week 5 research discussion response

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Please respond to these two discussions attached.

Discussion 1

1. Is the use of soap and
water or alcohol-based rubs more effective in preventing nosocomial infections?

Quantitative interventional
experimental design utilizing randomized block testing with multifactorial
design, the floors of the hospital are randomly assigned to either exclusively
wash their hands or use alcohol based rubs. Another floor is to use both alcohol-based
rubs and hand washing. An example of this being the medical floor uses both
hand washing and alcohol foam. The telemetry unit uses solely hand
washing. The Oncology floor uses solely alcohol foam. Each of the floors will
use both hand hygiene as stated by current hospital guidelines for their
specific soap or alcohol foam. Lastly the surgical floor will not change
their current practice as guided by the hospital protocol. The floors are
assigned using randomly selective computer software A separate control group
maintains the current hospital protocol for hand hygiene. Exceptions must
be made to account for those based on precautions such as clostridium difficile
where hand washing is required. Infection rates will be measured pre and
post intervention to attempt to identify causality. This type of study is
selected to best control for threats to internal and external validity. Block
randomization is used to facilitate in ease of implementation and
measurement. Multifactorial design allows for the study of multiple
interventions. The three requirements of a true experiment are present
including manipulation, random selection, and the presence of a control group
(Gray, Grove, Sutherland,2017).

True experimental
design random assignment and the controlled setting of a hospital are all
strengths of this study.

Maturation threat, selection threat, and Hawthorne effect are all
weaknesses. The nurses on the floor will vary in their adherence to the
protocol. Some are more diligent about hand hygiene and glove use for
others. Selection threat is present due to using each hospital floor as a
group. Lastly some nurses may change their behavior because they know
they are being observed.

2. How
effective are anti-depressive medications on anxiety and depression?

The study design that would best
examine the effect of anti-depressive medications on anxiety and depression
would be a qualitative phenomenological research design. Data would be gathered
through purposive sampling of all patients being treated for depression and
anxiety in the county of study. Interviews would be conducted and
recorded with a standard set of questions and a combination of open ended,
multiple choice, and true false questions to evaluate the patients level of
depression after beginning medications. A similar interview would be
conducted prior to the prescription of medication. It will be important to
conduct a series of interviews to build rapport to control for stage fright,
which may invalid results (Gray, Grove, Sutherland,2017).

.

The rationale behind the choice of a qualitative study for this question is
that often times in mental health a decrease in depression and anxiety may be
difficult to measure by quantitative standards. The perceived decrease in
depression may vary widely from patient to patient. It is better to study
this in a qualitative manner to find what is the quality of life improvement in
those treated with medications. Withholding medications already widely
known to benefit those suffering from depression and anxiety would also raise
ethical concerns (Gray, Grove, Sutherland,2017).

Strengths of this study include
the ability to collect real-time data. Conducting a series of interviews
allows the interviewer to become familiar with the participant, however the use
of multiple interviewers would create a weakness in design. The
interviewers personal bias may spill over into the interview results.

3. What is the relationship
between alcohol and breast cancer?

This study could
consist of quantitative comparative descriptive research, utilizing a time
dimensional or longitudinal design variation of trend analysis. The
measurements will occur in spaced intervals of one year. With the aim to
measure the incidence of breast cancer in those who drink alcohol quantified by
more than three alcoholic drinks a week. Data could be collected
retrospectively through electronic medical record once yearly for three years.
Subjects may also be asked to fill out a survey which will assess other risk
factors for breast cancer control for extraneous variables (Gray, Grove,
Sutherland,2017). A retrospective statistical analysis may or may not prove
causality.

The rationale is that a true
experimental design may raise ethical concerns due to the known negative
affects of alcohol on the body. It would not be safe to ask participants
to drink three servings of alcohol for a week and then wait to see if they or
the control group develop breast cancer. Other methods must be used as pre-interventional
studies (Shadish,Cook,Campbell,2002).

The strength of this study is
large sample size. Weaknesses include a selection threat due to lack of
randomization; the subjects will be mostly women as it studies breast cancer.
This limits the ability to generalize the results. This is a
relatively narrow scope of study it may be difficulty to isolate alcohol
consumption as a causative factor in the development of breast cancer. There is
also a threat of attrition due to the mortality of those diagnosed with breast
cancer (Gray,Grove,Sutherland,2017).

Campbell DT, Stanley
JC (1963) Experimental and quasi-experimental designs for research on teaching.
Gage NL. Handbook of research on teaching. Rand McNally: Chicago, IL;
1963:171–246.

Gray,
J.R.,PhD,RN,FAAN,Grove,S.K.,PhD,RN,ANP-BC, Sutherland,G.A.S.,PhD. (2017). Burns
& Grove’s the Practice of Nursing Research: Appraisal, Synthesis, and
Generation of Evidence, 8th Edition
. [South University]. Retrieved from
https://digitalbookshelf.southuniversity.edu/#/boo…

Shadish SR, Cook TD,
Campbell DT. Experimental and quasi-experimental design for generalized causal
inference. Houghton Mifflin Company: Boston, MA; 2002

Discussion 2

  • Handwashing and Alcohol Rubs Design

The debate between the efficacy of handwashing and alcohol-based hand rubs
could be a case study. The study would be a twelve week and twenty four
week study on two separate intensive care units with equal rooms or available
space for patients. One unit will use alcohol rubs with the understanding
that if hands have visible soil or pathogens requiring washing, such as
Clostridium difficile, washing with soap and water is required. The
second unit will require staff engaged in direct patient care to use soap and
water for handwashing and alcohol will not be utilized. Alcohol
dispensing devices will be removed from the soap washing rooms. Over the
predetermined time sets the nosocomial rates will be tracked and logged for
review in the documentation system and reviewed in all patients admitted to the
units.

Strength and Weakness

Strengths will be ease of tracking in computerized documentation for review of
prospective and retrospective comparative data. The study will be
relatively easy to set up and should have little to no added cost associated as
all rooms are set up for both types of washing techniques. Education and
training of staff should be relatively simple.

Weaknesses are that nosocomial infection could generate from elsewhere such as
improperly cleaned equipment and poor housekeeping technique which could skew
results. Patients may have higher risk from poor nutrition,
immunocompromised states, pre-existing colonized pathogens, and other comorbid
conditions. Staff may not be compliant with either method of
washing. High surgeon infection rates will be a factor of
infections. Family and visitors in the room may not clean appropriately
causing potential infections. Case studies are considered to have less
rigor than higher experimental studies with randomness and controlled variables
(Gray, Grove, & Sutherland, 2017).

Rationale

The initial design of a case study was chosen for flexibility while studying
populations and fits multiple areas and application of nursing research (Gray,
Grove, & Sutherland, 2017). The main objective of a descriptive case
study is an attempt to describe a case in real-world settings and circumstances
(Gray, Grove, & Sutherland, 2017) (Yin, 2013).

Older
Adult Self-Efficacy Scoring

A possibility would be a cross-sectional study for self-efficacy in older
adults. Similar time frames of twelve weeks and again at twenty four
weeks would be utilized. A self-efficacy self-scoring or report card
system will be beneficial to provide information on individual self-efficacy
before the study begins and again at the designated three and six month
checkpoints.

Strength and Weakness

A strength would be ease of
information extracted from the scoring systems and insight would be gained from
correlations between self-efficacy and exercise. Another strength is the
fast turnaround time for collected data (Gray, Grove, & Sutherland,
2017). Weakness may be that small sample sizes may not provide enough
information to prove significant. Scores may be skewed related to various
life events or untruth on self-reporting mechanisms.

Rationale

This design may be used looking
associations or relationships (Sph.umich.edu, 2017). This design examines
a change over a specified time period, obtains data at various stages, and can
be used to study patterns or trends over a time period (Gray, Grove, &
Sutherland, 2017) (Rice, 2012).

Breast
Cancer and Alcohol

The longitudinal study design may be used for the study on relationships of
breast cancer and use of alcohol. Consenting volunteers between the ages
of 20-60 may be chosen who utilize and who do not utilize alcohol. Annual
screenings and physicals will be performed and the study would conclude at the
end of the tenth year from initiation date of the first assessment.

Strength and Weakness

Strengths would be range and span of
age for the group with a ten year time frame which should be sufficient to
measure suspected change. Longitudinal studies can produce better and
more meaningful data for the research team (Gray, Grove, & Sutherland,
2017). Weaknesses are that the amount of alcohol used may not be measured
correctly. Other weaknesses suspected would be smoking history,
environmental hazards, demographics, work or potential toxic exposures which
will also skew results. The group must also be large enough for an
appropriate study design which may be a weakness if the group is too small
(Gray, Grove, & Sutherland, 2017).

Rationale

Longitudinal studies are able to track variables over a specific time period in
a defined group (Gray, Grove, & Sutherland, 2017).

References

Gray, J.,
Grove, S., & Sutherland, S. (2017). Burns and Groves The Practice of
Nursing Research: Appraisal, Synthesis, and Generation of Evidence; Edition 8.

Retrieved from South University Online Library:
https://digitalbookshelf.southuniversity.edu/#/boo…

Rice, V. H.
(2012). Handbook of Stress, Coping, and Health: Implications for Nursing
Research, second edition, (p.506-512).
Thousand Oaks, CA: Sage
Publications.

Sph.umich.edu.
(2017, December 07). Sph.umich.edu. Retrieved from University of
Michigan School of Public Health:
https://practice.sph.umich.edu/micphp/epicentral/c…

Yin, R.
(2013). Case Study Research: Design and Methods , edition 5. Thousand
Oaks, CA: SAGE Publications.

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