NURSING RESEARCH courses can intimidate undergraduate nursing students. Most students don't have any research experience and are apprehensive about statistical methods. However, our research course was experiential. In other words, it was hands-on, rather than solely lecture-based, giving us the opportunity to conduct a small pilot study. Because conducting research and analyzing findings can take several months, our instructor saved us time hypothesizing by providing us with a choice of five research topics. The 18 students in our class were divided into four groups, and each group chose a research topic. The authors' group decided to conduct a study comparing bacterial culture results from specimens obtained from the bottom of shoes worn by nursing students with those from shoes worn by nonnursing students.
Introduction and literature review
While the importance of our topic seemed clear, we thought about the "so what" factor: Why does it matter if nursing students' shoes harbor harmful pathogens? Nursing students living on college campuses typically have no hospital lockers for storing their clinical shoes. So, between clinicals, shoes are stored in dorm rooms, closets, or cars. After a review of the literature, we found that a growing number of antibiotic-resistant organisms pose a significant threat of community-acquired diseases.1 Therefore, nursing students could potentially spread harmful pathogens to themselves, roommates, or family members by contaminating their living environment with their clinical shoes.
As novice researchers, we initially found the literature review challenging. We learned to identify keywords for searches, located primary rather than secondary sources, and worked to understand new or unfamiliar terminology, differing research methods, and statistical analysis. With the help of classroom instruction, a library session on conducting searches, group discussions, and our textbook, we navigated online databases, found key studies, and determined their applicability to our own study.
After concluding our review of the literature, we identified a gap regarding contamination of nursing students' shoes; most of the literature was based on contamination of nursing uniforms or medical professionals' equipment. From here, we developed our purpose: to compare the number and type of organisms, specifically Pseudomonas aeruginosa, Escherichia coli, Clostridium sporogenes, and Staphylococcus aureus, on the shoes of nursing majors and nonnursing majors.
Methods
The methods section of a study identifies all the variables and gives clear instructions on how the study was performed so a reader could replicate the study, if desired. Before we began our study, we applied for and obtained approval from our university's Institutional Review Board (IRB). The IRB protects participants from harm because of research involvement and is used in all practice settings, not only nursing. The possible risk for participants was the potential for shoe loss or damage.
When volunteers agreed to donate their shoes to our study, they were required to sign a consent form. This document informed participants about our study, our methods, the risk to the participant's shoes, how we would maintain participant confidentiality, and how to contact our group with any questions or concerns. We collected the signed forms for safekeeping.
A study sample is a selected group from a population of interest. This typically involves a power analysis, or a calculation to determine the needed number of participants so the researchers have confidence in their findings.2 However, because our study was a pilot study (small, practice study), we didn't need to perform a power analysis. Rather, we recruited a convenience sample of 20 participants from our university. Each participant donated one pair of shoes for a total of 10 pairs of clinical shoes from nursing majors and 10 pairs of shoes from nonnursing majors. To promote equal wear among nursing students, the inclusion criterion for nursing students was senior-level rank in the nursing program.
After collecting all the needed shoes, we bagged, tagged, and transported them to our campus microbiology lab for analysis. Forty-five undergraduate students enrolled in a microbiology course at our university, many of them nursing majors, swabbed all the shoes and incubated the specimens for aerobic and anaerobic growth. After the incubation period, the microbiology students identified and counted the pathogens present.
Results
In the results or findings section of a research report, researchers provide the results, the number and demographics of participants, and data concerning the variables of interest (types and number of pathogens grown). However, sometimes the unexpected happens while conducting research.
The study began with 40 shoes, but 33% of the sample was determined to be missing after analysis, meaning some plates with the bacterial cultures were misplaced during the incubation process or colony count interpretations weren't reported by the microbiology students. For the latter, either the students were unable to interpret the plates or they simply omitted this step. In other instances, the culture results reported by the students were contradicted by the microbiology professor. This resulted in the culture of 16 nursing shoes and 14 nonnursing shoes for a total of 30 shoe cultures.
Our professor conducted an independent samples t-test on the data. This test compared the means of colony counts between cultures from nursing major shoes and nonnursing major shoes. For nursing major shoes, the mean colony count for the aggregate of investigated pathogens was 1.5 (SD = 1.789). For nonnursing major shoes, the mean was 1.14 (SD = 1.879). There was no statistically significant difference between the two groups: (t = -5.32, P = .599). Our professor cautioned us that the reliability and validity of our study was flawed, making our results untrustworthy.
Discussion
In the discussion section of a study, researchers often relate their research findings back to previous studies, such as those found in the literature review; describe the potential application to nursing practice; and identify limitations (weaknesses or flaws of the study). However, because our results were considered unreliable or invalid-two critical components for good research-we reflected on the lessons learned from conducting our study.
Reliability reflects the consistent measurement of an attribute, and validity is the extent to which an instrument measures what it's intended to measure and can be further categorized as internal and external validity.2 Internal validity is the ability to eliminate extraneous factors that may alter a study's results. While we're grateful for the help we received from students enrolled in a junior-level microbiology course, their interpretations compromised the reliability and internal validity of our study. Each student possessed varying skills and used a different microscope to examine the cultured plates, which were potential and actual threats to reliability and internal validity.
In contrast to internal validity, external validity is the ability to generalize a study's findings outside of the study to other settings.2 This too was compromised due to a limited sample size and missing data.
Although our findings were disappointing, our group members were optimistic and we decided to report some of the lessons we learned as novice researchers. We realized the essential need for a well-designed study that would promote both accuracy and consistency in the collection and interpretation of the cultures obtained and the consequences of missing data. We also learned to value resiliency and the ability to stay motivated to conduct research in the future.
Conclusion
Our study morphed from comparing data of bacterial cultures from nursing and nonnursing majors' shoes to lessons learned by novice researchers. We came away with a basic understanding of the key steps of the research process and an appreciation of the planning and detail required to produce sound research. We're excited and encouraged to continue conducting research in the future, especially after learning these important lessons from our pilot study. We hope that sharing our experience with others provides encouragement and hopefully eases some anxieties related to nursing research at the undergraduate level.
Bonus content!
Head to http://www.nursing2018.com for more Student Voices articles.
Shouldering a patient's pain
https://journals.lww.com/nursing/Fulltext/2018/01000/Shouldering_a_patient_s_pai
Ending the stigma
https://journals.lww.com/nursing/Fulltext/2017/09000/Ending_the_stigma.16.aspx
Approaching ethical dilemmas with CARE
https://journals.lww.com/nursing/Fulltext/2017/11000/Approaching_ethical_dilemma
REFERENCES