Activities, Whether They Are Experimental,

¶ … activities, whether they are experimental, descriptive, case study, or historical in design, must command interest, enthusiasm, and passionate commitment if the information garnered is to be added to the body of scientific content knowledge. Further, it is vital that the research investigator capture the essential quality of the excitement of discovery that comes from research well done if expected results are to be gained. The most critical and pivotal concern in all investigative research endeavors is to evaluate the extent to which the investigator has taken a scientific approach to the phenomenon being investigated. if, however, there exists a loosely defined and ad hoc approach to the investigation the resulting data serves no purpose and is of no value. To this end the focus of this report will be on the evaluation of two research papers in the field of nursing with respect to proper and acceptable research formatting and presentation. Specifically the following components will be more precisely examined: the establishment of a research need, presentation of research question and hypothesis, measurement and data collection, statistical data analysis, the presentation of results, and the sustainability of the results for future research endeavors. Additional research requirements will be discussed in the body of each of the aforementioned sections; however, there is no need to list those nested components here.

The same research investigators authored the two articles being reported upon and critically evaluated and the content of the research is identical; i.e., ways to increase hand washing by nurses to reduce the spread of possible infections/diseases within a hospital environment through patient empowerment (McGuckin, et al. 1999 & McGuckin, et al. 2001). Prior to discussing the merits and limitations of each research endeavor a short content summary is mandated in order for the reader to garner an understanding as to the intent of the overall research.

Health care in the twenty first century is facing demands that are not only financially restrictive but also greatly influenced by intervening variables such as increased life span, an awareness of advanced treatment programming, and better quality of life. Unfortunately, however, with better health care there exists a void in the availability of trained professionals who are qualified to provide the necessary medical service. One of the most critical challenges, therefore, facing the nursing profession now and for the future is the impending national nursing shortage (Corning, 2002) and is expected to grow and peak within the next 15 to 20 years (Woods & Cardin, 2002). Although these issues are paramount to, and directly affect, the nursing profession there exists other areas in medical service delivery that are as important to patient wellness; yet acknowledgement of their importance is seemingly less ubiquitous, much more subtle and less debated at conferences or roundtable seminars. The subjects to which this author makes mention are those such as patient rights and nursing responsibility, nurse 'burn-out', patient centered care, nursing leadership, and safe patient care. That of safe patient care, wherein the patient has a direct input into the sustainability of their wellness program is just now beginning to impact consumer medical delivery and, as such, the patient's involvement on the tangential side of medical care is becoming increasing important. In order to exemplify the need for patient involvement in wellness care the authors of the two studies under review chose an area of concern in all hospitals and an area wherein the patient could be directly involved in its outcome, namely, helping to control, minimize, and prevent the spread of infections in a hospital inpatient environment through frequent and continual washing of hands by nurses. The selected monitoring system implemented by the research investigators is that of direct patient involvement in administering of a program to increase hand wiping by nurses when treating patients. To this end the research investigators conducted two studies, on in the UK and one in America, wherein patients were asked to assist in getting nurses to either wash their hands before any patient contact as well as to record observations with respect to the frequency of nurses washing their hands before any patient contact. The intent of the dual program was to evaluate an educational program model for infectious control. The remainder of this report will evaluate the extent to which the authors, through their investigative research, accomplish the goals of the applied research effort. Further, the reader is cautioned with respect to the implied replication implications of the studies being evaluated and discussion as to efficacy will be presented at the conclusion of this report.

Research Design. Whether research investigations are designed on the basis of an experimental, descriptive, historical, or case study format there must exist a clearly defined research question which informs the reader as to the specific intent of the research undertaken. When the research design is experimental or descriptive there must follow a well-formulated testable null hypothesis (Ohlson, 1998). Should these two research tenets not be in place then the research is said to be ad hoc and of little useful propose with respect to the validity and reliability of content knowledge. The present articles reviewed and authored by McGuckin, et al. 1999 & 2001) can be best described as ad hoc research and did not follow the best-fit practice for effective research (Kerlinger, 1964). The reasons for this summary statement is based upon the following reasons:

research question is to be presented at the beginning of a research investigation and if designed as an experimental or descriptive study a testable null hypothesis (es) follows. Given that the authors employed numerical data further necessitates the need for a well-defined research question and testable null hypothesis. Unfortunately the research investigators did not present a research question or testable null hypothesis as required by quantitative descriptive research protocol. In fact in the 2001 article the authors failed to present to the reader with definable research intent let alone a question or testable hypothesis. The 1991 research report did, however, inform the reader of the research objective; however, as for the 2001 research situation, the 1991 research activity did not present a question or testable hypothesis. In fact, in the 1991 study the authors advise the reader that the investigation is a "control' situation and the use of the word control in any quantitative research activity mandates the presentation of a question and testable hypothesis (Ferguson, 1967). The authors could have avoided this fatal research error by stating a research question in the following manner: To what extent will the patient Partners in Your Care educational model influence the frequency of hand washing by nurses with respect to infectious disease control. Aligned with the research question would be the following primary testable null hypothesis: There will exist no statistically significant difference, relationship and/or effect at the ? 0.05 level of statistical acceptance for infectious disease reduction for those nurses participating in the Partners in Your Care program and those who do not participate. The reader is directed to that section dealing with statistical data analysis for a more thorough explanation of the null hypothesis requirements.

With respect to the presentation of a rationale or need for conducting primary research in the area of infectious disease control, hand washing, patient involvement, and nurses neither research situation fully explained why patient involvement was, has been, or should be a research consideration with respect to controlling, preventing, or lowering the frequency of infectious diseases in-patient hospital environments. The authors would have been well advised to build a rationale for patient participation in such a hospital environment. In addition, the authors are encouraged to have alerted the reader as to why nurses, themselves, require an outside or non-medical group to become a part of the awareness factor in a situation that is governed not only through hospital policy but HIPAA and accreditation organizations as well. Seemingly, therefore, the absence of a rationale leads the reader to believe that compliance agencies are not effective with respect to regulating the spread of infectious diseases through non-compliant nurse hand washing activities. Should this be the case the authors should have indicated that new methods of control are needed and that patient involvement is a possible influencing solution.

Not only have McGuckin, et al. failed in formulating a need for their studies, as well as not presenting a definable research question or testable hypothesis, they have not abided by the requirements for prudent sampling. The concept of sampling alone is of paramount importance as it can skew testing results, infuse uncontrollable error into the statistical process, and violate the empirical premise under which the research investigation is being conducted. In order for accurate conclusions to be drawn about any phenomenon under investigation there must exist a clear understanding of the sampling structure. Ideally sampling for any investigative undertaking should be random and representative of the population from this it came. In the event that random selection is not possible, or when clinical trial research is the venue, then the statistical tool use to analyze the measurement data must be one wherein randomization is not a factor or wherein the chosen tool can be modified to accommodate a non-random sample situation. With respect to the McGuckin studies neither randomization nor sample selection is ever discussed. In fact sampling per se is not presented except for cursory mention in the results section. Again, without proper identification as to the sampling method implemented, the reader is ever cautious as to how legitimate the results will be. Not wanting to pre-empt the discussion on statistical methodology, mention must be made at this time with respect to the Poisson Regression statistical tool selected for use in these two studies in terms of sampling. This particular regression technique, if utilized properly, requires the sample size to be determined on the basis of the square root transformation of the Poisson random variables. More specifically, the formula for calculating the sample size of the Poisson variables is as follows:

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The data received from this calculation will give the research investigator the number of sampling units per group that are needed. Unfortunately however the reader is not presented information with respect to the Poisson random variables selected not the unit sample number per group.

Statistical Tool and Selected Variables. Both studies made use of the Poisson regression technique to ascertain their results. When a statistical tool is chosen the tool must conform to the theoretical requirements of the selected process. According to the authors the Poisson regression method was used to test the significance of the intervention. Actually, researchers to test for the interaction of selected variables use a Poisson model and not to test for differences between and amongst a study's selected independent and dependent variables. In essence the Poisson regression model permits predictability of the results. At no time during either research project did the authors state, or allude to, the need to establish the predictability of the Partners in Your Care assessment instrument. The appropriate conclusion drawn, therefore, is that a more user-friendly statistical tool should have been employed - a modified orthogonal analysis of variances wherein nested variables are also considered.

As mentioned earlier, all research investigations must clearly define the variables under investigation. In descriptive research studies this involves the identification of the independent and dependent variables. Although both studies have independent (treatment) and dependent (change) variables they are never clearly identifies. Identification must take place prior to the establishment of the selected statistical tool. Further, when discussing or presenting the independent and dependent variables the research investigator is obligated to inform the reader as to whether or not differences, relationships or effects are being sought. It is not until the data analysis section is the reader advised that the study is seeking to determine intervention effects of the Partners in Your Care model. Again, the fact that the authors make use of the work 'intervention' is indicative of determining effects - which the Poisson regression model is not equipped to handle. Had the research investigators wanted to seek the predictability of the aforementioned model then consideration for using the Poisson model can be established. Furthermore, as the variance of the Poisson random variable is equal to the mean of the response recorded (i.e., response to the Partners in Your Care assessment instrument) and must be reported by the investigators as the regression model is set up to meet normality and variance homogeneity assumptions. Again, no such presentation was made in either study.

Selected Measurement Instruments. When employing any type of measurement instrument the instrument must be evaluated in terms of reliability and validity (Stanley & Hopkins, 1972). Reliability comes from the necessity for dependability in measurement. If the data is not dependable, any conclusions drawn will lack soundness. In order to achieve reliability the research investigator must maintain the integrity of the testing by ensuring that the same results from a testing instrument will deliver the same set of results when tested by a comparable instrument (Ohlson, 1998). As there exists no reported studies confirming the reliability of the Partners in Your Care instrument, the acceptance of the results is suspect. A measurement instrument that has not been properly serviced or calibrated will yield biased or erroneous data and faulty conclusions will be drawn. The error commonly associated with the measurement instrument is commonly called systematic variance or error (random) variance. In reference to the two studies conducted by McGuckin, et al. there is no reference to how the assessment instrument achieved the necessary required reliability. The reader is simply expected to accept the measurement instrument as a reliable indicator of the variables being examined.