105-Statistics for Nursing and Allied Health-Stacey Beth Plichta

434 Pages·2011·3.91 MB·English

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Statistics
for Nursing and Allied Health
Stacey B. Plichta, ScD
Professor of Urban Public Health
Hunter College
The City University of New York (CUNY)
New York, New York
Laurel S. Garzon, PhD, PNP
Director
Graduate Nursing Programs
School of Nursing
Old Dominion University
Norfolk, Virginia
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9 8 7 6 5 4 3 2 1
Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Plichta, Stacey Beth, 1965-
Statistics for nursing and allied health / Stacey B. Plichta, Laurel S. Garzon.
p. ; cm.
Includes bibliographical references and index.
ISBN–13: 978-0-7817-5459-0
ISBN–10: 0-7817-5459-3
1. Nursing—Research—Statistical methods. 2. Medical statistics. I. Garzon, Laurel S.
II. Title.
[DNLM: 1. Statistics as Topic—methods. 2. Nursing Research. WA 950 P728s 2009]
RT68.P65 2009
610.73072—dc22
2008024783
Care has been taken to confirm the accuracy of the information presented and to describe generally
accepted practices. However, the authors, editors, and publisher are not responsible for errors or
omissions or for any consequences from application of the information in this book and make no
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the publication. Application of this information in a particular situation remains the professional
responsibility of the practitioner; the clinical treatments described and recommended may not be
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dosage set forth in this text are in accordance with the current recommendations and practice at the time
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Some drugs and medical devices presented in this publication have Food and Drug Administration
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Dedications
I would like to dedicate this book to my family for all of the love and support that
they have given me, especially to my mother, Patricia Plichta, my husband, Bill
Kellar, and my children, Jesse Carroll and Samantha Lee.
I would also like to thank all of my graduate students, who over the years have
helped to shape this book. I would like to give special thanks to two of my former
students, Dr. Yan Zhang and Mr. Paul Magnant, who spent many hours reading
drafts, developing homework exercises, and making this book more accessible to
students. My thanks also extend to another former student, YuQuin Zhao, who
provided a diligent and thorough review of our earlier drafts. Finally, I would like
to thank the editors at LWW, notably Helene Caprari, Michelle Clarke, and
Margaret Zuccarini, who with much patience and support have seen this project
through to completion.
Stacey B. Plichta
I would like to thank Beth and Anna for their love and Dot for my strength.
Laurel S. Garzon
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Reviewer List
Noori Akhtar-Danesh, MSc, PhD Willa Marlene Doswell, PhD, RN, FAAN
Assistant Professor Associate Professor
McMaster University University of Pittsburgh School of Nursing
Hamilton, Canada Pittsburgh, Pennsylvania
Gina S. Brown, PhD, RN Mary Beth Flanders, PhD, RN
Professor and Chair Associate Professor
Edyth T. James Department of Nursing Fay Whitney School of Nursing
Columbia Union College University of Wyoming
Takoma Park, Maryland Laramie, Wyoming
Bruce A. Cooper, PhD David Anthony Forrester, PhD, RN
Senior Statistician Professor
Associate Adjunct Professor University of Medicine and Dentistry of New
University of California Jersey
San Francisco, California Newark, New Jersey
Marcus Davey, PhD Simon Geletta, PhD
Assistant Research Professor Assistant Professor
Department of Surgery Des Moines University
Assistant Course Director Des Moines, Iowa
School of Nursing
University of Pennsylvania Beth S. Hembree, RN, MSN, DSN
Philadelphia, Pennsylvania Professor
Director of Graduate Studies
Rose Ann DiMaria-Ghalili, PhD, RN, CNSN Lurleen B. Wallace College of Nursing
Associate Professor Jacksonville State University
West Virginia University Jacksonville, Alabama
Morgantown, West Virginia
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vi Reviewer List
James E. Hodge, EdD Patsy L. Ruchala, DNSc, RN
Professor of Mathematics Director
Mountain State University Orvis School of Nursing
Beckley, West Virginia University of Nevada
Reno, Nevada
Ezra C. Holston, PhD, MSN, RN
Assistant Professor Cynthia L. Russell, PhD, RN
University of California Assistant Professor
Los Angeles, California University of Missouri-Columbia Sinclair School
of Nursing
Ann F. Jacobson, PhD, RN Columbia, Missouri
Associate Professor
Kent State University College of Nursing Mina D. Singh, RN, PhD
Kent, Ohio Assistant Professor
York University
Tae Sook Kim, PhD Toronto, Canada
Associate Professor
Saint Joseph’s College Ida L. Slusher, RN, DSN
Brooklyn, New York Professor
Eastern Kentucky University
Rosalie O. Mainous, PhD, ARNP Richmond, Kentucky
Acting Associate Dean for Academic Affairs
University of Louisville Sandra L. Smith, PhD, APRN
Louisville, Kentucky Assistant Professor
University of Utah
Margaret E. Miller, PhD Salt Lake City, Utah
Professor of Nursing
Bellarmine University Darlene Steven, MHSA, PhD, PHN, RN
Louisville, Kentucky Professor and Coordinator
Lakehead University
Catherine Pearsall, PhDc, FNP, RN Thunder Bay, Canada
Assistant Professor
Saint Joseph’s College Jessica L. Thomson, PhD
Patchogue, New York Statistician, Adjunct Professor
Louisiana State University Health Sciences
Michael Perlow, DNS, RN Center
Professor of Nursing Baton Rouge, Louisiana
Murray State University
Murray, Kentucky Karen S. Ward, PhD, RN, COI
Professor and Associate Director of Online
Marjorie A. Pett, MStat, DSW Programs
Research Professor Middle Tennessee State University
University of Utah College of Nursing Murfreesboro, Tennessee
Salt Lake City, Utah
Sarah Ransdell, PhD
Associate Professor
Nova Southeastern University
Fort Lauderdale, Florida
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Preface
Statistical analysis is an important tool in the conduct of clinical, basic, and out-
comes research in nursing and allied health. Nurses and allied health providers
with a focus on practice are best qualified to identify and develop research that
affects the delivery of care and patient outcomes. Current concerns about the
cost, quality, and equitable delivery (i.e., among all racial and ethnic groups) of
health care can be addressed by evidenced-based practices with measurable out-
comes of care.
Evidence-based practice is a process by which systematic inquiry is used to
explain or answer questions of interest. Research provides a process for careful,
organized, and thoughtful analysis and consideration of myriad evolving prob-
lems. Health care issues require an ongoing review and analysis of the congru-
ency of financial issues, personnel issues, methods of care, and outcomes.
A systematic research approach includes a step-by-step process of identifying
a problem or question, selecting the relevant variables, and then using the most
appropriate statistical method. This process can overwhelm beginners, but
approaching a research project in an organized way with the knowledge of the
basic statistics provided in this text can lead to a new and exciting understanding
of how powerful statistics can be. The choice of a particular statistical method
depends on the type of question asked (e.g., Are two or more things being com-
pared?), the variables selected (e.g., What are the important components of the
problem?), the level of measurement of the variables (e.g., What types of instru-
ments will be used?), and the level of certainty that is required. This text takes the
reader through this process. Readers will learn the language of statistics, how to
organize the data, and how to describe the data with simple statistics. This text
provides a good beginning to understand what data can reveal about research.
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viii Preface
DEVELOPING RESEARCH AND STATISTICAL METHODS
Nursing research began in Florence Nightingale’s Notes of Nursing (1859). She
described the factors that she believed affected the outcomes of soldiers in the
Crimean war in a systematic way. Her notes provided the basis for a review of the
care these soldiers received, which, in turn, stimulated changes in nursing care
and public health.
Much of the research in the decades to follow was research about the education
of nurses. Sigma Theta Tau, the International Honor Society of Nursing, became
the first organization to fund nursing research in the United States, awarding a
research grant in 1936. In the 1930s, the American Journal of Nursingbegan pub-
lishing nursing research studies. In 1952, Nursing Researchwas created to share the
developing body of nursing studies. Today, this journal enjoys an international rep-
utation for being the foremost journal for peer-reviewed nursing research.
In the 1970s, the focus of research changed to the investigation of nursing
practice and the outcomes of nursing. The increased rigor required to investigate
practice-related issues required an in-depth knowledge of research design and sta-
tistical methods. Peer review was required for publication as additional journals,
such as Research in Nursing and Health and Advances in Nursing Science, were
developed to publish these studies. Clinical problems and issues related to practice
were identified as the foremost need for nursing research (Lindeman, 1975).
In 1986, the importance of nursing research was recognized with the estab-
lishment of the National Center for Nursing Research (NCNR), which is part of
the National Institutes of Health. This center provides funding for nursing
research and trains nurse researchers. The selection for funding developed into a
rigorous peer-reviewed process in which the design and statistical methods of
research projects are carefully reviewed. The funding provided by the NCNR has
grown to over $150 million annually. Current trends in nursing research are
focused on evidenced-based practice (Huddleston, Berkheimer, Landis, et al.,
2005; McCormick, Naimark, and Tate, 2006), increased rigor of studies (Im,
Page, Lin, Tsai, and Cheng, 2004; Sterling and Peterson, 2005), multidisciplinary
research, more visibility for nursing research, and a focus on culture and health
disparities (Peragallo, DeForge, O’Campo, et al., 2005).
ORGANIZATION OF THE CONTENT
The Role of Research in Health Care
In Chapter 1, “Using Research and Statistics in Health Care,” the role of research
in health care is explored. Research in nursing and allied health has contributed