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Evaluating Research Questions, Hypotheses, and Quantitative Research Designs

Evaluating Research Questions, Hypotheses, and Quantitative Research DesignsOrder Descriptiona critique of the research study in which you:Evaluate the research questions and hypotheses using the Research Questions and Hypotheses Checklist as a guide1.Identify the type of quantitative research design used and explain how the researchers implemented the design2.Analyze alignment among the theory, problem, purpose, research questions and hypotheses, and designResearch Questions and Hypotheses ChecklistUse the following criteria to evaluate an author’s research questions and/or hypotheses.Look for indications of the following:•Is the research question(s) a logical extension of the purpose of thestudy?•Does the research question(s) reflect the best question to addressthe problem?•Does the research question(s) align with the design of the study?•Does the research question(s) align with the method identifiedfor collecting data?If the study is qualitative, does the research question(s)do as follows?•Relate the central question to the qualitative approach•Begin with What or How (not Why)•Focus on a single phenomenon•Use exploratory verbs•Use no directional language•Use an open-ended format•Specify the participants and research site If the study isquantitative:•Do the descriptive questions seek to describe responses to majorvariables?•Do the inferential questions seek to compare groups or relate.variables?•Do the inferential questions follow from a theory?•Are the variables positioned consistently from independent/predictor to dependent/outcome in the inferential questions?•Is a null and/or alternative hypothesis provided as aPredictive statement?•Is the hypothesis consistent with its respective research question?•Does the question(s) and/or hypothesis specify the participants andresearch site?If the study is mixed methods, do the research questions and/orhypotheses do the following?•Include the characteristics of a good qualitative research question (aslisted above)•Include the characteristics of a good quantitative research and/orhypothesis (as listed above)•Indicate how the researcher will mix or integrate the two approachesof the study•Specify the participants and research site•Convey the overall intent of the study that calls for a mixed methodapproachOriginal Article Faculty Perception of the Effectiveness of EBP Courses for Graduate Nursing Students Ren´ata Zelen´ikov´a, RN, PhD•Michael Beach, DNP, ACNP-BC, PNP• Dianxu Ren, MD, PhD•Emily Wolff•Paula Sherwood, RN, PhD, CNRN, FAANKeywords evidence-based practice, faculty, teaching, curriculaABSTRACT Background: Effective teaching is key in preparing students to become successful evidence- based healthcare professionals. The effectiveness of graduate evidence-based practice (EBP) pedagogy is not often a subject of research studies. Purpose: The purpose of this study was to determine how faculty from the 50 top graduate nursing schools in the United States perceived the effectiveness of EBP courses for graduate nursing students. Methods: A descriptive cross-sectional design was used to explore faculty perception of the effectiveness of EBP courses. A web-based survey was used for data collection. A total of 45 questionnaires were subjected to statistical analysis. Results: The mean perception of the effectiveness of EBP courses for the whole sample, on a scale from 1 to 7, was 5.58 (min. 4.29; max. 6.73), a higher score signifying higher perceived effectiveness. The highest rated item concerned a school’s access to different databases. The strongest correlations were found between the total score and the scores for items describing students’opportunitiestostrengthenandapplytheirEBPskills(rs=.66).Theinternalconsistency of the Perception of Effectiveness of EBP Courses scale, based on standardized Cronbach’s alpha, was .84, which signi?es strong internal consistency. Faculty perceived themselves as most competent at the following EBP skills: (a) “Asking questions regarding patients’ care” (6.56), (b) “Considering patient preferences when implementing EBP” (6.40), and (c) “Critically appraising the relevant body of evidence to address clinical questions” (6.40). Discussion: To strengthen the effectiveness of EBP courses, students should have more oppor- tunities to implement their EBP knowledge and skills after completing EBP courses. Linking EvidencetoAction:EvaluationoffacultyperceptionsoftheeffectivenessofEBPcourses can help to guide the development of nursing school curricula that better integrate EBP. Further evaluation of the psychometric properties of the instrument used to measure perception of the effectiveness of EBP courses is required along with objective measures of faculty knowledge and skills in teaching EBP.BACKGROUND AND SIGNIFICANCE Worldwide, evidence-based practice (EBP) has emerged as a major healthcare initiative (Thiel & Ghosh, 2008). One of the most consistent ?ndings in health service research is the gap betweenbestpractice(asdeterminedbyscienti?cevidence)and actual clinical care (Flores-Mateo & Argimon, 2007). To accel- erate the translation of research ?ndings into clinical practice, two major outcomes must be achieved: (a) Advanced practice and direct care nurses must acquire suf?cient EBP knowledge and skills as well as strong beliefs about the value of EBP in clinicalsettings,and(b)educatorsmustteachtheirstudentsthe EBPprocesstoinstillinthemlifelongskillsandthemotivation todeliverthehighestqualityofcare(Melnyk,Fineout-Overholt, Feinstein, Sadler, & Green-Hernandez, 2008).FindingsfromarecentnationalsurveybyMelnyk,Fineout- Overholt, Gallagher-Ford, and Kaplan (2012) indicated that nurses surveyed across the country are ready for and do value EBP.Themajorityofparticipantswhorespondedtothesurvey reportedwantingtogainmoreknowledgeandskillsinorderto deliver evidence-based care in their institutions. Nurses cited a top requirement for helping them implement EBP in daily practice as education. For students to become evidence-based healthcare profes- sionals, the teaching of EBP has to be effective (Spek, Wolf, Dijk, & Lucas, 2012). Little has been published about teach- ing EBP to nursing students (Stif?er & Cullen, 2010). Though therearesystematicreviewsandmeta-analysesofteachingEBP inschoolsofmedicine,thereisadearthofresearchinnursing,Worldviews on Evidence-Based Nursing, 2014; 11:6, 401–413. 401 C 2014 Sigma Theta Tau InternationalPerception of Effectiveness of EBP Coursesespeciallyinregardtograduate-levelEBPpedagogy.According to Fineout-Overholt and Johnston (2005), further research is needed to assess effective teaching and evaluation strategies for EBP. Teaching EBP to nursing students is usually based on the basic steps of EBP. Melnyk and Fineout-Overholt (2011) added two more steps to the ?ve basic steps of EBP, which include: (a) cultivate a spirit of inquiry; (b) ask the burning clinical question in PICOT (P = patient population; I = intervention orareaofinterest;C=comparisoninterventionorgroup;O= outcomes; and T=time) format; (c) search for and collect the mostrelevantbestevidence;(d)criticallyappraisetheevidence; (e) integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change; (f) evaluate outcomes of the practice decision or change based on evidence; and (g) disseminate the outcomes of the EBP decision or change. The seven steps of EBP can serve as a structure around which to build EBP curriculum for graduate nursing students. The effectiveness of graduate EBP pedagogy is not often a subject of research studies. One of the problems is the com- plexity of the EBP process and the dif?culty of assessing all aspects of its effectiveness. Shaneyefelt and colleagues (2006) performed a systematic review of EBP instruments. Their re- sults showed that the majority of instruments targeted stu- dents and postgraduate trainees, whereas nonphysicians were rarely evaluated. The available instruments most commonly evaluatedEBPskills(predominantlyfocusingonthecriticalap- praisalofevidence),knowledge,attitudes,andbehaviors.Most instruments are designed for speci?c purposes, such as the evaluation of theoretical EBP courses (instruments to assess cognitive skills), or the evaluation of EBP in clinical practice (instruments to assess performance-based skills and applica- tion; Ilic, 2009). The instrument used in this study for measuring the per- ception of the effectiveness of EBP courses was inspired by the ARCC-E (advancing research and clinical practice through close collaboration and education) conceptual model for teaching EBP (Melnyk & Fineout-Overholt, 2011). This model shows that organizational support, the identi?cation of curricular strengths and barriers to teaching EBP and use of faculty EBP mentors play an important role in the effectiveness of EBP pedagogy. Based on this model, the parameters of effective EBP courses were set. The neces- sary conditions for successful EBP courses are: curricular strengths, organizational support, teachers’ mastery of EBP, and teachers’ involvement in EBP learning. In our instru- ment, we focused on the evaluation of the effectiveness of EBP courses from a faculty perspective. Therefore, items re- ?ected faculty perception of the integration of EBP in the curriculum, faculty involvement in learning and expectations they had of their students, mastery of subject matter, and or- ganizational support. The instrument for measuring faculty perception of their own and students’ competence in EBP skills was designed toaddressallsevenstepsoftheEBPprocessbasedonamodi?ed version of the list of EBP skills in Melnyk et al. (2008). EBP skills can be divided into three groups:Skills related to the implementation and dissemina- tion of EBP (e.g., applying synthesized evidence to initiate change, mentoring/teaching EBP to others).Skills in searching for and appraising evidence (e.g., searching ef?ciently for evidence, critically apprais- ing the relevant body of evidence to address clinical questions).Skills relating to cooperation with the clinical envi- ronment (e.g., assessing the clinical environment for readiness for EBP, asking questions regarding pa- tients’ care).Teacher competency is one of the most important factors in the learning process. To be able to deliver EBP knowledge and skills properly, faculty have to be experts in these skills. However,thereisalackofstudiesfocusingonthecompetence of teachers of EBP courses and on how they perceive their own EBP skills. It is not well known how competent graduate nursing faculty members are in EBP knowledge and skills. This study focuses particularly on faculty perception of the effectiveness of EBP courses and faculty perception of their own competence in EBP skills. Inclusion of a core EBP course ingraduatenursingcurriculaisessentialtoestablishingafoun- dationfromwhichEBPknowledgeandskillscanbefurtherde- veloped in the remainder of the students’ didactic and clinical coursework (Melnyk et al., 2008). Evaluation of the effective- ness of EBP courses can inform the improvement of future programs. Three main research questions guided this study:(1) What are faculty perceptions of the effectiveness of EBP courses for graduate nursing students?(2) What are faculty perceptions of their own compe- tence in EBP skills?(3) As judged by their teachers, how competent in EBP skillsarestudentsuponcompletionofEBPcourses?PURPOSE Thepurposeofthisdescriptivecross-sectionalstudywastode- termine how faculty from the 50 top graduate nursing schools intheUnitedStatesperceivedtheeffectivenessofEBPcourses for graduate nursing students.METHODS Study Design and Methods A descriptive cross-sectional design was used to explore per- ception of the effectiveness of EBP courses and perception of competence in EBP skills. A web-based survey was used402 Worldviews on Evidence-Based Nursing, 2014; 11:6, 401–413. C 2014 Sigma Theta Tau InternationalOriginal Articlefor data collection. Data collection was conducted by sending potential respondents an e-mail with a hyperlink to the web- basedsurvey.Facultymembersagreeabletoparticipatingwere required to click on the link in the e-mail directing them to a study-speci?c, secured Survey Monkey website. The website consisted of a questionnaire that was developed by the investi- gatorstoassessperceptionsoftheeffectivenessofEBPcourses and perceptions of EBP skills. The questionnaire took approx- imately 5–10 minutes to complete.Sample and Data Collection The sample population consisted of faculty from the top 50 graduate nursing schools across the United States according to the Top Universities in U.S. website (http://www.university-list.net/us/rank/univ-20131118.htm), who taught EBP courses for graduate nursing students. Sixty-two nursing schools were contacted through their deans’of?ces.E-mailsweresenttothedeans.Eache-mailcon- tainedacoverletteraddressedtothedeanandacoverletterfor facultymembersinvolvedinteachingEBPcourses.Deanswho wereagreeabletotheirfacultyparticipatinginthestudywerere- questedtoforwardane-mailincludingthelattercoverletterand astudy-speci?c,secure,andde-identi?edlinktotheweb-based survey to faculty members involved in teaching EBP courses. Deansof?venursingschoolsdidnotagreetotheirfacultypar- ticipating in the study. E-mails were sent only once. Data were collected from the middle of January 2013 through the middle of March 2013. The study was conducted in three steps. Step 1: Development of a questionnaire for evaluating the effectiveness of teaching EBP in nursing. The survey items weredevelopedbytheauthors.Surveyitemswerederivedfrom theliteratureandfromtheauthors’teachingexperiences.Items measuringperceptionoftheeffectivenessofEBPcourseswere devised in consultation with an expert from the Center for InstructionalDevelopmentandDistanceEducationattheUni- versity of Pittsburgh. The survey was comprised of the following sets of ques- tions:(1) Fifteen questions on the survey employed a scale of 1(strongly disagree) to 7 (strongly agree) to assess per- ception of the effectiveness of EBP courses. These questions covered four areas: perception of the in- tegration of EBP in the curriculum, faculty involve- ment in EBP learning and the expectations they had ofstudents,masteryofsubjectmatter,andorganiza- tional support.(2) Fourteenquestionsincludedinthesurveyemployed ascaleof1(notatallcompetent)to7(extremelycompe- tent) to assess faculty perceptions of their own com- petenceinEBPskills.AlistofEBPskillswasadapted fromMelnykandcolleagues(2008)withtheconsent of the ?rst author. The list of skills did not include those with an immediate bearing on patient care.These skills were added following an analysis of the de?nition of EBP by the researchers, and re?ected a consensus reached among them. Besides this modi- ?cation,someitemsontheoriginallistwereomitted and others were paraphrased to make the question- naire more accessible to participants.(3) Fourteen questions employed a scale of 0 (not well at all) to 7 (extremely well) to measure faculty per- ceptions of students’ competence in EBP skills af- ter completing EBP courses. Faculty members were asked how well students who had completed EBP courses had mastered a speci?c set of EBP skills. The list of EBP skills was the same as the list of EBP skills for faculty.(4) Samplecharacteristics (e.g., gender,age, years of ex- perience teaching EPB courses, number of years as a faculty member, and training in teaching EBP).(5) Questions regarding teaching strategies (e.g., barri- ers to teaching EBP, the most important EBP skills to focus on).Once the survey items were developed, they were reviewed for content validity and clarity by an interdisciplinary group of EBP experts. Step2:Conversionofpapersurveytoweb-basedsurveyand pilottesting. Thepapersurveywasconvertedtoawebversion and piloted by the authors and several colleagues. Issues and limitations with the design of the web-based survey were dis- cussedwithintheresearchteamandmodi?cationsweremade to increase ease of use. Step 3: Web-based survey. Questionnaires were completed online via SurveyMonkey, which keeps data private, safe, and secure.ETHICAL CONSIDERATIONS Approval was obtained from the Institutional Review Board of theUniversityofPittsburghpriortoparticipantrecruitment.A cover letter explaining the aim of the study was attached to all surveys.Thecoverletteralsoaddressedthevoluntarynatureof thesurveyandguaranteedcon?dentialitytothefullestpossible extent. Completing the questionnaire served as a participant’s consenttotakepartintheresearchstudy.Thetotaldurationof subjectparticipationwasthetimetakentocompleteaone-time questionnaire.STATISTICAL ANALYSIS Descriptive statistics were used to describe the sample char- acteristics and perceptions of effectiveness of EBP courses as well as perceptions of competence in EBP skills. The Spear- man Correlation coef?cient was used to examine the correla- tionbetweenthetotalscorefortheinstrumentandthescorefor eachitem.ReliabilityofthescalewasmeasuredbyCronbach’sWorldviews on Evidence-Based Nursing, 2014; 11:6, 401–413. 403 C 2014 Sigma Theta Tau InternationalPerception of Effectiveness of EBP CoursesAlpha. Interitem correlations were calculated and an item- totalanalysiswasperformed.TheKaiser-Meyer-OlkinMeasure of Sampling Adequacy and Bartlett’s Test of Sphericity were conducted before factor analysis. Factor analysis (extraction method: principal component analysis) with Varimax rotation was performed. Statistical analyses were conducted using the Statistical Package for the Social Sciences 16.0 for Windows (SPSS, Chicago, IL, USA).RESULTS Fifty-seven nursing schools deemed likely to agree to partici- pate were contacted. In response, 74 questionnaires from fac- ulty were received, though not all of them were complete. A total of 45 completed questionnaires (60%) had less than 5% ofthedatamissingandwereusedinthestatisticalanalysis.The majorityofparticipantswereinvolvedinteachingEBPcourses. Approximatelytwo-thirdsoftheparticipantswereteachingEBP courses for graduate students (62.3%), others were teaching EBP courses for both graduate and undergraduate students (15.5%), or were teaching EBP courses for undergraduate stu- dents (13.3%), or else included EBP content in other courses (8.9%). Of the entire sample, 42 (93.3%) participants were fe- male and 3 were male (6.7%). The largest segment of the sam- ple, 24 (53.4%), were 56 years old or older, whereas 15 (33.3%) were 46–55 years old. More than 80% of those surveyed had been faculty members for more than 6 years. Approximately two-thirds of participants had been teaching EBP courses for 4 or more years. Of all the participants, 30 (66.7%) cited self- studyastheirprimarytrainingintheteachingofEBP,whereas 12 (26.7%) received several days of training, and 3 (6.6%) of the participants used online training (see Table 1).Teaching Strategies Faculty from the top 50 graduate nursing schools across the United States cited lectures (n = 32; 71.1%), projects (n = 32; 71.1%), group work (n = 31; 68.9%), computer-based teach- ing strategies (n = 26; 57.8%), training students to critically appraise a published article (n=26; 57.8%), and training stu- dents to develop clinical protocols (n = 8; 17.8%) as the most frequently used teaching strategies in EBP courses. The num- ber of students enrolled in EBP courses was 5–20 (n = 21; 46.6%), 21–40 students (n=12; 26.7%), and 41 or more (n= 12; 26.7%).Barriers to the Teaching of EBP The main barriers to the teaching of EBP identi?ed by faculty were (a) time (n = 8) “limited class time and competition for thattimewithsomanyotherskillsandtheory,”(b)insuf?cient statisticalandresearchbackgroundofstudents(n=5),(c)lack of faculty experts in the area of EBP (n=4), and (d) large class size (n=3).The Most Important EBP Skills to Teach According to our sample, the most important EBP skills to focus on when teaching EBP courses are:Critically appraising the relevant body of evidence to address clinical questions (n=37; 82.2%); Searching ef?ciently for evidence that answers the clinical questions (n=29; 64.4%); Synthesizing evidence to make decisions about pa- tient care (n=27; 60%); Formulating searchable, answerable clinical ques- tions in PICOT format (n=24; 53.3%); Selecting the best evidence from what is found in the search (n=21; 46.7%); Analyzingoutcomesofevidence-based interventions, practice changes, and clinical guidelines (n = 20; 44.4%).Perception of the Effectiveness of EBP Courses The mean perception of the effectiveness of EBP courses mea- sured on a scale from 1 to 7 was 5.58 (s2 0.45; min. 4.29; max. 6.73)forthewholesample,andthemeanperceptionoffaculty competence in EBP skills was 6.16 (s2 0.06; min. 5.73; max. 6.56). In both cases, a higher score signi?es higher perceived effectiveness or competency (see Table 1). Reliability. The interitem correlations of the 15 items ranged from-.16to.98,withthemajoritybeingaround.40.Theinter- nalconsistencyofthescale,basedonstandardizedCronbach’s alpha,was.84,whichsigni?esstronginternalconsistency.The item-totalanalysisshowedarangeforCronbach’salphaifitem deleted from .81 to .85, showing that every item contributes to the overall reliability. Factor analysis of perception of the effectiveness of EBP courses. A factor analysis (extraction method: principal com- ponentanalysis)withVarimaxrotationinSPSSwasperformed on the 15 items of the Perception of the Effectiveness of EBP Courses scale. A ratio of 3:1 (subject-to-variables) was used in the sample. The minimum sample size according to Mund- from, Shaw, and Ke (2005), with good level for variables-to- factors ratio set at seven and the number of factors set at three, is 40–65. The Kaiser-Meyer-Olkin Measure of Sam- pling Adequacy was .647, above the .6 suggested minimum. Bartlett’s Test of Sphericity was signi?cant (