Transforming Nursing and Healthcare through Technology 2025

Discussions 1. Electronic Health Records Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization. In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records. To prepare Review the implementation of EHRs in an organization. Reflect on the various approaches used. If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process? Reflect on the reactions of others during the implementation process. Were concerns handled effectively? If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience. Search and indicate examples of effective and poor implementation of EHRs. RESOURCES Required Readings McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. Chapter 15, “The Electronic Health Record and Clinical Informatics” This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one. Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176. The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs. Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160. This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges. Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67. This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provides insights on change management, the reasons people resist change, and the ways to establish a culture that is more open to change initiatives. Gruber, N., Darragh, J., Puccia, P. H., Kadric, D. S., & Bruce, S. (2010). Embracing change to improve performance. Long-Term Living: For the Continuing Care Professional, 59(1), 28–31. This text describes the implementation of a new electronic health record system at a 105-bed hospital related-facility. The authors highlight five key elements that were deemed necessary for a successful EHR implementation. Hyrkäs, K., & Harvey, K. (2010). Leading innovation and change. Journal of Nursing Management, 18(1), 1–3. According to the authors, the health care field is in need of more effective leaders who understand innovation, who appreciate diversity and change, and who can foster and implement innovation and creativity. The authors describe how nurse leaders can be instrumental in embracing and disseminating innovation throughout the health care system and provide scaffolding for subsequent articles in this issue of the journal. Mooney, B. L., & Boyle, A. M. (2011). 10 steps to successful EHR implementation. Medical Economics, 88(9), S4–6, S8–S11. The authors of this article describe the incentives and requirements for electronic health records (EHRs) outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act. The authors then provide 10 steps for health care leaders and organizations to follow when implementing EHRs. Murphy, J. (2011). Leading from the future: Leadership makes a difference during electronic health record implementation. Frontiers of Health Services Management, 28(1), 25–30. In this article, the author examines the causes behind the increasing complication of EHR implementations. In addition, the author explores the role of leadership in guiding successful EHR implementations. Required Media Laureate Education (Producer). (2012b). Electronic health records. Baltimore, MD: Author. In this video, Katie Skelton, Richard Rodriguez, Carina Perez, Shannon Mori, and Carmen Ferrell describe how their hospital implemented an electronic health record. They also outline the general considerations, benefits, and support measures related to electronic health records. 2. Successful Implementation of Electronic Health Information Technology Since the inception of the HITECH Act, health organizations have faced increased pressure to update their health information technology (HIT) resources. As discussed last week, many believe that the increased use of electronic health records and the quick and efficient communication afforded by HIT can lead to improved quality of patient care. Yet there are significant costs associated with implementing such systems. What can organizations do to ensure that the correct system is selected and that the system will be appropriate for those required to use it? Who should be involved in those decisions? This week introduces the systems development life cycle and discusses how it can guide an organization through the complexities of adopting a new HIT system. In this Discussion, you are asked to consider the role of nurses in the SDLC process. To prepare: Review the steps of the systems development life cycle. Think about your own organization, or one with which you are familiar, and the steps the organization goes through when purchasing and implementing a new HIT system. Consider what a nurse could contribute to decisions made at each stage when planning for new health information technology. What might be the consequences of not involving nurses? Reflect on your own experiences with your organization selecting and implementing new technology. As an end user, do you feel you had any input in the selection or and planning of the new HIT system? RESOURCES Required Readings McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. Chapter 10, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” This chapter explains the systems development life cycle and explores various methods of applying it. The chapter also examines the importance of interoperability in implementing HITECH. Chapter 11, “Administrative Information Systems” This chapter provides an overview of agency-based health information systems. The text also details how administrators can use core business systems in their practice. Boswell, R. A. (2011). A physician group’s movement toward electronic health records: A case study using the transtheoretical model for organizational change. Consulting Psychology Journal: Practice and Research, 63(2), 138–148. The authors of this article present a case study on an EHR implementation in a multispecialty physician group. The case study attempts to determine actions that promote successful EHR implementation and the pros and cons of implementation. Hsiao, J., Chang, H., & Chen, R. (2011).A study of factors affecting acceptance of hospital information systems: A nursing perspective. Journal of Nursing Research, 19(2), 150–160. The focus of this article is to determine what factors are most important in predicting the acceptance of new health information technology. The results of the study indicated that self-efficacy, top management support, and the quality of information retrieved are the most important determinants of the willingness of nurses to adopt and use a new technology. Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011). Electronic nursing documentation as a strategy to improve quality of patient care. Journal of Nursing Scholarship, 43(2), 154–162. This article summarizes a literature review of the relationship between electronic health records (EHRs) and quality of patient care. The article identifies deficiencies in existing research regarding the daily interactions of nurses, patients, and electronic documentation, and it provides a comparison between electronic and paper-based documentation and its effect on quality of care. Nurse leaders discuss the nurse’s role in driving technology decisions. (2010). Virginia Nurses Today, 18(1), 8–9. This article summarizes a roundtable held with a number of nursing executives to discuss the role nurses should take in the selection and adoption of new technologies for health care. The executives concluded that the nurses’ goals should be to select technology that will further their ability to provide safe, quality care to their patients. Page, D. (2011). Turning nurses into health IT superusers. Hospitals & Health Networks, 85(4), 27–28. This article highlights the importance of involving nurses with all phases of the decision and implementation process surrounding new health information technology. The author stresses the importance of communication in the process as well as defining success. Swab, J., & Ciotti, V. (2010). What to consider when purchasing an EHR system. hfm(Healthcare Financial Management), 64(5), 38–41. In this article, recommendations are given for purchasing health information technology. These include selecting the appropriate vendor, carefully considering the cost of both new equipment and personnel, and involving clinicians in decisions. Required Media Laureate Education (Producer). (2012g). Systems development life cycle. Baltimore, MD: Author. The systems development life cycle (SLDC) provides a framework for all of the steps necessary to implementing a new technology or process within an organization. This video explains the SDLC and how it is used in the health care field. Optional Resources Agency for Healthcare Research and Quality. (2005). A toolkit for redesign in health care. Retrieved from http://www.ahrq.gov/legacy/qual/toolkit/index.html This website supplies strategies for reconfiguring and transforming a hospital’s care processes. The text breaks down the redesign process into a series of steps. 3. Understanding Workflow Design As you explored last week, the implementation of a new technology can dramatically affect the workflow of an organization. Newly implemented technologies can initially limit the productivity of users as they adjust to their new tools. Such implementations tend to be so significant that they often require workflows to be redesigned in order to achieve improvements in safety and patient outcomes. However, before workflows can be redesigned, they must first be analyzed. This analysis includes each step in completing a certain process. Some systems duplicate efforts or contain unnecessary steps that waste time and money and could even jeopardize patient health care. By reviewing and modifying the workflow, you enable greater productivity. This drive to implement new technologies has elevated the demand for nurses who can perform workflow analysis. In this Discussion, you explore resources that have been designed to help guide you through the process of workflow assessment. To prepare: · Take a few minutes and peruse the information found in the article “Workflow Assessment for Health IT Toolkit”. o As you check out the information located on the different tabs, identify key concepts that you could use to improve a workflow in your own organization and consider how you could use them. o Go the Research tab and identify and read one article that is of interest to you and relates to your specialty area. RESOURCES Required Readings McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. Chapter 14, “Nursing Informatics: Improving Workflow and Meaningful Use” This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques. Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11 (1), 43–61. Retrieved from the Walden Library databases. In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements. Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157 , 7–14. Retrieved from the Walden Library databases. This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT. U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit . Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865 This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research. Document: Sample Workflow of Answering a Telephone in an Office (Word document) Required Media Laureate Education (Producer). (2012f). System design and workflow . Baltimore, MD: Author. This video provides an overview of how workflow modeling can be used in a health care setting to target areas for revising current practices and procedures. The video also shows how technology and informatics can be used to improve workflow efficiency and increase the quality of care. 4. Using Health Information Technology as a Source of Evidence-Based Practice Before the digital revolution, health information technology supplied very limited support for evidence-based practice. If nurses wanted to be informed about cutting-edge research, their best bet was to either subscribe to leading journals or make periodic trips to the library. With the establishment of research databases, however, nurses became empowered to learn about and facilitate interdisciplinary and translational research. Databases are just one example of how health information technology supports evidence-based practice. To prepare: · Read the following scenario from the text (McGonigle & Mastrian, 2015, p. 445): Twelve-hour shifts are problematic for patient and nurse safety, and yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (Board on Health Care Services & Institute of Medicine, 2004) published a report that referred to studies as early as 1988 that discussed the negative effects of rotating shifts on intervention accuracy. Workers with 12-hour shifts realized more fatigue than workers on 8-hour shifts. In another study done in Turkey by Ilhan, Durukan, Aras, Turkcuoglu, and Aygun (2006), factors relating to increased risk for injury were age of 24 or less, less than 4 years of nursing experience, working in the surgical intensive care units, and working for more than 8 hours. · Consider how the resources identified in the scenario above could influence an organization’s practice. · Select an issue in your practice that is of concern to you. Using health information technology, locate at least three evidence-based practice resources that address your concern and that could possibly inform further action. RESOURCES Required Readings McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. Chapter 23, “Research: Data Collection, Processing, and Analytics” The authors of this chapter relate nursing research to the foundation of knowledge model. The chapter assesses informatics tools for collecting data, storing information, and processing and analyzing data. Chapter 25, “Translational Research: Generating Evidence for Practice” In this chapter, the authors differentiate evidence-based practice and translation research. They also describe models used to introduce research findings intro practice. Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D., & Francis, J. (2010). Use of health information technology to advance evidence-based care: Lessons from the VA QUERI program. Journal of General Internal Medicine, 25 (Suppl. 1), S44–S49. This article presents a study that evaluated the role of health information technology (HIT) in the Department of Veteran Affairs’ Quality Enhancement Research Initiative. The authors convey their findings on how HIT provided data and information to aid implementation research, and how implementation research helped further HIT development. Additionally, the text details methods of overcoming common HIT barriers to implementation research. Jamal, A., McKenzie, K., & Clark, M. (2009). The impact of health information technology on the quality of medical and health care: A systematic review. Health Information Management Journal, 38 (3), 26–37. This text details a study that reviews the published evidence concerning the impact of health information technology (HIT) on the quality of health care. The study investigated the use of HIT in medical care and allied health and preventive services. The authors primarily focus on the impact of electronic health records, computerized provider order-entry, and decision support systems. Umscheid, C. A., Williams, K., & Brennan, P. (2010). Hospital-based comparative effectiveness centers: Translating research into practice to improve the quality, safety and value of patient care. JGIM: Journal of General Internal Medicine, 25 (12), 1,352–1,355. This article revolves around the usage of the hospital-based comparative effectiveness (CE) center model. The authors highlight the model’s benefits and the increasing usage of CE evidence. The article also reviews solutions to overcoming many of the challenges to operating hospital-based CE centers. Optional Resources Chlan, L., Tracy, M. F., & Grossbach, I. (2011). Pulmonary care. Achieving quality patient-ventilator management: Advancing evidence-based nursing care. Critical Care Nurse, 31 (6), 46–50. 5. HITECH Legislation In order for organizations to receive the incentives offered through the HITECH legislation, they must be able to demonstrate that they are using the technology in meaningful ways. The following criteria for meaningful use must be evident to qualify for EHR incentives (U.S. Department of Health & Human Services, 2012). The technology must: · Improve quality, safety, and efficiency, and reduce health disparities · Engage patients and families · Improve care coordination · Improve population and public health · Ensure adequate privacy and security protections for personal health information For this Discussion, you consider the impact of the meaningful use criteria of the HITECH legislation on the adoption of health information technology. To prepare: · Review the Learning Resources on the HITECH legislation and its primary goals. · Reflect on the positive and negative impact this legislation has had on your organization or one with which you are familiar. · Consider the incentives to encourage the use of EHRs. Focus on the definition of meaningful use and how it is measured. · Reflect on how the incentives and meaningful use impact the quality of patient care. · Find an article dealing with one of the criteria to qualify for meaningful use and how it has been successfully met. RESOURCES Required Readings McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. Chapter 9, “Legislative Aspects of Nursing Informatics: HITECH and HIPAA” This chapter explores two pieces of legislation that dramatically impact nursing informatics: the Health Information Technology for Economic and Clinical Health Act of 2009 and the Health Insurance Portability and Accountability Act of 1996. Arlotto, P. (2010). 7 strategies for improving HITECH readiness. hfm(Healthcare Financial Management) , 64 (11), 90–96. This article reviews seven strategies to help prepare for the implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). The central point of the article focuses on demonstrating meaningful use of electronic health records. Begum, R., Smith Ryan, M., Winther, C. H., Wang, J. J., Bardach, N. S., Parsons, A. H., & … Adams Dudley, R. (2013). Small Practices’ Experience With EHR, Quality Measurement, and Incentives. American Journal Of Managed Care, 19e SP12–8. This article presents a study of clinician’s attitudes toward the use of financial incentives for the implementation of electronic health records in small practices. Brown, B. (2010). The final rules for meaningful use of EHRs. Journal of Health Care Compliance, 12 (5), 49–50. In this article, the author poses four questions pertaining to the EHR system in the United States. In particular, the article examines Medicare and Medicaid incentive payments and the ways the meaningful use of certified EHRs will be verified. Classen, D. C., & Bates, D. W. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365 (9), 855–858. This article details the challenges of meeting the meaningful use standards in order to receive the benefits legislated under the HITECH Act. The authors specify the requisites for achieving benefits with EHRs, the relationship between meaningful use and commercial EHRs, and the tools needed to evaluate EHRs after implementation. Kempfert, A. E., & Reed, B. D. (2011). Health care reform in the United States: HITECH Act and HIPAA privacy, security, and enforcement Issues. FDCC Quarterly, 61 (3), 240–273. The authors of this article examine HITECH, in addition to the impact of the privacy rules under the Health Insurance Portability and Accountability Act (HIPAA). The article details the potential negative repercussions of failing to comply with HIPAA and HITECH. Murphy, J. (2010b). Nursing informatics. The journey to meaningful use of electronic health records. Nursing Economic$, 28 (4), 283–286. This article reviews HITECH and the background leading up to its passage. The author also details the financial incentives intended to assist health care providers in purchasing and implementing HIT and EHR systems. Optional Resources U.S. Department of Health & Human Services. (2011). Health IT home . Retrieved from http://www.healthit.gov/ U.S. Department of Health & Human Services. (2012). Regulations and guidance . Retrieved from http://www.healthit.gov/policy-researchers-implementers/health-it-rules-regulations

Nursing Assignment Help 2025

Please see below and contact 2025

Exercise 16 Understanding Independent Samples t -Test Statistical Technique in Review The independent samples t -test is a parametric statistical technique used to determine significant differences between the scores obtained from two samples or groups. Since the t -test is considered fairly easy to calculate, researchers often use it in determining differences between two groups. The t -test examines the differences between the means of the two groups in a study and adjusts that difference for the variability (computed by the standard error) among the data. When interpreting the results of t -tests, the larger the calculated t ratio, in absolute value, the greater the difference between the two groups. The significance of a t ratio can be determined by comparison with the critical values in a statistical table for the t distribution using the degrees of freedom ( df ) for the study (see Appendix A Critical Values for Student’s t Distribution at the back of this text). The formula for df for an independent t -test is as follows: d f = ( number of subjects in sample 1 + number of subjects in sample 2 ) − 2 Example d f = ( 65 in sample 1 + 67 in sample 2 ) − 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 163 levels than the control group, according to parents' and the observer's reports ( p < 0.001) ( Table 3 )” ( Canbulat et al., 2015 , p. 36). TABLE 1 COMPARISON OF GROUPS IN TERMS OF VARIABLES THAT MAY AFFECT PROCEDURAL PAIN AND ANXIETY LEVELS Characteristic Buzzy ( n = 88) Control ( n = 88) χ 2 p Sex Female (%), n 11 (12.5) 13 (14.8) .82 Male (%), n 77 (87.5) 75 (85.2) .41 Characteristic Buzzy ( n = 88) Control ( n = 88) t p Age (mean ± SD ) 8.25 ± 1.51 8.61 ± 1.69 −1.498 .136 BMI (mean ± SD ) 25.41 ± 6.74 26.94 ± 8.68 −1.309 .192 Preprocedural anxiety Self-report (mean ± SD ) 2.03 ± 1.29 2.11 ± 1.58 −0.364 .716 Parent report (mean ± SD ) 2.11 ± 1.20 2.17 ± 1.42 −0.285 .776 Observer report (mean ± SD ) 2.18 ± 1.17 2.24 ± 1.37 −0.295 .768 BMI, body mass index. Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16 (1), p. 36. TABLE 2 COMPARISON OF GROUPS' PROCEDURAL PAIN LEVELS DURING PERIPHERAL IV CANNULATION Buzzy ( n = 88) Control ( n = 88) t p Procedural self-reported pain with WBFS (mean ± SD ) 2.75 ± 2.68 5.70 ± 3.31 −6.498 0.000 Procedural self-reported pain with VAS (mean ± SD ) 1.66 ± 1.95 4.09 ± 3.21 −6.065 0.000 IV, intravenous; WBFS, Wong-Baker Faces Scale; SD , standard deviation; VAS, visual analog scale. Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16 (1), p. 37. TABLE 3 COMPARISON OF GROUPS' PROCEDURAL ANXIETY LEVELS DURING PERIPHERAL IV CANNULATION Procedural Child Anxiety Buzzy ( n = 88) Control ( n = 88) t p Parent reported (mean ± SD ) 0.94 ± 1.06 2.09 ± 1.39 −6.135 0.000 Observer reported (mean ± SD ) 0.92 ± 1.03 2.14 ± 1.34 −6.745 0.000 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 χ 2 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 Answers to Study Questions 1. An independent samples t -test was conducted to examine group differences in the dependent variables in this study. The two groups analyzed for differences were the Buzzy experimental or intervention group and the control group. 2. The level of significance or alpha (α) was set at 0.05. 3. The result was t = −6.065, p = 0.000 for procedural self-reported pain with the VAS (see Table 2 ). The t value is statistically significant as indicated by the p = 0.000, which is less than α = 0.05 set for this study. The t result means there is a significant difference between the Buzzy intervention group and the control group in terms of the procedural self-reported pain measured with the VAS. As a point of clarification, p values are never zero in a study. There is always some chance of error. 4. The null hypothesis is: There is no difference in observer-reported procedural anxiety levels between the Buzzy intervention and the control groups for school-age children. The t = −6.745 for observer-reported procedural anxiety levels, p = 0.000, which is less than α = 0.05 set for this study. Since this study result was statistically significant, the null hypothesis was rejected. 5. The t = −1.309 for BMI. The nonsignificant p = .192 for BMI is greater than α = 0.05 set for this study. The nonsignificant result means there is no statistically significant difference between the Buzzy intervention and control groups for BMI. The two groups need to be similar for demographic variables to decrease the potential for error and increase the likelihood that the results are an accurate reflection of reality. 6. The conduct of multiple t -tests causes an increased risk for Type I errors. If only one t -test is conducted on study data, the risk of Type I error does not increase. The Bonferroni procedure and the more stringent Tukey's honestly significant difference (HSD), Student Newman-Keuls, or Scheffé test can be calculated to reduce the risk of a Type I error ( Plichta & Kelvin, 2013 ; Zar, 2010 ). 7. The Bonferroni procedure is calculated by alpha ÷ number of t -tests conducted on study variables' data. Note that researchers do not always report all t -tests conducted, especially if they were not statistically significant. The t -tests conducted on demographic data are not of concern. Canbulat et al. reported the results of four t -tests conducted to examine differences between the intervention and control groups for the dependent variables procedural self-reported pain with WBFS, procedural self-reported pain with VAS, parent-reported anxiety levels, and observer-reported anxiety levels. The Bonferroni calculation for this study: 0.05 (alpha) ÷ number of t -tests conducted = 0.05 ÷ 4 = 0.0125. The new α set for the study is 0.0125. 8. Based on the Bonferroni result = 0.0125 obtained in Question 7, the t = −6.745, p = 0.000, is still significant since it is less than 0.0125. 167 9. The intervention and control groups were examined for differences related to the demographic variables gender, age, and BMI and the dependent variable preprocedural anxiety that might have affected the procedural pain and anxiety posttest levels in the children 7 to 12 years old. These nonsignificant results indicate the intervention and control groups were similar or equivalent for these variables at the beginning of the study. Thus, Canbulat et al. (2015) can conclude the significant differences found between the two groups for procedural pain and anxiety levels were probably due to the effects of the intervention rather than sampling error or initial group differences. 10. No, the independent samples t -test would not have been appropriate to analyze the differences in gender between the Buzzy intervention and control groups. The demographic variable gender is measured at the nominal level or categories of females and males. Thus, the χ 2 test is the appropriate statistic for analyzing gender data (see Exercise 19 ). In contrast, the t -test is appropriate for analyzing data for the demographic variables age and BMI measured at the ratio level. 169 EXERCISE 16 Questions to Be Graded Follow your instructor's directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.” Name: _______________________________________________________ Class: _____________________ Date: ___________________________________________________________________________________ 1. What do degrees of freedom ( df ) mean? Canbulat et al. (2015) did not provide the df s in their study. Why is it important to know the df for a t ratio? Using the df formula, calculate the df for this study. 2. What are the means and standard deviations ( SD s) for age for the Buzzy intervention and control groups? What statistical analysis is conducted to determine the difference in means for age for the two groups? Was this an appropriate analysis technique? Provide a rationale for your answer. 3. What are the t value and p value for age? What do these results mean? 4. What are the assumptions for conducting the independent samples t -test? 170 5. Are the groups in this study independent or dependent? Provide a rationale for your answer. 6. What is the null hypothesis for procedural self-reported pain measured with the Wong Baker Faces Scale (WBFS) for the two groups? Was this null hypothesis accepted or rejected in this study? Provide a rationale for your answer. 7. Should a Bonferroni procedure be conducted in this study? Provide a rationale for your answer. 8. What variable has a result of t = −6.135, p = 0.000? What does the result mean? 9. In your opinion, is it an expected or unexpected finding that both t values on Table 2 were found to be statistically significant. Provide a rationale for your answer. 10. Describe one potential clinical benefit for pediatric patients to receive the Buzzy intervention that combined cold and vibration Exercise 17 Understanding Paired or Dependent Samples t -Test Statistical Technique in Review The paired or dependent samples t -test is a parametric statistical procedure calculated to determine differences between two sets of repeated measures data from one group of people. The scores used in the analysis might be obtained from the same subjects under different conditions, such as the one group pretest–posttest design. With this type of design, a single group of subjects experiences the pretest, treatment, and posttest. Subjects are referred to as serving as their own control during the pretest, which is then compared with the posttest scores following the treatment. Paired scores also result from a one-group repeated measures design, where one group of participants is exposed to different levels of an intervention. For example, one group of participants might be exposed to two different doses of a medication and the outcomes for each participant for each dose of medication are measured, resulting in paired scores. The one group design is considered a weak quasi-experimental design because it is difficult to determine the effects of a treatment without a comparison to a separate control group ( Shadish, Cook, & Campbell, 2002 ). A less common type of paired groups is when the groups are matched as part of the design to ensure similarities between the two groups and thus reduce the effect of extraneous variables ( Grove, Burns, & Gray, 2013 ; Shadish et al., 2002 ). For example, two groups might be matched on demographic variables such as gender, age, and severity of illness to reduce the extraneous effects of these variables on the study results. The assumptions for the paired samples t -test are as follows: 1. The distribution of scores is normal or approximately normal. 2. The dependent variable(s) is(are) measured at interval or ratio levels. 3. Repeated measures data are collected from one group of subjects, resulting in paired scores. 4. The differences between the paired scores are independent. Research Article Source Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37 (3), 185–193. Introduction Despite the widespread use of the artificial sweetener aspartame in drinks and food, there are concern and controversy about the mixed research evidence on its neurobehavioral 172 effects. Thus Lindseth and colleagues (2014) conducted a one-group repeated measures design to determine the neurobehavioral effects of consuming both low- and high-aspartame diets in a sample of 28 college students. “The participants served as their own controls. . . . A random assignment of the diets was used to avoid an error of variance for possible systematic effects of order” ( Lindseth et al., 2014 , p. 187). “Healthy adults who consumed a study-prepared high-aspartame diet (25 mg/kg body weight/day) for 8 days and a low-aspartame diet (10 mg/kg body weight/day) for 8 days, with a 2-week washout between the diets, were examined for within-subject differences in cognition, depression, mood, and headache. Measures included weight of foods consumed containing aspartame, mood and depression scales, and cognitive tests for working memory and spatial orientation. When consuming high-aspartame diets, participants had more irritable mood, exhibited more depression, and performed worse on spatial orientation tests. Aspartame consumption did not influence working memory. Given that the higher intake level tested here was well below the maximum acceptable daily intake level of 40–50 mg/kg body weight/day, careful consideration is warranted when consuming food products that may affect neurobehavioral health” ( Lindseth et al., 2014 , p. 185). Relevant Study Results “The mean age of the study participants was 20.8 years ( SD = 2.5). The average number of years of education was 13.4 ( SD = 1.0), and the mean body mass index was 24.1 ( SD = 3.5). . . . Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period ( Table 2 ). Two participants had clinically significant cognitive impairment after consuming high-aspartame diets. . . . Participants were significantly more depressed after they consumed the high-aspartame diet compared to when they consumed the low-aspartame diet ( Table 2 ). . . . Only one participant reported a headache; no difference in headache incidence between high- and low-aspartame intake periods could be established” ( Lindseth et al., 2014 , p. 190). TABLE 2 WITHIN-SUBJECT DIFFERENCES IN NEUROBEHAVIOR SCORES AFTER HIGH AND LOW ASPARTAME INTAKE ( N = 28) Variable M SD Paired t -Test p Spatial orientation High-aspartame 14.1 4.2 2.4 .03 * Low-aspartame 16.6 4.3 Working memory High-aspartame 730.0 152.7 1.5 N.S. Low-aspartame 761.1 201.6 Mood (irritability) High-aspartame 33.4 9.0 3.4 .002 ** Low-aspartame 30.5 7.3 Depression High-aspartame 36.8 7.0 3.8 .001 ** Low-aspartame 34.4 6.2 * p < .05. ** p < .01. M = Mean; SD = Standard deviation; N.S. = Nonsignificant. Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37 (3), p. 190 173 Study Questions 1. Are independent or dependent (paired) scores examined in this study? Provide a rationale for your answer. 2. What independent (intervention) and dependent (outcome) variables were included in this study? 3. What inferential statistical technique was calculated to examine differences in the participants when they received the high-aspartame diet intervention versus the low-aspartame diet? Is this technique appropriate? Provide a rationale for your answer. 4. What statistical techniques were calculated to describe spatial orientation for the participants consuming low- and high-aspartame diets? Were these techniques appropriate? Provide a rationale for your answer. 5. What was the dispersion of the scores for spatial orientation for the high- and low-aspartame diets? Is the dispersion of these scores similar or different? Provide a rationale for your answer. 6. What is the paired t -test value for spatial orientation between the participants' consumption of high- and low-aspartame diets? Are these results significant? Provide a rationale for your answer. 174 7. State the null hypothesis for spatial orientation for this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer. 8. Discuss the meaning of the results regarding spatial orientation for this study. What is the clinical importance of this result? Document your answer. 9. Was there a significant difference in the participants' reported headaches between the high- and low-aspartame intake periods? What does the result indicate? 10. What additional research is needed to determine the neurobehavioral effects of aspartame consumption? 175 Answers to Study Questions 1. This study was conducted using one group of 28 college students who consumed both high- and low- aspartame diets and differences in their responses to these two diets (interventions) were examined. Lindseth et al. (2014 , p. 187) stated that “the participants served as their own controls” in this study, indicating the scores from the one group are paired. In Table 2 , the t -tests are identified as paired t -tests, which are conducted on dependent or paired samples. 2. The interventions were high-aspartame diet (25 mg/kg body weight/day) and low-aspartame diet (10 mg/kg body weight/day). The dependent or outcome variables were spatial orientation, working memory, mood (irritability), depression, and headaches (see Table 2 and narrative of results). 3. Differences were examined with the paired t -test (see Table 2 ). This statistical technique is appropriate since the study included one group and the participants served as their own control ( Plichta & Kelvin, 2013 ). The dependent variables were measured at least at the interval level for each subject following their consumption of high- and low-aspartame diets and were then examined for differences to determine the effects of the two aspartame diets. 4. Means and standard deviations ( SD s) were used to describe spatial orientation for high- and low-aspartame diets. The data in the study were considered at least interval level, so means and SD s are the appropriate analysis techniques for describing the study dependent variables ( Grove et al., 2013 ). 5. Standard deviation ( SD ) is a measure of dispersion that was reported in this study. Spatial orientation following a high-aspartame diet had an SD = 4.2 and an SD = 4.3 for a low-aspartame diet. These SD s are very similar, indicating similar dispersions of spatial orientation scores following the two aspartame diets. 6. Paired t -test = 2.4 for spatial orientation, which is a statistically significant result since p = .03*. The single asterisk (*) directs the reader to the footnote at the bottom of the table, which identifies * p < .05. Since the study result of p = .03 is less than α = .05 set for this study, then the result is statistically significant. 7. There is no significant difference in spatial orientation scores for participants following consumption of a low-aspartame diet versus a high-aspartame diet. The null hypothesis was rejected because of the significant difference found for spatial orientation (see the answer to Question 6). Significant results cause the rejection of the null hypothesis and lend support to the research hypothesis that the levels of aspartame do effect spatial orientation. 8. The researchers reported, “Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period ( Table 2 )” ( Lindseth et al., 2014 , p. 190). This result is clinically important since the high-aspartame diet significantly reduced the participants' spatial orientation. 176 Healthcare providers need to be aware of this finding, since it is consistent with previous research, and encourage people to consume fewer diet drinks and foods with aspartame. The American Heart Association and the American Diabetic Association have provided a statement about the effects of aspartame that can be found on the National Guideline Clearinghouse website at http://www.guideline.gov/content.aspx?id=38431&search=effects+aspartame . 9. There was no significant difference in reported headaches based on the level (high or low) of aspartame diet consumed. Additional research is needed to determine if this result is an accurate reflection of reality or is due to design weaknesses, sampling or data collection errors, or chance ( Grove et al., 2013 ). 10. Additional studies are needed with larger samples to determine the effects of aspartame in the diet. Lindseth et al. (2014) conducted a power analysis that indicated the sample size should have been at least 30 participants. Thus, the sample size was small at N = 28, which increased the potential for a Type II error. Diets higher in aspartame (40–50 mg/kg body weight/day) should be examined for neurobehavioral effects. Longitudinal studies to examine the effects of aspartame over more than 8 days are needed. Future research needs to examine the length of washout period needed between the different levels of aspartame diets. Researchers also need to examine the measurement methods to ensure they have strong validity and reliability. Could a stronger test of working memory be used in future research? 177 EXERCISE 17 Questions to Be Graded Name: _______________________________________________________ Class: _____________________ Date: ___________________________________________________________________________________ Follow your instructor's directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.” 1. What are the assumptions for conducting a paired or dependent samples t -test in a study? Which of these assumptions do you think were met by the Lindseth et al. (2014) study? 2. In the introduction, Lindseth et al. (2014) described a “2-week washout between diets.” What does this mean? Why is this important? 3. What is the paired t -test value for mood (irritability) between the participants' consumption of high- versus low-aspartame diets? Is this result statistically significant? Provide a rationale for your answer. 4. State the null hypothesis for mood (irritability) that was tested in this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer. 178 5. Which t value in Table 2 represents the greatest relative or standardized difference between the high- and low-aspartame diets? Is this t value statistically significant? Provide a rationale for your answer. 6. Discuss why the larger t values are more likely to be statistically significant. 7. Discuss the meaning of the results regarding depression for this study. What is the clinical importance of this result? 8. What is the smallest, paired t -test value in Table 2 ? Why do you think the smaller t values are not statistically significant? 9. Discuss the clinical importance of these study results about the consumption of aspartame. Document your answer with a relevant source. 10. Are these study findings related to the consumption of high- and low-aspartame diets ready for implementation in practice? Provide a rationale for your answer. | Exercise 17 Understanding Paired or Dependent Samples t -Test Statistical Technique in Review The paired or dependent samples t -test is a parametric statistical procedure calculated to determine differences between two sets of repeated measures data from one group of people. The scores used in the analysis might be obtained from the same subjects under different conditions, such as the one group pretest–posttest design. With this type of design, a single group of subjects experiences the pretest, treatment, and posttest. Subjects are referred to as serving as their own control during the pretest, which is then compared with the posttest scores following the treatment. Paired scores also result from a one-group repeated measures design, where one group of participants is exposed to different levels of an intervention. For example, one group of participants might be exposed to two different doses of a medication and the outcomes for each participant for each dose of medication are measured, resulting in paired scores. The one group design is considered a weak quasi-experimental design because it is difficult to determine the effects of a treatment without a comparison to a separate control group ( Shadish, Cook, & Campbell, 2002 ). A less common type of paired groups is when the groups are matched as part of the design to ensure similarities between the two groups and thus reduce the effect of extraneous variables ( Grove, Burns, & Gray, 2013 ; Shadish et al., 2002 ). For example, two groups might be matched on demographic variables such as gender, age, and severity of illness to reduce the extraneous effects of these variables on the study results. The assumptions for the paired samples t -test are as follows: 1. The distribution of scores is normal or approximately normal. 2. The dependent variable(s) is(are) measured at interval or ratio levels. 3. Repeated measures data are collected from one group of subjects, resulting in paired scores. 4. The differences between the paired scores are independent. Research Article Source Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37 (3), 185–193. Introduction Despite the widespread use of the artificial sweetener aspartame in drinks and food, there are concern and controversy about the mixed research evidence on its neurobehavioral 172 effects. Thus Lindseth and colleagues (2014) conducted a one-group repeated measures design to determine the neurobehavioral effects of consuming both low- and high-aspartame diets in a sample of 28 college students. “The participants served as their own controls. . . . A random assignment of the diets was used to avoid an error of variance for possible systematic effects of order” ( Lindseth et al., 2014 , p. 187). “Healthy adults who consumed a study-prepared high-aspartame diet (25 mg/kg body weight/day) for 8 days and a low-aspartame diet (10 mg/kg body weight/day) for 8 days, with a 2-week washout between the diets, were examined for within-subject differences in cognition, depression, mood, and headache. Measures included weight of foods consumed containing aspartame, mood and depression scales, and cognitive tests for working memory and spatial orientation. When consuming high-aspartame diets, participants had more irritable mood, exhibited more depression, and performed worse on spatial orientation tests. Aspartame consumption did not influence working memory. Given that the higher intake level tested here was well below the maximum acceptable daily intake level of 40–50 mg/kg body weight/day, careful consideration is warranted when consuming food products that may affect neurobehavioral health” ( Lindseth et al., 2014 , p. 185). Relevant Study Results “The mean age of the study participants was 20.8 years ( SD = 2.5). The average number of years of education was 13.4 ( SD = 1.0), and the mean body mass index was 24.1 ( SD = 3.5). . . . Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period ( Table 2 ). Two participants had clinically significant cognitive impairment after consuming high-aspartame diets. . . . Participants were significantly more depressed after they consumed the high-aspartame diet compared to when they consumed the low-aspartame diet ( Table 2 ). . . . Only one participant reported a headache; no difference in headache incidence between high- and low-aspartame intake periods could be established” ( Lindseth et al., 2014 , p. 190). TABLE 2 WITHIN-SUBJECT DIFFERENCES IN NEUROBEHAVIOR SCORES AFTER HIGH AND LOW ASPARTAME INTAKE ( N = 28) Variable M SD Paired t -Test p Spatial orientation High-aspartame 14.1 4.2 2.4 .03 * Low-aspartame 16.6 4.3 Working memory High-aspartame 730.0 152.7 1.5 N.S. Low-aspartame 761.1 201.6 Mood (irritability) High-aspartame 33.4 9.0 3.4 .002 ** Low-aspartame 30.5 7.3 Depression High-aspartame 36.8 7.0 3.8 .001 ** Low-aspartame 34.4 6.2 * p < .05. ** p < .01. M = Mean; SD = Standard deviation; N.S. = Nonsignificant. Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37 (3), p. 190 173 Study Questions 1. Are independent or dependent (paired) scores examined in this study? Provide a rationale for your answer. 2. What independent (intervention) and dependent (outcome) variables were included in this study? 3. What inferential statistical technique was calculated to examine differences in the participants when they received the high-aspartame diet intervention versus the low-aspartame diet? Is this technique appropriate? Provide a rationale for your answer. 4. What statistical techniques were calculated to describe spatial orientation for the participants consuming low- and high-aspartame diets? Were these techniques appropriate? Provide a rationale for your answer. 5. What was the dispersion of the scores for spatial orientation for the high- and low-aspartame diets? Is the dispersion of these scores similar or different? Provide a rationale for your answer. 6. What is the paired t -test value for spatial orientation between the participants' consumption of high- and low-aspartame diets? Are these results significant? Provide a rationale for your answer. 174 7. State the null hypothesis for spatial orientation for this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer. 8. Discuss the meaning of the results regarding spatial orientation for this study. What is the clinical importance of this result? Document your answer. 9. Was there a significant difference in the participants' reported headaches between the high- and low-aspartame intake periods? What does the result indicate? 10. What additional research is needed to determine the neurobehavioral effects of aspartame consumption? 175 Answers to Study Questions 1. This study was conducted using one group of 28 college students who consumed both high- and low- aspartame diets and differences in their responses to these two diets (interventions) were examined. Lindseth et al. (2014 , p. 187) stated that “the participants served as their own controls” in this study, indicating the scores from the one group are paired. In Table 2 , the t -tests are identified as paired t -tests, which are conducted on dependent or paired samples. 2. The interventions were high-aspartame diet (25 mg/kg body weight/day) and low-aspartame diet (10 mg/kg body weight/day). The dependent or outcome variables were spatial orientation, working memory, mood (irritability), depression, and headaches (see Table 2 and narrative of results). 3. Differences were examined with the paired t -test (see Table 2 ). This statistical technique is appropriate since the study included one group and the participants served as their own control ( Plichta & Kelvin, 2013 ). The dependent variables were measured at least at the interval level for each subject following their consumption of high- and low-aspartame diets and were then examined for differences to determine the effects of the two aspartame diets. 4. Means and standard deviations ( SD s) were used to describe spatial orientation for high- and low-aspartame diets. The data in the study were considered at least interval level, so means and SD s are the appropriate analysis techniques for describing the study dependent variables ( Grove et al., 2013 ). 5. Standard deviation ( SD ) is a measure of dispersion that was reported in this study. Spatial orientation following a high-aspartame diet had an SD = 4.2 and an SD = 4.3 for a low-aspartame diet. These SD s are very similar, indicating similar dispersions of spatial orientation scores following the two aspartame diets. 6. Paired t -test = 2.4 for spatial orientation, which is a statistically significant result since p = .03*. The single asterisk (*) directs the reader to the footnote at the bottom of the table, which identifies * p < .05. Since the study result of p = .03 is less than α = .05 set for this study, then the result is statistically significant. 7. There is no significant difference in spatial orientation scores for participants following consumption of a low-aspartame diet versus a high-aspartame diet. The null hypothesis was rejected because of the significant difference found for spatial orientation (see the answer to Question 6). Significant results cause the rejection of the null hypothesis and lend support to the research hypothesis that the levels of aspartame do effect spatial orientation. 8. The researchers reported, “Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period ( Table 2 )” ( Lindseth et al., 2014 , p. 190). This result is clinically important since the high-aspartame diet significantly reduced the participants' spatial orientation. 176 Healthcare providers need to be aware of this finding, since it is consistent with previous research, and encourage people to consume fewer diet drinks and foods with aspartame. The American Heart Association and the American Diabetic Association have provided a statement about the effects of aspartame that can be found on the National Guideline Clearinghouse website at http://www.guideline.gov/content.aspx?id=38431&search=effects+aspartame . 9. There was no significant difference in reported headaches based on the level (high or low) of aspartame diet consumed. Additional research is needed to determine if this result is an accurate reflection of reality or is due to design weaknesses, sampling or data collection errors, or chance ( Grove et al., 2013 ). 10. Additional studies are needed with larger samples to determine the effects of aspartame in the diet. Lindseth et al. (2014) conducted a power analysis that indicated the sample size should have been at least 30 participants. Thus, the sample size was small at N = 28, which increased the potential for a Type II error. Diets higher in aspartame (40–50 mg/kg body weight/day) should be examined for neurobehavioral effects. Longitudinal studies to examine the effects of aspartame over more than 8 days are needed. Future research needs to examine the length of washout period needed between the different levels of aspartame diets. Researchers also need to examine the measurement methods to ensure they have strong validity and reliability. Could a stronger test of working memory be used in future research? 177 EXERCISE 17 Questions to Be Graded Name: _______________________________________________________ Class: _____________________ Date: ___________________________________________________________________________________ Follow your instructor's directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.” 1. What are the assumptions for conducting a paired or dependent samples t -test in a study? Which of these assumptions do you think were met by the Lindseth et al. (2014) study? 2. In the introduction, Lindseth et al. (2014) described a “2-week washout between diets.” What does this mean? Why is this important? 3. What is the paired t -test value for mood (irritability) between the participants' consumption of high- versus low-aspartame diets? Is this result statistically significant? Provide a rationale for your answer. 4. State the null hypothesis for mood (irritability) that was tested in this study. Was this hypothesis accepted or rejected? Provide a rationale for your answer. 178 5. Which t value in Table 2 represents the greatest relative or standardized difference between the high- and low-aspartame diets? Is this t value statistically significant? Provide a rationale for your answer. 6. Discuss why the larger t values are more likely to be statistically significant. 7. Discuss the meaning of the results regarding depression for this study. What is the clinical importance of this result? 8. What is the smallest, paired t -test value in Table 2 ? Why do you think the smaller t values are not statistically significant? 9. Discuss the clinical importance of these study results about the consumption of aspartame. Document your answer with a relevant source. 10. Are these study findings related to the consumption of high- and low-aspartame diets ready for implementation in practice? Provide a rationale for your answer. There are two exercises that i posted exercise 16 and 17. both exercises has 10 questions at the end which says questions to be graded. I need to do that questions. Nursing Assignment Help 2025

Sambeh 2025

In this assignment, you will review the interactive Upper Respiratory Case Study patient scenario and analyze the data to determine the health status of the patient. You will need a minimum of two evidence-based practice articles to include clinical practice guidelines, as well as the course textbook. Use the NU641 Upper Respiratory Case Study Questions (Word) document to complete the case study assignment. Follow the requirements posted in the rubric. This case study should be three to five pages, excluding title and references pages. All papers must conform to the most recent APA standards. RUBRIC: Clinical Case Study Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Clinical Case Study Rubric – 100 PointsCriteriaExemplary Exceeds ExpectationsAdvanced Meets ExpectationsIntermediate Needs ImprovementNovice InadequateTotal PointsContent of Clinical Case StudyThe writer demonstrates a well-articulated understanding of the case study subject matter in a clear, complex, and informative manner. The case study content and theories are well developed and linked to the course content, assignment requirements, and practical experience. The case study includes relevant material that fulfills all objectives of the assignment. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. all instruction requirements noted 30 points The writer demonstrates an understanding of the subject matter, and the components of the case study are accurately represented with evidence-based practice, ethics, theory, and/or role content. Course materials and scholarly resources are present to support required concepts. The paper includes relevant material that fulfills all objectives of the case study. Cites two references. Most instruction requirements are noted. 26 points The writer demonstrates a moderate understanding of the subject matter. as evidenced by components of the case study and use of evidence-based practice, theory, or role-development. Course content is present but missing depth and or development. Cites one reference. 23 points Absent application to evidence-based practice, theory, or role development. Demonstrates incomplete understanding of content and/or inadequate preparation. Significant content of case study is vague, inaccurately portrayed, or missing. No references cited. Submits assignment late. 20 points30 Analysis and Synthesis of Case Study Content and Meaning with Content Related to Preventative GuidelinesThrough critical analysis, the submitted case study provides an accurate, clear, concise, and complete summary of the scenario. Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints Includes all major and minor relevant risk factors based on standard preventative guidelines for age and gender and treatment/follow-up plans. all instruction requirements noted. 30 points Case study is complete, providing evidence of further synthesis of course content via scholarly resources. Information is synthesized to help fulfill the case study requirements. The content supports at least one viewpoint. Submission provides clarification of the assignment by correctly answering all posed questions within the instructions. Includes all major risk factors and most minor relevant risk factors based on standard preventative guidelines for age and gender (i.e.’ to two minor risk factors are missing and/or one incorrect treatment plan). Most instruction requirements are noted. 26 points Lacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. Case study content may be confusing or unclear, and the summary may be incomplete. Risk factors are partially complete (i.e., missing one to two major risk factors or three to four minor risk factors, or two incorrect treatment plans). Missing some instruction requirements. 23 points Submission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario. Demonstrates incomplete understanding of content and/or inadequate preparation. Multiple risk factors missing (e.g., three major risk or five to six minor risk factors or three incorrect treatment plans, or four or more major risk factors or seven or more minor risk factors or four or more incorrect treatment plans). Scholarly reference(s) are incorrect or inappropriate for the topic case. Missing several instruction requirements. Submits assignment late. 20 points30 Application of Knowledge To Clinical Aspect of Patient EncounterThe summary of the case study provides validated information via scholarly resources that offer a multidisciplinary approach to the scenario provided. The student’s application in practice is accurate and plausible, and additional scholarly resources supporting the application are provided. all questions posed within the assignment are answered correctly in a well-developed manner, applying knowledge with citations for validation. Includes all relevant subjective and objective data; diagnostic testing; routine care to be provided; patient education; anticipatory guidance; review of previous diagnostics; and follow-up of acute concern and chronic health issues, etc.—based on assignment instructions. all instruction requirements noted. 30 points A summary of the study, findings, and knowledge gained from the assignment is presented. Student indicates how the information will be used within their professional practice. all questions posed by the study are answered correctly. Includes most of the routine content (subjective and objective data; diagnostic testing; routine care to be provided; education; anticipatory guidance; review of previous diagnostics; and follow-up) (is missing two minor details or one major detail). Most instruction requirements are noted. 26 points Components of the case study are summarized with minimal application to evidence-based practice, theory, or role development, thus presenting a more superficial analysis of content between the assignment and the broader course content. Synthesis of course content is present but missing depth and or development. Student’s explanation of how the information will be used within their professional practice is vague or incomplete. One of the questions posed is not answered and/or one of the questions is answered incorrectly. Includes some of the routine content (subjective and objective data; diagnostic testing; routine care to be provided; education; anticipatory guidance; review of previous diagnostics; and follow-up) (is missing three minor details or two major details). Cited one reference. Missing some instruction requirements. 23 points Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. Content of case study is inaccurately portrayed or missing. Student’s explanation of how the information will be used within their professional practice is not feasible or appropriate, or student fails to explain how the information will be used within their personal practice. Omits routine content (subjective and objective data; diagnostic testing; routine care to be provided; education; anticipatory guidance; review of previous diagnostics; and follow-up) (is missing four to five minor details or three major details or six or more minor details or four or more major details. Two or more questions are not answered and/or are answered incorrectly. No references cited. Missing several instruction requirements. Submits post late. 20 points30Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise, with a logical flow of ideas. 5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed, with minimal issues in content flow. 4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points5APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors, or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. 2 points5 Total Points 100

Nursing Assignment Help 2025

Assignment: Assessing a Healthcare Program/Policy Evaluation 2025

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives. Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy. To Prepare: Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources. Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor. Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described. The Assignment: (2–3 pages) Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following: Describe the healthcare program or policy outcomes. How was the success of the program or policy measured? How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? At what point in program implementation was the program or policy evaluation conducted? What data was used to conduct the program or policy evaluation? What specific information on unintended consequences was identified? What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples. Did the program or policy meet the original intent and objectives? Why or why not? Would you recommend implementing this program or policy in your place of work? Why or why not? Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

Nursing Assignment Help 2025