NUR253/ NUR 253 Exam 3 (NEW 2026/ 2027 Update) Concepts of Mental Health Nursing Guide| Questions and Answer| Grade A| 100% Correct (Accurate Solutions)- Galen

NUR253/ NUR 253 Exam 3 (NEW 2026/ 2027 Update) Concepts of Mental Health Nursing Guide| Questions and Answer| Grade A| 100% Correct (Accurate Solutions)- Galen Q. A child diagnosed with autism will demonstrate impaired development in which area? ANSWER Socail interactions and communication skills Q. What is nursing education provided to parents on Tic disorders? ANSWER Tics are sudden, nonrhythmic and rapid motor movements or vocalizations. Tics usually involve the head, torso or limbs and change in location, frequency and severity over time. Q. Characteristics of a resilient child ANSWER - Adaptive temperament - Ability to form nurturing relationships with surrogate parental figures - Ability to distance self from emotional chaos in parents and family - Good social intelligence and problem-solving skills - Ability to perceive a future Q. attention-deficit/hyperactivity disorders are evidenced by ANSWER - Inattentiveness - Hyperactivity - Impulsivity that are developmentally inappropriate Q. Dyscalculia ANSWER Difficulty understanding math Q. Side effects of medication (Stimulant) for ADD ANSWER Insomnia, appetite suppression, headache, abdominal pain and lethargy Q. What symptom can the nurse expect a client diagnosed with depersonalization disorder to manifest? ANSWER A feeling of detachments from one's body or mental processes. Depersonalization is characterized by a sense of unreality or self-estrangement Q. Empathic listening is therapeutic because it focuses on making the patient feel? ANSWER Lessening feelings of isolation Empathic listening can be healing because it can help minimize feelings of isolation. Q. Symptoms of adjustment disorder can include which characteristics? ANSWER Depression, guilt, anger, social withdrawal. SX of adjustment disorder can run the gamut of all forms of distress. These feelings may be combined with other manifestations (physical complaints, social withdrawal, or work/academic inhibition.) Q. What information should the nurse give to the family of a client who has a dissociate episode? What is it? What causes it? ANSWER Dissociation is a method for coping with severe stress. Dissociative symptoms are not under the persons conscious control. Childhood, physical, sexual or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms. Q. Trauma interventions for a child with PTSD ANSWER - Establish trust and safety - Use developmentally appropriate language to explore feelings - Teach relaxation techniques before trauma exploration - Help identify and cope with feelings through the use of art and play to promote expression - Involve the parents/caregivers in 1:1 unless they are the cause of trauma - Educate children and parents about the grief process and response to the trauma. - Assist the parents in resolving their emotional distress about the trauma. Q. Attachment theory describes ANSWER The importance and dynamics of the infant/caregiver relationship and how this early relationship can affect the individual throughout their life. (Positive and negative) Q. Presence of 2 or more distinct personality states that recurrently take control of behavior ANSWER Dissociative Identity Disorder Q. A women suddenly finds she cannot see but seems unconcerned about her symptoms and tells her husband "Don't worry dear, things will all work out." Her attitude is an example of what process? La belle indifference Q. La belle indifference ANSWER An attitude of unconcern about symptoms that is unconsciously used to lower anxiety. Q. The primary difference between unconscious and conscious somatic disorders are? ANSWER Unconscious not under the patients voluntary control (Headache, N/V, sweating, GI) Conscious has symptomatology that is controlled by the client. Factitious disorders and malingering in contrast to other somatic disorders and under conscious control. Q. Nursing assessment for pts with somatic symptom disorders ANSWER - Assess for nature, location, onset, characteristics and duration of sx. - Explore past hx of adverse childhood events - Identify sx of anxiety, depression and past trauma - Determine current quality of life, social support and coping skills - identify any secondary gains - explore the pts cognitive style and ability to communicate feelings/needs - assess current psychosocial and biological needs - screen for misuse of prescribed mediations and or substance abuse Q. Which disorder is characterized by the pts misinterpretations of physical sensations or feelings? ANSWER Illness anxiety disorder (hypochondriasis.) Can be obsessive, thoughts about illness may be intrusive and difficult to dismiss, even when the pt recognizes that his or her fears are unrealistic. Q. Pt presents with neurological symptoms in the absence of a neurological diagnosis. Deficits in voluntary motor or sensory function, paralysis, blindness, movement disorder, numbness, paresthesia, loss of vision or hearing. ANSWER Conversion Disorder Q. What is secondary gain? ANSWER Benefits from the sx (Sick role for attention) Q. Six key elements for effective tx for a pt with somatic disorder. ANSWER 1. provide continuity of care 2. avoid unnecessary procedures 3. provide frequent, brief and regular visits 4. always conduct a physical exam 5. avoid disparaging comments 6. set reasonable therapeutic goals Q. The mother of a 6-year-old child expresses concern over the child's frequent temper outburst. He deals with any frustration by bulling and hitting and seldom showers and remorse for his actions. The nurse who gathers this data will note that the child's behaviors are most consistent with which diagnosis? ANSWER Conduct Disorder Q. Identify ways to communicate/interventions with a potentially hostile patient. ANSWER - Use nonthreatening body posture - Use a flat neutral tone of voice when correcting behavior - Speak matter-of-fact in easy to understand words - Consistently set limits - Avoid personal terms such as "I" or "You" when setting limits Q. Identify 3 important nursing interventions when caring for patient with impulse control disorder. ANSWER 1. Promote a climate of safety for the pt and others 2. Establish rapport 3. Set limits and exceptions Q. What are techniques for managing disruptive behaviors? ANSWER Counseling, modeling, role-playing, planned to ignore, physical distance and touch control, redirection of positive feedback, clarification, restructuring, limit setting, simple restitution, physical restraint Q. This disorder conflicts with authority and adults, emotion dysregulation, chronic negative mood, temper, outbursts, and if left untreated - the child may grow out of it. ANSWER Oppositional Defiant Disorder Q. This disorder has the inability to control aggressive impulses, leads to problems with interpersonal relationships, occupation and criminal difficulties. Anything can trigger ANSWER Intermittent Explosive Disorder Q. This disorder conflict with authority/adults is more severe than oppositional defiant, with aggressions towards people/animals, theft, deceit, distraction of property (abnormally aggressive), callousness, untreated can develop into antisocial personality disorder as an adult. ANSWER Conduct Disorder Q. A family member report that the pt has been oriented and bale to carry on a logical conservation last evening, but this morning is confused and disoriented. The nurse can suspect that the pt is displaying sx associated with which cognitive disorder? Delirium ANSWER Characterized by a disturbance of consciousness, a change in cognition, and fluctuating LOC that develop over a short time. Q. The nurse caring for a pt diagnosed with Alzheimer's disease can anticipate that the family will need information about which of medication therapy? ANSWER Acetylcholinesterase Inhibitors Prevents chemical that destroys acetylcholine from acting, thus leaving more available. Q. An older pt diagnosed with early-stage Alzheimer's disease will have the greatest difficulty with? ANSWER Memory lapses, initially recent member is impaired, and remote memory remains intact. EX - Difficulty retrieving correct gourds of names previously known Broad term used to describe progressive deterioration of cognitive function and global impairment of intellect. Dementia What are the two cognitive and perceptual disturbances? Illusions - error in perception of sensory stimuli The stimulus is a real object in the environment but the individual misinterprets it and often become the object of pts projected fear Hallucinations - false sensory stimuli Visual hallucinations are common in delirium yet tactile hallucinations may also be present. Auditory hallucinations occur more often in schizophrenia. The term "perceptual disturbance" refers to difficulty in which area of function? Processing information about one's internal and external environment Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way. Modifiable risk factors For AD - Exercise and sleep - Social engagement and diet - Education and mental stimulation When working with a client who may have made a covert reference to suicide, the nurse should base the response on what statement? Asking the client directly if they are thinking of attempting suicide. Covert references should be made overt. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis. A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations. When a colleague committed suicide, the nurse stated, "I do not understand why she would take her own life." This is an expression of which feeling? Disbelief Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life." What suicide protective factors have the greatest impact on a client's safety (making it less likely to consider, attempt or die by suicide)? - Effective mental healthcare - Strong connections to individuals family, community and social institutions - Problem-solving and conflict resolution skills - Contact with providers - Attending church A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." How should the nurse respond to the client's concern? "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation and the reason (your safety) reinforces the basic need for client safety. These injuries are deliberate and direct attempt to inflict shallow but painful injuries. There is NOT an intent to end one's life. Cutting, burning, scratching, and scraping self. Self-Harm What is the Intent of self-harm.. why do they do it. - Alleviate psychic pain - Pierce psychic numbness - Get attention - Escape a responsibility - Avoid a situation Obsessive-Compulsive personality disorder is characterized by limited emotional expression, stubbornness, perseverance and indecisiveness. What are the 3 hallmarks of this disorder? 1.Preoccupation with orderliness 2. Preoccupation with perfectionism 3. Preoccupation with control This PD has symptoms of severe impairments in functioning, emotional lability, impulsivity, self-destructive behaviors, and antagonism. Borderline PD All personality disorders (PD) share characteristics of inflexibility and difficulties in interpersonal relationships that impair social or occupational functioning. Which PD is characterized by feelings of entitlement and lacks empathy but in reality suffer from weak self-esteem and are hypersensitive to criticism? Narcissistic Personality Disorder This PD has symptoms of lifelong pattern of social withdrawal, expressionless and operate with restricted range of emotional expression, viewed as odd or eccentric due to discomfort with social interaction, and emotional Detachment, no enjoyment from close relationships. (friendship/dating/sexual relationships) - Rare Schizoid Personality Disorder Identify Interventions for the following: Manipulative/Aggressive Behavior 1. Limit setting -establish parameters of desirable & acceptable patient behavior 2. Facilitate the expression of anger in an adaptive nonviolent manner Histrionic personality disorder are excitable and dramatic yet are often high functioning. What are the nursing care guidelines to follow when caring for this type of patient? 1.Nursing care should reflect an understanding that seductive behavior is a response to distress 2. Keep communication and interactions professional 3. Patients may exaggerate symptoms and have difficulty in functioning 4. Encourage and model the use of concrete and descriptive rather than vague and impressionistic language 5. Assist the patient to clarify feelings because they often have difficulty identifying them 6. Teach and role model assertiveness Characteristics/symptoms of Anti-social PD - Deceitful and manipulative for personal gain. Exploit others - Hostile if needs are blocked - Antagonistic behaviors - Disinhibited - high risk taking, disregard for responsibility and impulsivity - Criminal misconduct and substance misuse are common - Main concern - gaining personal power or pleasure - Callousness - lack of empathy, lack of concern about other's feelings and the absence of remorse or guild except when facing punishment What are the protective factors in the elderly to help mitigate suicide risk? 1. Spiritual beliefs 2. Married or have a partner 3. Personal resilience 4. Perception of social/family support 5. Children/other family members (in contact) An elderly patient who is newly confused, falling, disrobing and fighting with staff. What is the nursing priority? Assess for Delirium What are some key concepts to teach the patient & family about polypharmacy or drug safety? - Learn about your medicines - Keep track of side effects or possible drug interactions and notify your provider immediately - Have a "medicine check-up" as least once a year What is the Patient Self-Determination Act say about Mental Health patients? Guidelines and philosophy of care that call for patients to be free from unnecessary use of drugs and physical restraints. The most common anxiety disorder in older adults Generalized Anxiety Disorder. This disorder is often associated with pain, with both problems increasing the other. That is, increased pain increases anxiety and increased anxiety results in increased perception of pain. Priority Intervention for an elderly client admitted for depression after suicide assessment is completed Nutrition Older adult hospitalized is agitated and screaming in a foreign language... what is your next step. Interpretor Pervasive pattern of shyness, feelings of inadequacy, and hypersensitivity to negative evaluation. Avoidant Pervasive pattern of disregarding and violating the right of others. Anti-social Fear of abandonment, self mutilation Borderline Pervasive pattern of clinging behavior, with fears of separation Dependent Pervasive pattern of grandiosity, need for admiration, and lack of empathy for others Narcissistic Pervasive pattern of excessive emotionality and attention-seeking behavior Histrionic Pervasive pattern of preoccupation with orderliness, perfectionism, and mental control Obsessive Compulsive Pervasive pattern of distrust and suspiciousness Paranoid Pervasive pattern of detachment fromsocial relationships and restricted affect Schizoid Pervasive pattern of social deficits and eccentricities Schizotypal Trauma Informed Care -Realizes the widespread impact of trauma and understands potential paths for recovery; -Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; -Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and - Resist re-traumatizing the patient, family and all involved. PTSD Sx in Children Intrusion SX - Repetitive play w/ aspects of trauma, trauma reenactment in play, nightmares, self-blame, detachment, estrangements, loss of interest in significant activities, hyper-vigilance, loss of concentration. Avoidance Alterations in cognition and mood (somatic sx) Alterations in reactivity and arousal. Clinical Picture of PTSD in Children PTSD in preschool children may manifest as reduction in play. Play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame or confusion. Children may blame themselves for the traumatic event PTSD in adults persistent re-experiencing of a highly traumatic event, involves actual or threatened death or serious injury to self or others, responses of fear, helplessness, or horror are felt PTSD Sx in Adults Flashbacks, re-experiencing the trauma (involuntary memories), hypervigilance, alterations in mood, and avoidance of stimuli associated with trauma. Sensation of terror in the stomach, heart palpitations, muscle tensing occur. PTSD in adults psychoeducation Relaxation techniques Improve coping Self-care Recognizing problems Each alternate personality has its pattern of perceiving, reacting to, and thinking about the self and environment. The host is not aware of alters and perplexed by lost time. Switching occurs during times of stress and may be dramatic or not noticeable. Dissociative Identity Disorder R/F for dissociative disorders Childhood sexual, physical or emotional abuse and other traumatic event. Dissociation is the most primitive defense mechanism. Sudden unexpected travel and inability to recall one's identity and information about some or all of their past. May assume a whole new identity. After a few weeks to a few months, they may become amnesic to the identities they had. Dissociative Fugue Assessment questions for a patient complaining of pain with no significant findings. What would you ask this pt about their illness? Symptoms must be investigated - Have you been seen by anyone in the past for this problem? What are secondary gains? What are they getting out of the sick role? Consciously pretend to be ill to get emotional needs met and attain the status of the patient. Attention and excitement perpetuate the relationship with healthcare providers. What are symptoms of malingering? What is their secondary gain? Reported pains are vague and hard for clinical to prove or disprove, such as back pain, stomach ailments, headache, or toothache. To become eligible for disability compensation, communicate fraud against insurance companies, prescription meds, evade military service, or receive a reduced prison sentence. Ex: Mr.Harris injures his foot to avoid military service. What is somatic symptom disorder? One or more distressing sx Excessive thoughts, anxiety and behaviors around symptoms or health concerns Without significant physical findings and medical diagnosis Suffering is authentic High-level function impairment Symptoms are involuntary Sense of dread, choking, shaky, rapid HR, feeling faint, wobbly legs. (Must rule out medical first- VS, Labs, Assessment) Somatic Symtom Disorder Factitious disorder imposed on another caregiver deliberately falsifies illness in a vulnerable dependent Secondary gain of attention and excitement to perpetuate the relationship with healthcare providers factitious disorder imposed on self symptoms of illness are deliberately induced, simulated, or exaggerated. The secondary gain of being ill is to get their emotional needs met and attain the status of the patient. Deficits in voluntary motor or sensory function - paralysis, blindness, movement disorder, gait disorder, numbness, paresthesias, loss of vision or hearing Conversion disorder Many pts show lack of emotional concern (La belle indifference) Dementia - Interventions Focus on forming meaningful relationship with pt and caregivers Education on cognitive impairment, involve family in tx plan, community supports, use of distraction, finger foods limit number of choices, monitor nutrition and weight. What is delirium s/s? When you suspected delirium, what are your priority intervention? Inability to direct, focus, sustain, and shift attention Abrupt onset* Moments of lucidity* Disorganized thinking Poor executive functioning Medical Emergency Delirium - interventions Tx cause of delirium Assist needs r/t urination, nutrition, ADLs Communicate simple direct statements Well lit environment What is the education you would give on medication management to older adults? Have a "medicine check-up" at least once a year. Go through your medicine cabinet to get rid of old or expired medicines. Polypharmacy Adverse drug reactions Prescribing cascades What are the age-related changes vs Alzheimer's? Age-related changes - sometimes forgetting names or appointments, developing specific way of doing something and becoming irritable when routine is disrupted Dementia/Alzheimer's - trouble understanding usual imagines, decreased or poor judgment. Educational materials for families of clients who have early-stage Alzheimer's. What education will you give them? Safe environment - Falls, driving, cooking, minimize sensory stimulation Wandering - Medical alert bracelet, notify police/neighborhood, complex locks on door. Useful activities - Exercise that allows exercise of large muscles, when ability to read diminishes, provide children's books. Use of distractions, finger foods, limit number of choices, monitors nutrition and weight. Donepezil (Aricept) side effects N/V/D, insomnia, fatigue, muscle cramps, incontinence, bradycardia, syncope. Risk of side effects double in those over 85 Cholinesterase inhibitors Donepezil, rivastigmine, galantamine Inhibit acetylcholinesterase, increasing available acetylcholine Mild to severe alzheimers (Donepezil) Top 2 priority assessments/intervention for the depressed older adult admitted to a mental health unit. Suicidal thoughts and monitor nutritional intake Dysgraphia, dyscalculia, and dyslexia. What is the child having difficulty with? Written expression, math, and reading Specific learning disorder Tic disorder Sudden, rapid, recurrent, nonrhythmic motor movement or vocalizations Tourette syndrome - Education disorder of multiple motor and vocal tics CNS stimulants increase severity of tic Habit reversal -Comprehensive behavior interventions for ticks (CBITS) pt becomes aware of its urge Deep brain stimulation last option Attention-deficit disorder (ADD) Lack of hyperactivity attention-deficit/hyperactivity disorder (ADHD) inappropriate degree of inattention, impulsiveness and hyperactivity. What class of medications is used to treat ADHD and what are the side effects? Stimulants - insomnia, appetite suppression, h/a, abd pain, and lethargy ADHD - Assessment questions Level of physical activity, attention span, talkativeness Social skills Comorbidity SX present in at least 2 settings What is the main issue affected by the child with ADHD? Low frustration tolerance, temper outburst, labile mood, poor school performance, and low self esteem. Persistent pattern of behaviors where the rights of others are violated and societal norms/rules are disregarded. Abnormally aggressive, initiates fights, bullies, intimidates, and hurts others. Callousness - may be a predictor for future antisocial personality disorder Conduct disorder Behavior exceeds the boundaries of what is socially acceptable. Angry and irritable mood, defiant and vindictive behavior. Difficult to attend school, form friends ships or function as a family member. Oppositional defiance disorder Oppositional Defiant Disorder VS Conduct Disorder ODD Conflict with authority/adults, emotional dysregulation, chronic negative mood, temper outburst, left untreated - child may grow out of it. CD Conflict with authority/adults, more severe than ODD, aggression toward people/animals, theft, deceit, destruction of property, callousness, untreated - antisocial personality disorder. What are protective factors for a person against suicide? - Effective mental healthcare; easy access - Strong connections to individuals, family, community and social institutions - Problem-solving and conflict resolution skills - contact with providers - Some religions What do you do if your patient is making passive statements of suicidal ideation? If patient is not directly saying they are going to kill themselves, but you suspect it, then you need to ask directly. Why do patients engage in self-injury? What are they trying to accomplish? Deliberate and direct attempt to inflict shallow but painful injuries. Intent is to alleviate psychiatric pain, pierce psychic numbness, get attention, escape reasonability, avoid a situation. What is a safety plan? What is included in it? Six step plan that includes identifying warning signals, coping strategies, identifying support systems and something most important to them (worth living for). Cluster A - Behaviors described as odd or eccentric Paranoid, schizoid and schizotypal personality disorders Cluster B - Behaviors desired as dramatic, emotional or erratic Borderline, narcissistic, histrionic, antisocial personality disorders Cluster C - Behaviors described as anxious or fearful Avoidant, dependent, obsessive-compulsive Paranoid Personality Disorder Distrust, suspiciousness, hypervigilant for no reason schizoid personality disorder social withdrawal, expressionless, emotional detachments, no enjoyment from close relationships Schizotypal Personality disorder Strange, unusual, magical thinking, odd beliefs, strange speech patterns, inappropriate affect, paranoia, extreme anxiety in social situations. Histrionic Personality Disorder Excitable, dramatic, high-functioning "drama queen", self-centeredness, impulsive, flirtatious, provocative Narcissistic Personality Disorder Entitled, exaggerated belied of one's importance, arrogant, antagonistic, hypersensitive to criticism, excessive need for admiration, lack of empathy Borderline Personality Disorder Self destructive, suicidal ideations, splitting, impulsive, emotional lability AntiSocial Personality Disorder Deceitful. manipulative, hostile, callousness, criminal midconduct Avoidant Personality Disorder low self esteem, shyness, inferiority, avoids contact with other due to fear of rejections Dependent Personality Disorder Submissive, clinging, overwhelming need to be cared for. Intense fears of separation Obsessive Compulsive personality disorder Limited emotional expression, stubbornness, perseverance and indecisiveness. Preoccupation with order, control and perfectionism. audit trail the documentation of the research process and the researcher's decision making in qualitative studies confirmability one of four criteria for a trustworthy qualitative study that relates to the rigorous attempts to be objective and the maintenance of audit trails to document the research process; findings can be substantiated by participants; degree to which findings of a qual study are objective, unbiased, and supported by data collection--- detailed review of data, question open ended and not leading, & data confirmed by member checks constant comparison a method for inductively categorizing and comparing qualitative data for analysis credibility one of four criteria for establishing a trustworthy qualitative study; refers to the truth or believability of findings; qualit equiv of validity in quant-- similar to internal validity (strategies to help establish are data satur, peer debrief, member checks, triangulation, reflexivity) data reduction the simplification of large amounts of data obtained from qualitative interviews or other sources dependability one of four criteria for a trustworthy qualitative study that relates to consistency in the findings over time; auditability; findings are reflective of data; satisfied when the research has est a sufficient audit trail and papers trails through accurate & detailed journaling and notes, record keeping and reflective writing are key ethnography a type of qualitative research that describes a culture; use of key informants; 3 types of information usually sought (cultural behavior, cultural artifacts, & cultural speech); typically uses a realist voice but may benefit from impressionist style to convey cultural insights fieldwork the time researchers spend interacting with participants through interviews, observations, and detailed records (ie: field notes, methodological logs, reflective journals) field notes notes made before, during, and after contacts with participants to record observations focus groups A strategy to obtain data from a small group of people using interview questions grounded theory A type of qualitative research that examines the process of a phenomenon and culminates in the generation of a theory; addresses questions about how people deal with life situations by describing processes by which they move through experiences over time; used focus groups and constant comparison; often presented in a traditional analytical style to communicate discovered processes key informants individuals who have intimate knowledge of a subject and are willing to share it with the researcher lived experience the perspective of an individual who has experienced the phenomenon participant observation role of the researcher in qualitative methods when the researcher is not only an observer but also a participant during data collection; describes role of researcher in qualitative data collection peer debriefing a technique used in qualitative research in which the researcher enlists the help of another person, who is a peer, to discuss the data and findings phenomenology A type of qualitative research that describes the lived experience to achieve understanding of an experience from the perspective of the participants; uses realist, confessional, or impressionist storytelling, depending on audience and sample size purposive sampling nonprobability sampling method used in qualitative studies to select a distinct group of individuals who either have lived the experience or have expertise in the event or experience being studied (have insight); sampling method to recruit specific persons who could provide inside information; called "key informants" because have intimate knowledge of topic and willing to share with investigator saturation in qualitative research, the time when no new information is being obtained and repetition of information is consistently heard; data collection stops when no new info is obtained strategic sampling sampling in historical research to locate a small group of people who were either witnesses of or participants in the phenomenon being studied transferability one of four criteria for a trustworthy qualitative study that relates to whether findings from one study can be transferred to a similar context; application of findings to a different situation; accomplished through thick description, adequate sampling, & data saturation quantitative number/ deductive qualitative words/ inductive; hallmark is subjectivity sampling the process of selecting a sample; volunteers who take part in a qual study are participants or informants, not subjects data collecting interviews, direct observations, artifacts (reports, journals, books, memos, photos, letters, diaries); comes from fieldwork snowball sampling recruitment of participants based on word of mouth or referrals from other participants analysis identify themes, patterns, and relationships interpretation provide meaning that can be used in EBP immersion refers to the data collection process and which researcher "lives" with the data overtime; researchers engage deeply with the data by reading and rereading transcripts. patterns and trends emerge through this in depth review memoing a technique used in qualitative research to record ideas that come to researchers as they live with the data bracketing a strategy used by qualitative researchers to set aside personal interpretations to avoid bias historical research learning from the past; examine events or people; used to guide present and future; strategic sampling; eyewitness accounts, documentation & artifacts----- commonly uses realist reporting based on document analysis and observations mixed methods approach/ design a design that combines both qualitative and quantitative data gathering and evaluation; 4 major approaches to data collection are connecting data, building data, merging data, embedding data auditability When another researcher can clearly follow decisions made by the investigator, arriving at the same or comparable conclusions axial coding the analysis of categories and labels after completion of open coding data saturation no new information is being provided to participants member checks a strategy used in qualitative studies when the researcher goes back to participants and shares the results with them to ensure the findings reflect what participants said; involves returning to participants to verify or validate the accuracy and interpretation of the data collected open coding the grouping of qualitative data into categories that seem logical personal narrative a way of conveying the meaning of experiences through storytelling reflexive thinking Thinking that involves self-critique, self-appraisal, and constant awareness of bias throughout the entire research process (essential to establishing rigor in qual research)-- using journal to record thoughts, ideas, and decisions during qual data gathering reflexivity using a journal to record thoughts, ideas, and decisions during qualitative data gathering replicated when another researcher has findings similar to a previous study (confirms representativeness) representativeness the degree to which elements of the sample are like elements in the population (confirmed through replication) thematic analysis a method of data analysis that is associated with phenomenology and ethnography that involves coding to develop themes triangulation use of different research methods in qualitative research to gather and compare data; another way to promote credibility; 2 ways it helps establish credibility are (1) confirming the data, (2) ensure completeness of the data trustworthiness the quality, authenticity, and truthfulness of findings from qualitative research coding assignment of labels to each lone of transcript in qualitative analysis realist tales a real-life account of the culture being studied presented in a third-person voice that clearly separates researchers from participants confessionist tales qualitative researchers' personal accounts that provide insight about data collection and scientific rigor impressionist tales researcher's storytelling & personal descriptions about the experiences of conducting studies (helps reader relive the experience) personal narratives co-created with participants can highlight lived experiences computer software software programs are available to help researchers label statements within transcripts, group them into categories and make interpretations. help manage high volume of "words" and can quickly search through pages of text to identify specific words or phrases, make charts and graphs, etc active rejection purposefully deciding not to adopt an innovation adoption applying an innovation to practice change champion individuals who continually promote new ideas for change and act as role models; charismatic individuals who can enthusiastically support the innovation by acting as a source of information about the innovation and influencing the perceptions of others critical appraisal tools tools used to guide nurses use when evaluating the quality of different types of evidence evidence hierarchies predetermined scales that guide decisions for ranking evidence; levels of evidence passive rejection lack of consideration given to adopting an innovation; hence, old practices are continued pilot study a small study to test a new intervention with a small number of participants before testing with larger samples; adopting an innovation on a trial basis rejection decision not to adopt an innovation uncertainty degree to which alternatives are perceived relative to the occurrence of an event and the probability of these alternatives authorship list of authors in order that reflects the amount of their contributions call for abstracts notices publicizing the desire for posters or presentations at conferences conventional journal print journals that usually have an established peer review process without author fees dissemination communication of clinical research and theoretical findings to transition new knowledge to the point of care 3 Ps of Dissemination posters, presentations, papers manuscript a scholarly paper prior to its publication networking interacting with colleagues to exchange information and build relationships open access journal journal that allows free, online access to articles or books papers manuscripts published in professional journals posters A scholarly venue for disseminating evidence predatory journal Journal that has questionable peer-review practices and often charges unreasonable fees to authors presentations scholarly oral presentations to disseminate new knowledge (best when topic is too complex to present in the space of a poster) descriptive statistics describes, summarizes, and synthesizes collected data inferential statistics helps to explain relationships among phenomenon if interest frequencies percentage or P mean mathematical average calculating by adding all values and then dividing them by the total number of values median the point at the center of the data mode the most frequently occurring value in a data set amodal without a mode unimodal with one mode bimodal with two modes normal distributions symmetrical shapes; represented by the bell curve skewed when data is asymmetrical positively skewed a distribution patter when the mean is greater than the median and mode negatively skewed a distribution pattern when the mean is less than median and the mode homogenous elements that share many common characteristics heterogeneous the degree to which elements are diverse or not alike precentile a measure or a rank; each percentile represents the percentage of cases that a given value exceeds statistical range the difference between the maximum and minimum values in a data set standard deviation the measure of average deviations of a value from the mean in a given data set z score a standard unit used to describe the distance a score is away from the mean per standard deviation confidence intervals estimate the degree of confidence one can have about being correct; reported as p= type I error the researcher is making false claims about the hypothesis; null hypothesis should be accepted type II error the researcher believes he/she was wrong when they were right; null hypothesis should be rejected nominal groups of data; exclusive categories ordinal groups are ranked or ordered interval continous; no meaningful zero ratio continuous; has a meaningful zero nonparametric tests involving nominal or ordinal level data; chi-square parametric tests involving interval or ratio level data; T-test, ANOVA t test determines whether the means of two groups are significantly different Analysis of Variance ANOVA; similar to t tests but used when there are more than 2 groups in a variable; eliminates the need for multiple t tests correlations used when the IV is ordinal, interval or ratio multiple regression describes the relationship of three or more variables; used when researchers want to study the relationship of many independent variables on a dependent variable hallmark of qualitative research subjectivity purposive sampling sampling method to recruit specific persons who could provide inside information key informants participants who have intimate knowledge of a subject snowball sampling recruitment of participants based on word of mouth or referrals from other participants data saturation data collection stops when there is no new information being heard and repetition of information is consistent fieldwork the time the researchers spend interacting with participants through interviews, observations, and detailed records ways to collect qualitative data interviews focus groups, case studies, direct observation, artifacts immersion living with the data over time memoing recording ideas that come to the researcher bracketing setting aside personal interpretations to avoid bias data reduction simplification of large amounts of data 4 essentials of evaluation credibility, transferability, dependability, confirmability credibility believability of findings trasnferability application of findings to a different solution dependability findings are reflective of data confirmability findings can be sustained by participants phenomenological research studying the lived experience grounded theory examines the process of a phenomenon ethnographic research describing a culture historical research examining events or people gatekeeper person who facilitates or hinders entry of the researcher into a particular group or setting qualitative data analysis a means to knowledge production that involves the breakdown, categorization and prioritization of data into a useful system managing the data reducing large amounts of data into manageable units for analysis coding assignment of labels to each line of transcript in qualitative analysis open coding grouping of qualitative data into categories that seem logical axial coding analysis of categories and labels after completion of open coding QRS NUD*IST qualitative research and solutions nonnumerical unstructured data indexing searching and theorizing ethnograph a software program for the analysis of text-based data that is highly regarded by qualitative researchers qualitative data interpretation provides evidence for practice representativeness degree to which participants are like the population replicated when another researcher has findings similar to a previous study realist tales account of culture presented in a third person voice clearly separating researchers from participants confessionist tales qualitative researchers' personal accounts that provide insight about data collection and scientific rigor impressionist tales qualitative researchers' storytelling and personal descriptions about conducting studies priori framework lowest level of qualitative data; data analyzed according to a preexisting framework; provides no new knowledge descriptive second level; researcher develops labels for data categories but does not explicate relationships among them developing a synthesis third level; researcher explains and explores relationships among themes with logical intergration increased complexity and case variacne fourth level; researcher explains variations and negative case examples of the research a product that comprehensively explains a complex human phenomenon gold standard of research; provides an explanation of phenomenon with depth and breadth as to increase others' understanding and advance science member checks when the researcher shares the results with participants to ensure the findings reflect what they said negative case analysis qualitative strategy involving the analysis of cases that do not fit patterns