Tag Archive for: nursing

hospital-acquired conditions

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PREPARATION

Consider the hospital-acquired conditions that are not reimbursed for under Medicare/Medicaid. Among these conditions are specific safety issues such as infections, falls, medication errors, and other safety concerns that could have been prevented or alleviated with the use of evidence-based guidelines. Hospital Safety Score, an independent nonprofit organization, uses national performance measures to determine the safety score for hospitals in the United States. The Hospital Safety Score Web site and other online resources provide hospital safety scores to the public.

Read the scenario below:

Scenario
As the manager of a unit, you have been advised by the patient safety office of an alarming increase in the hospital safety score for your unit. This is a very serious public relations matter because patient safety data is public information. It is also a financial crisis because the organization stands to lose a significant amount of reimbursement money from Medicare and Medicaid unless the source of the problem can be identified and corrected. You are required to submit a safety score improvement plan to the organization’s leadership and the patient safety office.

Select a specific patient safety goal that has been identified by an organization, or one that is widely regarded in the nursing profession as relevant to quality patient care delivery, such as patient falls, infection rates, catheter-induced urinary infections, IV infections, et cetera.

DELIVERABLE: SAFETY SCORE IMPROVEMENT PLAN

Develop a 3–5 page safety score improvement plan.

  • Identify the health care setting and nursing unit of your choice in the title of the mitigation plan. For example, “Safety Score Improvement Plan for XYZ Rehabilitation Center.”
  • You may choose to use information on a patient safety issue for the organization in which you currently work, or search for information from a setting you are familiar with, perhaps from your clinical work.
    • Demonstrate systems theory and systems thinking as you develop your recommendations.

Organize your report with these headings:

Study of Factors
  • Identify a patient safety issue.
  • Describe the influence of nursing leadership in driving the needed changes.
  • Apply systems thinking to explain how current policies and procedures may affect a safety issue.
Recommendations
  • Recommend an evidence-based strategy to improve the safety issue.
  • Explain a strategy to collect information about the safety concern.
    • How would you determine the sources of the problem?
  • Explain a plan to implement a recommendation and monitor outcomes.
    • What quality indicators will you use?
    • How will you monitor outcomes?
    • Will policies or procedures need to be changed?
    • Will nursing staff need training?
    • What tools will you need to do this?
Additional Requirements
  • Written communication: Written communication should be free of errors that detract from the overall message.
  • APA formatting: Resources and in-text citations should be formatted according to current APA style and formatting.
  • Length: The plan should be 3–5 pages.
  • Font and font size: Times New Roman, 12 point, double-spaced.
  • Number of resources: Use a minimum of three peer-reviewed resources.

Write a 3–5 page safety score improvement plan for mitigating concerns, addressing a specific patient-safety goal that is relevant to quality patient care. Determine what a best evidence-based practice is and design a plan for resolving issues resulting from not maintaining patient safety.Quality improvement and patient safety are health care industry imperatives (Institute of Medicine’s Committee on Quality of Health Care in America, 2001). Effective quality improvement results in system and organizational change. This ultimately contributes to the creation of a patient safety culture

Context

  • attachment

    safetyscoreimprovement1.pdf

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Understanding Productivity

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Report Issue

Reflect on the current roles of advanced practice nurses in healthcare as the care providers at the front line of disease management and health promotion in primary care and many other specialty settings. What do you think are some effective tactics for APN strategic positioning regarding pay equality? Should APNs position themselves as lower-cost providers who provide better care or push for comparable worth, same service and same pay?

Below is an article that provides great practical information that highlights how provider productivity is calculated in the clinical setting, which is important to know as future nurse practitioners.

Calculating Your Worth: Understanding Productivity and Value- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093517/

Must be minimum 250 words, references must be cited in APA format(6th), and must include minimum of 2 scholarly resources published within the past 5-7 years. Word document, double space

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Ethics and Evidence-Based Research

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Ethics and Evidence-Based Research

Write a 1250-1500 word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each bullet point. There should be three main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least two (2) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment.

Part 1: Describe why ethical safeguards designed for clinical research may not be feasible or appropriate for evidence-based practice or evidence-based practice implementation projects.

Part 2: Review the sectioned headed, Two Ethical Exemplars in Chapter 22 of the textbook (Melnyk and Fineout-Overholt, 2015, pages 518-519). Discuss three main ethical controversies related to implementing Evidence-Based Quality Improvement (EBQI) Initiatives. Describe how these controversies relate to the four core ethical principles.

Part 3: Identify which ethical principles may be in conflict with the concept of “patients having an ethical responsibility in improving healthcare.” Discuss how these conflicts may be resolved.

At least 2 scholarly references should be used for this assignment.

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health care discipline

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Max Points: 5.0
Find an organization related to your health care discipline and identify the mission and vision statement. Based on your experiences as a member of the health care team, explain how the values of the organization are or are not reflected in these statements.

 

It needs to be at least 500 word, APA format and a couple references. I work in Long term care facility. Psych facility.

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Change Implementation and Management Plan

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It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

To Prepare:

  • Review the Resources and identify one change that you believe is called for in your organization/workplace.
    • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
  • Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.

Your presentation should be 5–6 minutes in length and should include a video with you as presenter.

Your Change Implementation and Management Plan should include the following:

  • An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
  • A description of the change being proposed
  • Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
  • Details about the type and scope of the proposed change
  • Identification of the stakeholders impacted by the change
  • Identification of a change management team (by title/role)
  • A plan for communicating the change you propose
  • A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose

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Quantitative and Qualitative Summary (Abstract)

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Week 4: Quantitative and Qualitative Summary (Abstract)

This week, you will submit summaries of quantitative and qualitative studies. The purpose of this assignment is to become familiar with published research, research designs, and methodologies. For the assignment, you will select one quantitative research study and one qualitative study related to the field of nursing and write a summary of each study. Each summary must be accurate, succinct, and clear. These articles should be somewhat related to your PICOT questions.

Ensure the following questions are addressed in each summary:

1. What type of research is it (quantitative, qualitative, and design)?
2. What was the research question(s) or hypothesis?
3. What is the sample, the sample size, and sample attributes?
4. What was the setting of the study?
5. What were the researcher’s findings? (Identify one.)

 You must submit the research study articles along with your summaries.

  • Each summary should be between 150–250 words. 
  • Use current APA format to style your paper and to cite your sources.

Review the rubric for further information on how your assignment will be graded.

Due Sunday, 11:59 p.m. (Pacific time)

Points  150

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clinical problems

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A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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outpatient orthopedic clinic

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Create a Power Point Presentation to discuss the following

Sgt. Eddie Johns leaned back against the chair in the outpatient orthopedic clinic. His head was killing him! He wasn’t sure which was worse, the “morning after” headache or not being able to sleep at night. At least when he had a few beers under his belt so he could catch a few hours of sleep. It had been like this since he was air evacuated back stateside from Afghanistan after the roadside bomb went off. He was thankful that he had only broken his leg in a couple of places and gotten a bad bump on the head. They called that traumatic brain injury but he didn’t know what that was and really didn’t believe them anyway. He was still thinking just fine. His friend Joe wasn’t so lucky! How was Joe going to learn to walk on those artificial legs? He was still in the hospital in Washington, DC. That was pretty far from his home. Eddie wished he could visit Joe. They had been in the same platoon for 9 months. But, Eddie was glad that he had been able to come back to his own home town for outpatient treatment. It took an hour to get here but at least he could see his girl almost every day. Sure he had moved back in with his mom but it was easier to have someone to help him get around and cook for him. It was a bummer that he couldn’t work right now. He guessed it didn’t matter much since he really didn’t have a job to go back to. He had been replaced at the plant. They said they would find something for him to do once he could get around more easily. Eddie sure hoped the doc would take the pins out of his leg today and give him a clearance to work.

  • How would the use of the Roy Adaptation Model assist the nurse in planning the continuation of care for Sgt. Johns?
  • Describe the influence of Roy’s Theory in guiding the nurse’s actions in promoting Sgt. Johns adjusted self-concept.
  • From the perspective of the Roy Adaptation Model, why is it important for the nurse to listen to Sgt. Johns’ “story” in his own words and not just base her interactions on information from the chart, fellow colleagues, or his family?
  • Based on Neuman System’s Model, identify at least 4 stressors from the case study. Create a plan of care based on Neuman Systems Model for Sgt. Johns.

Your PowerPoint should include at least 1 outside reference and your book. The presentation should be 10 to 15 slides in length.

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Statistical Technique i

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Exercise 16

Understanding Independent Samples t-Test

Statistical Technique in Review

The independent samples t-test is a parametric statistical technique used to determine significant differences between the scores obtained from two samples or groups. Since the t-test is considered fairly easy to calculate, researchers often use it in determining differences between two groups. The t-test examines the differences between the means of the two groups in a study and adjusts that difference for the variability (computed by the standard error) among the data. When interpreting the results of t-tests, the larger the calculated t ratio, in absolute value, the greater the difference between the two groups. The significance of a t ratio can be determined by comparison with the critical values in a statistical table for the t distribution using the degrees of freedom (df) for the study (see Appendix A Critical Values for Student’s t Distribution at the back of this text). The formula for df for an independent t-test is as follows:

df=(numberofsubjectsinsample1+numberofsubjectsinsample2)−2

image

Exampledf=(65insample1+67insample2)−2=132−2=130

image

The t-test should be conducted only once to examine differences between two groups in a study, because conducting multiple t-tests on study data can result in an inflated Type 1 error rate. A Type I error occurs when the researcher rejects the null hypothesis when it is in actuality true. Researchers need to consider other statistical analysis options for their study data rather than conducting multiple t-tests. However, if multiple t-tests are conducted, researchers can perform a Bonferroni procedure or more conservative post hoc tests like Tukey’s honestly significant difference (HSD), Student-Newman-Keuls, or Scheffé test to reduce the risk of a Type I error. Only the Bonferroni procedure is covered in this text; details about the other, more stringent post hoc tests can be found in Plichta and Kelvin (2013) and Zar (2010).

The Bonferroni procedure is a simple calculation in which the alpha is divided by the number of t-tests conducted on different aspects of the study data. The resulting number is used as the alpha or level of significance for each of the t-tests conducted. The Bonferroni procedure formula is as follows: alpha (α) ÷ number of t-tests performed on study data = more stringent study α to determine the significance of study results. For example, if a study’s α was set at 0.05 and the researcher planned on conducting five t-tests on the study data, the α would be divided by the five t-tests (0.05 ÷ 5 = 0.01), with a resulting α of 0.01 to be used to determine significant differences in the study.

The t-test for independent samples or groups includes the following assumptions:

1. The raw scores in the population are normally distributed.

2. The dependent variable(s) is(are) measured at the interval or ratio levels.

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3. The two groups examined for differences have equal variance, which is best achieved by a random sample and random assignment to groups.

4. All scores or observations collected within each group are independent or not related to other study scores or observations.

The t-test is robust, meaning the results are reliable even if one of the assumptions has been violated. However, the t-test is not robust regarding between-samples or within-samples independence assumptions or with respect to extreme violation of the assumption of normality. Groups do not need to be of equal sizes but rather of equal variance. Groups are independent if the two sets of data were not taken from the same subjects and if the scores are not related (Grove, Burns, & Gray, 2013; Plichta & Kelvin, 2013). This exercise focuses on interpreting and critically appraising the t-tests results presented in research reports. Exercise 31 provides a step-by-step process for calculating the independent samples t-test.

Research Article

Source

Canbulat, N., Ayhan, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), 33–39.

Introduction

Canbulat and colleagues (2015, p. 33) conducted an experimental study to determine the “effects of external cold and vibration stimulation via Buzzy on the pain and anxiety levels of children during peripheral intravenous (IV) cannulation.” Buzzy is an 8 × 5 × 2.5 cm battery-operated device for delivering external cold and vibration, which resembles a bee in shape and coloring and has a smiling face. A total of 176 children between the ages of 7 and 12 years who had never had an IV insertion before were recruited and randomly assigned into the equally sized intervention and control groups. During IV insertion, “the control group received no treatment. The intervention group received external cold and vibration stimulation via Buzzy . . . Buzzy was administered about 5 cm above the application area just before the procedure, and the vibration continued until the end of the procedure” (Canbulat et al., 2015, p. 36). Canbulat et al. (2015, pp. 37–38) concluded that “the application of external cold and vibration stimulation were effective in relieving pain and anxiety in children during peripheral IV” insertion and were “quick-acting and effective nonpharmacological measures for pain reduction.” The researchers concluded that the Buzzy intervention is inexpensive and can be easily implemented in clinical practice with a pediatric population.

Relevant Study Results

The level of significance for this study was set at α = 0.05. “There were no differences between the two groups in terms of age, sex [gender], BMI, and preprocedural anxiety according to the self, the parents’, and the observer’s reports (p > 0.05) (Table 1). When the pain and anxiety levels were compared with an independent samples t test, . . . the children in the external cold and vibration stimulation [intervention] group had significantly lower pain levels than the control group according to their self-reports (both WBFC [Wong Baker Faces Scale] and VAS [visual analog scale] scores; p < 0.001) (Table 2). The external cold and vibration stimulation group had significantly lower fear and anxiety 163levels than the control group, according to parents’ and the observer’s reports (p < 0.001) (Table 3)” (Canbulat et al., 2015, p. 36).

TABLE 1

COMPARISON OF GROUPS IN TERMS OF VARIABLES THAT MAY AFFECT PROCEDURAL PAIN AND ANXIETY LEVELS

Characteristic Buzzy (n = 88) Control (n = 88) χ2
p
Sex
 Female (%), n 11 (12.5) 13 (14.8) .82
 Male (%), n 77 (87.5) 75 (85.2) .41
Characteristic Buzzy (n = 88) Control (n = 88) t
p
Age (mean ± SD) 8.25 ± 1.51 8.61 ± 1.69 −1.498
.136
BMI (mean ± SD) 25.41 ± 6.74 26.94 ± 8.68 −1.309
.192
Preprocedural anxiety
 Self-report (mean ± SD) 2.03 ± 1.29 2.11 ± 1.58 −0.364
.716
 Parent report (mean ± SD) 2.11 ± 1.20 2.17 ± 1.42 −0.285
.776
 Observer report (mean ± SD) 2.18 ± 1.17 2.24 ± 1.37 −0.295
.768

image

BMI, body mass index.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 36.

TABLE 2

COMPARISON OF GROUPS’ PROCEDURAL PAIN LEVELS DURING PERIPHERAL IV CANNULATION

Buzzy (n = 88) Control (n = 88) t
p
Procedural self-reported pain with WBFS (mean ± SD) 2.75 ± 2.68 5.70 ± 3.31 −6.498
0.000
Procedural self-reported pain with VAS (mean ± SD) 1.66 ± 1.95 4.09 ± 3.21 −6.065
0.000

image

IV, intravenous; WBFS, Wong-Baker Faces Scale; SD, standard deviation; VAS, visual analog scale.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 37.

TABLE 3

COMPARISON OF GROUPS’ PROCEDURAL ANXIETY LEVELS DURING PERIPHERAL IV CANNULATION

Procedural Child Anxiety Buzzy (n = 88) Control (n = 88) t
p
Parent reported (mean ± SD) 0.94 ± 1.06 2.09 ± 1.39 −6.135
0.000
Observer reported (mean ± SD) 0.92 ± 1.03 2.14 ± 1.34 −6.745
0.000

image

SD, standard deviation; IV, intravenous.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 37.

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Study Questions

1. What type of statistical test was conducted by Canbulat et al. (2015) to examine group differences in the dependent variables of procedural pain and anxiety levels in this study? What two groups were analyzed for differences?

2. What did Canbulat et al. (2015) set the level of significance, or alpha (α), at for this study?

3. What are the t and p (probability) values for procedural self-reported pain measured with a visual analog scale (VAS)? What do these results mean?

4. What is the null hypothesis for observer-reported procedural anxiety for the two groups? Was this null hypothesis accepted or rejected in this study? Provide a rationale for your answer.

5. What is the t-test result for BMI? Is this result statistically significant? Provide a rationale for your answer. What does this result mean for the study?

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6. What causes an increased risk for Type I errors when t-tests are conducted in a study? How might researchers reduce the increased risk for a Type I error in a study?

7. Assuming that the t-tests presented in Table 2 and Table 3 are all the t-tests performed by Canbulat et al. (2015) to analyze the dependent variables’ data, calculate a Bonferroni procedure for this study.

8. Would the t-test for observer-reported procedural anxiety be significant based on the more stringent α calculated using the Bonferroni procedure in question 7? Provide a rationale for your answer.

9. The results in Table 1 indicate that the Buzzy intervention group and the control group were not significantly different for gender, age, body mass index (BMI), or preprocedural anxiety (as measured by self-report, parent report, or observer report). What do these results indicate about the equivalence of the intervention and control groups at the beginning of the study? Why are these results important?

10. Canbulat et al. (2015) conducted the χ2 test to analyze the difference in sex or gender between the Buzzy intervention group and the control group. Would an independent samples t-test be appropriate to analyze the gender data in this study (review algorithm in Exercise 12)? Provide a rationale for your answer.

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Answers to Study Questions

1. An independent samples t-test was conducted to examine group differences in the dependent variables in this study. The two groups analyzed for differences were the Buzzy experimental or intervention group and the control group.

2. The level of significance or alpha (α) was set at 0.05.

3. The result was t = −6.065, p = 0.000 for procedural self-reported pain with the VAS (see Table 2). The t value is statistically significant as indicated by the p = 0.000, which is less than α = 0.05 set for this study. The t result means there is a significant difference between the Buzzy intervention group and the control group in terms of the procedural self-reported pain measured with the VAS. As a point of clarification, p values are never zero in a study. There is always some chance of error.

4. The null hypothesis is: There is no difference in observer-reported procedural anxiety levels between the Buzzy intervention and the control groups for school-age children. The t = −6.745 for observer-reported procedural anxiety levels, p = 0.000, which is less than α = 0.05 set for this study. Since this study result was statistically significant, the null hypothesis was rejected.

5. The t = −1.309 for BMI. The nonsignificant p = .192 for BMI is greater than α = 0.05 set for this study. The nonsignificant result means there is no statistically significant difference between the Buzzy intervention and control groups for BMI. The two groups need to be similar for demographic variables to decrease the potential for error and increase the likelihood that the results are an accurate reflection of reality.

6. The conduct of multiple t-tests causes an increased risk for Type I errors. If only one t-test is conducted on study data, the risk of Type I error does not increase. The Bonferroni procedure and the more stringent Tukey’s honestly significant difference (HSD), Student Newman-Keuls, or Scheffé test can be calculated to reduce the risk of a Type I error (Plichta & Kelvin, 2013; Zar, 2010).

7. The Bonferroni procedure is calculated by alpha ÷ number of t-tests conducted on study variables’ data. Note that researchers do not always report all t-tests conducted, especially if they were not statistically significant. The t-tests conducted on demographic data are not of concern. Canbulat et al. reported the results of four t-tests conducted to examine differences between the intervention and control groups for the dependent variables procedural self-reported pain with WBFS, procedural self-reported pain with VAS, parent-reported anxiety levels, and observer-reported anxiety levels. The Bonferroni calculation for this study: 0.05 (alpha) ÷ number of t-tests conducted = 0.05 ÷ 4 = 0.0125. The new α set for the study is 0.0125.

8. Based on the Bonferroni result = 0.0125 obtained in Question 7, the t = −6.745, p = 0.000, is still significant since it is less than 0.0125.

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9. The intervention and control groups were examined for differences related to the demographic variables gender, age, and BMI and the dependent variable preprocedural anxiety that might have affected the procedural pain and anxiety posttest levels in the children 7 to 12 years old. These nonsignificant results indicate the intervention and control groups were similar or equivalent for these variables at the beginning of the study. Thus, Canbulat et al. (2015) can conclude the significant differences found between the two groups for procedural pain and anxiety levels were probably due to the effects of the intervention rather than sampling error or initial group differences.

10. No, the independent samples t-test would not have been appropriate to analyze the differences in gender between the Buzzy intervention and control groups. The demographic variable gender is measured at the nominal level or categories of females and males. Thus, the χ2 test is the appropriate statistic for analyzing gender data (see Exercise 19). In contrast, the t-test is appropriate for analyzing data for the demographic variables age and BMI measured at the ratio level.

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EXERCISE 16 Questions to Be Graded

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.”

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

1. What do degrees of freedom (df) mean? Canbulat et al. (2015) did not provide the dfs in their study. Why is it important to know the df for a t ratio? Using the df formula, calculate the df for this study.

2. What are the means and standard deviations (SDs) for age for the Buzzy intervention and control groups? What statistical analysis is conducted to determine the difference in means for age for the two groups? Was this an appropriate analysis technique? Provide a rationale for your answer.

3. What are the t value and p value for age? What do these results mean?

4. What are the assumptions for conducting the independent samples t-test?

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5. Are the groups in this study independent or dependent? Provide a rationale for your answer.

6. What is the null hypothesis for procedural self-reported pain measured with the Wong Baker Faces Scale (WBFS) for the two groups? Was this null hypothesis accepted or rejected in this study? Provide a rationale for your answer.

7. Should a Bonferroni procedure be conducted in this study? Provide a rationale for your answer.

8. What variable has a result of t = −6.135, p = 0.000? What does the result mean?

9. In your opinion, is it an expected or unexpected finding that both t values on Table 2 were found to be statistically significant. Provide a rationale for your answer.

10. Describe one potential clinical benefit for pediatric patients to receive the Buzzy intervention that combined cold and vibration

Exercise 17

Understanding Paired or Dependent Samples t-Test

Statistical Technique in Review

The paired or dependent samples t-test is a parametric statistical procedure calculated to determine differences between two sets of repeated measures data from one group of people. The scores used in the analysis might be obtained from the same subjects under different conditions, such as the one group pretest–posttest design. With this type of design, a single group of subjects experiences the pretest, treatment, and posttest. Subjects are referred to as serving as their own control during the pretest, which is then compared with the posttest scores following the treatment. Paired scores also result from a one-group repeated measures design, where one group of participants is exposed to different levels of an intervention. For example, one group of participants might be exposed to two different doses of a medication and the outcomes for each participant for each dose of medication are measured, resulting in paired scores. The one group design is considered a weak quasi-experimental design because it is difficult to determine the effects of a treatment without a comparison to a separate control group (Shadish, Cook, & Campbell, 2002).

A less common type of paired groups is when the groups are matched as part of the design to ensure similarities between the two groups and thus reduce the effect of extraneous variables (Grove, Burns, & Gray, 2013; Shadish et al., 2002). For example, two groups might be matched on demographic variables such as gender, age, and severity of illness to reduce the extraneous effects of these variables on the study results. The assumptions for the paired samples t-test are as follows:

1. The distribution of scores is normal or approximately normal.

2. The dependent variable(s) is(are) measured at interval or ratio levels.

3. Repeated measures data are collected from one group of subjects, resulting in paired scores.

4. The differences between the paired scores are independent.

Research Article

Source

Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37(3), 185–193.

Introduction

Despite the widespread use of the artificial sweetener aspartame in drinks and food, there are concern and controversy about the mixed research evidence on its neurobehavioral 172effects. Thus Lindseth and colleagues (2014) conducted a one-group repeated measures design to determine the neurobehavioral effects of consuming both low- and high-aspartame diets in a sample of 28 college students. “The participants served as their own controls. . . . A random assignment of the diets was used to avoid an error of variance for possible systematic effects of order” (Lindseth et al., 2014, p. 187). “Healthy adults who consumed a study-prepared high-aspartame diet (25 mg/kg body weight/day) for 8 days and a low-aspartame diet (10 mg/kg body weight/day) for 8 days, with a 2-week washout between the diets, were examined for within-subject differences in cognition, depression, mood, and headache. Measures included weight of foods consumed containing aspartame, mood and depression scales, and cognitive tests for working memory and spatial orientation. When consuming high-aspartame diets, participants had more irritable mood, exhibited more depression, and performed worse on spatial orientation tests. Aspartame consumption did not influence working memory. Given that the higher intake level tested here was well below the maximum acceptable daily intake level of 40–50 mg/kg body weight/day, careful consideration is warranted when consuming food products that may affect neurobehavioral health” (Lindseth et al., 2014, p. 185).

Relevant Study Results

“The mean age of the study participants was 20.8 years (SD = 2.5). The average number of years of education was 13.4 (SD = 1.0), and the mean body mass index was 24.1 (SD = 3.5). . . . Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period (Table 2). Two participants had clinically significant cognitive impairment after consuming high-aspartame diets. . . . Participants were significantly more depressed after they consumed the high-aspartame diet compared to when they consumed the low-aspartame diet (Table 2). . . . Only one participant reported a headache; no difference in headache incidence between high- and low-aspartame intake periods could be established” (Lindseth et al., 2014, p. 190).

TABLE 2

WITHIN-SUBJECT DIFFERENCES IN NEUROBEHAVIOR SCORES AFTER HIGH AND LOW ASPARTAME INTAKE (N = 28)

Variable M SD Paired t-Test p
Spatial orientation
 High-aspartame 14.1 4.2 2.4 .03*
 Low-aspartame 16.6 4.3
Working memory
 High-aspartame 730.0 152.7 1.5 N.S.
 Low-aspartame 761.1 201.6
Mood (irritability)
 High-aspartame 33.4 9.0 3.4 .002**
 Low-aspartame 30.5 7.3
Depression
 High-aspartame 36.8 7.0 3.8 .001**
 Low-aspartame 34.4 6.2

image

*p < .05.

**p < .01.

M = Mean; SD = Standard deviation; N.S. = Nonsignificant.

Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37(3), p. 190

173

Study Questions

1. Are independent or dependent (paired) scores examined in this study? Provide a rationale for your answer.

2. What independent (intervention) and dependent (outcome) variables were included in this study?

3. What inferential statistical technique was calculated to examine differences in the participants when they received the high-aspartame diet intervention versus the low-aspartame diet? Is this technique appropriate? Provide a rationale for your answer.

4. What statistical techniques were calculated to describe spatial orientation for the participants consuming low- and high-aspartame diets? Were these techniques appropriate? Provide a rationale for your answer.

5. What was the dispersion of the scores for spatial orientation for the high- and low-aspartame diets? Is the dispersion of these scores similar or different? Provide a rationale for your answer.

6. What is the paired t-test value for spatial orientation between the participants’ consumption of high- and low-aspartame diets? Are these results significant? Provide a rationale for your answer.

174

7. State the null hypothesis for spatial orientation for this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer.

8. Discuss the meaning of the results regarding spatial orientation for this study. What is the clinical importance of this result? Document your answer.

9. Was there a significant difference in the participants’ reported headaches between the high- and low-aspartame intake periods? What does the result indicate?

10. What additional research is needed to determine the neurobehavioral effects of aspartame consumption?

175

Answers to Study Questions

1. This study was conducted using one group of 28 college students who consumed both high- and low- aspartame diets and differences in their responses to these two diets (interventions) were examined. Lindseth et al. (2014, p. 187) stated that “the participants served as their own controls” in this study, indicating the scores from the one group are paired. In Table 2, the t-tests are identified as paired t-tests, which are conducted on dependent or paired samples.

2. The interventions were high-aspartame diet (25 mg/kg body weight/day) and low-aspartame diet (10 mg/kg body weight/day). The dependent or outcome variables were spatial orientation, working memory, mood (irritability), depression, and headaches (see Table 2 and narrative of results).

3. Differences were examined with the paired t-test (see Table 2). This statistical technique is appropriate since the study included one group and the participants served as their own control (Plichta & Kelvin, 2013). The dependent variables were measured at least at the interval level for each subject following their consumption of high- and low-aspartame diets and were then examined for differences to determine the effects of the two aspartame diets.

4. Means and standard deviations (SDs) were used to describe spatial orientation for high- and low-aspartame diets. The data in the study were considered at least interval level, so means and SDs are the appropriate analysis techniques for describing the study dependent variables (Grove et al., 2013).

5. Standard deviation (SD) is a measure of dispersion that was reported in this study. Spatial orientation following a high-aspartame diet had an SD = 4.2 and an SD = 4.3 for a low-aspartame diet. These SDs are very similar, indicating similar dispersions of spatial orientation scores following the two aspartame diets.

6. Paired t-test = 2.4 for spatial orientation, which is a statistically significant result since p = .03*. The single asterisk (*) directs the reader to the footnote at the bottom of the table, which identifies * p < .05. Since the study result of p = .03 is less than α = .05 set for this study, then the result is statistically significant.

7. There is no significant difference in spatial orientation scores for participants following consumption of a low-aspartame diet versus a high-aspartame diet. The null hypothesis was rejected because of the significant difference found for spatial orientation (see the answer to Question 6). Significant results cause the rejection of the null hypothesis and lend support to the research hypothesis that the levels of aspartame do effect spatial orientation.

8. The researchers reported, “Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period (Table 2)” (Lindseth et al., 2014, p. 190). This result is clinically important since the high-aspartame diet significantly reduced the participants’ spatial orientation. 176Healthcare providers need to be aware of this finding, since it is consistent with previous research, and encourage people to consume fewer diet drinks and foods with aspartame. The American Heart Association and the American Diabetic Association have provided a statement about the effects of aspartame that can be found on the National Guideline Clearinghouse website at http://www.guideline.gov/content.aspx?id=38431&search=effects+aspartame.

9. There was no significant difference in reported headaches based on the level (high or low) of aspartame diet consumed. Additional research is needed to determine if this result is an accurate reflection of reality or is due to design weaknesses, sampling or data collection errors, or chance (Grove et al., 2013).

10. Additional studies are needed with larger samples to determine the effects of aspartame in the diet. Lindseth et al. (2014) conducted a power analysis that indicated the sample size should have been at least 30 participants. Thus, the sample size was small at N = 28, which increased the potential for a Type II error. Diets higher in aspartame (40–50 mg/kg body weight/day) should be examined for neurobehavioral effects. Longitudinal studies to examine the effects of aspartame over more than 8 days are needed. Future research needs to examine the length of washout period needed between the different levels of aspartame diets. Researchers also need to examine the measurement methods to ensure they have strong validity and reliability. Could a stronger test of working memory be used in future research?

177

EXERCISE 17 Questions to Be Graded

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.”

1. What are the assumptions for conducting a paired or dependent samples t-test in a study? Which of these assumptions do you think were met by the Lindseth et al. (2014) study?

2. In the introduction, Lindseth et al. (2014) described a “2-week washout between diets.” What does this mean? Why is this important?

3. What is the paired t-test value for mood (irritability) between the participants’ consumption of high- versus low-aspartame diets? Is this result statistically significant? Provide a rationale for your answer.

4. State the null hypothesis for mood (irritability) that was tested in this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer.

178

5. Which t value in Table 2 represents the greatest relative or standardized difference between the high- and low-aspartame diets? Is this t value statistically significant? Provide a rationale for your answer.

6. Discuss why the larger t values are more likely to be statistically significant.

7. Discuss the meaning of the results regarding depression for this study. What is the clinical importance of this result?

8. What is the smallest, paired t-test value in Table 2? Why do you think the smaller t values are not statistically significant?

9. Discuss the clinical importance of these study results about the consumption of aspartame. Document your answer with a relevant source.

10. Are these study findings related to the consumption of high- and low-aspartame diets ready for implementation in practice? Provide a rationale for your answer.

|
       Exercise 17

Understanding Paired or Dependent Samples t-Test

Statistical Technique in Review

The paired or dependent samples t-test is a parametric statistical procedure calculated to determine differences between two sets of repeated measures data from one group of people. The scores used in the analysis might be obtained from the same subjects under different conditions, such as the one group pretest–posttest design. With this type of design, a single group of subjects experiences the pretest, treatment, and posttest. Subjects are referred to as serving as their own control during the pretest, which is then compared with the posttest scores following the treatment. Paired scores also result from a one-group repeated measures design, where one group of participants is exposed to different levels of an intervention. For example, one group of participants might be exposed to two different doses of a medication and the outcomes for each participant for each dose of medication are measured, resulting in paired scores. The one group design is considered a weak quasi-experimental design because it is difficult to determine the effects of a treatment without a comparison to a separate control group (Shadish, Cook, & Campbell, 2002).

A less common type of paired groups is when the groups are matched as part of the design to ensure similarities between the two groups and thus reduce the effect of extraneous variables (Grove, Burns, & Gray, 2013; Shadish et al., 2002). For example, two groups might be matched on demographic variables such as gender, age, and severity of illness to reduce the extraneous effects of these variables on the study results. The assumptions for the paired samples t-test are as follows:

1. The distribution of scores is normal or approximately normal.

2. The dependent variable(s) is(are) measured at interval or ratio levels.

3. Repeated measures data are collected from one group of subjects, resulting in paired scores.

4. The differences between the paired scores are independent.

Research Article

Source

Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37(3), 185–193.

Introduction

Despite the widespread use of the artificial sweetener aspartame in drinks and food, there are concern and controversy about the mixed research evidence on its neurobehavioral 172effects. Thus Lindseth and colleagues (2014) conducted a one-group repeated measures design to determine the neurobehavioral effects of consuming both low- and high-aspartame diets in a sample of 28 college students. “The participants served as their own controls. . . . A random assignment of the diets was used to avoid an error of variance for possible systematic effects of order” (Lindseth et al., 2014, p. 187). “Healthy adults who consumed a study-prepared high-aspartame diet (25 mg/kg body weight/day) for 8 days and a low-aspartame diet (10 mg/kg body weight/day) for 8 days, with a 2-week washout between the diets, were examined for within-subject differences in cognition, depression, mood, and headache. Measures included weight of foods consumed containing aspartame, mood and depression scales, and cognitive tests for working memory and spatial orientation. When consuming high-aspartame diets, participants had more irritable mood, exhibited more depression, and performed worse on spatial orientation tests. Aspartame consumption did not influence working memory. Given that the higher intake level tested here was well below the maximum acceptable daily intake level of 40–50 mg/kg body weight/day, careful consideration is warranted when consuming food products that may affect neurobehavioral health” (Lindseth et al., 2014, p. 185).

Relevant Study Results

“The mean age of the study participants was 20.8 years (SD = 2.5). The average number of years of education was 13.4 (SD = 1.0), and the mean body mass index was 24.1 (SD = 3.5). . . . Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period (Table 2). Two participants had clinically significant cognitive impairment after consuming high-aspartame diets. . . . Participants were significantly more depressed after they consumed the high-aspartame diet compared to when they consumed the low-aspartame diet (Table 2). . . . Only one participant reported a headache; no difference in headache incidence between high- and low-aspartame intake periods could be established” (Lindseth et al., 2014, p. 190).

TABLE 2

WITHIN-SUBJECT DIFFERENCES IN NEUROBEHAVIOR SCORES AFTER HIGH AND LOW ASPARTAME INTAKE (N = 28)

Variable M SD Paired t-Test p
Spatial orientation
 High-aspartame 14.1 4.2 2.4 .03*
 Low-aspartame 16.6 4.3
Working memory
 High-aspartame 730.0 152.7 1.5 N.S.
 Low-aspartame 761.1 201.6
Mood (irritability)
 High-aspartame 33.4 9.0 3.4 .002**
 Low-aspartame 30.5 7.3
Depression
 High-aspartame 36.8 7.0 3.8 .001**
 Low-aspartame 34.4 6.2

image

*p < .05.

**p < .01.

M = Mean; SD = Standard deviation; N.S. = Nonsignificant.

Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37(3), p. 190

173

Study Questions

1. Are independent or dependent (paired) scores examined in this study? Provide a rationale for your answer.

2. What independent (intervention) and dependent (outcome) variables were included in this study?

3. What inferential statistical technique was calculated to examine differences in the participants when they received the high-aspartame diet intervention versus the low-aspartame diet? Is this technique appropriate? Provide a rationale for your answer.

4. What statistical techniques were calculated to describe spatial orientation for the participants consuming low- and high-aspartame diets? Were these techniques appropriate? Provide a rationale for your answer.

5. What was the dispersion of the scores for spatial orientation for the high- and low-aspartame diets? Is the dispersion of these scores similar or different? Provide a rationale for your answer.

6. What is the paired t-test value for spatial orientation between the participants’ consumption of high- and low-aspartame diets? Are these results significant? Provide a rationale for your answer.

174

7. State the null hypothesis for spatial orientation for this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer.

8. Discuss the meaning of the results regarding spatial orientation for this study. What is the clinical importance of this result? Document your answer.

9. Was there a significant difference in the participants’ reported headaches between the high- and low-aspartame intake periods? What does the result indicate?

10. What additional research is needed to determine the neurobehavioral effects of aspartame consumption?

175

Answers to Study Questions

1. This study was conducted using one group of 28 college students who consumed both high- and low- aspartame diets and differences in their responses to these two diets (interventions) were examined. Lindseth et al. (2014, p. 187) stated that “the participants served as their own controls” in this study, indicating the scores from the one group are paired. In Table 2, the t-tests are identified as paired t-tests, which are conducted on dependent or paired samples.

2. The interventions were high-aspartame diet (25 mg/kg body weight/day) and low-aspartame diet (10 mg/kg body weight/day). The dependent or outcome variables were spatial orientation, working memory, mood (irritability), depression, and headaches (see Table 2 and narrative of results).

3. Differences were examined with the paired t-test (see Table 2). This statistical technique is appropriate since the study included one group and the participants served as their own control (Plichta & Kelvin, 2013). The dependent variables were measured at least at the interval level for each subject following their consumption of high- and low-aspartame diets and were then examined for differences to determine the effects of the two aspartame diets.

4. Means and standard deviations (SDs) were used to describe spatial orientation for high- and low-aspartame diets. The data in the study were considered at least interval level, so means and SDs are the appropriate analysis techniques for describing the study dependent variables (Grove et al., 2013).

5. Standard deviation (SD) is a measure of dispersion that was reported in this study. Spatial orientation following a high-aspartame diet had an SD = 4.2 and an SD = 4.3 for a low-aspartame diet. These SDs are very similar, indicating similar dispersions of spatial orientation scores following the two aspartame diets.

6. Paired t-test = 2.4 for spatial orientation, which is a statistically significant result since p = .03*. The single asterisk (*) directs the reader to the footnote at the bottom of the table, which identifies * p < .05. Since the study result of p = .03 is less than α = .05 set for this study, then the result is statistically significant.

7. There is no significant difference in spatial orientation scores for participants following consumption of a low-aspartame diet versus a high-aspartame diet. The null hypothesis was rejected because of the significant difference found for spatial orientation (see the answer to Question 6). Significant results cause the rejection of the null hypothesis and lend support to the research hypothesis that the levels of aspartame do effect spatial orientation.

8. The researchers reported, “Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period (Table 2)” (Lindseth et al., 2014, p. 190). This result is clinically important since the high-aspartame diet significantly reduced the participants’ spatial orientation. 176Healthcare providers need to be aware of this finding, since it is consistent with previous research, and encourage people to consume fewer diet drinks and foods with aspartame. The American Heart Association and the American Diabetic Association have provided a statement about the effects of aspartame that can be found on the National Guideline Clearinghouse website at http://www.guideline.gov/content.aspx?id=38431&search=effects+aspartame.

9. There was no significant difference in reported headaches based on the level (high or low) of aspartame diet consumed. Additional research is needed to determine if this result is an accurate reflection of reality or is due to design weaknesses, sampling or data collection errors, or chance (Grove et al., 2013).

10. Additional studies are needed with larger samples to determine the effects of aspartame in the diet. Lindseth et al. (2014) conducted a power analysis that indicated the sample size should have been at least 30 participants. Thus, the sample size was small at N = 28, which increased the potential for a Type II error. Diets higher in aspartame (40–50 mg/kg body weight/day) should be examined for neurobehavioral effects. Longitudinal studies to examine the effects of aspartame over more than 8 days are needed. Future research needs to examine the length of washout period needed between the different levels of aspartame diets. Researchers also need to examine the measurement methods to ensure they have strong validity and reliability. Could a stronger test of working memory be used in future research?

177

EXERCISE 17 Questions to Be Graded

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

Follow your instructor’s directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.”

1. What are the assumptions for conducting a paired or dependent samples t-test in a study? Which of these assumptions do you think were met by the Lindseth et al. (2014) study?

2. In the introduction, Lindseth et al. (2014) described a “2-week washout between diets.” What does this mean? Why is this important?

3. What is the paired t-test value for mood (irritability) between the participants’ consumption of high- versus low-aspartame diets? Is this result statistically significant? Provide a rationale for your answer.

4. State the null hypothesis for mood (irritability) that was tested in this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer.

178

5. Which t value in Table 2 represents the greatest relative or standardized difference between the high- and low-aspartame diets? Is this t value statistically significant? Provide a rationale for your answer.

6. Discuss why the larger t values are more likely to be statistically significant.

7. Discuss the meaning of the results regarding depression for this study. What is the clinical importance of this result?

8. What is the smallest, paired t-test value in Table 2? Why do you think the smaller t values are not statistically significant?

9. Discuss the clinical importance of these study results about the consumption of aspartame. Document your answer with a relevant source.

10. Are these study findings related to the consumption of high- and low-aspartame diets ready for implementation in practice? Provide a rationale for your answer.

There are two exercises that i posted exercise 16 and 17. both exercises has 10 questions at the end which says questions to be graded. I need to do that questions.

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clinical environment

/in /by

In collaboration with your approved course mentor, you will identify a specific evidence-based practice proposal topic for the capstone project. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.

Write a 500-750 word description of your proposed capstone project topic. Make sure to include the following:

  1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project
  2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
  3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
  4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
  5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.
  6. A proposed solution to the identified project topic

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