Research Glossary

The Research Enews team invites your research word!

We are currently seeking to build a glossary of research terminology that will serve the holistic nursing community.  In each issue of Connections in Holistic Nursing Research, a new term will be featured and the glossary will be on the website as well. If you have a research term you think would benefit AHNA members, and would like to be a guest contributor to our glossary, please contact research@ahna.org with your recommendation.

Companion Animals        Phenomenology     
Dissemination                   Power Analysis
Effect Size                          The RCT: Randomized controlled trial
Hawthorne Effect            Significance

 
 

Companion Animals
Definition by Mara M. Baun, PhD, FAAN

Animals are playing many therapeutic roles in the lives of humans.  Many people have had animals as pets, especially when they were children, and fondly remember their relationships.  Today, animals not only are highly valued in many homes, but they have also assumed therapeutic roles with humans.

At present, animals frequently are visitors in health care institutions.  Many hospitals and nursing homes allow animals, particularly dogs, to visit patients/residents.  These visitors can be “therapy dogs” who are unknown to the patients or in some hospitals the patients’ own dogs.  Certified therapy dogs generally visit a number of patients who request them.  The patients’ own dogs usually just visit their owners and are known as “companion animals”.  Various studies have shown that humans respond more positively both physiologically and psychologically to dogs to which they are attached than to unknown dogs (Baun, Bergstrom, Langston, & Thoma et al., 1984; Schuelke, Trask, Wallace, Baun, Bergstrom, & McCabe, 1991/92).

It is not uncommon for nursing homes to have “resident” dogs and sometimes other animals who wander freely among the residents. Besides dogs, the most common are cats, rabbits, small rodents, birds, and fish.  Problem behaviors of persons with Alzheimer’s were measured for one week prior to and 4 weeks after the placement of a dog.  Participants on the day shift exhibited significantly fewer problem behaviors across the entire four weeks after the dog was living on the unit (McCabe, Baun, Speich, & Agrawal, 2002).

In another study conducted in an Alzheimer’s unit, it was found that particularly during the sundown period when persons with Alzheimer’s can become very agitated, residents were much calmer when a therapy dog was present (Churchill, Safaoui, McCabe, & Baun, 1999).  For example, one person with Alzheimer’s who was pacing in the hallway responded very positively when a resident dog took him by the sleeve and lead him back to his room.

Caged birds in the rooms of the elderly in rehabilitation have been shown to decrease depression.  Residents reported that their grandchildren enjoyed coming to visit with them and stayed longer, and one resident said that her physician came in each morning and sang a song to the bird.  Another resident who received a diagnosis of a terminal disease while at the institution said that she talked to the bird about it, and her depression level decreased (Jessen, Cardiello, & Baun, 1997).

Children seem to have special relationships with animals.  Children having physical examinations in a pediatric clinic were much calmer and less stressed when a therapy dog was present in the examination room (Nagengast, Baun, Leibowitz, & Megel, 1997); Hansen, Messinger, Baun, & Megel, 1999).  Likewise, children undergoing dental procedures in a dental office and who had a therapy dog present experienced less physiological arousal and behavioral distress during the procedures than those who did not have a therapy dog (Havener, Thaier, Gentes, Megel, & Baun,  2001).

In summary, animals, especially dogs, are very active in health care these days.  In a variety of settings they are having very positive effects.  More research, however, needs to be done on the health benefits of companion animals.

References

Baun, M. M., Bergstrom, N., Langston, N. F., & Thoma, L.  (1984).  Physiological effects of human/companion animal bonding.  Nursing Research, 33, 3, 126 129.

Churchill, M., Safaoui, J., McCabe, B. W., & Baun, M. M.  (1999).  Effects of a therapy dog in alleviating the agitation behavior of sundown syndrome and in increasing socialization for persons with Alzheimer’s Disease. Journal of Psychosocial Nursing and Mental Health Services, 37, 4, 16-22.

Hansen, K. M., Messinger, C. J., Baun, M. M., & Megel, M. (1999).  Companion animals alleviating distress in children. Anthrozoös, 12. 3, 142-148.

Havener, L., Thaier, B., Gentes, L., Megel, M., & Baun, M. (2001) The effects of a companion animal on distress undergoing dental procedures.  Issues in Comprehensive Pediatric Nursing, 24, 2, 137-152.

Jessen, J., Cardiello, F., & Baun, M. M.  (1996).  Avian companionship in alleviation of depression, loneliness, and low morale of older adults in skilled rehabilitation units. Psychological Reports, 78, 339-348.

McCabe, B. W., Baun, M. M., Speich, D., & Agrawal, S. (2002) Resident Dog in the Alzheimer’s Special Care Unit. Western Journal of Nursing Research, 24, 6, 684-696.

Nagengast, S. L., Baun, M. M., Leibowitz, M. J., & Megel, M.  (1997). The effects of the presence of a companion animal on physiological and behavioral distress in children during a physical examination. Journal of Pediatric Nursing, 12, 6, 323-330.

Schuelke, S. T., Trask, B., Wallace, C., Baun, M. M., Bergstrom, N., & McCabe, B.  (Winter, 1991/92).  Physiological effects of the use of a companion dog as a cue to relaxation in diagnosed hypertensives. The Latham Letter, 14-17.

Dissemination

Dissemination is the final step in the research process. In an evidenced based practice project this would be the implementation step. It is critical that the information be shared. It is the responsibility of the team to disseminate the results especially when individuals (both human and/or non-human) have given of their time and energy to participate in the project. It is a moral responsibility.
Many granting agencies request specifics on the audiences and mechanisms that will be utilized to meet this goal. Usually the proposal (grant, dissertation, project, etc) identifies the areas were this information will be clinically significant, for example, by suggesting the journals that would be interested in the findings. No matter the size of the study, a review of the findings can be made in some public venue at the local, regional, national or international level. Posters may be a first step as criteria for acceptance are usually less stringent. Posters provide an opportunity to synthesize the study from the conceptual framework, question to be answered, methods used, the sample characteristics, findings, through the discussion. Poster sessions give individuals an opportunity to ask questions and share their ideas on a one-on-one format. Podium presentations still require the same information but there is a specific timeframe in which the content is to be delivered. A larger audience may be reached in this context and often the abstract and/or presentation is published in the meetings proceedings. Both of these steps provide the opportunity to organize the material in a meaningful way and helps in the preparation of a manuscript. Manuscript preparation should involve the team with each person contributing in some way to the final product. It is good, however, to designate the primary author up front so this person can be responsible for keeping the writing on task. It is also helpful to have a journal in mind when writing as it can help target specific requirements that might be request (i.e. nursing journals often want a conceptual framework which might not be asked for in other professional journals). If asked to do major edits to the manuscript by the editor it is usually wise to attend to this request by addressing each question specifically. Identify what has been changed or why not in the response to the editor recognizing that the person who made the suggestion may very well review this response. The wider audience you wish to reach with your findings can be influenced by the journals availability through a national search engine like PubMed. Additionally, journals are given an "impact score" which is assigned by such things as the numbers of readers/subscriptions and commonality of citations.

Dissemination can be made more difficult when the findings are not significant or do not provide a clear explanation of the results. However, it is still critical that this information be shared. Posters and presentations are still available. Publication is also important to identify both the strengths and weaknesses of approaches (i.e. timing of and modifications to the intervention, sample population and size). More attention can be placed in the discussion section to explain the possible reasons for the results.

This final step in the research process is an invaluable contribution and one that requires fortitude and integrity. Holistic nurses often have complex studies to present as they are interested in the body-mind-spirit and how it is sustained for healing of the self and others. The greater the body of research literature we have
the more support there is available for others to provide holistic care.

Effect Size

The Effect Size (ES) in a study is a relative number expressing the strength of the relationship between statistical populations (sample and control) and the interventions they were exposed to. This measure of association is complex. The researchers and the reviewers must ensure that the study design has internal validity, free of bias and accounts for confounding variables and random error. ES is expressed as small, moderate or large using numbers between -1 and +1. Because the ES is a relative number it complements other statistical measures. There are also several measures of ES dependent upon the type of study. There are three common approaches to determining the effect size; 1) statistical significance, 2) practical significance using the raw mean differences of experimental groups, and 3) relative size of the effects based on standardized estimates.

The Effect Size (ES) in a study is a relative number expressing the strength of the relationship between statistical populations (sample and control) and the interventions they were exposed to. This measure of association is complex. The researchers and the reviewers must ensure that the study design has internal validity, free of bias and accounts for confounding variables and random error. ES is expressed as small, moderate or large using numbers between -1 and +1. Because the ES is a relative number it complements other statistical measures. There are also several measures of ES dependent upon the type of study. There are three common approaches to determining the effect size; 1) statistical significance, 2) practical significance using the raw mean differences of experimental groups, and 3) relative size of the effects based on standardized estimates.

Reference:

Effect Size Guidelines - Effect Size Substantive Interpretation

Hawthorne Effect

The Hawthorne Effect is a placebo type effect that involves a change in the dependent variable resulting from subjects' awareness that they are participants under study (Polit & Beck, 2012, p. 729). This effect was identified in research by Henry Landsberger in 1955 by analyzing data from experiments carried out in Hawthorne, Chicago between 1924 and 1932, by Elton Mayo at the Western Electric Corporation (Shuttleworth, 2009). It is the process where human subjects in an experiment change their behavior, simply because they are being studied. This is one of the hardest internal biases to eliminate or factor into a design. The fact that the workers in these studies were singled out or observed was enough to change the results of the studies. Consequently, what has developed is an attempt to control for this innate human response to attention (Hawthorne effect and placebo effects) that modifies results. Instead, researchers attempt to design studies in which the variables that are being manipulated are not influenced by this attention. In order to do so in modern day science it is believed that the participant needs to be "blinded" to their group assignment (intervention or control) so that this can not influence the outcomes that are being evaluated. Additionally, the control group can not simply be "no treatment" but one that has a similar level of attention provided. For example, if designing a meditation study one would have 10 minutes of meditation daily via tape and the control group would get equal attention by listening to 10 minutes of self-help information.

Not only does the "fact" of being observed or being a participant in a study influence the response of participants but their expectations about the effectiveness, (or non), personal experiences, and beliefs about if they are in the control or active treatment group can also influence the outcome. Luana and Miller (2011) recently wrote about these issues in relation to medication and behavioral studies and offered that it can be a complex function between participant, intervention, and presenting condition. They provide an interesting review of these factors and suggest that this information is an element of clinical practice

References:

Luana, C. & Miller, F. (2011). Role of expectation in health. Current Opinion in Psychiatry, 24(2), 149-15. DOI: 10.1097/YCO.0b013e328343803b.
Polit, D., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice, 9th Ed. Philadelphia, PA: Lippincott Williams and Wilkins.
Shuttleworth, M. 2009. The hawthorne effect and modern day research. Retrieved from http://www.experiment-resources.com/hawthorne-effect.html 

Phenomenology
Jen Reich, co-editor


Phenomenology is both a philosophical tradition and human science method (Dowling, 2007, Wojnar & Swanson, 2007, Van Manen, 2002).  Phenomenology seeks a deep understanding of lived experiences in our human world (Starks & Brown Trinidad, 2007, Van Manen, 1990). Van Manen (1990) noted that a real understanding of phenomenology can only be done by doing phenomenology. He explained that in the process of doing phenomenological research, we become connected to it, thus we “become the world.” (Van Manen 1990, p. 5). Heidegger terms this being in the world “dasein” (Koch, 1995).

A major concept in phenomenology is intentionality.  Crotty (1998) explained that that intentionality in the phenomenological sense is means referentiality, relatedness, “aboutness”, rather than purpose or deliberation (p.44).  Intentionality posits a relationship between conscious mind and object of consciousness (Crotty, 1998).  Existential phenomenologists would explain this as a “radical interdependence of subject and world.” (Crotty, 1998, p.45). This unity of subject and object that intentionality posits requires a rejection of objectivism and subjectivism (Crotty, 1998)

Of the two major schools of phenomenology, Heideggerian and Husserlian, Heidegger’s version of phenomenology is more existential, seeking the meaning and understanding of our being in the world (Koch, 2005).  Husserl’s method is descriptive, and stems from the Cartesian tradition, describing phenomena as brought through consciousness (Koch, 2005). 

Since Husserl and Heidegger, there have been seven unique perspectives of phenomenology identified (Wojnar & Swanson, 2007).  Max van Manen, a phenomenologist from the Utrecht (Dutch) tradition, has guided the research of many in the health profession and education fields (Dowling, 2007).  Van Manen expressed that the ultimate goal of phenomenology “is to effect a more direct contact with the experience as lived” (Van Manen 1990, p.78).  His work is considered a combination of descriptive and interpretive phenomenology (Dowling, 2007).

In both descriptive and interpretive traditions, phenomenology is intended to be an initial critique and not a be-all, end-all method (Crotty, 1998). Crotty explained that it is a valuable starting point in social inquiry, with research for the phenomenologist an attempt to “break free and see the world afresh.” (Crotty, 1998, p. 86).

REFERENCES

Crotty, M. (1998). The Foundations of Social Research. London: Sage

Dowling, M. (2005).  From Husserl to van Manen: A review of different
 phenomenological approaches.  International journal of nursing studies,
 44, 131-142.

Koch, T. (1995).  Interpretive approaches in nursing research: The
Influences of Husserl and Heidegger. Journal of Advanced Nursing, 21: 827-83

Starks, H & Brown-Trinidad, H (2007).  Choose your method: A comparison of
phenomenology, discourse analysis and grounded theory. Qual Health Res 17: 1372-1380

Van Manen, M. (1990). Researching Lived Experience: Human Science for an Action
Sensitive Pedagogy. New York: SUNY Press.

Wojnar, D. M., & Swanson, K. M. (2007). Phenomenology: an exploration. Journal of
Holistic Nursing, 25(3), 172-180

Power Analysis

Researchers use a power analysis to determine the sample size before conducting the study and to determine statistical significance after the study is completed.  This is important when one is conducting a study that has as its purpose determining the benefit of one treatment/intervention over another.  There are a variety of computer programs that may be used to calculate a power analysis.  In holistic nursing research this may be more of a challenge as multiple factors  may be contributing to the affect a particular treatment/intervention has on the participant.
Power is a function of effect size and sample size.  Effect size denotes the degree of relationship between the research variables..  A power analysis  is the combined effect size and sample size and is used to make a more precise prediction of the study results.  A small effect size requires a larger sample size.  If the intervention has a large effect size, fewer responses or participants are needed. Cohen sets a range to determine a small, medium, and large effect size.  Effect size may be referred to as Cohen's d.  Sometimes the ranges are used to estimate these values and sometimes the effect size is estimated from previous research. 

A power analysis that meets ethical standards is performed prior to conducting the study in order to determine resources needed to carry out the research.  A sample size that is larger than necessary wastes valuable resources and places an unnecessary burden on participants.  A sample size that is underpowered will not determine conclusive results of a study.  It is important to remember that a power analysis is only a calculated estimate that provides the researcher with an objective means for guiding a scientific basis for the statistical significance of the study.

The RCT: Randomized controlled trial

Randomized controlled trial: (RCT) An experimental design in which individuals are assigned randomly to two or more groups: a treatment group (experimental therapy) and a control group (placebo and/or standard therapy) and the outcomes are compared. Someone who takes part in a randomized controlled trial (RCT) is called a participant or subject. RCTs seek to measure and compare the outcomes after the participants receive an intervention. Because the outcomes are objectively measured (instruments and/or physiological data) RCTs are quantitative studies.
The RCT is currently the most accepted scientific method of determining the benefit of a drug or a therapeutic procedure. It is one of the simplest and most powerful tools in clinical research.It can represent the "best" evidence available, which is integrated into the final decision about the management of a condition by healthcare practitioners in what is called evidence-based healthcare but is limited by its generalizability to groups.

In sum, RCTs are quantitative, comparative, controlled experiments in which investigators study two or more interventions in individuals who are assigned to receive an intervention in random order. Sources:http://www.medterms.com

MedTerms is the Medical Dictionary of MedicineNet.com; Millodot: Dictionary of Optometry and Visual Science, 7th edition. © 2009 Butterworth-Heinemann; www.wickipedia.com

Numerous forms of the RCT designs exist. This approach, while the 'gold standard' for scientific and often clinical evidence, has been criticized by many as a research approach that does not account for the numerous factors involved in behavioral sciences including holistic nursing, and in integrative, complementary and alternative practices. Currently there is national emphasis on multiple approaches to research that capture the complexities of clinical practice. (see report of integrative health care conference link).

Effectiveness versus Efficacy

These two terms have recently been discussed in evaluating the usefulness and applicability of research results. Research that aims for efficacy most often utilizes the RCT. Statistically significant results of a treatment or intervention in a controlled situation is an example. Effectiveness on the other hand, attempts to evaluate treatments and approaches in real clinical situations. Effectiveness is associated with 'what works most of the time'. Such interventions may not meet consistent statistically significant results when tested on controlled situations. People reporting greater comfort after a healing touch procedure while their blood pressures may not decrease significantly is an example.
 
Significance

Significance in statistics represents a causal relationship, rather than chance occurrence (McGraw-Hill, 2002). A "statistically significant" result is one that would occur by chance less than a certain percent of the time. Usually significance level is set at .05 (95 percent likelihood not due to chance) but other levels such as .01 are commonly used (99 percent likelihood not due to chance). It has been argued that significance level should always be accompanied by effect-size statistics to understand the size and importance of the difference (Wikipedia, 2011). Historically, Lehrer (2010) explained that .05 as cutoff was a somewhat arbitrary decision made by English mathematician Fisher, in 1922, as it made pencil and slide rule calculations easier. Often the .05 level is chosen because it is conventional (Wikipedia 2011).

References:

Lehrer, J (2010). The Truth Wears Off: Is there something wrong with the scientific method? Retrieved:
www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer?currentPage=3
Statistical Significance (2002). In McGraw-Hill Concise Dictionary of Modern Medicine. Retrieved:
http://medical-dictionary.thefreedictionary.com/Statistically+significant 
Statistical Significance (2011) in Wikipedia. Retrieved: http://en.wikipedia.org/wiki/Statistical_significance

 


 
 


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