problem statement. The problem statement identifies the specific gap in the knowledge needed for practice. The research purpose is a clear, concise statement of the specific goal or aim of the study that is generated from the research problem, so the purpose is usually identified after the research purpose is identified. Consequently, more than one purpose can emanate from a given problem statement. Based on the research purpose, specific research objectives, questions, or hypotheses are developed to direct the study. DIF: Cognitive Level: Analysis REF: Page 73 A researcher gains support of the medical staff, the nursing staff, and the nurse manager of a cardiothoracic ICU within a prestigious private hospital, aligned with a teaching institution. A research proposal, concerning ambulation patterns after bypass surgery, is approved by the Human Subjects Committee. Federal funding is obtained. Just before data collection is to begin, the hospital is sold to a large university with a medical school, the nurse manager is replaced with a manger from another hospital in the corporation, and there is a 30% staff turnover. Choose the factors that are real concerns and could impact feasibility. (Select all that apply.) a. Most of the newly hired nurses are BSNs and newly graduated. b. The new manager grudgingly allows the research to proceed but makes it clear that she will not support subsequent research until the unit is more stable. c. Fewer patients come to this hospital now for bypass surgery, going instead to its sister hospital across town. d. Two of the research assistants, who were already trained, take jobs elsewhere. Staff nurses dislike the new manager and miss the old one. ANS: B, C, D The feasibility of a study is determined by examining the time and money commitment; the tesearcher’s expettise; availability of subjects, facility, and equipment; cooperation of others; and the study’s ethical considerations. A study might appear feasible but, without the cooperation of others, it is not. However, most nursing studies involve human subjects and are conducted in hospitals, clinics, schools, offices, or homes. Having the cooperation of people in the research setting, the subjects, and the research assistants involved in data collection is essential. People are frequently willing to cooperate with a study if they view the problem and purpose as significant or if they are personally interested. DIF: Cognitive Level: Analysis REF: Page 84 A master’s student decides to conduct a pilot study in order to help with which of the following? (Select all that apply.) a. Assess working nurses’ responses to having a researcher collect data in the middle of their unit. b. Re-evaluate the actual expenditure of the researcher’s time for each subject consented and studied. Allow potential subjects to sample research participation before they fully commit. d. Apply for Human Subjects permission to perform the actual study. Determine whether the research side has enough research subjects who are interested in participating in the research. ° ANS: A | A pilot study is commonly defined as a smaller version of a proposed study conducted to refine the methodology. It is developed much like the proposed study, using similar subjects, the same setting, the same treatment, and the same data collection and analysis techniques. As the research problem and purpose increase in clarity and conciseness, the researcher has greater direction in determining the feasibility of a study. The feasibility of a study is determined by examining the time and money commitment; the researcher’s expertise; availability of subjects, facility, and equipment; cooperation of others; and the study’s ethical considerations. The purpose selected for investigation must be ethical, and Human Subjects permission must be obtained before even a pilot study is conducted. A pilot study is not used to allow potential subjects to sample participation before they commit: Human Subjects permission must be obtained before study participation. DIF: Cognitive Level: Analysis Chapter 6: Review of Relevant Literature Test Bank SS MULTIPLE CHOICE 1. Which of the following would be landmark research? a. The discovery that during pancreatitis, the pancreas is actually digested by its own enzymes b. A description of the importance of injecting immunizations in the proper location of the deltoid c. The third in a series of four papers describing patterns of emergency room use in vacation communities d. The first paper on the effect of using insulin for type I diabetes in humans ANS: D Seminal studies are the first studies that prompted the initiation of the field of research. Landmark studies are the studies that led to an important development or a turning point in the field of research. DIF: Cognitive Level: Application REF: Page 100 2. A publication is printed every two months. Its volume number coincides with its year of publication (2008 = 1; 2009 = 2; 2010 = 3; etc.). Its issue number coincides with the order of publication, within a given year (Jan—Feb = 1; Mar—Apr = 2; etc). What kind of a publication is this? a. A monograph b. A periodical ec. An e-book d. A serial ANS: D | Serials are published over time or may be in multiple volumes, but do not necessarily have a predictable publication date. Periodicals are subsets of serials with predictable publication dates, such as journals, which are published over time and are numbered sequentially for the years published. This sequential numbering is seen in the year, volume, issue, and page numbering of a journal. Monographs, such as books, hard-copy conference proceedings, or pamphlets, are usually written once and may be updated with a new edition as needed. Textbooks are monographs written to be used in formal education programs. Entire volumes of books available in a digital or electronic format are called e-books. DIF: Cognitive Level: Application REF: Page 100 3. The type of literature that describes concept analyses, models, and frameworks is which of the following? a. Empirical b. Applicable c. Able to be replicated d. Theoretical ANS: D Theoretical literature consists of concept analyses, models, theories, and conceptual frameworks that support a selected research problem and purpose. Empirical literature comprises knowledge derived from research. DIF: Cognitive Level: Application REF: Page 100 4. What primary sources might be available to someone writing a biography of Queen Elizabeth I, who died in the 17th century? a. An interview with one of her maids-in- waiting b. A previous history written about her ec. An article about her in a 17th-century publication d. A diary written by her ANS: D The published literature contains primary and secondary sources. A primary source is written by the person who originated, or is responsible for generating, the ideas published. A research publication published by the person or people who conducted the research is a primary source. A theoretical book or paper written by the theorist who developed the theory or conceptual content is a primary source. A secondary source summarizes or quotes content from primary sources. Thus, authors of secondary sources paraphrase the works of researchers and theorists. The problem with a secondary source is that the author has interpreted the works of someone else, and this interpretation is influenced by that author’s perception and bias. Authors have sometimes spread errors and misinterpretations by using secondary sources rather than primary sources. You should use mostly primary sources to write literature reviews. Secondary sources are used only if primary sources cannot be located or if a secondary source contains creative ideas or a unique organization of information not found in a primary source. DIF: Cognitive Level: Application REF: Page 101 5. What is the purpose of the minimal review of relevant studies that the grounded theory researcher undertakes before writing the research proposal? a. It compares the anticipated findings with the findings of similar research. | schools studied had a disproportionate number of students who reported sleeplessness, nervousness, nightmares, and guilt. These were attributed to various factors, the most significant of which was a very strict principal, who voiced open disapproval of students she felt were underachieving their enormous academic potential. Parents were very accepting of this behavior, echoing it in their interactions with the students. (Atchison, Topeka, & Santa Fe, 2009). c. As compared with other high schools, Atchison, Topeka, and Santa Fe (2009) reported a higher incidence of distress manifestations, such as nightmares and nervousness, in a strictly college-prep school with an extremely disapproving principal, who verbally berated students for less-than-expected academic performance. d. High schools with disapproving authority figures have a higher incidence of somatization (see Atchison et al, 2009). ANS: C Rather than using direct quotes from an author, the writer of the literature review should paraphrase the author’s ideas. Use of the author’s exact words represents plagiarism. Eliminating the quotation marks, and citing an entire paragraph, with the authors’ names at the end, also constitutes plagiarism. Paraphrasing involves expressing the ideas clearly and in one’s own words. The meanings of these sources are then connected to the proposed study. DIF: Cognitive Level: Application REF: Page 111 MULTIPLE RESPONSE 1. Which of the following might a researcher include in a review of the literature concerning acupuncture and conscious sedation for major surgical procedures? (Select all that apply.) a. A research article from the Journal of Acupuncture comparing the use of acupuncture with general anesthesia b. Bryson’s Human Physiology textbook c. A research synthesis on alternatives to general anesthesia compiled by the Agency for Health Policy and Research d. An article in National Enquirer on the dangers of major surgery e. A master’s thesis on the use of acupuncture during closed reduction of radial-ulnar fractures f. A Wikipedia article on how acupuncture works A monograph written by a physician in a third world country who used acupuncture to control pain during surgical procedures ANS: A, B, C, E,G “The literature” consists of all written sources relevant to the selected topic. The literature includes newspapers, monographs, encyclopedias, conference papers, scientific journals, textbooks, other books, theses, dissertations, and clinical journals. Websites and reports developed by government agenc: nd professional organizations are also included. Online encyclopedias to which anyone can contribute, such as Wikipedia, are not considered scholarly sources. DIF: Cognitive Level: Analysis REF: Page 97 2. Astudent’s first draft of her thesis contains the following: | Evidence to the contrary was provided in several studies of efficacy but never examined in a context of “the adolescent at sea with the ghost of his losses” (Reynolds, 2011). The student’s reference list contains the following citation for this work: Reynold, A. R. (2010). Never underestimate depression. Journal of Applied Psychology. What is wrong with it? (Select all that apply.) a. The reference list should re-state the quotation. b. The reference is incomplete, lacking volume number and page numbers. c. The years of the citation differ. d. The author’s name is spelled differently in the citation and in the reference list. e. No page number is provided for the direct quotation. ANS: B, C, D,E Sources that will be cited in a paper or recorded in a reference list should be cross-checked two or three times to prevent errors. Questions that will identify common errors are displayed in Box 6-1. To prevent these errors, the author checks all the citations within the text of the literature review and each citation in his or her reference list, to assure agreement and completeness. DIF: Cognitive Level: Application REF: Page 112 3. In which of the following methods does substantive review of the literature take place after data analysis? (Select all that apply.) a. Grounded theory b. Historicism c. Phenomenology d. Ethnography €. Quantitative descriptive ANS: A,C In qualitative research, the purpose and timing of the literature review depends on the type of study to be conducted. Some phenomenologists believe the literature should not be reviewed until after the data have been collected and analyzed so that the literature will not interfere with the researcher’s ability to suspend what is known and approach the topic with openness. In development of a grounded theory study, a minimal review of relevant studies provides the beginning point of the inquiry, but this review is only a means of making the researcher aware of what studies have been conducted. This information, however, is not used to direct the collection of data or interpretation of the findings in a grounded theory study. During the data analysis stage, a core variable is identified and the researcher theoretically samples the literature for extant theories that may assist in explaining and extending the emerging theory. In historical research, the initial review of the literature helps the researcher define the study questions and make decisions about relevant sources. The data collection is actually an intense review of published and unpublished documents that the researcher has found. The purposes for reviewing the literature for ethnographic studies and for exploratory descriptive qualitative research are more similar to the literature review for quantitative research. The researcher develops a general understanding of the concepts to be examined related to the selected culture or topic. The literature review also provides a background for conducting the study and interpreting the findings. The review of literature in quantitative research directs the development and implementation of a study. The focus of the major literature review at the beginning of the research process is to identify a gap in what is known. | DIF: Cognitive Level: Synthesis REF: Page 98 4. Which of the following are purposes of the literature review in quantitative research concerning patient compliant with alternating leg pressure stockings (ALPs)? (Select all that apply.) a. It gives the researcher an overview of anecdotal reports about how it feels to the patient to wear ALPs. b. It allows the researcher to use the data from previous research on ALPs to add to his or her database. c. It allows the researcher to construct theory about compliance with ALPs. d. It gives the researcher something with which to compare his or her findings on compliance with ALPs. e. It allows the researcher to discover previous research in the area of ALPs, so as to identify what is not known (the research gap). ANS: D,E The review of literature in quantitative research directs the development and implementation of a study. The focus of the major literature review at the beginning of the research process is to identify a gap in what is known. The study is designed to add knowledge in the area of the identified gap. After a thorough review of the literature, the researcher identifies a specific gap in knowledge. After the data have been analyzed and the findings described, the researcher will return to the literature in the generalization phase of the research report to integrate knowledge from the literature with new knowledge obtained from the study. The purpose of the literature review is similar for the different types of quantitative studies (descriptive, correlational, quasi-experimental, and experimental). DIF: Cognitive Level: Application REF: Page 98 5. In phenomenology, often the review of the literature is conducted after data analysi: complete. What is the reason for this? (Select all that apply.) a. The data analysis phase of phenomenology includes a literature review. b. Phenomenology is data-free, and analyses are based only on the interpretation of the researcher. c. Some phenomenologists do believe that one can “bracket” what is known, in order to perform an unbiased analysis, but it seems pointless to absorb information just to then put it aside, so literature review is usually postponed. d. Some phenomenologists don’t believe that one can “bracket” what is known, in order to perform an unbiased analysis of the data, so they try to minimize what they read about the topic of the study until data analysis is complete. e. The review of the literature provides an objective cross-check for the researcher’s interpretation. ANS: C, D In qualitative research, the purpose and timing of the literature review depends on the type of study to be conducted. Some phenomenologists believe the literature should not be reviewed until after the data have been collected and analyzed so that the literature will not interfere with the researcher’s ability to suspend what is known and approach the topic with openness. DIF: Cognitive Level: Analysis REF: Page 98 | relationship to children’s homelessness. b. Does children’s homelessness affect length of hospital stay, verbal skills, and fear of separation from parents? c. Was homelessness related to length of hospital stay, verbal skills, and fear of separation from parents in this study? d. Is homelessness in children related to length of hospital stay, verbal skills, and fear of separation from parents? ANS: D A research question is a concise, interrogative statement that is worded in the present tense and includes one or more variables (or concepts). The research questions focus on (1) the description of the variable(s), (2) a determination of differences between two or more groups regarding selected variables, (3) an examination of relationships among variables (relational), and (4) the use of independent variables to predict a dependent variable. In this case (3), the examination of relationships among variables, would be the focus of the research question, since cause is not a focus of study. DIF: Cognitive Level: Application REF: Page 140 3. What is the research hypothesis? a. Longer length of hospital stay, worse verbal skills, and fear of separation from parents are caused by children’s homelessness. b. Homelessness in children is related to length of hospital stay, verbal skills, and fear of separation from parents. c. There is no relationship between children’s homelessness and length of hospital stay, verbal skills, and fear of separation from parents. d. If achild is homeless, that child is likely to have poor verbal skills, more difficulty separating from parents, and a longer hospital stay. ANS: B A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. The hypothesis translates the problem and purpose into a clear explanation or prediction of the expected results or outcomes of the study. A hypothesis (1) specifies the variables the researcher will manipulate or measure, (2) identifies the population the researcher will examine, (3) indicates the type of research, and (4) directs the conduct of the study. Hypotheses are described using the terms in the following four categories: (1) associative vers 1, (2) simple versus complex, (3) directional versus nondirectional, and (4) null versus research. DIF: Cognitive Level: Application REF: Page 142 4. A researcher identifies three variables and formulates a hypothesis that links them. That hypothesis is testable. What does it mean that the hypothesis is testable? All the variables in the hypothesis are measurable. b. The hypothesis must be replaced by a research question. c. The value of the hypothesis is low. d. The hypothesis is causational. S ANS: A | 6. Hypotheses identify different types of relationships and numbers of variables. A well- formulated hypothesis clearly identifies the relationship between the variables. A hypothesis’s value is ultimately derived from whether it can be tested in the real world. A testable hypothesis is one that contains variables that can be measured or manipulated in the world. DIF: Cognitive Level: Synthesis REF: Page 144 A stimulus or activity that is measured to examine the effect created by the independent variable best describes a(n), variable. a. Independent b. Demographic c. Extraneous d. Dependent ANS: D In quantitative research, the independent variable (intervention, treatment, or experimental variable) is manipulated or varied by the researcher to cause an effect on the dependent variable. The dependent variable (response or outcome variable) is measured to examine the effect created by the independent variable. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. A dependent variable is the response behavior or outcome that the researcher wants to predict or explain. Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. Extraneous variables are of primary concern in quantitative studies, because they can obscure one’s understanding of the relational or causal dynamics within the studies. Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample. DIF: Cognitive Level: Comprehension REF: Page 145 The intervention that the researcher manipulates is the variable. a. Independent b. Demographic c. Extraneous d. Dependent ANS: A In quantitative research, the independent variable (intervention, treatment, or experimental variable) is manipulated or varied by the researcher to cause an effect on the dependent variable. The dependent variable (response or outcome variable) is measured to examine the effect created by the independent variable. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. A dependent variable is the response behavior or outcome that the researcher wants to predict or explain. Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. Extraneous variables are of primary concern in quantitative studies, because they can obscure one’s understanding of the relational or causal dynamics within the studies. The extraneous variables that are not recognized until the study is in process or are recognized before the study is initiated but cannot be controlled are referred to as confounding variables. Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample. DIF: Cognitive Level: Comprehension REF: Page 145 | 7. It is important for the researcher to identify extraneous variables so that a. All of the extraneous variables can be manipulated by the researcher. b. The findings can be explained as clearly and truthfully as possible. c. The research results are not critiqued unfairly. d. The extraneous variables have no influence on the dependent variable. ANS: B Extraneous variables exist in all studies and can affect the measurement of study variables and the relationships among them. Extraneous variables are of primary concern in quantitative studies, because they can obscure one’s understanding of the relational or causal dynamics within the studies. Extraneous variables are classified as (1) recognized or unrecognized and (2) controlled or uncontrolled. The extraneous variables that are not recognized until the study is in process or are recognized before the study is initiated but cannot be controlled are referred to as confounding variables. Sometimes these variables can be measured during the study and controlled statistically during analysis. In other cases, it is not possible to measure a confounding variable, and the variable thus hinders the interpretation of findings. Such extraneous variables must be identified as limitations or areas of study weakness in the discussion section of a research report. DIF: Cognitive Level: Analysis REF: Page 152 Simple descriptive statistics may be used to depict the sample characteristics, reflecting demographic variable values, in which kind of research? a. Quantitative research only b. Qualitative research only c. Both quantitative and qualitative research d. Only when data has been extracted from an electronic database ANS: C Demographic variables are attributes of the subjects that are measured during the study and used to describe the sample. Demographic variables are presented as the sample characteristics, using simple descriptive statistics such as frequency and percentage, in both quantitative and qualitative research. DIF: Cognitive Level: Application REF: Page 154 In the following hypothesis, what is the independent variable? Patients with recurrent bowel obstruction due to Crohn’s disease who are assigned to be treated in an emergency room complain less frequently of pain and require less pain medication than those patients admitted, in the usual fashion, and treated on a medical floor. a. Bowel obstruction due to Crohn’s disease b. Place treated c. Number of complaints of pain d. Number of doses of pain medication ANS: B An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. In this example, place treated (emergency room versus medical floor) is the independent variable. | MULTIPLE RESPONSE 1. Which of the following are the research variables in this study? (Select all that apply.) Patient age Verbal skills Homelessness Parental presence Fear of separation from parents Whether or not a child is homeless Length of hospital stay ANS: B, E,G Research variables or concepts are the qualities, properties, or characteristics that are measured in qualitative studies and selected quantitative studies. Concrete concepts, such as temperature, weight, and blood pressure, are referred to as variables in a study; abstract concepts, such as creativity, empathy, and social support, are sometimes referred to as research concepts. emeasge DIF: Cognitive Level: Application REF: Page 151 2. Which of the following could be a dependent variable in an experimental study? (Select all that apply.) a. Medication A b. The number of times the gerbil rings the bell ¢. Quality of life d. The number of times the subject is instructed in how to use the experimental equipment e. Vomiting ANS: B, C, E A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. DIF: Cognitive Level: Synthesis REF: Page 151 3. Which of the following could be an independent variable in an experimental study? (Select all that apply.) a. Quality of life The percentage of moisture in the inspired air the subject breathes The researcher’s preference for quantitative versus qualitative methodologies Wearing a hat with a large brim Seizure activity during the experiment ANS: B, D An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain. eae DIF: Cognitive Level: Analysis REF: Page 151 | 4. 6. Which of the following are operational definitions? (Select all that apply.) a. Length of smoking cessation is the subject’s statement of how long it has been since the subject last smoked tobacco. b. Pain is whatever the patient says it is, whenever the patient says it is (Margo McCaffrey). Imagination is the ability to see what will be, not what is. d. Startle is the distance the research subject moves when a puppet tarantula is dropped into his field of view, in front of a computer screen. e. Nausea is the number the subject provides, on a 0- to 10-point numerical scale, in response to being asked how nauseated the subject is. ANS: A, D,E An operational definition is derived from a set of procedures and progressive acts that a researcher performs either to manipulate an independent variable or to measure the existence or degree of existence of the dependent variable. ° DIF: Cognitive Level: Application REF: Page 155 Which of the following could be a research question? (Select all that apply.) a. What does postoperative vomiting feel like, to research subjects? b. How is hypnosis related to smoking cessation? c. In an English course, how do grading, praise, practice, submitting papers for publication, and writing skills interact? d. What are the differences between clients with pre-op orientation and those without, in terms of procedural anxiety? e. How does the researcher define loneliness? ANS: A,B,C,D Research questions meet the following criteria: (1) the identification and/or description of the variable(s), (2) a determination of differences between two or more groups regarding selected variables, (3) an examination of relationships among variables (relational), and (4) the use of independent variables to predict a dependent variable. DIF: Cognitive Level: Application REF: Page 140 Martha wants to know what happens when she fries bacon in a frying pan, versus microwaving it: does the bacon end up moister and more flavorful when fried, or when microwaved? What are the dependent variables? (Select all that apply.) Frying bacon Microwaving bacon Consistent cooking temperature Variable cooking temperature Moistness of bacon Kitchen burns Flavor of bacon ANS: E,G emeeasge | A dependent variable is the response behavior, or outcome that the researcher wants to predict or explain. An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. In this example, whether the bacon ends up moister and more flavorful is the dependent variable and method of cooking is the independent variable. DIF: Cognitive Level: Application REF: Page 145 7. Ralph is an experimental psychologist. He studies rat behavior. He runs rats through a maze, under different scent conditions. At the end of the maze is cheese. Sometimes the maze is lit, and sometimes it is dark. During each run, the rates are subjected to different scents (cat pheromone, the smell of cheddar cheese, tiger pheromone, the smell of rat feces) at crucial decision-points in the maze. Ralph measures the time it takes the rats to finish the maze. Which of the following could be considered independent variables in this study? (Select all that apply.) a. The rats b. Light versus dark c. Ralph d. The amount of time the rats take to finish the maze e. The scents f. The cheese at the end of the maze g. Rat behavior ANS: B, E An independent variable is a stimulus or activity that is manipulated or varied by the researcher to create an effect on the dependent variable. The independent variable is also called an intervention, treatment, or experimental variable. In this example, how long in seconds it takes the rats to run through the maze is the dependent variables and different scents are independent variables; light versus dark are the two experimental conditions, and these could also affect the outcome, so they could also be considered independent variables. DIF: Cognitive Level: Application REF: Page 145 8. What type of hypothesis is the following? (Select all that apply.) Increased intake of dietary fiber in elders and increased fluid intake are associated with fewer episodes of diverticulitis? Simple hypothesis Complex hypothesis Causal hypothesis Associative hypothesis Nondirectional hypothesis Directional hypothesis ANS: B, D, F mepoge A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables. DIF: Cognitive Level: Analysis REF: Page 142 What type of hypothesis is the following? (Select all that apply.) The number of children in the home is associated with noise level in that home, and with parental stress. a. Simple hypothesis b. Complex hypothesis c. Causal hypothesis d. Associative hypothesis e. Nondirectional hypothesis f. Directional hypothesis ANS: B, D,E A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables. DIF: Cognitive Level: Analysis REF: Page 142 What type of hypothesis is the following? (Select all that apply.) The number of minutes a 16-year-old girl spends applying her makeup in the morning is related to her perceived personal attractiveness. Simple hypothesis Complex hypothesis Causal hypothesis Associative hypothesis Nondirectional hypothesis Directional hypothesis ANS: A, D,E mepoge atement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables. DIF: Cognitive Level: Analysis REF: Page 142 15. What type of hypothesis is the following? (Select all that apply.) Decreasing the time allotted for weekly in-class pop quizzes increases student anxiety and decreases student grades. Simple hypothesis Complex hypothesis Causal hypothesis Associative hypothesis Nondirectional hypothesis Directional hypothesis mepoge ANS: B, C, F A hypothesis is a formal statement of the expected relationship or relationships between two or more variables in a specified population. A simple hypothesis predicts the relationship (associative or causal) between two variables. A complex hypothesis predicts the relationship (associative or causal) among three or more variables. The relationships identified in hypotheses are associative or causal. An associative relationship identifies variables that occur or exist together in the real world. Causal relationships identify a cause-and-effect interaction between two or more variables. A nondirectional hypothesis states that a relationship exists but does not predict the nature of the relationship. A directional hypothesis states the nature or direction of the relationship between two or more variables. DIF: Cognitive Level: Analysis REF: Page 142 Chapter 9: Ethics in Research Test Bank Se MULTIPLE CHOICE 1. A research study offers elderly men who have, in the past, been prison inmates $1,500 for participation in an all-day workshop at which they agree to be hypnotized and tell stories of incarceration, which are later published. The research participants are allowed to listen to the tapes of what they say under hypnosis and to withdraw permission to use any part of the information. Why is this scenario a violation of self-determination? a. Allowing participants to withdraw permission to use part of the research information violates the study integrity and represents deception. b. It is an example of coercion. ¢. Prisoners are a vulnerable population and should not be used as research subjects. | d. What is said under hypnosis may not be true. ANS: B The right to self-determination is based on the ethical principle of respect for persons. This principle holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception. Coercion occurs when an overt threat of harm or excessive reward is intentionally presented by one person to another to obtain his or her compliance. In the example, offering elderly men $1,500 for one day could be considered offering an excessive reward: therefore, it is an act of coercion violating the human right to self-determination. DIF: Cognitive Level: Analysis REF: Page 164 2. A researcher working for Google collects data on fair treatment in the workplace. He attempts to attach one of the raw data forms to a message to himself, so that he can finish the data analysis at home that evening, but accidentally sends it to another employee who had provided data for the study. The two employees, coincidentally, have an identical opinion about fair treatment in the workplace. This best describes an example of a violation of which of the following human rights? a. Confidentiality b. Fair treatment ¢c. Protection from harm d. None of these—no ethical violation occurred, because the two subjects share a point of view. ANS: A Confidentiality is the researcher’s management of private information shared by a subject that must not be shared with others without the authorization of the subject. In the example, sending one research subject the raw data of a different subject is a direct breach of confidentiality. A breach in confidentiality can occur when a researcher, by accident or direct action, allows an unauthorized person to gain access to raw study data. The right to fair treatment is based on the ethical principle of justice. This principle holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. DIF: Cognitive Level: Application REF: Page 172 3. Ina study of outpatients experiencing panic attacks, a researcher was working in a busy clinic waiting room and left his computer to consent a new study participant. A transcription of a patient interview was displayed, and at the end of the transcription was the patient’s medical record number and a list of medications currently taken. The researcher had not closed down the screen, and when he returned to his computer, he found an adult patient playing a video game on the computer. This best describes an example of a violation of which of the following human rights? a. Protection from the harm of exposure b. Security c. Confidentiality d. Privacy | 10. DIF: Cognitive Level: Synthesis REF: Page 161 The right an individual has to be told that he is a potential participant in a research study and may decide not to be so best defines which of the following human rights? a. Beneficence b. Justice ce. Privacy d. Self-determination ANS: D The right to self-determination holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. Justice holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. DIF: Cognitive Level: Application REF: Page 162 The right an individual has to receive treatment even if he decides not to participate in the research best defines which of the following human rights? a. Beneficence b. Justice ce. Privacy d. Respect ANS: B The right to fair treatment is based on the ethical principle of justice. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. The right to self-determination is based on the ethical principle of respect for persons. DIF: Cognitive Level: Application REF: Page 164 To take positive action to prevent any harm to the research subjects best defines which of the following principles? a. Beneficence b. Justice ce. Privacy d. Respect ANS: A | 12. 13. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. This includes positive actions taken to prevent harm to research subjects. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to fair treatment is based on the ethical principle of justice. The right to self-determination is based on the ethical principle of respect for persons. DIF: Cognitive Level: Comprehension REF: Page 164 An institutional review board (IRB) ensures that (1) the rights and welfare of the individuals involved were protected, (2) the appropriate methods were used to secure informed consent, and (3) the potential benefits of the investigation were greater than the risks. Which of the following is an example of how an IRB determines the level of potential risk? a. It requires the researcher to provide a list of potential benefits to the clients, as well as the results of a pilot study verifying this. It compels the researcher to disclose his consenting process. It provides for a supervisor from the IRB to be present for all data collection. d. It reviews the researcher’s description of the study’s potential risks and compares them with everyday risk. ss ANS: D The functions and operations of an IRB involve the review of research at three different levels: (1) exempt from review, (2) expedited review, and (3) complete review. The level of the review required for each study is decided by the IRB chairperson and/or committee, not by the researcher, based on information provided by the researcher. Studies are usually exempt from review if they pose no apparent risks for the research subjects. Studies that have some risks, which are viewed as minimal, are expedited in the review process. DIF: Cognitive Level: Synthesis REF: Page 183 A researcher who is also a university professor is performing a multi-site study in which on- site interviews are conducted with nurses in five hospitals in a major city. Each hospital has an institutional review board (IRB). From how many IRBs or committees must the researcher obtain permission to conduct the study? a. Six: each of the five hospitals, and the university b. One: only the university c. Five: only the hospitals d. None: educational research is exempt from review ANS: A Universities and healthcare agencies have IRBs that function in a similar way to review research following federal regulations. If both a university and a hospital, or if more than one hospital, should be involved in a research study, both IRBs must give permission for the study to be conducted. This poses significant expenditure of time for such research. DIF: Cognitive Level: Application REF: Page 183 What specific area of ethics does HIPAA address? a. Privacy | 14. 15. b. Justice c. Coercion to participate in a research study d. Informed consent ANS: A The Health Insurance Portability and Accountability Act (HIPAA) was implemented in 2003 to protect an individual’s health information. The U.S. DHHS developed regulations titled the Standards for Privacy of Individually Identifiable Health Information, and compliance with these regulations is known as the Privacy Rule. DIF: Cognitive Level: Comprehension REF: Page 159 A researcher is applying for renewal of a large federal grant, without which his very promising research on panic disorder cannot continue. He is completing renewal forms, which include a synopsis of his results to date. If he excludes two of the subjects with very severe panic disorder, and three with mental health disorders of another kind, the results are statistically significant. He writes the report and does not mention the five subjects he excluded. This is an instance of which of the following? a. Beneficence b. Fabrication ce. Falsification d. Plagiarism ANS: C Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the tesearch record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. The principle of beneficence requires the researcher to do good and “above all, do no harm.” DIF: Cognitive Level: Application REF: Page 188 A researcher is applying for a grant renewal on the subject of a promising new treatment for liver cancer. His research group has used the treatment for 13 subjects. The results—9 responded and 4 did not—are not s cally significant. However, if the researcher entered each patient as three different people and reported the results as 27 responded and 12 did not, the results would be statistically significant. If he chose to do this, what would it represent? a. Beneficence b. Fabrication ce. Falsification d. Plagiarism ANS: B | 21. 22. c. Mrs. Adamson shouldn’t be a member of the study: it’s a conflict of interest. d. Mrs. Adamson has no right to be included in the experimental group: it unfairly excludes someone else from this special benefit. ANS: D A concern with subject selection that is related to justice is that some researchers select certain people as subjects because they like them and want them to receive the specific benefits of a study. Other researchers have been swayed by power or money to make certain individuals subjects so that they can receive potentially beneficial treatments. It is especially important in research not to show preference in assigning subjects. That is the benefit of random assignment: it is fair. DIF: Cognitive Level: Application REF: Page 173 From an ethical point of view, what is the point of determining that a potential research subject is incompetent? a. An incompetent subject must receive more extensive explanation before consenting to participate in research. b. According to HIPAA, a different level of records security must ensue. c. Inclusion of the subject necessitates a different consenting process. d. The researcher has a responsibility to exclude all incompetent persons from research participation. ANS: C Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. DIF: Cognitive Level: Synthesis REF: Page 165 How would a professor who wants to have his students provide data for a research study go about achieving this without involving coercion? a. Mention that participation provides extra points. b. Have a research assistant consent all subjects and collect all data. c. Offer extra points to the whole class if 50% of them act as subjects. d. Open the study to all students on campus and provide a nonacademic incentive. ANS: D A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception. Coercion occurs when one person intentionally presents another with an overt threat of harm or the lure of excessive reward to obtain compliance. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. They are being coerced. DIF: Cognitive Level: Analysis REF: Page 164 MULTIPLE RESPONSE | 1. Why are research ethics essential? (Select all that apply.) Research subjects must be protected from accidental disclosure of information. Institutional review boards exist to protect patient rights. Researcher misconduct may result in dissemination of potentially harmful results. Results published in professional journals represent a clear violation of privacy. Research subjects must be protected from deliberate violation of their rights. ANS: A,C,E Ethical research is essential to generate sound knowledge for practice. The ethical conduct of research has been a focus since the 1940s because of the mistreatment of human subjects in selected studies. Human rights are claims and demands that have been justified in the eyes of an individual or by the consensus of a group of individuals. Having rights is necessary for the self-respect, dignity, and health of an individual. The human rights that require protection in research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair treatment, and (5) protection from discomfort and harm. Although institutional review boards exist to protect patient rights, this is not a reason that research ethics are essential. Results published in professional journals do not represent a violation of privacy if the researcher has attended to ethical mandates. eae re DIF: Cognitive Level: Synthesis REF: Page 159 2. Why are vulnerable populations considered vulnerable and to what are they vulnerable? (Select all that apply.) a. Physical harm because of a preexistent mental or physical condition The possibility of being assigned to the experimental group Unethical researchers Coercion Diminished autonomy because of an impaired ability to consent ANS: A, D,E Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Neonates are extremely vulnerable and require extra protection to determine their involvement in research. Some hospitalized patients are survivors of trauma (such as auto accidents, gunshot wounds, or physical and sexual abuse) who are very vulnerable and who often have decreased decision-making capacities. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. Other subjects are coerced to participate in studies because they believe that they cannot refuse the excessive rewards offered, such as large sums of money, specialized health care, special privileges, and jobs. eae DIF: Cognitive Level: Analysis REF: Page 165 3. Which one of the following are considered vulnerable populations from an ethical point of view? (Select all that apply.) a. Students | b. Persons with osteoporosis who are subject to hip fracture c. Persons who are depressed d. Prisoners e. Persons who have recently suffered loss of a spouse ANS: A,D Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. DIF: Cognitive Level: Analysis REF: Page 165 4. A nurse plans to interview prisoners as part of her master’s thesis on treatment of health problems in correctional institutions. What special measures must she take before she studies these potential subjects? (Select all that apply.) a. Justify to an institutional review board why she must use prisoners as subjects. Devise a consent process that provides for a conservator’s signature. Destroy all of her records. Devise interview questions that avoid any mention of prisons or prisoners. Bracket her previous beliefs about prisoners. Assure that the consent process involves no coercion. ANS: A, F The U.S. DHHS has identified certain vulnerable groups of individuals, including pregnant women, human fetuses, neonates, children, mentally incompetent persons, and prisoners, who require additional protection in the conduct of research. Researchers need to justify their use of subjects with diminished autonomy in a study, and the need for justification increases as the subjects’ risk and vulnerability. Subjects with diminished autonomy may be subject to coercion. menos DIF: Cognitive Level: Analysis REF: Page 165 5. A researcher conducts a mixed-methods study on exercise as a modality of controlling hyperglycemia. The study has both quantitative results, describing the amount that glucose falls with various amounts of exercise, and qualitative results, describing participants’ mood and sense of well-being with different kinds of exercise. The researcher decides to publish an article based on the quantitative findings immediately but wait to publish the qualitative results later. What are the reasons that this would not be an instance of researcher misconduct? (Select all that apply.) a. The data from the quantitative part of the study are reported completely and honestly. The journal does not accept qualitative research. Both “arms” of the study are freestanding. Nobody will know that a qualitative study was performed. No denial of the full scope of data collection is made. eae | 10. The unique vulnerability of children makes the decision to include them as research subjects particularly important. To safeguard their interests and protect them from harm, special ethical and regulatory considerations have been put in place for research involving children. However, the laws defining the minor status of a child are statutory and vary from state to state. Often a child’s competency to consent is governed by age, with incompetence being nonrefutable up to age 7 years. Thus, a child younger than 7 years is not believed to be mature enough to assent or consent to research. A child 7 years or older with normal cognitive development can provide assent or dissent to participation in a study, and the process for obtaining the assent should be included in the research proposal. To obtain informed consent, federal regulations require both the assent of the children (when capable) and the permission of their parents or guardians. An infant is not capable of speech or of understanding the purpose of a research study. DIF: Cognitive Level: Synthesis REF: Page 166 The Tuskegee study was ethically objectionable because informed consent was flawed, an available treatment was not provided, and deception was practiced. If informed consent had been properly administered and research subjects informed of the availability of penicillin when it became available, why would this still represent an ethically objectionable study? (Select all that apply.) a. The researcher has an obligation to actively do good for the research subjects; merely informing them of the availability of penicillin would not have been sufficient to meet this obligation. b. It took place in one state of the Union and so had limited generalizability. Some of the research subjects were illiterate and could not provide consent. d. There was no need for the study to be performed in the first place, since enough was known about syphilis at the time. e. Since African American men in Alabama were in an inferior social position, they constituted an underrepresented and potentially vulnerable population; every effort should have been made to include participants from other ethnic groups. ANS: A,E In 1932, the U.S. Public Health Service (U.S. PHS) initiated a study of syphilis in black men in the small rural town of Tuskegee, Alabama. The study, which continued for 40 years, was conducted to determine the natural course of syphilis in the adult black male. The research subjects were organized into two groups: one group consisted of 400 men who had untreated syphilis and the other consisted of a control group of 200 men without syphilis. Many of the subjects who consented to participate in the study were not informed about the purpose and procedures of the research. Some individuals were unaware that they were subjects in a study. The subjects were examined periodically but were not treated for syphilis, even after penicillin was determined to be an effective treatment for the disease in the 1940s. There was insufficient knowledge about the natural course of syphilis at the time the study was begun. Consent of illiterate subjects does not prohibit consent. Single-site research is not considered ethically objectionable per se. ° DIF: Cognitive Level: Analysis REF: Page 180 | 11. 12. A researcher obtains consent from a person with a recent traumatic brain injury (TBI) to observe the person and test her at intervals, using cognitive survey instruments. The person has not yet regained the ability to speak, and can understand and obey only simple commands. She nods yes, and shakes her head for no. The subject’s husband, who has the authority to consent for his wife because he has legal power of attorney for health care, is consented for the study, and the patient is asked to assent.. Does this fulfill the requirements for consenting someone with diminished capabilities? Why or why not? (Select all that apply.) a. Yes, it does. b. No, it does not. ¢. The subject should have been told the purpose of the study over and over again, and the tests the researcher planned to administer, until the subject nodded that she understood. Her husband should not make this decision for her. d. The researcher must obtain consent from both the legal representative and the subject. e. The researcher need not obtain assent for research involving persons with decreased ability or total inability to give informed consent. The subject will probably not remember any of this later, anyhow. f. The subject should have been asked to consent, and the husband to assent. That is the proper procedure. g. The prospective subject can understand only simple commands but, because of her TBI, she is not competent to consent. h. The subject is asked to assent in case she has an opinion about this and might understand the purpose of the study. Eliciting her cooperation is wise in either case. ANS: A,G,H Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution (Fry et al., 2011). These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. Neonates and children (minors), the mentally impaired, and unconscious patients are legally or mentally incompetent to give informed consent. They should, however, be asked to assent, since their cooperation is essential for high-quality data collection. If an individual is judged incompetent and incapable of consent, the researcher must seek approval from the prospective subject and his or her legally authorized representative. DIF: Cognitive Level: Analysis REF: Page 165 In the Jewish Chronic Disease Hospital Study, 22 patients were injected —unknowingly—with a suspension containing live cancer cells that had been generated from human cancer tissue. What ethical principles apply here? (Select all that apply.) a. Beneficence b. Self-determination c. Anonymity d. Confidentiality e. Fair treatment ANS: A,B, E | 13. 14. A highly publicized example of unethical research was a study conducted at the Jewish Chronic Disease Hospital in the 1960s. Its purpose was to determine the patients’ rejection responses to live cancer cells. Twenty-two patients were injected with a suspension containing live cancer cells that had been generated from human cancer tissue. An extensive investigation of this study revealed the patients were not informed that they were taking part in research or that the injections they received were live cancer cells. In addition, the Jewish Chronic Disease Hospital Institutional Review Board never reviewed the study; even the physicians caring for the patients were unaware that the study was being conducted. In addition, the principle of beneficence requires the researcher to do good and “above all, do no harm.” DIF: Cognitive Level: Application REF: Page 162 Monica is a nurse researcher. She completes her paperwork for an institutional review board (IRB). Her application for approval is returned to her, with comments as to how it should be revised and resubmitted. Which of the following comments are within the scope of the IRB? (Select all that apply.) a. “You have failed to provide a copy of your survey. Please do so.” b. “Your study protocol does not provide information on potential risks to anonymity. Please indicate this in Section 1g.” c. “Because of inexperience in this area, the IRB invites you to meet with us as one of the reviewers of this protocol.” d. “We can only provide provisional approval of your study.” e. “You have not included information about the risk-to-benefit ratio of this research. Please do so.” ANS: A,B, E An institutional review board (IRB) is a committee that reviews research to ensure that the investigator is conducting the research ethically. Universities, hospital corporations, and many managed care centers have IRBs to promote the conduct of ethical research and protect the rights of prospective subjects at these institutions. Each IRB has at least five members of various backgrounds (cultural, economic, educational, gender, racial) to promote a complete, scholarly, and fair review of research that is commonly conducted in an institution. If an institution regularly reviews studies with vulnerable subjects, such as children, neonates, pregnant women, prisoners, and mentally disabled persons, the IRB should include one or more members with knowledge about and experience in working with these individuals. The members must have sufficient experience and expertise to review a variety of studies, including quantitative, outcomes, intervention, and qualitative research (Munhall, 2012b). The IRB members must not have a conflicting interest related to a study conducted in an institution. Any member having a conflict of interest with a research project being reviewed must excuse himself or herself from the review process, except to provide information requested by the IRB. In reviewing the research, the reviewers may exercise all of the authorities of the IRB such as require revision of a study protocol or study documents and disapproval of the research. The IRB reviews research in progress at least yearly. DIF: Cognitive Level: Application REF: Page 183 Which of the following statements are true? (Select all that apply.) a. HIPAA regulations were formulated to address ethical treatment of research subjects. b. If electronic medical records had not been invented, HIPAA would not have been | ANS: D Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. This information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The Privacy Act of 1974 provided the initial protection of an individual’s privacy. Because of this act, data collection methods were to be scrutinized to protect subjects’ privacy, and data cannot be gathered from subjects without their knowledge. Individuals also have the right to access their records and to prevent access by others. The intent of this act was to prevent the invasion of privacy that occurs when private information is shared without an individual’s knowledge or against his or her will. Invading an individual’s privacy might cause loss of dignity, friendships, or employment or create feelings of anxiety, guilt, embarrassment, or shame. The HIPAA Privacy Rule expanded the protection of an individual’s privacy, specifically his or her protected individually identifiable health information, and described the ways in which covered entities can use or disclose this information. De-identifying health data involves removing 18 elements that could be used to identify an individual. An important one on this list is the individual’s medical record number. In the example, the researcher’s use of an actual patient identification number on a transcription risks the human right to privacy; a code number should have been used instead. DIF: Cognitive Level: Application REF: Page 169 4. Ellen is a participant in a research study. She will receive either the customary medication to treat her metastatic colon cancer or a new medication that has shown better results in animal studies and one small human study. This is_research. a. Coercive b. Correlational c. Therapeutic d. Dangerous ANS: C Therapeutic research gives the patient an opportunity to receive an experimental treatment that might have beneficial results. Nontherapeutic research is conducted to generate knowledge for a discipline, and the results from the study might benefit future patients but will probably not benefit those acting as research subjects. The Declaration of Helsinki differentiated therapeutic research from nontherapeutic research. Neither descriptive nor correlational research involves treatment or manipulation of a variable. There is no evidence of coercion. DIF: Cognitive Level: Application REF: Page 160 5. A graduate student receives a mailed survey asking her to participate in research about unpleasant experiences in graduate school. She is asked to return the survey, and the instructions say, “Return of this instrument implies consent.” Why does this constitute consent? a. Studies like this are exempt from institutional review board oversight, so consent is not required. b. Not returning the survey constitutes refusal, and subjects may indeed refuse by not completing the survey. The opposite is equally true. The study is anonymous, so there is no risk of disclosure. d. Only interventional research requires consent. ° | 6. ANS: B The requirements for written consent may be waived in research that “presents no more than. minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.” For example, if questionnaires are used to collect relatively harmless data, a signed consent form from the subjects would not be tequired. The subject’s completion of the questionnaire may serve as consent. The top of the questionnaire might contain a statement such as “Your completion of this questionnaire indicates your consent to participate in this study.” DIF: Cognitive Level: Analysis REF: Page 180 Both a subject in an experimental group who receives an experimental treatment and a subject in a control group who receives a control treatment are considered to be subjects in therapeutic research. Why is this? a. A patient in an experimental research study who elects to be a member of the experimental group knows he or she will be receiving the experimental treatment. b. Each patient who is consented to be a research subject in an experimental study in which the treatment has potentially beneficial results has the potential to receive a therapeutic intervention. c. The research is designed to measure the effect of the therapeutic treatment as compared with the usual therapeutic treatment; hence, this is therapeutic research. d. Each subject is blind to treatment. ANS: C Therapeutic research gives the patient an opportunity to receive an experimental treatment that might have beneficial results. In experimental research this means only that the subject is recruited into the study and randomly assigned to either a treatment or control group, not that the subject receives the experimental treatment. DIF: Cognitive Level: Evaluation REF: Page 160 In what way could the researchers in the Willowbrook study have designed their research on the hepatitis virus so that it was ethically acceptable? a. The researchers could have given each participant a chance to assent. b. The researchers could have performed their study on persons who were capable of full assent. c. The researchers could have made the study available at many institutions for the mentally retarded. d. The researchers could have performed descriptive research on persons already infected with hepatitis. ANS: D From the mid-1950s to the early 1970s, research on hepatitis was conducted by Dr. Krugman at Willowbrook, an institution for the mentally retarded. The subjects, all children, were deliberately infected with the hepatitis virus. During the 20-year study, Willowbrook closed its doors to new inmates because of overcrowded conditions. However, the research ward continued to admit new inmates. To gain their child’s admission to the institution, the parents were forced to give permission for the child to be a subject in the study. Because, the principal of beneficence requires the researcher to do good and “above all, do no harm,” the only way to study a virus that clearly harms people is non-interventionally: through descriptive or correlational research. | 10. DIF: Cognitive Level: Synthesis REF: Page 161 The right an individual has to be told that he is a potential participant in a research study and may decide not to be so best defines which of the following human rights? a. Beneficence b. Justice ce. Privacy d. Self-determination ANS: D The right to self-determination holds that because humans are capable of self-determination, or controlling their own destiny, they should be treated as autonomous agents who have the freedom to conduct their lives as they choose without external controls. Privacy is an individual’s right to determine the time, extent, and general circumstances under which personal information will be shared with or withheld from others. Justice holds that each person should be treated fairly and should receive what he or she is due or owed. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. DIF: Cognitive Level: Application REF: Page 162 The right an individual has to receive treatment even if he decides not to participate in the research best defines which of the following human rights? a. Beneficence b. Justice ce. Privacy d. Respect ANS: B The right to fair treatment is based on the ethical principle of justice. Privacy is the right an individual has to determine the time, extent, and general circumstances under which personal information will be shared or withheld from others. Such information consists of one’s attitudes, beliefs, behaviors, opinions, and records. The right to protection from discomfort and harm is based on the ethical principle of beneficence, which holds that one should do good and, above all, do no harm. The right to self-determination is based on the ethical principle of respect for persons. DIF: Cognitive Level: Application REF: Page 164 To take positive action to prevent any harm to the research subjects best defines which of the following principles? a. Beneficence b. Justice ce. Privacy d. Respect ANS: A | 16. 17. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. The principle of beneficence requires the researcher to do good and “above all, do no harm.” DIF: Cognitive Level: Application REF: Page 188 A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs but, on her advisor’s recommendation, decides to use it as a theoretical framework for her thesis. The student goes to the library and accesses an old master’s thesis that also uses the theory and copies three pages, word for word. She uses the other student’s reference to Maslow’s work. This is an example of which of the following? a. Nonmaleficence b. Fabrication ce. Falsification d. Plagiarism ANS: D Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The principle of beneficence requires the researcher to do good and “above all, do no harm.” DIF: Cognitive Level: Application REF: Page 188 A master’s student knows next to nothing about Maslow’s theory related to hierarchy of needs but, on her advisor’s recommendation, decides to use it as a theoretical framework for her thesis. The student goes online and finds a Wikipedia page and copies the description of Maslow’s theory verbatim, putting a citation at the end of the paragraph but not using quotation marks. This is an example of which of the following? a. Nonmaleficence b. Fabrication ce. Falsification d. Plagiarism ANS: D Plagiarism is the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit, including those obtained through confidential review of others’ research proposals and manuscripts. Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The principle of beneficence requires the researcher to do good and “above all, do no harm.” DIF: Cognitive Level: Application REF: Page 188 | 18. 19. 20. A researcher receives permission to use the information in a hospital data set, without patient identifiers. What level of subject consent is required? a. Partial: the subjects must all be notified that their data is being re-used. b. None. c. Partial: the subjects must all be notified if the results are published. d. Full: all subjects must be contacted and must agree to have their data used. ANS: B Covered entities (healthcare provider, health plan, and healthcare clearinghouse) may use and disclose a limited data set to a researcher for a study without an individual subject’s authorization or an IRB waiver. DIF: Cognitive Level: Comprehension REF: Page 170 A researcher is applying for institutional review board (IRB) approval, and the form specifies that the researcher indicate the probable level of risk. The research creates situations in which the RN research subjects are placed in unusual code-like situations in which they do not know what action to take, and actors play the parts of other healthcare providers. The RN subjects are then asked to describe their feelings and their levels of confidence as they go through 15 scenarios. What level of risk does this study pose? a. No anticipated effects b. Temporary discomfort c. Unusual discomfort d. Risk of permanent harm ANS: B Studies that cause temporary discomfort are described as minimal-risk studies, in which the discomfort encountered is similar to what the subject would experience in his or her daily life and ceases with the termination of the study. Many nursing studies require the subjects to complete questionnaires or participate in interviews, which usually involve minimal risk. The physical discomforts might be fatigue, headache, or muscle tension. The emotional and social risks might entail the anxiety or embarrassment associated with responding to certain questions. The economic risks might consist of the time spent participating in the study or travel costs to the study site. Participation in many nursing studies is considered a mere inconvenience for the subject, with no foreseeable risks of harm. Most clinical nursing studies examining the impact of a treatment involve minimal risk. DIF: Cognitive Level: Comprehension REF: Page 174 Dr. Adamson is conducting research on a new and promising chemotherapy treatment for breast cancer that improves survival and decreases adverse symptoms. Sixty subjects will be recruited; of these, thirty will be assigned to the experimental group, receiving the new treatment, and thirty to the control group, receiving the usual chemotherapy. His wife, newly diagnosed with breast cancer, is randomly assigned to the treatment group; he removes her from the treatment group and places her in the experimental group. What ethical violation has occurred? a. Mrs. Adamson has a right to self-determination: her husband has decided her group assignment for her. b. Mrs. Adamson’s husband has no right to know about her breast cancer: this is a violation of confidentiality. | 21. 22. c. Mrs. Adamson shouldn’t be a member of the study: it’s a conflict of interest. d. Mrs. Adamson has no right to be included in the experimental group: it unfairly excludes someone else from this special benefit. ANS: D A concern with subject selection that is related to justice is that some researchers select certain people as subjects because they like them and want them to receive the specific benefits of a study. Other researchers have been swayed by power or money to make certain individuals subjects so that they can receive potentially beneficial treatments. It is especially important in research not to show preference in assigning subjects. That is the benefit of random assignment: it is fair. DIF: Cognitive Level: Application REF: Page 173 From an ethical point of view, what is the point of determining that a potential research subject is incompetent? a. An incompetent subject must receive more extensive explanation before consenting to participate in research. b. According to HIPAA, a different level of records security must ensue. c. Inclusion of the subject necessitates a different consenting process. d. The researcher has a responsibility to exclude all incompetent persons from research participation. ANS: C Some persons have diminished autonomy or are vulnerable and less advantaged because of legal or mental incompetence, terminal illness, or confinement to an institution. These persons require additional protection of their right to self-determination, because they have a decreased ability, or an inability, to give informed consent. In addition, these persons are vulnerable to coercion and deception. DIF: Cognitive Level: Synthesis REF: Page 165 How would a professor who wants to have his students provide data for a research study go about achieving this without involving coercion? a. Mention that participation provides extra points. b. Have a research assistant consent all subjects and collect all data. c. Offer extra points to the whole class if 50% of them act as subjects. d. Open the study to all students on campus and provide a nonacademic incentive. ANS: D A subject’s right to self-determination can be violated through the use of (1) coercion, (2) covert data collection, and (3) deception. Coercion occurs when one person intentionally presents another with an overt threat of harm or the lure of excessive reward to obtain compliance. Sometimes students feel forced to participate in research to protect their grades or prevent negative relationships with the faculty conducting the research. They are being coerced. DIF: Cognitive Level: Analysis REF: Page 164 MULTIPLE RESPONSE | 6. ANS: A,C,E Research misconduct is defined as “the fabrication, falsification, or plagiarism in processing, performing, or reviewing research, or in reporting research results. It does not include honest error or differences in opinion.” Fabrication in research is the making up of results and recording or reporting them. Falsification of research is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record. The data from this study were neither fabricated nor falsified; it is the researcher’s decision when to disseminate research results. DIF: Cognitive Level: Evaluation REF: Page 188 Which of the following represent a breach in confidentiality? (Select all that apply.) a. The teenaged son of a researcher reads some of the raw interview data on the researcher’s computer. b. The researcher accidentally includes the real names of one participant’s husband and two daughters in the finished article, instead of changing these to pseudonyms. A researcher presents her findings at a research conference. d. A tape of a research interview is misplaced in the researcher’s home and is never found. e. The researcher mentions to a colleague that all of the participants in a recent research project on anger were divorced women. ANS: A,B, D A breach of confidentiality can occur when a researcher, by accident or direct action, allows an unauthorized person to gain access to the study raw data. Confidentiality can also be breached in the reporting or publication of a study when a subject’s identity is accidentally tevealed, violating the subject’s right to anonymity. Breaches of confidentiality can harm subjects psychologically and socially, as well as destroy the trust they had in the researchers. Breaches of confidentiality can be especially harmful to a research participant if they involve (1) religious preferences; (2) sexual prac ; (3) employment; (4) racial prejudices; (5) drug use; (6) child abuse; and (7) personal attributes, such as intelligence, honesty, and courage. ° DIF: Cognitive Level: Comprehension REF: Page 172 An improvement in research ethics could prevent some or all of which of the following? (Select all that apply.) a. Breaches of anonymity Researchers’ failures to report their funding sources in publications Minimal risk to research participants Unauthorized data collection Patients’ inability to understand complex research designs ANS: A,B, D ene | Ethical research is essential to generate sound knowledge for practice. The ethical conduct of research has been a focus since the 1940s because of the mistreatment of human subjects in selected studies. Human rights are claims and demands that have been justified in the eyes of an individual or by the consensus of a group of individuals. Having rights is necessary for the self-respect, dignity, and health of an individual. The human rights that require protection in research are (1) self-determination, (2) privacy, (3) anonymity and confidentiality, (4) fair treatment, and (5) protection from discomfort and harm. Although Institutional Review Boards exist to protect patient rights, this is not a reason that research ethics are essential. Results published in professional journals do not represent a violation of privacy, if the researcher has attended to ethical mandates. DIF: Cognitive Level: Synthesis REF: Page 159 8. In order for consent to be voluntary, which must occur? (Select all that apply.) a. The subject must sign a consent form. b. The subject cannot be mentally incompetent. ¢. The subject cannot be shamed, forced, or cajoled into participation. d. The subject cannot be paid (remunerated), because this would be coercive. e. The researcher must confirm that the person signing the consent form truly understands what the research will involve. ANS: C, E Voluntary consent means that the prospective subject has decided to take part in a study of his or her own volition without coercion or any unique influence. Voluntary consent is obtained after the prospective subject has been given essential information about the study and has shown comprehension of this information. In some studies, the consent form may be replaced by oral consent or the consent form may be used but the subject’s signature is waived. A person who is mentally incompetent or incapacitated may be a research subject, but his or her legal representative must consent for participation. If an individual is judged incompetent and incapable of consent, the researcher must seek approval from the prospective subject and his or her legally authorized representative. It is the researcher’s responsibility to confirm that the person signing the consent form truly understands what the research entails. Sometimes nursing studies have included a small financial reward of $10 to $30 or support for transportation to increase participation, but this would not be considered coercive. DIF: Cognitive Level: Analysis REF: Page 180 9. Which of these statements concerning guidelines for consenting children for research participation are true? (Select all that apply.) a. No infant or child may be used in research if he or she refuses treatment. Emancipated minors may consent for themselves. Coercion is wrong, but begging a child to participate is acceptable. An 11-year-old should be asked to assent for research participation. If infants and children participate in research, they should sign a consent form. Infants cannot refuse to participate in research if their parents consent. ANS: B, D, F meaoe | 10. The unique vulnerability of children makes the decision to include them as research subjects particularly important. To safeguard their interests and protect them from harm, special ethical and regulatory considerations have been put in place for research involving children. However, the laws defining the minor status of a child are statutory and vary from state to state. Often a child’s competency to consent is governed by age, with incompetence being nonrefutable up to age 7 years. Thus, a child younger than 7 years is not believed to be mature enough to assent or consent to research. A child 7 years or older with normal cognitive development can provide assent or dissent to participation in a study, and the process for obtaining the assent should be included in the research proposal. To obtain informed consent, federal regulations require both the assent of the children (when capable) and the permission of their parents or guardians. An infant is not capable of speech or of understanding the purpose of a research study. DIF: Cognitive Level: Synthesis REF: Page 166 The Tuskegee study was ethically objectionable because informed consent was flawed, an available treatment was not provided, and deception was practiced. If informed consent had been properly administered and research subjects informed of the availability of penicillin when it became available, why would this still represent an ethically objectionable study? (Select all that apply.) a. The researcher has an obligation to actively do good for the research subjects; merely informing them of the availability of penicillin would not have been sufficient to meet this obligation. b. It took place in one state of the Union and so had limited generalizability. Some of the research subjects were illiterate and could not provide consent. d. There was no need for the study to be performed in the first place, since enough was known about syphilis at the time. e. Since African American men in Alabama were in an inferior social position, they constituted an underrepresented and potentially vulnerable population; every effort should have been made to include participants from other ethnic groups. ANS: A,E In 1932, the U.S. Public Health Service (U.S. PHS) initiated a study of syphilis in black men in the small rural town of Tuskegee, Alabama. The study, which continued for 40 years, was conducted to determine the natural course of syphilis in the adult black male. The research subjects were organized into two groups: one group consisted of 400 men who had untreated syphilis and the other consisted of a control group of 200 men without syphilis. Many of the subjects who consented to participate in the study were not informed about the purpose and procedures of the research. Some individuals were unaware that they were subjects in a study. The subjects were examined periodically but were not treated for syphilis, even after penicillin was determined to be an effective treatment for the disease in the 1940s. There was insufficient knowledge about the natural course of syphilis at the time the study was begun. Consent of illiterate subjects does not prohibit consent. Single-site research is not considered ethically objectionable per se. ° DIF: Cognitive Level: Analysis REF: Page 180