Please respond to these two discussions attached.

Discussion 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Discussion 2

• Handwashing and Alcohol Rubs Design

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

Strength and Weakness

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

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

Rationale

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

Older Adult Self-Efficacy Scoring

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

Strength and Weakness

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

Rationale

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

Breast Cancer and Alcohol

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

Strength and Weakness

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

Rationale

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

References

Gray, J., Grove, S., & Sutherland, S. (2017). Burns and Groves The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence; Edition 8. Retrieved from South University Online Library: https://digitalbookshelf.southuniversity.edu/#/boo…

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

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

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