Chapter 3 Introduction to Quantitative Research 43

MEASUREMENT METHODS
SAMPLE The ASI Questionnaire contains 10 sections: demographics;
The convenience sample [nonrandom sampling family origin; educational history, occupational history and
method] MS retained by advertising for subjects at public assistance; legal history; characteristics of the child
three state universities in the southwest [setting]. sexual abuse (duration, perpetrator, pregnancy, type, and
Despite the sensitive nature of the study, 22 [sample threats); past and present other victimizations; past and
size] usable interviews were obtained. The sample present physical symptoms; past and present psychosocial
included women (population) between the ages of 18 symptoms; and relationship with own children. Each section
and 39 years (mean = 28 years, SD = 6.5 years) who is followed by a response set that includes space for other.
were identified as survivors of child sexual abuse Content validity was established by Brown and Garrison
(sample criteria). The majority of these women were (1990) using an in-depth review of 132 clinical records.... For
white (91%) and students (82%). A little more than half this descriptive correlational study, content validity of the
(54%) were single, seven (32%) were divorced, and ASI questionnaire was examined by asking an open-ended
three (14%) were married. Most (64%) had no question: Is there additional information you would like to
children. A small percentage (14%) was on some form share or think is important for describing your experience?
of public assistance and only (14%) has been arrested. (Hulme & Grove, 1994, p.524)
Although 27% of the subjects had stepfamily
members, the parents of 14 subjects (64%) were still
married. Half the fathers were working class or self-
employed; the rest were professionals.
Mothers were either working class or self-employed
(50%), homemakers (27%), or professionals (11%). Developing a Plan for Data Collection
Most subjects (95%) had siblings, and 36% knew or
suspected their siblings also had been abused and Analysis
[sample characteristics]. (Hulme & Grove, 1994, pp. Data collection is the precise, systematic gathering of
523-524) information relevant to the research purpose
or the specific objectives, questions, or hypotheses
of a study. The data collected in quantitative studies are
usually numerical. Planning data collection
will enable you to anticipate problems that are likely
to occur and to explore possible solutions. Usually,
detailed procedures for implementing a treatment
Methods of Measurement and collecting data are developed, with a schedule
. ; * is the process of assigning numbers to that identifies the initiation and termination of the
:r events or situations) in accord with some process (see Chapter 17).
iaplan, 1964, p. 177). A component of mea- Planning data analysis is the final step before the
ts instrumentation, which is the application study is implemented. The analysis plan is based on
rules to the development of a measure- (1) the research objectives, questions, or hypotheses; (2) the
te or instrument. An instrument is selected data to be collected; (3) research design;
a specific variable in a study. Data gener- (4) researcher expertise; and (5) availability of
2E instrument are at the nominal, ordinal, computer resources.
or ratio level of measurement. The level of Several statistical analysis techniques are available to
,ea:. with nominal being the lowest form of describe the sample, examine relationships,
rat and ratio being the highest, determines or determine significant differences within studies.
statistical analyses that you can perform Most researchers consult a statistician for assistance in
developing an analysis plan.

Implementing the Research Plan

Implementing the research plan involves treatment
or intervention implementation, data collection, data
:r of an instrument requires extensive analysis, interpretation of research findings, and,
of its reliability and validity. Reliability sometimes, a pilot study.
s consistently the measurement technique
i . i ncept. The validity of an instrument
tc which it actually reflects the abstract
err examined. Chapter 15 introduces the
* measurement and explains the differ-
it reliability and validity for instruments.
r
vides a background for selecting mea-
ner hods for a study. Hulme and Grove
fed the following description of the ASI
that was used to measure their study
 .44 Unit ONE IntroductioiLto Nursing Research
Pilot Study
A pilot study is commonly defined as a smaller version
of a proposed study conducted to refine the
methodology (Van Ort. 1981). 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. However, you could
use a pilot study to develop various steps in the
research process (Prescott & Soeken, 1989). For
example, you could conduct a pilot study to develop
and refine an intervention or treatment, a
measurement method, a data collection tool, or the
data collection process. Thus, a pilot study could be
used to develop a research plan rather than to test an
already developed plan.
Some of the reasons for conducting pilot studies
are as follows (Prescott & Soeken, 1989; Van Ort, 1981):
1. To determine whether the proposed study is
feasible (e.g., are the subjects available, does
the researcher have the time and money to do
the study?).
2. To develop or refine a research treatment or
intervention.
3. To develop a protocol for the implementation
of a treatment.
4. To identify problems with a study design.
5. To determine whether the sample is
representative of the population or whether the
sampling technique is effective.
6. To examine the reliability and validity of the
research instruments.
7. To develop or refine data collection
instruments.
8. To refin the data collection and analysis plan.
9. To give the researcher experience with the
subjects, setting, methodology, and methods of
measurement.
10. To try out data analysis techniques.
Hayward et al. (2007) believed that conducting a pilot
study improved the strength of their study design and
directed their development of a quality proposal for a
large multisite trial that received external grant
support. Thus, as a researcher you conduct pilot
studies to improve the development and
implementation of your future major studies.
Data Collection
In quantitative research, data collection involves
obtaining numerical data to address the research
objectives, questions, or hypotheses. To collect data,
you must obtain consent or permission from the
setting or agency where the study is to be conducted
and from potential subjects. Frequently, the subjects
are asked to sign a consent form, which describes the
study, promises the subjects confidentiality and indicates
that the subjects can stop participation at any time (see
Chapter 9).
During data collection, the study variables are
measured through a variety of techniques, such as
observation, interview, questionnaires, scales, and
physiological measurement methods. In a growing
number of studies, nurses measure physiological
variables with high-technology equipment. The data are
collected and recorded systematically for each subject
and are organized to facilitate computer entry. Hulme
and Grove (1994) identified the following procedure for
data collection:
Although the tool can be self-reporting, it was
administered by personal interview to allow for
elaboration of other responses. The interviews
lasted about one hour and were conducted in a
private room provided by The University of Texas at
Arlington. Each interview started with a discussion of
the study benefits and risks and included signing a
consent form. Risks included possible painful
memories and embarrassment during the interview
as well as emotional and physical discomfort after
the interview. Sources of public and private
counseling were provided to assist subjects with any
difficulties experienced related to the study. (Hulme
& Grove, 199, pp. 524-525)
Data Analysis
Data analysis reduces, organizes, and gives meaning to
the data. The analysis of data from quantitative research
involves the use of (1) descriptive and exploratory
procedures (see Chapter 19) to describe study variables
and the sample, (2) statistical techniques to test
proposed relationships (see Chapter 20), (3) techniques
to make predictions (see Chapter 21), and (4) analysis
techniques to examine causality (see Chapter 22)
Computers are used to perform most analyses. So
Chapter 18 provides a background for using computers
in research.
The choice of analysis techniques implemented is
determined primarily by the research objectives
questions, or hypotheses; the research design; and the
level of measurement achieved by the research
instruments. Hulme and Grove (1994) chose frequencies,
percentages, means, standard deviations and Pearson
correlations to answer their research questions.
 Chapter 3 Introduction to Quantitative Research 45 .

psychosocial symptoms) comprise the long-term effects of

Results
The first search question focused on description
of the patterns of physical and psychosocial
symptoms,
Six physical symptoms occurred in 50% or more of
the
subjects :insomnia. sexual dysfunction, overeating,
drug
Abuse severe headache, and two or more major
surgeries eleven psychosocial symptoms occurred
in
75% or more of the subjects: depression, guilt, low
selfesteem, inability to trust others, mood swings,
suicidal
Thoughts, difficulty in relationships, confusion,
flashbacks of the abuse, extreme anger, and
memory lapse....
Self injurious behavior was reported by eight
subjects (33%) hulme & Grove, 1994, pp. 527-528)
The second research question focused on the
relationships among the number of physical and
psychosocial Symptoms and three contributing
factors (age abuse began, duration of abuse and
multiple victimizations). There were five significant
correlations among study variables: physical
symptoms with multiple victimizations (r = 0.59, p =
0.002) physical svmptoms with psychosocial
symptoms (r = 0.56, p = 0.003), age abuse began
with duration of abuse r = 0.50, p = 0.009),
psychosocial symptoms with multiple victimizations
(r = 0.40, p = 0.033), and duration of abuse with
psychososial symptoms (r = 0.40, p = 0.034).
(hulme & grove, 1994, p. 528)
child sexual abuse. (Hulme & Grove, 1994, p. 528) Brown and
Garrisons (1990) ASI Questionnaire was effective in identifying
patterns of physical and psychosocial symptoms in women
with a history of child sexual abuse.... As data on the
behavioral manifestations (physical and psychosocial
symptoms) and the effect of each of the contributing factors
accumulate, hypotheses need to be formulated to further test
Browne and Finkelhors (1986) framework explaining the long-
term effects of child sexual abuse.... With additional research,
the ASI Questionnaire might be adapted for use in clinical
situations. This questionnaire might facilitate identification and
delivery of appropriate treatment to female survivors of child
sexual abuse in clinical settings. (Hulme & Grove, 1994, pp.
529-530)
Communicating Research Findings
Research is not considered complete until the findings have
been communicated. Communicating research findings
involves developing and disseminating a research report to
appropriate audiences; the research report is disseminated
through presentations and publication (see Chapter 25). The
Hulme and Grove (1994) study was presented at a national
nurse practitioner conference and published in the Issues in
Mental Health Nursing journal.

TYPES OF QUANTITATIVE RESEARCH

This text describes four types of quantitative research: (1 )
descriptive, (2) correlational, (3) quasi-experimental, and (4)
experimental. The level of existing knowledge for the
research problem influences the type of research planned.
Interpreting research Outcomes
When little knowledge is available, descriptive studies are
The results obtained from data analysis require
often conducted. As the knowledge level increases,
interpretation to be meaningful. Interpretation of
correlational, quasi-experimental, and experimental studies
Research outcomes involves (1) examining the
are implemented. This section identifies the purpose of each
results
quantitative research approach and presents an example of
From data analysis, (2) exploring the significance of
the steps of the research process from a published quasi-
the findings (3) forming conclusions, (4)
experimental study.
generalizing the findings
(5)considering the implications for nursing and (6) Descriptive Research
suggesting further studies. Data analysis yields five The purpose of descriptive research is to explore and
types of results: significant as predicted by describe phenomena in real-life situations. This approach is
The researcher,nonsignificant, significant but not used to generate new knowledge about concepts or topics
predited by the researcher, mixed findings, and about which limited or no research has been conducted.
unexpected findings. The study results are then Through descriptive research, concepts are described and
translated and interpreted to become findings, relationships are identified that provide a basis for further
and these findings are synthesized to form quantitative research and theory testing. The study by Hulme
conclusions. The conclusions, provide a basis for and Grove
identifying nursing implications, generalizing
findings, and suggesting further studies (see
chapter 24) In the excerpts that follow, Hulme &
grove (1994) discuss their findings, with
implications of nursing and suggestions for
further study.

Discussion
While this study may have limited
generalizability due to the relatively small
nonprobability sample, the findings do
support previous research.... In addition,
the findings support browne and
Finkelhors (1986) framework that a wide
range of behavioral manifestations
(physical and
 46 Unit ONE Introduction to Nursing Research
(1994) on the symptoms of female survivors of child sexual
abuse, which we used earlier in the chapter to illustrate the basic
discussion of the steps of the quantitative research process, is a
combined descriptive and correlational study. The descriptive
aspects of this study can be clearly identified in its purpose,
research questions, design, data analysis, and findings.
Correlational Research
Correlational research examines linear relationships 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 togetherthat 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 decreases. The descriptive
correlational study conducted by Hulme and Grove (1994),
presented earlier in this chapter, provides an example of the
steps of the quantitative research process for correlational
research.
Quasi-Experimental Research
The purpose of quasi-experimentai research is to examine
cause-and-effect relationships among selected independent and
dependent variables. Quasi- experimentai studies in nursing are
conducted to determine the effects of nursing interventions or
treatments (independent variables) on patient outcomes
(dependent variables) (Cook & Campbell, 1979). Artinian et al.
(2007) conducted a quasi-experimentai study to determine the
effects of nurse-managed telemonitoring (TM) on the BP of
African-Americans. The steps for this study, which were
introduced earlier in this chapter, are described here and
illustrated with extracts from the study.
STEPS OF THE RESEARCH PROCESS IN A QUASI-
EXPERIMENTAL STUDY
1: RESEARCH PROBLEM
Nearly one in three, or approximately 65 million adults in
the United States have hypertension, defined as (a) having
systolic blood pressure (SBP) of 140mm Hg or higher or
diastolic blood pressure (DBP) of at least 90 mm Hg or
higher, (b) taking antihypertensive
medication, or (c) being told at least twice by a
physician or other health professional about having
high blood in pressure (BP) (American Heart
Association (AHA) 2004; AHA Statistics Committee &
Stroke Subcommittee [AHASC], 2006; Fields et
al.2004. Estimated direct and indirect costs
associated with hypertension total $63.5 billion
(AHA. 2004; the crisis of high BP (HBP) is particularly
apparent among African Americans; their
prevalence of HBP is among the highest in the
world.... Unless healthcare professionals can
improve care for individuals with hypertension,
approximately two thirds of the population will
continue to have uncontrolled BP and face other
major health risks (Chobanian et al., 2003).... There
is a need to test alternative treatment strategies.
(Artinian et al 4 2007, pp. 312-313)
2: RESEARCH PURPOSE
The purpose of this randomized controlled trial with
urban African Americans was to compare usual care
(UC) only with BP telemonitoring (TM) plus UC to
determine which leads to greater reduction in BP
from baseline over 12 months of follow-up, with
assessments at 3, 6, and 12 months postbaseline.
(Artinian et al, 2007, p. 313)
3: REVIEW OF LITERATURE
The literature review for this study included relevant
current studies that summarized what is known
about the impact of TM on BP. The sources were
current and ranged in publication dates from 1998
to 2005, with the majority of the studies published
in the last 5 years. The study was accepted for
publication on May 31. 2007 and published in the
September/October 2007 issue of Nursing Research.
Artinian et al. (2007, p. 314) summarized the current
knowledge about the effect of TM on BP by stating
Although promising, the effects of TM on BP have
been tested in small, sometimes nonrandomized,
samples, with one study suggesting that patients
may not always adhere to measuring their BP at
home. The influence of TM on BP control warrants
further study.
4: FRAMEWORK
Artinian et al. (2007) developed a model that
identified the theoretical basis for their study. The
model is presented in Figure 3-4 and indicates that
nurse-managed TM is an innovative strategy that
may offer hope to hypertensive African Americans
who have difficulty accessing care for frequent BP
checks.... In other words, TM may lead to a reduction
in opportunity costs or barriers for obtaining follow-
up care by minimizing the contextual risk factors that
interfere with frequent healthcare visits Combined
with information about how to control hypertension,
TM may both help individuals gain conscious control
over their HBP and contribute to feelings
 Chapter 3 Introduction to Quantitative Research
Theoretical basis for the effects of teiemonitoring on blood pressure.
Of confidence for carrying out hypertension self care
actions, home TM appeared to contribute to
individuals, increased personal control and self
responsibility for managing their BP, which ultimately
led to improved BP control (Artinian et al., 2004;
artinian Washington, & Templin, 2001). (Artinian et
al., 2007, pp. 313-314) .The framework for this study
was based on tentative theory that was developed from
the findings of previous research by Artinian et al
(2004;2001) and other investigators. This framework
provides a basis for interpreting the study findings and
giving them meaning.
5. HYPOTHESIS TESTING
H1: individuals who participate in UC plus nurse
managed TM will have a greater reduction in BP
from baseline at 3-. 6-. And 12 month follow-up than
would individuals who receive UC only. (Artinian et
al., 2007, p. 317)
6. variables
The independent variable was TM program and the
dependent variables were SBP and DBP, only the TM
program and SBP conceptual and operational
defenitions are derived from the study framework and
the operational
47
definitions are often found in the methods section under
measurement methods and intervention headings.
Independent Variable: TM Program
Conceptual Definition
TM program is an innovative strategy that may offer
hope to hypertensive African Americans to reduce
their opportunity costs and barriers for obtaining
follow-up care for BP management (Artinian et a!.,
2007).
Operational Definition
TM refers to individuals self-monitoring their BP
at home, then transmitting the BP readings over exist-
ing telephone lines using a toll-free number (Artinian
et al., 2007, p. 313). The readings were reviewed by the
care providers with immediate feedback provided to the
patients about their treatment plan.
Independent Variable: SBP
Conceptual Definition
. SBP is an indication of the patients blood pressure
control and ultimately the management of his or her
hypertension.
 48 Unit ONE Introduction to Nursing Research
Operational Definition
The outcome of SBP was measured with the electronic BP
monitor (Omron HEM-737 Intellisense, Omron Health Care,
Inc.). (Artinian et al., 2007)
7: DESIGN
A randomized, two-group, experimental, longitudinal design
was used. The treatment group received nurse- managed TM
and the control group received enhanced UC. Data were
collected at baseline and 3-, 6-, and 12-month follow-ups.
(Artinian et al., 2007, p. 314)
8: SAMPLE
African Americans with hypertension [population] were
recruited through free BP screenings offered at community
centers, thrift stores, drug stores, and grocery stores located
on the east side of Detroit [natural settings]. (Artinian et al.,
2007, p. 315) The sample criteria for including and excluding
subjects from the study were detailed and provided a means of
identifying patients with hypertension. The sample size was 387
(194 in the TM group and 193 in the UC group) with a 13%
attrition or loss of subjects over the 12-month study.
9: PROCEDURES
Artinian et al. (2007) detailed the nurse-managed TM
intervention that was presented earlier in this chapter and
provided in entirety on pages 315-316 in the research article.
The BP was measured with the electronic Omron BP monitor
after a 5-minute rest period; at least two BPs were measured,
and the average of all was used for analyses. Participants wore
unrestrictive clothing and sat next to the interviewers table,
their feet on the floor; their back supported; and their arm
abducted, slightly flexed, and supported at heart level by the
smooth, firm surface of a table. (Artinian et al., 2007, pp. 316-
317)
Most of the data were collected during 2-hour structured
face-to-face interviews and brief physical exams, which were
conducted by trained interviewers in a private room at one of
the project-affiliated neighborhood community centers. Mailed
postcards provided interview' appointment reminders 1 week
before the scheduled interview'; telephone call reminders were
made the evening before the interview.... Participants were
compensated $25.00 after the completion of each interview.
(Artinian et al., 2007, p. 316) The study was approved by the
Wayne State University Human Investigation Committee and
all participants signed consent forms indicating their
w'illingness to be subjects in the study.
10: RESULTS
The hypothesis was supported partially by the data. Overall,
the TM intervention group had a greater reduction in SBP
(13.0mm Hg) than the UC group did (7.5 mm Hg; t = -2.09, p =
0.04) from baseline to the
12-month follow-up. Although the TM intervention
group had a greater reduction in the DBP (6.3 mm
Hg) compared with the UC group (4.1 mm Hg), the
differences were not statistically significant (t = -
1.56, p = 0.12). (Artinian et al., 2007, pp. 317-318)
E 11: DISCUSSION
The nurse-managed TM group experienced both
clinically and statistically significant reductions in
SBP (13.0 mm Hg) and clinically significant
reductions in DBP (6.3mmHg) over a 12-month
monitoring period [study conclusions)
The BP reductions achieved here are important
which, if maintained over time, could improve care
and outcomes significantly for urban African
American with hypertension.... This may mean that
an individual could avoid starting a drug regimen
or may achieve BP control using a one-drug
regimen rather than a two-drug regimen and thus
be at risk for fewer medication side effects
[implications of the findings for nursing practice]
Future research needs to determine if this
intevention effect maintained over time leads to
reducing the number of complications associated
with uncontrolled BP and if it leads to reducing the
number of drugs necessary to achieve BP control.
(Artinian et al., 2007, pp. 320-321)
Experimental Research
The purpose of experimental research is to
examine cause-and-effect relationships between
independent and dependent variables under
highly controlled conditions (Campbell & Stanley,
1963). The researcher exerts high control over the
planning and implementation of experimental
studies, and often these studies are conducted in
a laboratory setting on animals or objects. The
Graves et al. (2005) study introduced. earlier in
this chapter is an experimental study of the effect
of a diet supplemented with 0.5% conjugated
linoleic acid (CLA) on muscle mass in mice with
cancer that was conducted in a laboratory
setting. To improve your understanding of the
steps of the research process, read this study and
identify the steps of quantitative research process
outlined in this chapter.
SUMMARY
Nurses use a broad range of quantitative
approachesincluding descriptive,
correlational quasi-experimental, and
experimentalto develop nursing
knowledge.
Some of the concepts relevant to quantitative
research are (1) basic and applied research,(2)
rigor and (3) control.
 Chapter 3 Introduction to Quantitative Research
- Basic or pure research is a scientific
investigation that involves the pursuit of
knowledge for knowledgeor for the pleasure
s sake or of learning and finding truth.
- Applied or practical, research is a scientific
investigation ructed to generate knowledge
that will influence or improve clinical practice.
- Rigor involves discipline, scrupulous adherence
to detail and strict accuracy.
- Control involves the imposing of rules by the
researcher to decrease the possibility of error
and thus increase the probability that the
studys findings are an accurate reflection of
reality.
- The quantitative research process involves
conceptualizing a research project, planning
and implementing that project and
communicating the findings.
- The steps of the quantitative research process
are as follows :
1. Formulating a research problem and purpose
identifies an area of concern and the
specific goal or aim of the study.
2. Reviewing relevant literature allows the
researcher to build a picture of what is
known about a particular situation or
phenomenon and identify the knowledge
gaps that exist.
3. Developing a framework guides the
development of the study and enables the
researcher to link the findings to the body
of knowledge nursing
4. Formulating research objectives, questions, or
hypotheses allows the researcher to bridge
the gap between the more abstractly
stated research problem and purpose and
the study design and plan for data
collection and analysis.
5. Operationalizing research variables involves
developing a conceptual definition and
operational definition for each variable.
6. Identifying theoretical and methodological
limitations involves determining the
restrictions in a study that may decrease
the generalizability of the findings.
7. Selection a research design directs the
selection of a population, sampling
procedure, methods of measurement, and
a plan for data collection and analysis.
8. Defining the population and sample
determines
who will parcipate in the study.
9. Selecting methods of measurement involves
determining the best method(s) to
measure each study variable.
10. Developing a plan for data collection and
analysis directs the precise, systematic
gathering of information relevant to the
research purpose or
49
the specific objectives, questions, or
hypotheses of a study and involves the
selection of appropriate statistical
techniques to analyze the study data.
11. Implementing the research plan involves
treatment implementation, data collection,
data analysis, and interpretation of research
outcomes.
12. Communicating findings includes the
development and dissemination of a
research report to appropriate audiences
through presentations and publication.
This chapter introduces four types of
quantitative research: descriptive, correlational,
quasi- experimental, and experimental.
Examples from published studies are used to
illustrate the steps of the quantitative research
process.
REFERENCES
American Heart Association. (2004). Heart disease
and stroke statistics: 2005 update. Dallas, TX:
Author.
American Health Association Statistics Committee and
Stroke Statistics Subcommittee. (2006). Heart
disease and stroke statistics: 2006 update.
Circulation, 113(6), e85-el52.
Artinian, N. X, Flack, J. M Nordstrom, C. K.,
Hockman, E. M., Washington, O. G. M., Jen, K. C,
et al. (2007). Effects of nurse- managed
telemonitoring on blood pressure at 12-month
followup among urban African Americans. Nursing
Research, 56(5), 312-322.
Artinian. N. T., Washington, O. G., Klymko, K. W.,
Marbury, C. M., Miller, W. M., & Powell, J. L.
(2004). What you need to know about home blood
pressure telemonitoring, but may not know to ask.
Home Healthcare Nurse, 22(10), 680-686.
Artinian, N. T., Washington, O. G., &Templin, X N.
(2001). Effects of home telemonitoring and
community-based monitoring on blood pressure
control in urban African Americans: A pilot study.
Heart & Lung, 30(3), 191-199.
Bagiev, C. (1990). Development of a measure of
unwanted sexual contact in childhood, for use in
community health surveys. Psychology Reports,
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Bagley, C., & King, K. K. (1990). Child sexual abuse:
The search for healing. New York:
Travistock/Routledge.
Bond, E. E, & Heitkemper, M. M. (1987). Importance
of basic physiologic research in nursing science.
Heart & Lung, 16(A),. 347-349.
Brown, B. E., & Garrison, C. J. (1990). Patterns of
symptomatology of adult women incest survivors.
Western Journal of Nursing Research, 12(5), 587-
600.
Browne, A., & Finkelhor, D. (1986). Initial and long-
term effects: A review of the research. In D.
Finkelhor (Ed.): A source book on child sexual
abuse (pp. 143-179). Beverly Hills. CA: Sage
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Campbell, D. X, & Stanley, J. C. (1963). Experimental
and quasi- experimental designs for research.
Chicago: Rand McNallv.
 Dismantling Strategy (Subtraction Design). In dismantling
strategy, the full version of the program is compared with a
reduced version in which one or more components have been
removed. Criteria for selecting components to delete vary but
are often based on theory or on information from the
literature. Components that are expensive or difficult to
provide may also be selected for deletion. Components are
removed one at a time and the reduced set is tested against
the full version until a single base component remains, when
program are complex and include many components various
mixes of components may be tested.
Constructive Strategy. In constructive strategy, a base
intervention is identified. A component that is expected to
increase the effectiveness of the base intervention is added,
and the two interventions are tested.
There must be a theoretical rationale for the selection of
components to add to the base intervention. The components
are added one at a time, and each set of is tested for
effectiveness until the full set of possible combinations has
been studied. With the use of the dismantling strategy in large
programs, various mixes of components may be tested.
Factorial ANOVA Designs. Commonly used in psychology,
factorial ANOVA designs are potentially the must powerfull
way to examine all possible combinations of an intervention.
Factorial designs used in reals are usually limited to a 2 x 2
design, examining the presence or absence of two intervention
components. Factorial ANOVA designs usually involve a
multisite project with a large sample size to achieve adequate
statistical power. The complexity of the design increases with
the number of components in the intervention
Hal 337

Fractional Factorial Designs. Fractional factorial design are

simplifications of the factorial design. The researcher
systematically selects a portion of all possible intervention
component combinations to implement. Such a design
requires the researcher to be willing to assume that the
effects of higher-order interactions (multiple combination
effects) are negligible.
Response surface Methodology. With response surface
methodology, the dose response can be applied to more
than one dimension of a treatment. If several interventions
are constructed that represent a number of combinations of
differing levels of strenght for each component and the
outcome is plotted for each combination, the plotted figure
is referred to as a response surface. Researchers can use this
methodology to determine which combination of
components produces the optimum outcome.
Chapter 13 Intervention Research 337

Results of previous response surface analyses have shown that increasing

the strength of a component does not always increase its effectiveness. When
two individually effective components are combined, the resulting program may
be more or less effective than each component alone or may not change the
effect. A researcher can improve a program sequentially by refining each
component and then studying the combined effects. Developing an optimal
program is often an evolutionary process.

Field Tests
Field tests are conducted in clinical settings in which the intervention will
typically be implemented. Field tests are ideal for graduate nursing student
projects. These studies evaluate the effectiveness of the intervention when
implemented in uncontrolled situations. Rather than being controlled, patient
characteristics are allowed to vary and are measured. Sampling criteria are
limited to the selection of only those patients experiencing the problem. No
other constraints are imposed.
The observation system is in operation, and patient characteristics,
intervener characteristics, and setting characteristics are measured. Outcome
variables are measured at least once before the treatment and once afterward.
Repeated measures of outcome variables are often performed during the
posttest period (Fawcett et ah, 1994; Sidani & Braden, 1998). Design criteria
against which the intervention is judged are listed in Table 13-15.
Collecting and Analyzing Data
Data from the observation system, pilot tests, the formal stud)', and field tests
are collected and analyzed continuously. Data analysis goes beyond testing for
statistical significance. Two-way analysis of variance, regression

TABLE13-15 E Criteria for Intervention Design

1. The intervention is effective.

2. The intervention is replicable by typical interveners.
3. The intervention is simple to use.
4. The intervention is practical.
5. The intervention is adaptable to various contexts.
6. The intervention is compatible with local customs and values.

Adapted from Fawcett, S. B., Suarez-Belcazar, Y., Belcazar, F.

E.. White, G. W., Paine, A .L., Blanchard, K. A., et al. (1994).
Conducting intervention research: The design and development
process. In J. Rothman & E. J. Thomas (Eds.), Intervention
research: Design and development for human service, (pp. 25-
54). New York: Haworth Press.
 338 Unit TWO The Research Process
analyses, path analyses, and residual analyses are
commonly used.
Exploratory analysis techniques provide
important information for determining, for
instance, when initial interventions should be
implemented and whether supplemental
procedures are necessary. Residual analyses may
identify subjects who respond differently to the
intervention. Qualitative analyses are used when
appropriate. Ongoing graphing of phases of the
intervention and outcomes over time provide
critical information. Data from the project
constitute an excellent source for secondary
analyses by nursing students.
Dissemination
Once field testing and evaluation are completed,
your intervention is ready for dissemination. In
nursing, dissemination has traditionally involved
presenting the findings at professional meetings,
describing the intervention in professional
journals, and reporting studies documenting its
effect on outcomes. Researchers may report their
results by traditional means throughout the
process of developing and evaluating the
intervention. These contributions are vital to the
development of science in nursing.
You should also consider a higher level of
dissemination. Nurse researchers might think
about viewing the intervention as a product and
its dissemination in terms of marketing and
selling a product (Fawcett et ah, 1994). This
would be an important consideration if the users
initial implementation required a considerable
investment of time, perhaps to consult with or
request assistance from members of the project
team. In this case, the process of dissemination
would involve choosing a brand name,
establishing a price, and setting standards for the
interventions use.
Choosing a Brand Name
Give your intervention a name that is intuitively
appealing. It may address the purpose, patients,
or setting of the intervention. The name may link
the intervention to an established concept in a
theory. Establishing a brand name allows
adopters to recognize the intervention and
differentiate it from similar, but perhaps less
effective, interventions. The name of the
intervention will come to be associated with its
effectiveness, dependability, or efficiency
(Fawcett et al., 1994). Do you think Simple
Pleasures was a good brand name for Colling
and Buettners intervention?
Setting a Price
In setting a price for the intervention, determine
or define the market for your product and the
discretionary budget of potential adopters. In this
period of managed care, when health care
corporations are competing for patients by hospitals
seeking Magnet status and demonstrating more
effective outcomes that their competitors, the
motivation to purchase well designed interventions
with demonstrated positive outcomes is high. In 1994,
the American Nurses Credentialing Center developed
the Magnet Rcognition program to recognize
facilities that provide excellent nursing care. To achieve
Magnet status, the facility must meet. 14 standards with
63 criteria.
Other factors that you and your research team
must consider in setting the price are (1) the cost of
providing materials related to the intervention; (2 the
costs of staff time for phone calls, mailing material,
maintaining files, and so on; (3) organizational
requirements (4) the cost of training; and (5) the cost
of technical support that may be required after the
intervention is implemented. If your goal is the
widespread adoption of the intervention with a simple
training procedure and little need for ongoing
technical support, you might set the price very low,
only sufficient to recover costs. However, you are
offering a comprehensive or complex treatment
program that will require considerable involvement of
the researchers or other technical personnel, a higher
price might be appropriate (Fawcett et al., 1994)
Setting Standards for Use
The project team must establish guidelines for using
the intervention correctly that adopters must egree to
before they receive it. Develop specifications
regarding conditions under which the intervention can
be used. The project should be protected by a patent
or copyright until your costs are recovered. T:_
ment helps ensure the integrity of the price
quality of the product (Fawcett et al., 199-
Identifying Potential Markets
To identify all of the potential markets for your
intervention, you and your product team should
answer the following questions:
1. Which people can benefit personally from
our intervention?
2. Who (with the use of the intervention) could
contribute most to solving the problem ?
3. Is broad-based adoption our goal (I.e,,
saturation of the market), or do we seek
more restricted by selected adopters?
4. Which market segmentstypes of health or
human service organizationswould most
likely adopt and benefit from our
intervention if they were aware of it?
 Chapter 13 Intervention Research 339
Which media approachpublic service
annoucements, direct mail, or other strategies
would be most appropriate and feasible for
informing our targeted market segment?
Identifying potential early adopters may
encourage others in the identified market to adopt
the intervention. Early adopters tend to have
relatively greater resources, sophistication,
education, and willingness to try innovative
practices. These characteristics may put them in
more frequent contact with their colleagues
increasing the chances that other adopters will
become aware of the benefits of using your
intervention (Fawcett et ak, 1994). See Chapter 27
for a discussion of early adopters.
= Demand for the intervention
Anyone marketing the intervention must persuade
potential purchasers that it will actually benefit
them.
Strategies resigned to market innovations
include modeling the innovation, arranging
sampling of the innovation and its benefits, and
advertising. Modeling involves showing experts,
celebrities, or others easily identifiable by the
market segment using the intervention and
benefing from its use.
In sampling, allow potential purchasers to try
out portions of the product. This process might
consist of demonstrations of the intervention and
opportunities to review material at regional and
national professional
Advertising campaigns can highlight desired
features of the intervention, such as its relative
effectiveness, low cost, and decreased time and
effort for users. Incentives to encourage adoption,
such as describing support services available, can
positively influence purchasers ultimately,
however, these strategies will work only if your
product is more effective, is lower in cost, or
requires less user time than similar interventions
on the market (Fawcett et ak, 1994).
Encouraging Appropriate Adaptation
Adaptation involves changing the intervention to
fit local conditions and is sometimes referred to as
reinvention. Elements of the intervention may be
modified or deleted, or new elements may be
added. There is a tension between maintaining
the quality of an intervention and allowing others
to adapt it. Allowing adaption may increase the
speed with which an intervention is adopted, but
it may also diminish the interventions
effectiveness. The project team should permit (or
even encourage) necessary adaptation, but only
under the condition defined by the team. Your
team should be allowed to collect and analyze
data
related to the adaptation or see reports of
ongoing analysis by the adapting facility. It is
important for the team to determine whether the
changed intervention continues to meet the
established standards for the intervention (Fawcett
et ak, 1994).
Providing Technical Support for Adopters
The researchers and their staff are the primary'
experts on the intervention. Adopters may require
technical support with troubleshooting or
adapting the intervention to their specific needs
(Fawcett et ak, 1994).
JUST YOU AND ME: IMPLEMENTING AN INTERVENTION THEORY
STUDY ON A SMALL SCALE
Reading this chapter can be overwhelming. It may seem that
unless you have a couple of million dollar grants and a huge
research team, you might as well forget doing an intervention
theory study. And then you think about the Simple Pleasures
project. How feasible is it to consider using intervention
theory strategies to implement an idea that has been running
around the comers of your mind as you read this chapter?
We suggest considering it. You do need some partners
who are as committed as you are. You must realize that such
a project requires a long-term effort. It is a series of studies
and time invested in theoretical thinking and theory
development. It may require that you invest some time
building your knowledge in areas in which you are not yet
well informed. You can start small and build as you begin your
first steps. Contact researchers who have been involved in
intervention theory' work. They can help you to avoid some of
the mistakes they made. They may also be willing to guide
you across time. The nursing discipline needs more
intervention theory projects. The potential contribution to the
body of knowledge for nursing is great.
SUMMARY
* This chapter describes a revolutionary new approach to
intervention research that holds great promise for
designing and testing nursing.
* Nursing interventions are defined as deliberative cognitive,
physical, or verbal activities performed with, or on behalf
of, individuals and their families [that] are directed toward
accomplishing particular therapeutic objectives relative to
individuals health and well-being (Grobe, 1996, p. 50).
The
Data collection is one of the most exciting parts
of research. After all the planning, writing, and
negotiating, you are ready for the real part of
research the action part. There is a sense of
euphoria and excitement, an eagerness to start
the study. However, before you leap into data
collection, spend some time carefully planning
this adventure. It may save you difficulties later
on as you implement the final steps of the
research process. Consider problems you might
encounter while collecting data, and develop
srategies for addressing them. You must make
careful plans for managing data as you collect it
this chapter is divided into three sections to assist
you in planning data collection, collecting data,
and managing data for quantitative studies. Data
collection strategies for qualitative studies are
described in chapter 23.
PLANNING DATA COLLECTION
A data collection plan details bow you will
implement your study. The plan for collecting data
is specific to the study being conducted and
requires that you consider some of the more
commonplace elements of research. You will need
to map out the procedures you will use to collect
data, anticipate the time and cost of data collection.
develop data collection forms that ease data entry,
and prepare a codebook that will help you to
identify data to be entered in a database. This
extensive planning increases the accuracy of the
data collected and the validity of the study findings.
The strength of the findings from several studies
increases the quality of the research evidence that is
available
for use in practice (Craig & Smith, 2007; Melnyk & Fineout-
Overholt, 2005).
Planning Data Collection Procedures
To plan the process of data collection, you must determine
step by step how and in what sequence data will be
collected from a single subject. The timing of this process
also must be established. For example, how much time will
be required to identify potential subjects, explain the study,
and obtain consent? How much time is needed for activities
such as completing questionnaires or obtaining
physiological measures? Next, envision the overall activities
that will be occurring during data collection. At what point
are subjects assigned to groups? When and how will you
implement the study treatment? Will data be collected from
more than one subject at a time, or is it necessary to focus
attention on one subject at a time? How many subjects per
day can be accessed for data given the study design and
the setting? It might be helpful to cowduct A txvA ruw at
evew a. pilot study by collecting data from three to five
subjects to determine the strengths and weaknesses of the
data collection plan. You will need a minimum of five
subjects if you plan to conduct a pilot study. You might
develop a data collection tree or flow diagram to illustrate
the process for collecting data in your study. An example is
shown in Figure 17-1.
Decision Points
Decision points that occur during data collection must be
identified and all options considered. Decisions might
include whether potential subjects meet
 The sampling criteria, whether a subject
understands the infomation needed to give
informed consent, what group the subject will be
assigned to; whether the subject comprehends
instructions related to providing data and whether
the subject has provided all the data needed. your
data collection tree should indicate each point at
which a decision is made.
Consistency
Consistency in data collection across subjects is
critical, if more than one person is collecting the
data, consistency among data collectors (interrater
reliability) is also necessary (see Chapter 15). Identify
situations in your study that might interfere with
consistency, and develop a plan that will maximize
consistency. The specific days and hours of data
collection may influence the consistency of the data
collected and thus must be carefully considered. For
example, the energy level and state of mind of
subjects from whom data are gathered in the
morning may differ from that of subjects from
whom data are gathered in the evening, visitors are
more likely to be present at certain times of day and
may interfere with data collection or influence
responses. Patient care routines vary with the time
of day. In some studies, the care recently received
or the care currently being.provided may alter data
you gather. The subjects you approach on Saturday
to participate in the study may differ from the
subjects you approach on weekday mornings.
Subjects seeking care on Saturday may have a full-
time job, whereas those seeking. care on weekday
mornings may be either unemployed or too ill to
work,.
You and your research team also must decide who
will collect the data. Will the researcher collect alkl
data or will data collectors be employed for this
purpose? Can data collectors be nurses working in
the area? Researchers have experienced difficulties
in studies in which they expected nurses providing
patient care to also be data collectors. Patient care
takes priority over data collection, which may lead to
missing data or missed subjects.
If you decide to use data collectors, they
must be informed about the research project,
familiarized with the instruments to be used, and
provided equivalent training in the data collection
process. In addition to training data collectors need
written guidelines or protocols that indicate which
instruments to use, the order in which to introduce
the instruments, how to administer the instruments,
and a time frame for the data collection process
(Gift, Creasia, & Parker, 1991). After training, data
collectors must be evaluated to determine their
consistency in the data collection process
Washington and Moss (1988) suggested that
minimum of 10 subjects must be rated with the
Chapter 17 Collecting and Managing Data 431
complete instrument before interrater reliability can be
adequately assessed. The data collectors interrater
reliability is usually assessed intermittently throughout
data collection to ensure consistency. Data collectors
also must be encouraged to identify and record any
problems or variations in the environment that affect
the data collection process.
Determine how you will reliably and competently
deliver the study treatment. Often researchers develop
detailed protocols to guide them in delivering the
treatment or intervention, and they train data
collectors in this process. Stein, Sargent, and Rafaels
(2007) stressed the importance of achieving
intervention fidelity in a study, which involves training
an individual called an interventionalist to deliver the
intervention protocol. To achieve intervention fidelity,
the deliver}' of the intervention must include the core
components of adherence and competence.
Adherence is the most basic and exists when the
interventionalist reliably or consistently implements
the behaviors of the intervention protocol.
Competence is more complex and focuses on the
interventionalists skill and expertise in delivering the
study intervention. For more details on intervention
protocol development and implementation, refer to
Chapters 11 and 13.
Time Factors
Researchers often underestimate the time required to
collect data for a study, which sometimes takes two to
three times longer than anticipated. It is helpful to
write out a time plan for the data collection period.
Conduct a pilot study to refine the data collection
process, and determine the time required to collect
data from a subject.
Events during the data collection period sometimes
are not under the researchers control. For example, a
sudden heavy staff workload may make data collection
temporarily difficult or impossible, or the number of
potential subjects might be reduced for a period. In
some situations, researchers must obtain permission
from each subjects physician before they are
permitted to collect data on that subject. Activities
required to meet this stipulationsuch as contacting
physicians, explaining the study, and obtaining
permission require extensive time. In some cases,
potential subjects are lost before the researcher can
obtain the mandatory permission, thus extending the
time required to obtain the necessary number of
subjects.
Cost Factors
Cost is another consideration when planning a study.
Measurement toolssuch as Holter monitors,
spirometers, infrared thermometers, pulse oximeters,
or Glucometersused in physiological studies may
need
 432 Unit TWO The Research Process
to be rented, purchased, or obtained from the
company manufacturing .the equipment. You may
need to pay a fee for questionnaires or scales and for
analyzing the data. Data collection forms must be
typed and duplicated. In some cases, printing costs
for materials that are to be distributed during data
collection must be factored in, such as teaching
materials, questionnaires, or scales. In some studies,
postage is an additional expense. There may be costs
involved in coding the data for entry into the
computer and for conducting data analyses.
Consultation with a statistician early in the
development of a research project and during data
analysis must also be budgeted. You may need to
hire a secretary to type the final report, research
presentations, or a manuscript for publication.
In addition to these direct costs, there are also
indirect costs. The researchers time is a cost and
costs for travel to and from the study site and for
meals eaten out while working on the study must be
taken into account. You also must estimate the
expense of presenting the research project at
conferences, and include that cost in the budget. To
prevent unexpected expenses from delaying the
study, examine all costs in an organized manner
during the planning phase of the study. A budget is
best developed early in the planning process
and'revised as plans are modified (see Chapter 28 for
a sample budget). Seeking funding for at least part of
the study costs can facilitate the conduct of a study
(see Chapter 29 on funding for research).
Neophyte researchers have difficulty making
reasonable estimates of time and costs related to a
study. We advise validating the time and cost
estimates with an experienced researcher. If the cost
and time factors are prohibitive, simplify your study
so that fewer variables are measured, fewer
instruments are used. Make the design less complex,
and use fewer data collectors. These are serious
modifications, however, so you and your team should
thoroughly examine the consequences before making
such revisions. If time or cost estimates go beyond
expectations, you can revise the time schedules and
budget with a new projection for completing the
study.
Developing Data Collection Forms
Before data collection begins, you may need to
develop or modify forms on which to record data.
These forms can be used to record demographic
data, information from the patient record,
observations, or values from physiological measures.
The demographic variables commonly collected in
nursing studies include age, gender, race, education,
income or socioeconomic status, employment status,
diagnosis, and marital status. You also might need to
collect other data that may be
either extraneous or confounding variables such as
the subjects physician, stage of illness, length of
illness or hospitalization, complications, date of data
collection, time of day and day of week of data
collection, and any untoward events that occur
during the data collection period. In some cases, the
length of time required of individual subjects for data
collection may be a confounding variable and must
be recorded If it is necessary to contact the subject
at a later time, you will need to obtain the subjects
address and telephone number, but only with that
persons awareness, and permission. Names and
phone numbers of family members may also be
useful if subjects are likely to move or be difficult to
contact. Consider the importance of each piece of
datum and the amount of the subjects time required
to collect it. If the data can be obtained from patient
records or any other written sources, you do not
need to ask the subject to provide this information;
just make sure that the institusional review board
(IRB) has authorized your team to collect these data
in the study setting. You also need to protect the
participants private health information that is
regulated by the Health Insurance Portability and
Accountability Act (HIPAA) (available online at
www.hhs.gov/ocr/hipaa).
Data collection forms must be designed so that
the data are easily recorded and entered into the
computer. Decide whether data will be collected in
raw form or coded at the time of collection. Coding
is the process of transforming data into numerical
symbols that can be entered easily into the
computer. For example, variables such as gender,
ethnicity, and diagnoses can be categorized and
given numerical labels. For gender, the male
category could be identified by a 1 and the female
category by a 2. For the ethnicity variable, the
African-American category could be represented by
the number 1, Caucasian by a 2, Hispanic by a 3, and
Other by a 4.
The coding categories developed for a study must
be not only mutually exclusive but also exhaustive
which means that the value for a specific variable fits
into only one category, and each observation must fit
into a category. For example, the income ranges
would not be mutually exclusive or exhaustive if they
were categorized in the following way on a
demographic questionnaire:
Income Range (Please check the range that most
accu rately reflects your income.)
___(1) $30,000 to $35,000
___(2) $35,000 to $39,000
___(3) $40,000 to $45,000
___(4) $45,000 to $50,000
___(5) $50,000 and more
 Chapter 17 Collecting and Managing Data 433

These categories are not exclusive because they

DATA COLLECTION FORM
over-lap and a subject with a $35,000 income
could mark category 1, or category 2, or both. Demographics
The categories are not exhaustive because a __ Subject Identification Number
subject may have an income of either $25,000 or __ Age
$39,500, yet the questionnaire does not contain __ Gender
categories that include each of these incomes. 1. Male
2. Female
For many items, a code for Other should be
included for unexpected classifications of __ Weight (in pounds)
__ Height (in inches)
variables such as marital status, ethnicity', or _______ Surgical Procedure Performed
diagnosis, the following income ranges are both / / Surgery Date (Month/Day/Year)
exclusive and exhaustive and would be / / Surgery Time (Hour/Minute/AM or
appropriate for collecting demographic data PM) Narcotics Ordered After Surgery
from subjects:
Income range (Please check the range that most
accurately reflects your income.)
Data collection forms offer a number of response Narcotic Administration
styles. The person completing the form (subject or Date Time Narcotic Dose
data collector) might be asked to check a blank 1.
space before or after the words male or female, to 2.
circle the word male or female, or to write a 1 or a 3.
2 in a blank space before or after the word 4.
selected. If codes are used the meaning of the 5.
codes should be indicated on the collection forms Instruction on Use of Pain Scale
so that the individual completing the form will / / Date (Month/Day/Year)
understand them. / / Time (Hour/Minute/AM or PM)
Comments:
Placement of the data on the forms is important,
because careful placement makes it easier for users Treatment Group
to complete the form and to locate responses for 1. TENS
computer entry. Placement of blanks on the left 2. Placebo-TENS
side of the page seems to be most efficient for 3. No-Treatment Control

data entry,but this layout may prove problematic Treatment Implemented

when subjects are completing the forms. The least / / Date (Month/Day/Year)
effective arrangement is when the data are / / Time (Hour/Minute/AM or PM)
positioned irregularly on the form, because the risk Comments:
of data being missed during data entry is high.
Subjects names should not be on the data Dressing Change
/ / Date (Month/Day/Year)
collection forms; only the subjects identification / / Time (Hour/Minute/AM or PM)
number should appear. The researcher will usually ____Hours since surgery
keep a master list of subjects and assosiated Comments:
coding numbers, which is stored in a separate
location to ensure the subjects privacy, often this Measurement of Pain
master list of subjects and codes is kept with the ____Score on Visual Analogue Pain Scale
subject consent forms. Figure 17-2 provides a / / Date Pain Measured
(Month/Day/Year)
sample data collection form. It includes four items / / Time Pain Measured
that could be problematic in terms of coding, data (Hour/Minute/AM or PM)
analysis, or both. The blank used to enter Surgical ____ Hours since surgery
Comments:
Procedure Performed would lead to problems
when it is time to enter the data into a
____ Data Collector Code
computerized data set. Because multiple surgical Comments:
procedures could have been performed,
developing

Figure 17-2 Example of a data collection form.

 434 Unit TWO ri he Research Process
codes for the various surgical procedures would be
difficult and time consuming. In addition, different
words might be used to record the same surgical
procedure. It may be necessary to tally the surgical
procedures manually. Unless this degree of
specification of procedures is important to the stud}',
an alternative would be to develop larger categories
of procedures before data collection and place the
categories on the data collection form. A category of
Other might be useful for less commonly
performed surgical procedures. This method would
require the data collector to make a judgment
regarding which category was appropriate for a
particular surgical procedure. Another option would
be to write in the category code number for a
particular surgical procedure after the data
collection form is completed but before data entry.
Similar problems occur with the items Narcotics
Ordered after Surgery and Narcotic Administration.
Unless these data are to be used in statistical
analyses, it might be better to manually categorize
this information for descriptive purposes. If these
items are needed for planned statistical procedures,
use care to develop appropriate codes. In this study,
the researcher might be interested in determining
differences in the amount of narcotics administered
in a given period in relation to weight and height.
Recording the treatment groups on the data
collection form may be problematic because the
information could influence the data recorded by
the data collectors.
Using Electronic Devices for Data Collection
Electronic devices can be used to collect a variety of
scale, questionnaire, or physiological data. However,
the use of these devices for research may require
considerable preparation. You may need to
purchase, rent, or borrow the equipment. You also
may need to make arrangements with the data
collection site or to place measurement scales on
special forms.
Scantron Sheets
Scantron sheets are forms that allow subjects to
respond to test questions or scale items by using a
pencil to bubble in responses. These responses can
be entered directly into the computer by optic
scanner (Dennis, 1994) and stored into a database
for analysis. This practice speeds up the process of
entering data and reduces errors related to data
entry. However, subjects not familiar with Scantron
sheets may be reluctant to use them, and some
inaccuracies in data may occur because of subject
error. These forms have been used commonly for
administering multiple-choice tests to nursing
students. Scantrons are best used when subjects
cannot be accessed by e-mail or there is
no computer for direct data entry and data must
be collected using paper-and-pencil forms.
Teleform
Teleform is a computer software package
developed by Cardiff (see www.cardiff.com) that
enables researchers to design a form specific to a
scale or questionnaire to be used for data
collection. Cardiff software has unique features
that allow users to develop point-and-click
automated forms that can be distributed
electronically. Additional features include data
accuracy verification, selective data; extraction and
analysis, digital record signature support, auditing
and tracking, print merge applications, and flexible
export interfaces
(www.cardiff.com/products/teleform/index.html).
Training is available a at the Cardiff website or in
person at location around the United States.
Figure 17-3 shows a Teleform version of the Bums
Cancer Belief Scale, which allows data to be
scanned and stored in a database. Or this form
could be developed and sent to subjects_
electronically, and the data are collected online
and automatically entered into a database.
Universities and schools of nursing are purchasing
this software as, are some researchers who can
purchase it with grant monies. The costs of
acquiring the hardware and software are
considerably less than the costs of entering data
manually.
Im et al. (2007) conducted a multiethnic survey
in the United States of the gender and ethnic
difference in the cancer pain experience. These
researchers administered their questionnaire over
the Internet and through a paper-and-pencil
format based on the desires of the subjects. The
following excerpt describes the data collection
procedure for this study.
To administer the Internet questionnaire, a
web site conforming to the Health Insurance
Portability and Accountability Act standards, the
System Administration, Networking, and
Security Institute Federal bureaus of
Investigation recommendations, and the
institutional Review Board policy of the
institution where the. researchers were affiliated
was developed and published on an
independent, dedicated Web site server. When
potential participants visited the project Web
site, informed consent was obtained by asking
them to click a button labeled
I agree to participate. After this, questions on specific
diagnoses, cancer therapies, and medications were
asked, and the appropriateness of answers was
checked automatically through a server-side
program; participants were connected automatically
to the Internet survey web page if the answers were
appropriate.
With
Upon request, pen-and-pencil questionnaires were
provided by mail to the community consultants, who
distributed the questionnaires in person only to
those who were identified as cancer patients. These
questionnaires accompanied hard copies of the
same informed consent form included in the Internet
format of the questionare, and the pen-and-pencil
questionnaire included a sentence Filling out this
questionnaire means that you are aged over 18 years
old and giving your consent to participate in this
survey. After the self-administered questionnares
were completed, community consultants retrieved all
except five (these were mailed directly to the
research team by the participants) in person at the
community settings and mailed them to the
research team. Supplementing pen-and-pencil
questionnaires was essential to recruit the target
number of ethnic minority cancer patients across the
nation who did not have access to the internet but
were interested in participating in the study among
the 276 participants who were recruited through
community settings, 246 (49 Hispanics, 6 N-H [non-
Hispanic] Whites, 99 N-H African Americans, and 92
N-H Asians) used the pen-and-pencil questionnaires,
with an level of 0.05, there were no statistically
significant differences in psychometric properties
between format and the pen-and-pencil format of
the questionnaire. More detailed findings on
psychometric properties of the Internet and pen-
and-pencil format of the questionnaire can be found
in the larger study (Im .et al. 2006) It took an average
of 30-40 minutes for the participants to complete
either the Internet format or the pen-and-pencil
format of the questionnaire. (Im et al.,2007 pp .299-
300)
Im et al. 2007) maximized their sample size and
obtained a more representative sample by giving
participants an option to complete their
questionnaire on the internet or via the pen-and-
pencil format. The researchers then took steps to
ensure that the data collected two formats were
comparable by testing for significant differences
and finding none. The time to complete the
Internet and pen-and-pencil questionnaires did
not vary. Im et al. (2007) also ensured that the
rights of the subjects were protected and an
ethical study was inducted.
computerized Data Collection
with the advent of microcomputers, data
collectors can code data directly into a
microcomputer at the data collection site. If a
computer is used for data collection a program
must be written for entering, cleaning and
storing data. A microcomputer enables users
to collect large amounts of data with few
errors, which can be readily analyzed with a
variety of statistical software packaues.
Chapter 17 Collecting and Managing Data 435
Personal Digital Assistants
Personal digital assistants (PDAs) are small
handheld computers that allow the researcher to
enter data directly into the computer from
observations as they occur or to download data
from a larger computer for easy access. Bernhardt
et al. (2001) used PDAs to collect survey data and
found that participants preferred the PDA to
paper-and-pencil surveys. Health care providers
are loading programs on their PDAs that facilitate
accurate assessment, diagnosis, and
pharmacological and nonpharmacological
management of patients with a variety of health
needs. In addition, PDAs are being used to store
patient data from office computers in a form that
is easily transportable. Thus, they have easy access
to information about patients who call during off
hours. These small computers can also be used for
research purposes. PDA software is currently
available that may help nurse practitioners in busy
offices to collect data for research. Multiple nurse
practitioners involved in a research project could
forward data electronically from PDAs to a central
research site for analysis. Care would need to be
taken to protect the confidentiality of the data
during transmission. Also, PDAs can be misplaced
or stolen, thus threatening confidentiality.
Researchers need to protect the information on
their PDAf with a security code to ensure that no
one but themselves can access their PDAs.
Bioinstruments
Advancements in technology have made it
possible to interface bioinstruments with
computers for data collection. The advantages of
using computers for the acquisition and storage of
physiological data from bioinstruments are
numerous. Harrison (1989) summarized them as
follows:
1. Increased accuracy and reliability are
achieved by reducing errors that may occur
when manually recording or transcribing
physiologic data from patient monitors 01-
other clinical instruments.
2. Linking microcomputers with biomedical
instruments (e.g., cardiac, respiratory, blood
pressure, or oxygen saturation monitors)
permits more frequent acquisition and
storage of larger amounts of data (e.g., once
or more per second) than is practical with
manual recording procedures.
3. Once established, computerized data
acquisition systems save researcher time
during both the data collection and analysis
phases of research.