HEALTH CARE ADVOCATE

/in /by


This assignment has two parts, numbered below. Write each question as a new topic area, then follow with a paragraph or two to answer the question. You may find it necessary to search for answers to the questions outside of the assigned reading. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.  

Tasks: 

1.Imagine that you are going to make a visit to your representative in Congress. Develop a one-page document that supports your position on the AHCA that you would leave with your representative or his or her aide when you make your visit. This one-pager, also called a “leave behind,” should state your position clearly in bullet points and give your reasons why your position is preferred. This “leave behind” should have 1 inch margins and utilize 14-point font throughout. If you were making this visit in person, you would present your “leave behind” to the person with whom you speak during your visit. Include a second page that describes your rationale for the position in your “leave behind” page supported by at least two journal articles. 

2.Write a two-page brief to describe the scenario surrounding your legislative visit. Understanding the political affiliation of your representative, include answers to the following: 

•Was your member in support or in opposition to the AHCA? 

•State three points that you would cover in support or opposition to your representative’s position. 

•How does your nursing experience influence the advocacy position that you take on the AHCA?

Benchmark Capstone Change Proposal

/in /by

In  this assignment, students will pull together the change proposal project  components they have been working on throughout the course to create a  proposal inclusive of sections for each content focus area in the  course. At the conclusion of this project, the student will be able to  apply evidence-based research steps and processes required as the  foundation to address a clinically oriented problem or issue in future  practice.

Students will develop a 1,250-1,500 word (word count does not include references)  paper that includes the following information as it applies to the  problem, issue, suggestion, initiative, or educational need profiled in  the capstone change proposal:

  1. Background
  2. Problem statement
  3. Purpose of the change proposal
  4. PICOT
  5. Literature search strategy employed
  6. Evaluation of the literature
  7. Applicable change or nursing theory utilized
  8. Proposed implementation plan with outcome measures
  9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
  10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created (I am not sure what an appendix section is but if you know please add something. I do know it should come AFTER the references)

All reference resources are attached. Please use the Literature Review paper as just a REFERENCE.

Prepare this assignment according to APA Style Guidelines. An abstract is not required.

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

HEALTH CARE QUESTIONS

/in /by


Question

Week 6 quiz

Question 1

A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The nurse will advise her to take which of the following vitamin supplements while taking the drug?

A) Vitamin A
B) Vitamin B
C) Vitamin C
D) Vitamin D

Question 2

To minimize the risk of adverse effects of glucagon when given to an unconscious diabetic patient, as the patient regains consciousness, the nurse should

A) administer calcium supplements.
B) position the patient in the side-lying position.
C) administer carbohydrates.
D) monitor for nausea and vomiting.

Question 3

A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing neuropathic pain in recent months, a symptom that has not responded appreciably to conventional analgesics. The patient’s care provider has begun treatment with gabapentin (Neurontin). How is the addition of this drug likely to influence the management of the patient’s existing drug regimen?

A) The patient may be required to temporarily hold her other medications until a stable serum level of gabapentin is achieved.
B) It is unlikely to influence the patient’s other medications because gabapentin does not interact with other drugs.
C) Gabapentin is contraindicated with the use of exogenous insulin.
D) The patient’s medication-related risk for renal failure must be assessed prior to the use of gabapentin.

Question 4

A nurse is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?

A) History of taking anticoagulant drugs
B) Allergy to seafood
C) Hirsutism
D) The patient’s age

Question 5

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor which of the following?

A) Prothrombin time and partial thromboplastin time
B) Urine specific gravity
C) Alanine aminotransferase and total bilirubin levels
D) Follicle-stimulating hormone levels

Question 6

A nurse is assessing a patient who has come to the emergency department complaining of back spasms. The patient states that he has a history of opioid addiction and does not want to take any drug that “puts me at risk of becoming physically dependent.” Which of the following medications would the nurse question, if ordered?

A) Methocarbamol (Robaxin)
B) Orphenadrine (Norflex)
C) Cyclobenzaprine (Flexeril)
D) Metaxalone (Skelaxin)

Question 7

A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize when updating the nursing care plan for this patient?

A) Risk for Injury related to CNS depressant effects
B) Diarrhea related to anticholinergic effects
C) Altered Nutrition, Less than Body Requirements, related to appetite suppression
D) Impaired Swallowing related to increased muscle tone

Question 8

A nurse is working with a 57-year-old man who is a former intravenous drug abuser. He has been prescribed a weekly dosage of methotrexate for his rheumatoid arthritis. Which of the following will the nurse include in her teaching plan for this patient?

A) Avoid high-fat foods
B) Drink plenty of water every day
C) Take the tablets before bedtime
D) Avoid red meat

Question 9

Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

A) The resident has not eaten breakfast because of a recent loss of appetite
B) The resident’s apical heart rate is 112 beats/minute with a regular rhythm
C) The resident had a fall during the night while transferring from her bed to her bathroom
D) The resident received her annual influenza vaccination the previous day

Question 10

A nurse is caring for a 61-year-old man who has had a severe attack of gout while in the hospital for food poisoning. The nurse administers colchicine intravenously in order to

A) avoid aggravating the gastrointestinal tract.
B) ensure quick distribution of the drug.
C) prevent the risk of infection or bleeding.
D) minimize the risk of depressed bone marrow function.

THE DATA KNOWLEDGE

/in /by

Using the Data/Information/Knowledge/Wisdom Continuum

Assignment: Application:
Using the Data/Information/Knowledge/Wisdom Continuum

Have you ever gone online to search for a journal article on a specific topic? It is amazing to see the large number of journals that are available in the health care field. When you view the library in its entirety, you are viewing untapped data. Until you actually research for your particular topic, there is little structure. Once you have narrowed it down, you have information and once you apply the information, you have knowledge. Eventually, after thoughtful research and diligent practice, you reach the level of wisdom—knowledge applied in meaningful ways.

Are there areas in your practice that you believe should be more fully explored? The central aims of nursing informatics are to manage and communicate data, information, knowledge, and wisdom. This continuum represents the overarching structure of nursing informatics. In this Assignment, you develop a research question relevant to your practice area and relate how you would work through the progression from data to information, knowledge, and wisdom.

To prepare:

  • Review the information in Figure 6–2 in Nursing Informatics and the Foundation of Knowledge.
  • Develop a clinical question related to your area of practice that you would like to explore.
  • Consider what you currently know about this topic. What additional information would you need to answer the question?
  • Using the continuum of data, information, knowledge, and wisdom, determine how you would go about researching your question.
    • Explore the available databases in the Walden Library. Identify which of these databases you would use to find the information or data you need.
    • Once you have identified useful databases, how would you go about finding the most relevant articles and information?
    • Consider how you would extract the relevant information from the articles.
    • How would you take the information and organize it in a way that was useful? How could you take the step from simply having useful knowledge to gaining wisdom?
By Day 7 of Week 4

Write a 4-page paper that addresses the following: MUST BE APA FORMAT

  • Summarize the question you developed, and then relate how you would work through the four steps of the data, information, knowledge, wisdom continuum. Be specific.
    • Identify the databases and search words you would use.
    • Relate how you would take the information gleaned and turn it into useable knowledge.
  • Can informatics be used to gain wisdom? Describe how you would progress from simply having useful knowledge to the wisdom to make decisions about the information you have found during your database search.

Your paper must also include a title page, an introduction, a summary, and a reference page ( YOU CAN ONLY USE THE REFERENCES LISTED BELOW).

Family Focused Assessment

/in /by

Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:

  1. Values/Health Perception
  2. Nutrition
  3. Sleep/Rest
  4. Elimination
  5. Activity/Exercise
  6. Cognitive
  7. Sensory-Perception
  8. Self-Perception
  9. Role Relationship
  10. Sexuality
  11. Coping

Select a family, other than your own, and seek permission from the family to conduct an interview. Utilize the interview questions complied in your interview questionnaire to conduct a family-focused functional assessment. Document the responses as you conduct the interview.

Upon completion of the interview, write a 1000- 1250 word paper. Analyze your assessment findings. Submit your questionnaire as an appendix with your assignment.

Include the following in your paper:

Describe the family structure. Include individuals and any relevant attributes defining the family composition, race/ethnicity, social class, spirituality, and environment.

Summarize the overall health behaviors of the family. Describe the current health of the family.

Based on your findings, describe at least two of the functional health pattern strengths noted in the findings. Discuss three areas in which health problems or barriers to health were identified.

Describe how family systems theory can be applied to solicit changes in family members that, in turn, initiate positive changes to the overall family functions over time.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

The Systems Development Life Cycle and the Nurse Informaticist

/in /by

The systems development life cycle (SDLC) is a model for planning and implementing change within an organization. It is important for many individuals to be represented in the process, especially the end users of the system or the employees who must live with the change. As informatics become more and more widespread throughout the health care field, collaboration between information technology (IT) professionals and health care practitioners is becoming increasingly important. The nurse informaticist is able to combine the perspective of the information technology side with the clinical nursing perspective.

While the titles and specific responsibilities of nurse informaticists vary across organizations and practice settings, the fundamental purpose of the role remains the same. Nurse informaticists synthesize their knowledge of how technology can improve health care with an understanding of clinical practice and workflow. This is why nurse informaticists can be instrumental in facilitating the SDLC for informatics in health care. For this Discussion, you examine the relationship between the nurse informaticist and the use of the SDLC.

To prepare:

  • Review the information in this week’s Learning Resources on the SDLC and the role of the nurse informaticist. Reflect on Chapter 1 of the Dennis, Wixom, and Roth course text and consider how the information about the systems analyst role translates into nursing and health care.
  • Consider a recent change in your organization related to the implementation of a new technology or system. How was this change handled? What was the general SDLC process? Who was involved, and what were the outcomes?
  • Identify whether your organization (or one with which you are familiar) has a formal title or position for the nurse informaticist. This position may be called by a different name, such as nurse informatics specialist or informatics analyst, so be sure to review the position description.
  • If your organization has a position for the nurse informaticist, what are the responsibilities of that position? If your organization does not have such a position, conduct research in the Walden Library and at credible online sources on the role of the nurse informaticist.
  • Reflect on the role of the nurse informaticist in the overall health care field. How is this position connected to the SDLC? Assess the benefits of having this specialized position within health care organizations and involving the nurse informaticist in the SDLC.  Post by tomorrow 8/30/16 550 words in APA format with a minimum of 3 references from the list provided under Required Readings. Apply the level 1 headings as numbered below:1) A description of how the systems development life cycle is utilized in your organization (Hospital), or in one with which you are familiar, and assess its effectiveness. 2)  Assess the role of the nurse informaticist in your organization. If the nurse informaticist is not a current position within your organization, provide a description of the generally accepted role of the nurse informaticist based on this week’s Learning Resources and your own research. 3)  Explain why it is important for the nurse informaticist to be involved in the SDLC process and the overall organizational benefits of having such involvement.  

HEALTH CARE EXAMINATION

/in /by


Question 1 Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse’s first suggestion?

A) Bismuth subsalicylate
B) A bulk-forming (fiber) laxative
C) A stimulant laxative
D) A hyperosmotic laxative

Question 2 A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the patient about which of the following adverse effect(s)?

A) Constipation
B) Breathlessness and hypotension
C) Hyperthyroidism
D) Impaired cardiac function

Question 3 A 29-year-old female patient has been prescribed orlistat (Xenical) for morbid obesity. The nurse is providing patient education concerning the drug. An important instruction to the patient would be to

A) omit the dose if the meal does not contain fat
B) take orlistat and multivitamins together
C) take orlistat in one dose at breakfast
D) omit the dose if the meal does not contain protein

Question 4 Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle–specific chemotherapeutic agent. Which of the following statements best describes cell cycle–specific drugs?

A) They follow a specific sequence of cytotoxic events in order to achieve cell death
B) They affect cancerous cells during a particular phase of cellular reproduction
C) They achieve a synergistic effect when administered in combination with cell cycle–nonspecific drugs
D) They affect cancerous cells and normal body cells in a similar manner

Question 5 A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order?

A) Patient will have three to four loose bowel movements each day
B) Patient will express relief from constipation
C) Patient will have formed bowel movements that do not contain frank or occult blood
D) Patient will express an understanding of his current bowel regimen

Question 6 A nurse is assessing a female patient who is taking diphenoxylate HCl with atropine sulfate. Which of the following would lead the nurse to suspect that she is experiencing an allergic reaction?

A) Numbness of extremities
B) Headache and lethargy
C) Toxic megacolon
D) Urticaria

Question 7 A 73-year-old woman has scheduled an appointment with her nurse practitioner to discuss her recurrent constipation. The woman states that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly.How should the nurse best respond to this patient’s statements?

A) “Because we become more prone to constipation as we age, you’ll likely need to increase the number of stool softeners you take.”
B) “I’ll refer you to a specialist because it could be that you have a disease affecting your bowels or stomach.”
C) “Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation.”
D) “Try using a different over-the-counter laxative and see that if you resolves your problem.”

Question 8 A patient develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience

A) dizziness
B) bradycardia
C) muscle aches
D) increase in appetite

Question 9 Apatient who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess which of the following?

A) Blood glucose level
B) Serum phosphate level
C) Urine specific gravity
D) Aspartate transaminase levels

Question 10A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy’s diagnosis?

A) Lubiprostone
B) Mesalamine
C) Docusate
D) Bismuth subsalicylate

HEALTH QUESTION

/in /by


Question 1 Mesalamine (Asacol) is prescribed for a 22-year-old woman with Crohn disease. The nurse will discuss with the patient the possibility for which of the following adverse effects related to the new drug therapy?

A) Hair loss
B) Metallic taste
C) Fatigue
D) Increased appetite

Question 2 A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?

A) Hypertension
B) Diabetes mellitus
C) Glaucoma
D) Rheumatoid arthritis

Question 3 A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the patient’s safety.Which of the following would be an appropriate nursing diagnosis?

A) Diarrhea related to adverse effects of drug therapy
B) Acute Pain related to adverse drug effects, headache
C) Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations
D) Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy

Question 4 A 57-year-old man is to begin 5-FU therapy for colon cancer. It will be most important for the nurse to monitor which of the following during the first 72 hours of the initial treatment cycle?

A) Myelosuppression
B) Cardiac events
C) White blood cell nadir
D) Nausea and vomiting

Question 5 A patient is taking cholestyramine. The nurse will assess for which of the following common adverse effects of the drug?

A) Abdominal pain
B) Headache
C) Constipation
D) Indigestion

Question 6 A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?

A) Bradycardia
B) Diarrhea
C) Nausea
D) Slight headache

Question7A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to

A) ragweed
B) pollen
C) pork
D) shellfish

Question 8 A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at home. The nurse will encourage the patient to eat a diet that is

A) low in sodium and potassium
B) low in sodium, high in potassium
C) high in iron
D) low in proteins

Question 9 A nurse is aware that diphenoxylate HCl with atropine sulfate is an effective adjunct in the treatment of diarrhea. For which of the following patients could the administration of this drug be potentially harmful?

A) An 80-year-old man who has diarrhea secondary to Clostridium difficile infection
B) A woman who has experienced severe diarrhea associated with influenza
C) A man who has experienced diarrhea shortly after beginning tube feeding through a nasogastric tube
D) A 60-year-old woman who tends to get diarrhea during periods of intense stress

Question10 A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient’s safety, which of the following would be a priority nursing action?

A) Teach the patient to take omeprazole 1 hour before meals
B) Emphasize that the drug should not be crushed or chewed
C) Coordinate bone density testing for the patient
D) Monitor the patient for the development of diarrhea

Work Breakdown Structure (WBS)

/in /by

Within reason, is there such a thing as a project that is too complex to complete? Consider the Space Shuttle. One of the most complex machines ever built, the Space Shuttle had over 2.5 million parts, each of which had to be accounted for by someone. How did anyone manage to track and properly assemble these parts? The answer is through the application of a work breakdown structure (WBS). A WBS is a fundamental tool that project managers use to organize and divide the work of a project. A WBS focuses on breaking down a project’s scope into individual deliverables that may be created by assigned team members.

There are multiple work breakdown structure formats and each has its own advantages and disadvantages. Project managers select a type of WBS based upon the specifics of the project they are managing. Each WBS format emphasizes different aspects of a project. These varied perspectives may each be appropriate, depending upon what information a project manager needs.

In this Discussion, you analyze different WBS formats and evaluate whether they meet basic criteria for clarity.

To prepare:

  • Explore the Work Breakdown Structure Formats document included in this week’s Learning Resources. The document presents a scenario and three corresponding WBS formats that pertain to the scenario. (SEE ATTACHED PDF FILE)
  • Consider the advantages and disadvantages of each WBS format included in the document.
  • Think about the level of detail dedicated to task information in each WBS format. Evaluate the formats based on the following criteria for clarity:
  • The task has a measurable status or completion.
  • The task has defined start and end events.
  • The task has a deliverable.
  • The task’s time and cost are easily estimated.
  • The task can be completed without interruption and additional input after its start.

Post  by tomorrow 10/04/16 a minimum of 550 words essay in APA format with 3 references. Based on the Work Breakdown Structure Formats document attached in the file area, address the level one headings as numbered below:

1) An analysis of the advantages and disadvantages of each work breakdown structure format.

2) Provide an analysis of whether (and how) the work breakdown structures meet the assigned criteria for clarity.

3) Provide a rationale for your response.

Required Readings

Within reason, is there such a thing as a project that is too complex to complete? Consider the Space Shuttle. One of the most complex machines ever built, the Space Shuttle had over 2.5 million parts, each of which had to be accounted for by someone. How did anyone manage to track and properly assemble these parts? The answer is through the application of a work breakdown structure (WBS). A WBS is a fundamental tool that project managers use to organize and divide the work of a project. A WBS focuses on breaking down a project’s scope into individual deliverables that may be created by assigned team members.

There are multiple work breakdown structure formats and each has its own advantages and disadvantages. Project managers select a type of WBS based upon the specifics of the project they are managing. Each WBS format emphasizes different aspects of a project. These varied perspectives may each be appropriate, depending upon what information a project manager needs.

In this Discussion, you analyze different WBS formats and evaluate whether they meet basic criteria for clarity.

To prepare:

  • Explore the Work Breakdown Structure Formats document included in this week’s Learning Resources. The document presents a scenario and three corresponding WBS formats that pertain to the scenario. (SEE ATTACHED PDF FILE)
  • Consider the advantages and disadvantages of each WBS format included in the document.
  • Think about the level of detail dedicated to task information in each WBS format. Evaluate the formats based on the following criteria for clarity:
  • The task has a measurable status or completion.
  • The task has defined start and end events.
  • The task has a deliverable.
  • The task’s time and cost are easily estimated.
  • The task can be completed without interruption and additional input after its start.

Post  by tomorrow 10/04/16 a minimum of 550 words essay in APA format with 3 references. Based on the Work Breakdown Structure Formats document attached in the file area, address the level one headings as numbered below:

1) An analysis of the advantages and disadvantages of each work breakdown structure format.

2) Provide an analysis of whether (and how) the work breakdown structures meet the assigned criteria for clarity.

3) Provide a rationale for your response.

Required Readings

Understanding Independent Samples t-Test

/in /by

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 

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

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.162

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

CharacteristicBuzzy (n = 88)Control (n = 88)χ2
p
Sex   
 Female (%), n11 (12.5)13 (14.8).82
 Male (%), n77 (87.5)75 (85.2).41
CharacteristicBuzzy (n = 88)Control (n = 88)t
p
Age (mean ± SD)8.25 ± 1.518.61 ± 1.69−1.498
.136
BMI (mean ± SD)25.41 ± 6.7426.94 ± 8.68−1.309
.192
Preprocedural anxiety   
 Self-report (mean ± SD)2.03 ± 1.292.11 ± 1.58−0.364
.716
 Parent report (mean ± SD)2.11 ± 1.202.17 ± 1.42−0.285
.776
 Observer report (mean ± SD)2.18 ± 1.172.24 ± 1.37−0.295
.768

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 ± 2.685.70 ± 3.31−6.498
0.000
Procedural self-reported pain with VAS (mean ± SD)1.66 ± 1.954.09 ± 3.21−6.065
0.000

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 AnxietyBuzzy (n = 88)Control (n = 88)t
p
Parent reported (mean ± SD)0.94 ± 1.062.09 ± 1.39−6.135
0.000
Observer reported (mean ± SD)0.92 ± 1.032.14 ± 1.34−6.745
0.000

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. 37.164

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?165

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.166