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A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation

Aims and objectives: To quantify quantitative outcomes of a practice change to a blended form of bedside nursing report.

Background: The literature identifies several benefits of bedside nursing shift report. However, published studies have not adequately quantified outcomes related to this process change, having either small or unreported sample sizes or not testing for statistical significance.

Design: Quasi-experimental pre- and postimplementation design.

Methods: Seven medical-surgical units in a large university hospital implemented a blend of recorded and bedside nursing report. Outcomes monitored included patient and nursing satisfaction, patient falls, nursing overtime and medication errors.

Results: We found statistically significant improvements postimplementation in four patient survey items specifically impacted by the change to bedside report. Nursing perceptions of report were significantly improved in the areas of patient safety and involvement in care and nurse accountability postimplementation. However, there was a decline in nurse perception that report took a reasonable amount of time after bedside report implementation; contrary to these perceptions, there was no significant increase in nurse overtime. Patient falls at shift change decreased substantially after the implementation of bedside report. An intervening variable during the study period invalidated the comparison of medication errors pre- and postintervention. There was some indication from both patients and nurses that bedside report was not always consistently implemented.

Conclusions: Several positive outcomes were documented in relation to the implementation of a blended bedside shift report, with few drawbacks. Nurse attitudes about report at the final data collection were more positive than at the initial postimplementation data collection.

Relevance to clinical practice: If properly implemented, nursing bedside report can result in improved patient and nursing satisfaction and patient safety outcomes. However, managers should involve staff nurses in the implementation process and continue to monitor consistency in report format as well as satisfaction with the process.

Keywords: bedside shift report; nursing handover; nursing shift report; patient satisfaction; patient-centred care.

© 2014 John Wiley & Sons Ltd.

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Quantitative Data Analysis

Resources for study design through to data analysis and dissemination

Statistical analysis of quantitative data requires first choosing an appropriate method . Following analysis, results are summarized and reported in tables, charts, and graphs for interpretation, discussion, and dissemination in papers, manuscripts, and/or presentations.

UCalgary's Data Science Advisory Unit is available to help with study design, statistical analysis, visualization, and interpreting results (fee may apply).

Getting Started

Types of data, descriptive statistics, hypothesis testing, sample size & power, interpreting results, reporting results.

Designing a study includes developing good research question(s), choosing an appropriate methodology, estimating sample size, selecting data collection tools, and creating an analysis plan.

UCalgary's Research Computing Services is available to help researchers with study design, interpretation of results, and writing up results for publication.

Research Questions & Study Design

Your study design is guided by the research question(s). For example, does your question start with “How?” or “Why?” If so, your questions might be better addressed using qualitative methods. If you are asking “What?”, “When?, “Where?” or “How much?” you could consider quantitative methodologies. You might even combine both into a mixed methods approach.

Example Study Designs

Sample Size & Power Calculations

Sample size calculations are a key part of a research study. Sample size calculations should be run for each of your main/primary outcomes so you know that your study won’t be underpowered for any of the questions you plan to address.

The sample size calculation depends on your hypothesis test, the significance level (usually set as 5%), and the power and results from your pilot study. There are many formulas available for different research situations.

Data Collection & Sampling

Another important part of study planning is selecting a sampling technique. How will you select your participants? Will it be a convenience sample? Random sample? Cluster sample? Snowball sample?

Your choice will depend on the research question(s) and study design. Note that different sampling methods have corresponding potential biases. For example, if your sample was a “convenience sample,” the results may not be generalizable or may be biased in other ways (e.g. selection bias).

Analysis Plan

The analysis plan is your road map for data management and analysis. Writing up an analysis plan is a great way to keep things on track.

Conducting a complete analysis of the data you have collected will enable you to:

Plans also help with timelines and standardizing analytic approaches (e.g. treatment of missing values, inclusion and exclusion criteria).

Data Entry, Coding, & Cleaning

Data will have to be entered, coded and checked, new variables created, etc., even when doing secondary data analyses.

Create a data dictionary containing all of your variables, any derived variables and notes about how you coded them. This is useful not only if you will be sharing the dataset with other, but for yourself (e.g., if you need to come back to the data after some time away). Keep in mind that data cleaning is a process that will likely involve you revisiting the data several times over.

Primary data : data that you collect yourself from participants or health records using surveys, chart reviews, interviews, focus groups, etc.

Secondary data : data collected by other researchers that you are using to answer your own research questions

Qualitative vs. Quantitative Data

The type of data you collect depends on the question you want to answer and your resources. Both quantitative and qualitative data have strengths and limitations and may be appropriate for different settings, evaluation designs, and evaluation questions.

Qualitative data consist of words and narratives. The analysis of qualitative data can come in many forms including highlighting key words, extracting themes, and elaborating on concepts.

Quantitative data are numerical information, the analysis of which involves statistical techniques. The type of data you collect guides the analysis process.

Types of Variables

Dependent (Outcome) variables are the outcome of interest and will answer your research question(s).

Independent (Predictor) variables are those factors that may influence your dependent variable/outcome variable.

Example: Say you’re conducting a study on diet and exercise. Your weight would be your dependent variable and your diet and exercise (which both influence weight) would be your independent variables.

Categorical vs. Continuous Variables

Categorical variables are based on groupings or classification. There are two types: Nominal (no inherent order) and Ordinal (natural order).

Nominal Example – Smoker vs. Non-Smoker

Ordinal Example – Educational Level (Less than High School, High School, Some College, College, Bachelor’s Degree, Graduate Degree)

Continuous variables can take on any score or value within a measurement scale. There are two types: Interval and Ratio Scale . An interval variable can be ordered, and the distance or level between each category is equal and static. A ratio scale variable is similar to an interval variable with one difference: the ratio scale has true zero point (i.e., 0.0 = none/absence of the measurement).

Interval Example – Temperature

Ratio Scale Example – Weight

Descriptive statistics are commonly used to describe and explore quantitative datasets.

Before proceeding, you should assess the distribution of your data and consider variable transformations or non-parametric options, if necessary. It’s also a good idea to identify missing data and start thinking about how you might want to handle this (e.g. listwise deletion, imputation).

Common Descriptive Statistics

Data and Normality

The goal of estimation and hypothesis testing is to generalize the results from a sample to the population. We need to determine whether a pattern we observe in the sample is due to chance or due to program or intervention effects.

Inferential analysis is used to determine if there is a relationship between an intervention or program and an outcome, as well as the strength of that relationship. The type of test selected for inferential analysis should be guided by the distribution of your data. Is it a normal or non-normal distribution?

Normal Distribution

Normal Distribution

A normal distribution looks like a Bell Curve (right).

Looking at your distribution, draw a curve over it that most closely fits your data. If your curve closely resembles the one in the image, your distribution is normal.

In a normal distribution the majority of the data is clustered around one number or value. If the data is normal, we usually choose a parametric statistical test for data analysis.

Non-Normal Distributions

There are several reasons that a distribution may be non-normal. A small sample size or unusual sets of responses are common reasons that data may not be normally distributed. If the data is non-normal, we usually choose from a set of statistical tests called non-parametric statistical tests .

Non-normal data will have issues with skewness and/or kurtosis (below).

Negative Skew

The graph shows negatively skewed data; the majority of the scores are at the higher end of possible scores. The curve has a longer curve to the left.

Positive Skew

The graph shows positively skewed data; the majority of the scores are at the lower end of possible scores. The curve has a longer curve to the right.

This graph illustrates kurtosis, the spread or ‘peakedness’ of the distribution. A distribution can be too peaked or pointy.

Choosing a Statistical Test

Statistical tests allow us to make inferences about a sample because they can validate if the differences, associations, and patterns that we detect are real and not due to chance.

Selecting the appropriate test depends on the research design, the type of variable, and the distribution of the data.

If the data is normally distributed, you will choose a type of parametric test. If normality is violated, then you will need to use a test that doesn’t need the normality assumption to be valid. We call these non-parametric tests or parametric-independent tests.

SAGE Research provides an online tool to help you decide which test to choose.

Sample Size & Power

Sample size calculations should be run for each of your primary outcomes so that your study won't be underpowered for any of the research questions that you plan to address. *For surveys, Qualtrics has a sample size calculator .

Before calculating sample size, ask yourself:

1. Is my study descriptive or comparative ?

2. Is(are) the primary outcome variable(s) continuous or categorical ?

Descriptive Studies

Use the Confidence Interval Approach

Use this approach to estimate your sample size when you want an interval around an estimate with a certain confidence level.

The population prevalence of hypertension among Canadians aged 20 to 79 was found to be significantly higher for men (24.5%, 95% CI : 22.7% to 26.4%) than for women (21.5%, 95% CI : 19.8% to 23.2%). Statistics Canada

Therefore, for men, point estimate is 24.5%, the margin of error is 1.9%.

Comparative Studies

Use the Hypothesis Testing Approach

Use this approach to estimate your sample size so that if such a difference exists, then findings would be statistically significant . The information you need to calculate a sample size will vary according to your study design, research questions, analysis plan and study restrictions. Prior to the calculation, you will need to decide on your:

Power . This is the ability of the statistical test to detect differences or effects that lead to rejection of the null hypothesis. It depends on the sample size. The larger the sample size, the bigger the power. It is important to calculate the sample size to have sufficient power before you begin your data collection. When your sample size is small, your study might not be able to detect the difference or effect, even when it is real, because of lack of power. Power is usually set at 80-90% power.

Level of significance (α). This is the pre-set level of error that you want to commit in your research, determined before your data collection. It is usually set at 0.05 or 0.01. P-value is the actual level of error found when you perform the statistical test. When p-value < α, then it supports the evidence against the null hypothesis (no effect) and your results are ‘statistically significant’.

In the results section you report on just the objective “facts and figures” of what you found. You then interpret these results in the discussion section .

1. Discuss the results in relation to each hypothesis

You have to report the results of your project or study in relation to your research questions/hypothesis. Present the results of the outcome variable(s) for each hypothesis.

2. Explain your results

Some guiding questions to consider when explaining your results:

3. Interpret p-values

Use descriptive language to indicate the strength of the evidence.

p-value , Description

< 0.001, Extremely significant ; Very strong evidence against the null hypothesis in favor of the alternative

0.001 – 0.010, Highly significant ; Strong evidence against the null hypothesis in favor of the alternative

0.011 – 0.050, Significant ; Moderate evidence against the null hypothesis in favor of the alternative

0.051 – 0.100, Not significant ; Weak evidence against the null hypothesis in favor of the alternative

> 0.100, No evidence ; No evidence against the null hypothesis

4. Generalize your results

This is where you explain the extent to which your study is externally valid . Discuss strengths and weaknesses of applying your results to, e.g., another population, species, age, or sex.

5. Propose a plan of action for future research

Based on your results, and considering the study's limitations, introduce new ideas or ways to improve the current area of research.

6. If your results were unexpected, discuss possible explanations

Try to identify and discuss factors or conditions that may have contributed to unexpected results. For example, site conditions (e.g., room temperature) could have been different between two focus group sessions.

7. Do not overstate the importance of your findings

Be careful about drawing erroneous conclusions. Report only actual findings and the relationships and associations between outcomes and predictor variables that have been confirmed with statistical evidence. For example, just because you find that two variables are related, you cannot automatically leap to the conclusion that those two variables have a cause-and-effect relationship.

8. Avoid speculating beyond the data

Refrain from generalizing your results to a larger group than was actually represented by your study. For example, results from a study involving nursing students may not be applicable to registered nurses.

9. Remain focused on the research question(s)

Resist the temptation to deviate or to make sweeping generalities based on your findings.

10. End the discussion on a positive note

Summarize the study’s strengths, conclusions, implications, and your suggestions for future research.

The Results section of your paper should only be used to report, not interpret, your findings. The Discussion section is where the interpretation and implications of your findings are presented.

The American Psychological Association ( APA ) style guide is most commonly used within the social sciences.

Best Practices for Reporting

1. Summarize succinctly.

The Results section is the shortest and most condensed section in a manuscript or thesis/dissertation, typically 1-2 pages. Present each of your variables in separate subsections, writing a brief summary for each.

2. Keep the 'Results' and 'Discussion' sections separate.

Statistical results are presented but are not discussed in the results section . Reserve your interpretation for the discussion section .

3. Provide the results separately for each hypotheses.

The Results section should describe how your data supports or refutes each hypothesis.

4. Include tables and figures.

Using tables and figures is a great way to summarize your results. Include descriptive statistics (such as means and standard deviations) and/or the results of any inferential statistics (test statistic, degrees of freedom, confidence intervals, and the p-value).

5. Be careful when drawing conclusions.

Draw appropriate conclusions from your findings. Do not overstate the importance of results and limit your conclusions to the population that is actually represented by your study.

Frequently Asked Questions

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Quantitative research
Quantitative research This article describes the basic tenets of quantitative research. The concepts of dependent and independent variables are addressed and the concept of measurement and its associated issues, such as error, reliability and validity, are explored. Experiments and surveys – the principal research design …
Everett Library: Nursing: Quantitative Articles
This journal includes nursing research and has some quantitative studies. AJN, American Journal of Nursing Increasing Access to Diabetes Education in Rural Alabama Through Telehealth Evaluating the Impact of Smartphones on Nursing Workflow: Lessons Learned
A quantitative assessment of patient and nurse outcomes of
A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation If properly implemented, nursing bedside report can result in improved patient and nursing satisfaction and patient safety outcomes.
Most Popular Articles : Nursing Research
Nursing Research covers key issues, including health promotion, human responses to illness, acute care nursing research, symptom management, cost-effectiveness, vulnerable populations, health services, and community-based nursing studies.
Quantitative Data Analysis
Designing a study includes developing good research question(s), choosing an appropriate methodology, estimating sample size, selecting data collection tools, and creating an analysis plan. UCalgary's Research Computing Services is available to help researchers with study design, interpretation of results, and writing up results for publication.