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Complete Exercises in Statistics for Nursing Research: A Workbook for Evidence-Based Practice
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Introduction
Eckerblad and colleagues (2014, p. 351) conducted a comparative descriptive study to examine the symptoms of “patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.” The Memorial Symptom Assessment Scale (MSAS) was used to measure the symptoms of 42 outpatients with moderate airflow limitations and 49 patients with severe airflow limitations. The results indicated that the mean number of symptoms was 7.9 (±4.3) for both groups combined, with no significant differences found in symptoms between the patients with moderate and severe airflow limitations. For patients with the highest MSAS symptom burden scores in both the moderate and the severe limitations groups, the symptoms most frequently experienced included shortness of breath, dry mouth, cough, sleep problems, and lack of energy. The researchers concluded that patients with moderate or severe airflow limitations experienced multiple severe symptoms that caused high levels of distress. Quality assessment of COPD patients’ physical and psychological symptoms is needed to improve the management of their symptoms.
Relevant Study Results
Eckerblad et al. (2014, p. 353) noted in their research report that “In total, 91 patients assessed with MSAS met the criteria for moderate (n = 42) or severe airflow limitations (n = 49). Of those 91 patients, 47% were men, and 53% were women, with a mean age of 68 (±7) years for men and 67 (±8) years for women. The majority (70%) of patients were married or cohabitating. In addition, 61% were retired, and 15% were on sick leave. Twenty-eight percent of the patients still smoked, and 69% had stopped smoking. The mean BMI (kg/m2) was 26.8 (±5.7).
There were no significant differences in demographic characteristics, smoking history, or BMI between patients with moderate and severe airflow limitations (Table 1). A lower proportion of patients with moderate airflow limitation used inhalation treatment with glucocorticosteroids, long-acting β2-agonists and short-acting β2-agonists, but a higher proportion used analgesics compared with patients with severe airflow limitation.
TABLE 1
BACKGROUND CHARACTERISTICS AND USE OF MEDICATION FOR PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE LUNG DISEASE CLASSIFIED IN PATIENTS WITH MODERATE AND SEVERE AIRFLOW LIMITATION
Moderate
n = 42 Severe
n = 49 p Value
Sex, n (%) 0.607
Women 19 (45) 29 (59)
Men 23 (55) 20 (41)
Age (yrs), mean (SD) 66.5 (8.6) 67.9 (6.8) 0.396
Married/cohabitant n (%) 29 (69) 34 (71) 0.854
Employed, n (%) 7 (17) 7 (14) 0.754
Smoking, n % 0.789
Smoking 13 (31) 12 (24)
Former smokers 28 (67) 35 (71)
Never smokers 1 (2) 2 (4)
Pack years smoking, mean (SD) 29.1 (13.5) 34.0 (19.5) 0.177
BMI (kg/m2), mean (SD) 27.2 (5.2) 26.5 (6.1) 0.555
FEV1 % of predicted, mean (SD) 61.6 (8.4) 42.2 (5.8) <0.001
SpO2 % mean (SD) 95.8 (2.4) 94.5 (3.0) 0.009
Physical health, mean (SD) 3.2 (0.8) 3.0 (0.8) 0.120
Mental health, mean (SD) 3.7 (0.9) 3.6 (1.0) 0.628
Exacerbation previous 6 months, n (%) 14 (33) 15 (31) 0.781
Admitted to hospital previous year, n (%) 10 (24) 14 (29) 0.607
Medication use, n (%)
Inhaled glucocorticosteroids 30 (71) 44 (90) 0.025
Systemic glucocorticosteroids 3 (6.3) 0 (0) 0.094
Anticholinergic 32 (76) 42 (86) 0.245
Long-acting β2-agonists 30 (71) 45 (92) 0.011
Short-acting β2-agonists 13 (31) 32 (65) 0.001
Analgesics 11 (26) 5 (10) 0.046
Statins 8 (19) 11 (23) 0.691
Eckerblad, J., Tödt, K., Jakobsson, P., Unosson, M., Skargren, E., Kentsson, M., & Theander, K. (2014). Symptom burden in stable COPD patients with moderate to severe airflow limitation. Heart & Lung, 43(4), p. 353.
Symptom prevalence and symptom experience
The patients reported multiple symptoms with a mean number of 7.9 (±4.3) symptoms (median = 7, range 0–32) for the total sample, 8.1 (±4.4) for moderate airflow limitation and 7.7 (±4.3) for severe airflow limitation (p = 0.36) . . . . Highly prevalent physical symptoms (≥50% of the total sample) were shortness of breath (90%), cough (65%), dry mouth (65%), and lack of energy (55%). Five additional physical symptoms, feeling drowsy, pain, 61numbness/tingling in hands/feet, feeling irritable, and dizziness, were reported by between 25% and 50% of the patients. The most commonly reported psychological symptom was difficulty sleeping (52%), followed by worrying (33%), feeling irritable (28%) and feeling sad (22%). There were no significant differences in the occurrence of physical and psychological symptoms between patients with moderate and severe airflow limitations” (Eckerblad et al., 2014, p. 353).
EXERCISE 6 Questions to Be Graded
Name: ____j.d___________________________________________________ Class: _____________________
Date: ___________________________________________________________________________________
- What are the frequency and percentage of the COPD patients in the severe airflow limitation group who are employed in the Eckerblad et al. (2014) study?
- What percentage of the total sample is retired? What percentage of the total sample is on sick leave?
- What is the total sample size of this study? What frequency and percentage of the total sample were still employed? Show your calculations and round your answer to the nearest whole percent.
- What is the total percentage of the sample with a smoking history—either still smoking or former smokers? Is the smoking history for study participants clinically important? Provide a rationale for your answer.
- What are pack years of smoking? Is there a significant difference between the moderate and severe airflow limitation groups regarding pack years of smoking? Provide a rationale for your answer.
- What were the four most common psychological symptoms reported by this sample of patients with COPD? What percentage of these subjects experienced these symptoms? Was there a significant difference between the moderate and severe airflow limitation groups for psychological symptoms?
- What frequency and percentage of the total sample used short-acting β2-agonists? Show your calculations and round to the nearest whole percent.
- Is there a significant difference between the moderate and severe airflow limitation groups regarding the use of short-acting β2-agonists? Provide a rationale for your answer.
- Was the percentage of COPD patients with moderate and severe airflow limitation using short-acting β2-agonists what you expected? Provide a rationale with documentation for your answer.
- Are these findings ready for use in practice? Provide a rationale for your answer.
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EXERCISE 8 Questions to Be Graded
Name: ____________j.d___________________________________________ Class: _____________________
Date: ___________________________________________________________________________________
- The number of nursing students enrolled in a particular nursing program between the years of 2010 and 2016, respectively, were 563, 593, 606, 520, 563, 610, and 577. Determine the mean (image), median (MD), and mode of the number of the nursing students enrolled in this program. Show your calculations.
- What is the mode for the variable inpatient complications in Table 2 of the Winkler et al. (2014) study? What percentage of the study participants had this complication?
- Does the distribution of inpatient complications have a single mode, or is this distribution bimodal or multimodal? Provide a rationale for your answer.
- As reported in Table 1, what are the three most common cardiovascular medical history events in this study, and why is it clinically important to know the frequency of these events?
- What are the mean and median lengths of stay (LOS) for the study participants?
- Are the mean and median for LOS similar or different? What might this indicate about the distribution of the sample? Provide a rationale for your answer.
- Examine the study results and determine the mode for arrhythmias experienced by the participants. What was the second most common arrhythmia in this sample?
- Was the most common arrhythmia in Question 7 related to LOS? Was this result statistically significant? Provide a rationale for your answer.
- What study variables were independently predictive of the 50 premature ventricular contractions (PVCs) per hour in this study?
- In Table 1, what race is the mode for this sample? Should these study findings be generalized to American Indians with ACS? Provide a rationale for your answer.
Research Article
Source
Winkler, C., Funk, M., Schindler, D. M., Hemsey, J. Z., Lampert, R., & Drew, B. J. (2013). Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization. Heart & Lung, 42(6), 422–427.
Introduction
Winkler and colleagues (2013) conducted their study to describe the arrhythmias of a population of patients with acute coronary syndrome (ACS) during their first 24 hours of hospitalization and to explore the link between arrhythmias and patients’ outcomes. The patients with ACS were admitted through the emergency department (ED), where a Holter recorder was attached for continuous 12-lead electrocardiographic (ECG) monitoring. The ECG data from the Holter recordings of 278 patients with ACS were analyzed. The researchers found that “approximately 22% of patients had more than 50 premature ventricular contractions (PVCs) per hour. Non-sustained ventricular tachycardia (VT) occurred in 15% of the patients . . . . Only more than 50 PVCs/hour independently predicted an increased length of stay (p < 0.0001). No arrhythmias predicted mortality. Age greater than 65 years and a final diagnosis of acute myocardial infarction (AMI) independently predicted more than 50 PVCs per hour (p = 0.0004)” (Winkler et al., 2013, p. 422).
Winkler and colleagues (2013, p. 426) concluded: “Life-threatening arrhythmias are rare in patients with ACS, but almost one quarter of the sample experienced isolated PVCs. There was a significant independent association between PVCs and a longer length of stay (LOS), but PVCs were not related to other adverse outcomes. Rapid treatment of the underlying ACS should remain the focus, rather than extended monitoring for arrhythmias we no longer treat.”
Relevant Study Results
The demographic and clinical characteristics of the sample and the patient outcomes for this study are presented in this exercise. “The majority of the patients (n = 229; 83%) had a near complete Holter recording of at least 20 h and 171 (62%) had a full 24 h recorded. We included recordings of all patients in the analysis. The mean duration of continuous 12-lead Holter recording was 21 ± 6 (median 24) h.
The mean patient age was 66 years and half of the patients identified White as their race (Table 1). There were more males than females and most patients (92%) experienced chest pain as one of the presenting symptoms to the ED. Over half of the patients experienced shortness of breath (68%) and jaw, neck, arm, or back pain (55%). Hypertension was the most frequently occurring cardiovascular risk factor (76%), followed by hypercholesterolemia (63%) and family history of coronary artery disease (53%). A majority had a personal history of coronary artery disease (63%) and 19% had a history of arrhythmias” (Winkler et al., 2013, pp. 423–424).
TABLE 1
DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF THE SAMPLE (N = 278)
Characteristic N %
Gender
Male 158 57
Female 120 43
Race
White 143 51
Asian 60 22
Black 50 18
American Indian 23 8
Pacific Islander 2 <1
Presenting Symptoms to the ED (May Have >1)
Chest pain 255 92
Shortness of breath 189 68
Jaw, neck, arm, or back pain 152 55
Diaphoresis 116 42
Nausea and vomiting 96 35
Syncope 11 4
Cardiovascular Risk Factors (May Have >1)
Hypertension 211 76
Hypercholesterolemia 175 63
Family history of CAD 148 53
Diabetes 81 29
Smoking (current) 56 20
Cardiovascular Medical History (May Have >1)
Personal history of CAD 176 63
History of unstable angina 124 45
Previous acute myocardial infarction 114 41
Previous percutaneous coronary intervention 85 31
Previous CABG surgery 54 19
History of arrhythmias 53 19
Final Diagnosis
Unstable angina 180 65
Non-ST elevation myocardial infarction 74 27
ST elevation myocardial infarction 24 9
Interventions during 24-h Holter Recording
PCI ≤ 90 min of ED admission 14 5
PCI > 90 min of ED admission 3 1
Thrombolytic medication 3 1
Interventions Any Time during Hospitalization
PCI 76 27
Treated with anti-arrhythmic medication 16 6
CABG surgery 22 8
Mean (SD) Median Range
Age (years) 66 (14) 66 30–102
ECG recording time (hours) 21 (6) 24 2–25
ED, emergency department; CAD, coronary artery disease; CABG, coronary artery bypass graft; PCI, percutaneous coronary intervention; SD, standard deviation; ECG, electrocardiogram.
Winkler, C., Funk, M., Schindler, D. M., Hemsey, J. Z., Lampert, R., & Drew, B. J. (2013). Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization. Heart & Lung, 42(6), p. 424.
Winkler et al. (2013, p. 424) also reported: “We categorized patient outcomes into four groups: 1) inpatient complications (of which some patients may have experienced more than one); 2) inpatient length of stay; 3) readmission to either the ED or the hospital within 30-days and 1-year of initial hospitalization; and 4) death during hospitalization, within 30-days, and 1-year after discharge (Table 2). These are outcomes that are reported in many contemporary studies of patients with ACS. Thirty-two patients (11.5%) were lost to 1-year follow-up, resulting in a sample size for the analysis of 1-year outcomes of 246 patients” (Winkler et al., 2013, p. 424).
TABLE 2
OUTCOMES DURING INPATIENT STAY, AND WITHIN 30 DAYS AND 1 YEAR OF HOSPITALIZATION (N = 278)
Outcomes N %
Inpatient complications (may have >1)
AMI post admission for patients admitted with UA 21 8
Transfer to intensive care unit 17 6
Cardiac arrest 7 3
AMI extension (detected by 2nd rise in CK-MB) 6 2
Cardiogenic shock 5 2
New severe heart failure/pulmonary edema 2 1
Readmission*
30-day
To ED for a cardiovascular reason 42 15
To hospital for ACS 13 5
1-year (N = 246)
To ED for a cardiovascular reason 108 44
To hospital for ACS 24 10
All-cause mortality†
Inpatient 10 4
30-day 13 5
1-year (N = 246) 27 11
Mean (SD) Median Range
Length of stay (days) 5.37 (7.02) 4 1–93
* Readmission: 1-year data include 30-day data.
† All-cause mortality: 30-day data include inpatient data; 1-year data include both 30-day and inpatient data.
AMI, acute myocardial infarction; UA, unstable angina; CK-MB, creatinine kinase-myocardial band; ED, emergency department; ACS, acute coronary syndrome; SD, standard deviation.
Winkler, C., Funk, M., Schindler, D. M., Hemsey, J. Z., Lampert, R., & Drew, B. J. (2013). Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization. Heart & Lung, 42(6), p. 424.
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EXERCISE 9 Questions to Be Graded
Name: ________j.d._______________________________________________ Class: _____________________
Date: ___________________________________________________________________________________
- What were the name and type of measurement method used to measure Caring Practices in the Roch, Dubois, and Clarke (2014) study?
- The data collected with the scale identified in Questions 1 were at what level of measurement? Provide a rationale for your answer.
- What were the subscales included in the CNPISS used to measure RNs’ perceptions of their Caring Practices? Do these subscales seem relevant? Document your answer.
- Which subscale for Caring Practices had the lowest mean? What does this result indicate?
- What were the dispersion results for the Relational Care subscale of the Caring Practices in Table 2? What do these results indicate?
- Which subscale of Caring Practices has the lowest dispersion or variation of scores? Provide a rationale for your answer.
- Which subscale of Caring Practices had the highest mean? What do these results indicate?
- Compare the Overall rating for Organizational Climate with the Overall rating of Caring Practices. What do these results indicate?
- The response rate for the survey in this study was 45%. Is this a study strength or limitation? Provide a rationale for your answer.
- What conclusions did the researchers make regarding the caring practices of the nurses in this study? How might these results affect your practice?
Introduction
Roch and colleagues (2014) conducted a two-phase mixed methods study (Creswell, 2014) to describe the elements of the organizational climate of hospitals that directly affect nursing practice. The first phase of the study was quantitative and involved surveying nurses (N = 292), who described their hospital organizational climate and their caring practices. The second phase was qualitative and involved a study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. The researchers found the following: “Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs’ involvement in a full range of caring practices” (Roch et al., 2014, p. 229).
Relevant Study Results
The survey data were collected using the Psychological Climate Questionnaire (PCQ) and the Caring Nurse-Patient Interaction Short Scale (CNPISS). The PCQ included a five-point Likert-type scale that ranged from strongly disagree to strongly agree, with the high scores corresponding to positive perceptions of the organizational climate. The CNPISS included a five-point Likert scale ranging from almost never to almost always, with the higher scores indicating higher frequency of performing caring practices. The return rate for the surveys was 45%. The survey results indicated that “[n]urses generally assessed overall organizational climate as moderately positive (Table 2). The job dimension relating to autonomy, respondents’ perceptions of the importance of their work, and the feeling of being challenged at work was rated positively. Role perceptions (personal workload, role clarity, and role-related conflict), ratings of manager leadership, and work groups were significantly more negative, hovering around the midpoint of the scale, with organization ratings slightly below this midpoint of 2.5.
TABLE 2
NURSES’ RESPONSES TO ORGANIZATIONAL CLIMATE SCALE AND SELF-RATED FREQUENCY OF PERFORMANCE OF CARING PRACTICES (N = 292)
Scale and Subscales (Possible Range) M SD Observed Range
Organizational Climate
Overall rating (1–5) 3.13 0.56 1.75–4.67
Job (1–5) 4.01 0.49 1.94–5.00
Role (1–5) 2.99 0.66 1.17–4.67
Leadership (1–5) 2.93 0.89 1.00–5.00
Work group (1–5) 3.36 0.88 1.08–5.00
Organization (1–5) 2.36 0.74 1.00–4.67
Caring Practices
Overall rating (1–5) 3.62 0.66 1.95–5.00
Clinical care (1–5) 4.02 0.57 2.44–5.00
Relational care (1–5) 2.90 1.01 1.00–5.00
Comforting care (1–5) 4.08 0.72 1.67–5.00
Roch, G., Dubois, C., & Clarke, S. P. (2014). Research in Nursing & Health, 37(3), p. 234.
Caring practices were regularly performed; mean scores were either slightly above or well above the 2.5 midpoint of a 5-point scale. The subscale scores clearly indicated, however, that although relational care elements were often carried out, they were less frequent than clinical or comfort care” (Roch et al., 2014, p. 233).
