Archive for month: May, 2019

Assignment: Supportive Psychotherapy

versus

Interpersonal Psychotherapy

Although supportive psychotherapy and interpersonal psychotherapy share some similarities, these therapeutic approaches have many differences. When assessing clients and selecting therapies, it is important to recognize these differences and how they may impact your clients. For this Assignment, as you compare supportive and interpersonal psychotherapy, consider which therapeutic approach you might use with your clients.

.

The Assignment

In a 1- to 2-page paper, address the following:

· Briefly describe how supportive and interpersonal psychotherapies are similar.

· Explain at least three differences between these therapies. Include how these

differences might impact your practice as a mental health counselor.

· Explain which therapeutic approach you might use with clients and why. Support

your approach with evidence-based literature.

· PLEASE DO NOT FAIL TO INCLUDE INTRODUCTION, CONCLUSION, AND WITH

REFERENCES

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 5, “Supportive and Psychodynamic Psychotherapy” (pp. 238–242)

Chapter 9, “Interpersonal Psychotherapy” (pp. 347–368)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Abeles, N., & Koocher, G. P. (2011). Ethics in psychotherapy. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, J. C. Norcross, G. R. VandenBos, & D. K. Freedheim (Eds.), History of psychotherapy: Continuity and change (pp. 723–740). Washington, DC: American Psychological Association. doi:10.1037/12353-048

Cameron, S., & Turtle-Song, I. (2002). Learning to write case notes using the SOAP format. Journal of Counseling and Development, 80(3), 286–292. Retrieved from the Academic Search Complete database. (Accession No. 7164780)

Nicholson, R. (2002). The dilemma of psychotherapy notes and HIPAA. Journal of AHIMA, 73(2), 38–39. Retrieved from http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4

U.S. Department of Health & Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/

Required Media

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.

Stuart, S. (2010). Interpersonal psychotherapy: A case of postpartum depression [Video file]. Mill Valley, CA: Psychotherapy.net

Question 1 A patient asks the nurse practitioner about food sources such as soybeans and soy products. The nurse practitioner understands that these foods are considered

A) phytoestrogens.

B) monotherapy.

C) taboo.

D) inappropriate

Question 2 A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to

A) the mother regarding why the boy needs to take the medications.

B) both the boy and his mother regarding all medication issued.

C) the boy by telling him not to worry about the medications and to take them as directed

D) The mother and be sure to reinforce the need to force the medications, if her sondoes not want to take them

Question 3 A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?

A) Cardiac dysrhythmia

B) Hypertensive crisis

C) Nephrotoxicity

D) Hypokalemia

Question 4 A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should

A) cool the medication prior to administration.

B) use sterile technique when applying the medication.

C) allow the child to apply the medication if possible.

D) use clean technique only when applying the medication.

Question 5 A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is

A) a hepatotoxic response.

B) an idiosyncratic response.

C) a paradoxical response.

D) an allergic response.

Question 6 A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the

A) deltoid muscle.

B) rectus femoris muscle.

C) ventrogluteal muscle.

D) dorsogluteal muscle.

Question 7 A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects

A) breast cancer

B) PMS

C) pain in the heart

D) cancerous breast tenderness

Question 8 A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of

A) alcohol.

B) trans fat.

C) caffeine.

D) grapefruit juice.

Question 9 A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?

A) Renal function

B) Hepatic function

C) Respiratory function

D) Cardiac function

Question 10 A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.

A) Monophasic

B) Triphasic OC

C) Ortho Tri-Cyclen

D) Biphasic OC

Question 11 A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem?

A) Anxiety

B) Respiratory depression

C) Obesity

D) ADHD

Question 12 A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using

A) body surface area.

B) weight.

C) age in months.

D) age in years.

Question 13 A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?

A) Decreased myocardial contraction

B) Decreased heart rate

C) Increased cardiac conduction

D) Increased intranodal conduction time

Question 14 A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?

A) That the infant’s skin has greater permeability than that of an adult

B) That there is less body surface area to be concerned about

C) That there is decreased absorption rates of topical drugs in infants

D) That there is a lower concentration of water in an infant’s body compared with an adult

Question 15 A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?

A) “I walk two blocks to school every day.”

B) “I am on the middle school track team.”

C) “We live in a two-story house.”

D) “My mother is going to give me my insulin.”

Question 16 A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to

A) the inability of infants and children and describe symptoms of adverse drug reactions.

B) increased body surface area relative to body volume in infants and children.

C) increased heart rate and subsequently rapid drug distribution among infants and children.

D) immature liver and kidney function in infants and children.

Question 17 A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication

A) for 20 days.

B) once a day.

C) every day until the infection is gone.

D) for 30 days.

Question 18 To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?

A) A preterm neonate who has apnea

B) A 34-year-old woman with a diagnosis of gastric ulcerations

C) A school-age child with severe ADHD

D) A 52-year-old man with narcolepsy

Question 19 A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?

A) A 38-year-old Caucasian woman with glaucoma

B) A 60-year-old African-American man who experiences angina

C) A 48-year-old Caucasian man who has adult-onset diabetes

D) A 28-year-old African-American woman with hyperthyroidism

Question 20 A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should

A) teach the boy about the fact that he will feel much better after he takes his medications.

B) have the mother hold the child firmly and sooth him while the drugs are administered.

C) offer a choice between liquid and chewable medications, if possible.

D) insert a central intravenous line.

Question 21 The recommended treatment for trichomoniasis is

A) Flagyl.

B) Diflucan.

C) Meclizine.

D) Amoxicillan

Question 22 A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?

A) “Most people don’t know that marijuana can be just as addictive as heroin or cocaine over time.”

B) “Marijuana can easily interact with other drugs and cause potentially fatal reactions.”

C) “Every year, thousands of Americans end up in emergency departments with marijuana overdoses.”

D) “Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes.”

Question 23 A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops

A) at the back of the mouth.

B) in the buccal pouch.

C) under the tongue.

D) on top of the tongue.

Question 24 A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an

A) electrocardiogram (ECG).

B) electromyelogram (EMG).

C) electroencephalogram (EEG).

D) electrophysiologic study (EPS).

Question 25 A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be

A) height and weight.

B) Vision.

C) body temperature.

D) blood pressure.

Question 26 A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause

A) orange-tinged urine.

B) staining of permanent teeth.

C) sleep deprivation.

D) deep muscle pain.

Question 27 A nurse is administering drugs to a 10-year-old child who has multiple health problems.The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)

A) Age

B) Weight

C) Disease process

D) Diet

E) Route of administration

ACDE

Question 28 The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?

A) Having nurses check their math calculations with a colleague before administering a drug.

B) Ensuring that a full assessment takes place no more than 30 minutes before giving a drug.

C) Recording drug administration in both the nurse’s notes and the medication administration record (MAR)

D) Avoiding intravenous administration of drugs whenever possible.

Question 29 A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?

A) “Do you ever use alcohol or drugs?”

B) “How much do you weigh?”

C) “On a scale of zero to ten, what level of pain is acceptable to you?”

D) “Did Tylenol or other over-the-counter pain remedies ever relieve your pain?”

Question 30 A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. The nurse will inform the patient that during sibutramine therapy she should

A) abstain from sex.

B) obtain a pap smear .

C) use adequate contraception.

D) take a pregnancy test every month.

Question 31 A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?

A) Take the drug on a full stomach

B) Avoid high noise levels

C) Take the drug for one full week before coming in contact with allergens

D) Drink plenty of fluids.

Question 32 A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis.The nurse practitioner is aware that

A) trichomoniasis is an incurable disease.

B) trichomoniasis discharge is typically thin and clear.

C) asymptomatic women are diagnosed with trichomoniasis by a routine pap smear.

D) it is unusual to have an odor with trichomoniasis

Question 33 A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?

A) The mother and grandmother’s understanding about the drugs

B) How clean the house is

C) The health status of the other children

D) Where the medications will be stored

Question 34 A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should

A) have the parent gently force the child’s mouth open.

B) give the drug in a pill form.

C) involve the child in a play therapy session, and then tell the child that the medicine is candy.

D) offer the child a flavored ice chip or ice pop prior to administering the drug.

Question 35 A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy.These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?

A) Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity

B) Impaired maternal nutrition as a result of drug use

C) Vasoconstriction leading to reduced placental blood flow

D) Hypoxia as a result of a prolonged second stage of labor

Question 36 A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following?

A) Bloody stools

B) Bradycardia

C) Constipation

D) Hypoglycemia

Question 37 A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?

A) “Take this drug once each day on an empty stomach.”

B) “It’s best to take a dose of sibutramine after each meal.”

C) “This drug will help you to lose weight without having to exercise or change your normal diet.”

D) “Take a dose when you feel like you are tempted to binge on food.”

Question 38 A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?

A) 1000 mg

B) 2000 mg

C) 3000 mg

D) 4000 mg

Question 39 A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate.

A) A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.

B) A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects.

C) A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.

D) A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.

Question 40 An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis.Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation?

A) Caregiver Role Strain

B) Ineffective Family Therapeutic Regimen Management

C) Delayed Growth and Development

D) Knowledge Deficit

tize?

A. Risk for Injury related to drug–drug interactions or drug–nutrient interactions

B. Risk for Constipation related to decreased gastrointestinal peristalsis

C. Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine

D. Risk for Infection related to immunosuppressive effects of phenelzine

1 points

Question 21

A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?

A. A 20-year-old woman who will take the drug about once a week

B. A 46-year-old man who receives an antidepressant and needs a sleep aid

C. A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep

D. A 52-year-old woman who needs to fall asleep quickly and stay asleep all night

1 points

Question 22

A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies

A. drug tolerance.

B. dependence.

C. addiction.

D. withdrawal.

1 points

Question 23

A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient’s concerns?

A. “It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction.”

B. “You don’t need to worry. It’s actually not true that you can get addicted to the medications we use in a hospital setting.”

C. “It’s important that you accept that your current need to control your pain is more important than fears of becoming addicted.”

D. “If you do become addicted, we’ll make sure to provide you with the support and resources necessary to help you with your recovery.”

1 points

Question 24

A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of the following will the nurse include in a teaching plan for this patient? (Select all that apply.)

A. The drug does not cause sleepiness in the morning.

B. It is available in both quick-onset and continuous-release oral forms.

C. The drug should not be used for longer than 1 month.

D. It should be taken 1 hour to 90 minutes before going to bed.

E. One of the most common adverse effects of the drug is headache.

1 points

Question 25

A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and been treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome?

A. The patient develops yellowed sclerae and intense pruritis (itchiness).

B. The patient demonstrates a significant increase in agitation after being given haloperidol.

C. The patient develops muscle rigidity and a sudden, high fever.

D. The patient complains of intense thirst and produces copious amounts of urine.

1 points

Question 26

A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the nurse should be aware that

A. there is a risk of systemic absorption of the lidocaine through the patient’s traumatized skin.

B. intravenous lidocaine may be preferable to topical application.

C. lidocaine must be potentiated with another anesthetic in order to achieve pain control.

D. pain relief is unlikely to be achieved due to the destruction of nerve endings in the burn site.

1 points

Question 27

Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work?

A. Lorazepam (Ativan)

B. Diazepam (Valium)

C. Alprazolam (Xanax)

D. Buspirone (BuSpar)

1 points

Question 28

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse’s priority assessments?

A. Liver function studies, pain intensity, and blood glucose level

B. Pain intensity, respiratory rate, and level of consciousness

C. Respiratory rate, seizure activity, and electrolytes

D. Respiratory rate, pain intensity, and mental status

1 points

Question 29

A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to

A. administer after diluting the drug with gabapentin in intravenous solution.

B. inject very slowly, no faster than 100 mg/minute.

C. inject the diazepam very quickly, 15 mg in 10 to15 seconds.

D. avoid the small veins in the dorsum of the hand or the wrist.

1 points

Question 30

A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for

A. increased secretions.

B. facial flushing.

C. dizziness

Understanding Independent Samples t-Test
Statistical Technique in Review
The independent samples t-test is a parametric statistical technique used to determine significant differences between the scores obtained from two samples or groups. Since the t-test is considered fairly easy to calculate, researchers often use it in determining differences between two groups. The t-test examines the differences between the means of the two groups in a study and adjusts that difference for the variability (computed by the standard error) among the data. When interpreting the results of t-tests, the larger the calculated t ratio, in absolute value, the greater the difference between the two groups. The significance of a t ratio can be determined by comparison with the critical values in a statistical table for the t distribution using the degrees of freedom (df) for the study (see Appendix A Critical Values for Student’s t Distribution at the back of this text). The formula for df for an independent t-test is as follows:

df=(numberofsubjectsinsample1+numberofsubjectsinsample2)−2

image
Exampledf=(65insample1+67insample2)−2=132−2=130

image
The t-test should be conducted only once to examine differences between two groups in a study, because conducting multiple t-tests on study data can result in an inflated Type 1 error rate. A Type I error occurs when the researcher rejects the null hypothesis when it is in actuality true. Researchers need to consider other statistical analysis options for their study data rather than conducting multiple t-tests. However, if multiple t-tests are conducted, researchers can perform a Bonferroni procedure or more conservative post hoc tests like Tukey’s honestly significant difference (HSD), Student-Newman-Keuls, or Scheffé test to reduce the risk of a Type I error. Only the Bonferroni procedure is covered in this text; details about the other, more stringent post hoc tests can be found in Plichta and Kelvin (2013) and Zar (2010).

The Bonferroni procedure is a simple calculation in which the alpha is divided by the number of t-tests conducted on different aspects of the study data. The resulting number is used as the alpha or level of significance for each of the t-tests conducted. The Bonferroni procedure formula is as follows: alpha (α) ÷ number of t-tests performed on study data = more stringent study α to determine the significance of study results. For example, if a study’s α was set at 0.05 and the researcher planned on conducting five t-tests on the study data, the α would be divided by the five t-tests (0.05 ÷ 5 = 0.01), with a resulting α of 0.01 to be used to determine significant differences in the study.

The t-test for independent samples or groups includes the following assumptions:

1. The raw scores in the population are normally distributed.

2. The dependent variable(s) is(are) measured at the interval or ratio levels.

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3. The two groups examined for differences have equal variance, which is best achieved by a random sample and random assignment to groups.

4. All scores or observations collected within each group are independent or not related to other study scores or observations.

The t-test is robust, meaning the results are reliable even if one of the assumptions has been violated. However, the t-test is not robust regarding between-samples or within-samples independence assumptions or with respect to extreme violation of the assumption of normality. Groups do not need to be of equal sizes but rather of equal variance. Groups are independent if the two sets of data were not taken from the same subjects and if the scores are not related (Grove, Burns, & Gray, 2013; Plichta & Kelvin, 2013). This exercise focuses on interpreting and critically appraising the t-tests results presented in research reports. Exercise 31 provides a step-by-step process for calculating the independent samples t-test.

Research Article
Source
Canbulat, N., Ayhan, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), 33–39.

Introduction
Canbulat and colleagues (2015, p. 33) conducted an experimental study to determine the “effects of external cold and vibration stimulation via Buzzy on the pain and anxiety levels of children during peripheral intravenous (IV) cannulation.” Buzzy is an 8 × 5 × 2.5 cm battery-operated device for delivering external cold and vibration, which resembles a bee in shape and coloring and has a smiling face. A total of 176 children between the ages of 7 and 12 years who had never had an IV insertion before were recruited and randomly assigned into the equally sized intervention and control groups. During IV insertion, “the control group received no treatment. The intervention group received external cold and vibration stimulation via Buzzy . . . Buzzy was administered about 5 cm above the application area just before the procedure, and the vibration continued until the end of the procedure” (Canbulat et al., 2015, p. 36). Canbulat et al. (2015, pp. 37–38) concluded that “the application of external cold and vibration stimulation were effective in relieving pain and anxiety in children during peripheral IV” insertion and were “quick-acting and effective nonpharmacological measures for pain reduction.” The researchers concluded that the Buzzy intervention is inexpensive and can be easily implemented in clinical practice with a pediatric population.

Relevant Study Results
The level of significance for this study was set at α = 0.05. “There were no differences between the two groups in terms of age, sex [gender], BMI, and preprocedural anxiety according to the self, the parents’, and the observer’s reports (p > 0.05) (Table 1). When the pain and anxiety levels were compared with an independent samples t test, . . . the children in the external cold and vibration stimulation [intervention] group had significantly lower pain levels than the control group according to their self-reports (both WBFC [Wong Baker Faces Scale] and VAS [visual analog scale] scores; p < 0.001) (Table 2). The external cold and vibration stimulation group had significantly lower fear and anxiety 163levels than the control group, according to parents' and the observer's reports (p < 0.001) (Table 3)” (Canbulat et al., 2015, p. 36).

TABLE 1

COMPARISON OF GROUPS IN TERMS OF VARIABLES THAT MAY AFFECT PROCEDURAL PAIN AND ANXIETY LEVELS

Characteristic Buzzy (n = 88) Control (n = 88) χ2
p
Sex
Female (%), n 11 (12.5) 13 (14.8) .82
Male (%), n 77 (87.5) 75 (85.2) .41
Characteristic Buzzy (n = 88) Control (n = 88) t
p
Age (mean ± SD) 8.25 ± 1.51 8.61 ± 1.69 −1.498
.136
BMI (mean ± SD) 25.41 ± 6.74 26.94 ± 8.68 −1.309
.192
Preprocedural anxiety
Self-report (mean ± SD) 2.03 ± 1.29 2.11 ± 1.58 −0.364
.716
Parent report (mean ± SD) 2.11 ± 1.20 2.17 ± 1.42 −0.285
.776
Observer report (mean ± SD) 2.18 ± 1.17 2.24 ± 1.37 −0.295
.768
image

BMI, body mass index.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 36.

TABLE 2

COMPARISON OF GROUPS' PROCEDURAL PAIN LEVELS DURING PERIPHERAL IV CANNULATION

Buzzy (n = 88) Control (n = 88) t
p
Procedural self-reported pain with WBFS (mean ± SD) 2.75 ± 2.68 5.70 ± 3.31 −6.498
0.000
Procedural self-reported pain with VAS (mean ± SD) 1.66 ± 1.95 4.09 ± 3.21 −6.065
0.000
image

IV, intravenous; WBFS, Wong-Baker Faces Scale; SD, standard deviation; VAS, visual analog scale.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 37.

TABLE 3

COMPARISON OF GROUPS' PROCEDURAL ANXIETY LEVELS DURING PERIPHERAL IV CANNULATION

Procedural Child Anxiety Buzzy (n = 88) Control (n = 88) t
p
Parent reported (mean ± SD) 0.94 ± 1.06 2.09 ± 1.39 −6.135
0.000
Observer reported (mean ± SD) 0.92 ± 1.03 2.14 ± 1.34 −6.745
0.000
image

SD, standard deviation; IV, intravenous.

Canbulat, N., Ayban, F., & Inal, S. (2015). Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Management Nursing, 16(1), p. 37.

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Study Questions
1. What type of statistical test was conducted by Canbulat et al. (2015) to examine group differences in the dependent variables of procedural pain and anxiety levels in this study? What two groups were analyzed for differences?

2. What did Canbulat et al. (2015) set the level of significance, or alpha (α), at for this study?

3. What are the t and p (probability) values for procedural self-reported pain measured with a visual analog scale (VAS)? What do these results mean?

4. What is the null hypothesis for observer-reported procedural anxiety for the two groups? Was this null hypothesis accepted or rejected in this study? Provide a rationale for your answer.

5. What is the t-test result for BMI? Is this result statistically significant? Provide a rationale for your answer. What does this result mean for the study?

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6. What causes an increased risk for Type I errors when t-tests are conducted in a study? How might researchers reduce the increased risk for a Type I error in a study?

7. Assuming that the t-tests presented in Table 2 and Table 3 are all the t-tests performed by Canbulat et al. (2015) to analyze the dependent variables' data, calculate a Bonferroni procedure for this study.

8. Would the t-test for observer-reported procedural anxiety be significant based on the more stringent α calculated using the Bonferroni procedure in question 7? Provide a rationale for your answer.

9. The results in Table 1 indicate that the Buzzy intervention group and the control group were not significantly different for gender, age, body mass index (BMI), or preprocedural anxiety (as measured by self-report, parent report, or observer report). What do these results indicate about the equivalence of the intervention and control groups at the beginning of the study? Why are these results important?

10. Canbulat et al. (2015) conducted the χ2 test to analyze the difference in sex or gender between the Buzzy intervention group and the control group. Would an independent samples t-test be appropriate to analyze the gender data in this study (review algorithm in Exercise 12)? Provide a rationale for your answer.

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Answers to Study Questions
1. An independent samples t-test was conducted to examine group differences in the dependent variables in this study. The two groups analyzed for differences were the Buzzy experimental or intervention group and the control group.

2. The level of significance or alpha (α) was set at 0.05.

3. The result was t = −6.065, p = 0.000 for procedural self-reported pain with the VAS (see Table 2). The t value is statistically significant as indicated by the p = 0.000, which is less than α = 0.05 set for this study. The t result means there is a significant difference between the Buzzy intervention group and the control group in terms of the procedural self-reported pain measured with the VAS. As a point of clarification, p values are never zero in a study. There is always some chance of error.

4. The null hypothesis is: There is no difference in observer-reported procedural anxiety levels between the Buzzy intervention and the control groups for school-age children. The t = −6.745 for observer-reported procedural anxiety levels, p = 0.000, which is less than α = 0.05 set for this study. Since this study result was statistically significant, the null hypothesis was rejected.

5. The t = −1.309 for BMI. The nonsignificant p = .192 for BMI is greater than α = 0.05 set for this study. The nonsignificant result means there is no statistically significant difference between the Buzzy intervention and control groups for BMI. The two groups need to be similar for demographic variables to decrease the potential for error and increase the likelihood that the results are an accurate reflection of reality.

6. The conduct of multiple t-tests causes an increased risk for Type I errors. If only one t-test is conducted on study data, the risk of Type I error does not increase. The Bonferroni procedure and the more stringent Tukey's honestly significant difference (HSD), Student Newman-Keuls, or Scheffé test can be calculated to reduce the risk of a Type I error (Plichta & Kelvin, 2013; Zar, 2010).

7. The Bonferroni procedure is calculated by alpha ÷ number of t-tests conducted on study variables' data. Note that researchers do not always report all t-tests conducted, especially if they were not statistically significant. The t-tests conducted on demographic data are not of concern. Canbulat et al. reported the results of four t-tests conducted to examine differences between the intervention and control groups for the dependent variables procedural self-reported pain with WBFS, procedural self-reported pain with VAS, parent-reported anxiety levels, and observer-reported anxiety levels. The Bonferroni calculation for this study: 0.05 (alpha) ÷ number of t-tests conducted = 0.05 ÷ 4 = 0.0125. The new α set for the study is 0.0125.

8. Based on the Bonferroni result = 0.0125 obtained in Question 7, the t = −6.745, p = 0.000, is still significant since it is less than 0.0125.

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9. The intervention and control groups were examined for differences related to the demographic variables gender, age, and BMI and the dependent variable preprocedural anxiety that might have affected the procedural pain and anxiety posttest levels in the children 7 to 12 years old. These nonsignificant results indicate the intervention and control groups were similar or equivalent for these variables at the beginning of the study. Thus, Canbulat et al. (2015) can conclude the significant differences found between the two groups for procedural pain and anxiety levels were probably due to the effects of the intervention rather than sampling error or initial group differences.

10. No, the independent samples t-test would not have been appropriate to analyze the differences in gender between the Buzzy intervention and control groups. The demographic variable gender is measured at the nominal level or categories of females and males. Thus, the χ2 test is the appropriate statistic for analyzing gender data (see Exercise 19). In contrast, the t-test is appropriate for analyzing data for the demographic variables age and BMI measured at the ratio level.

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EXERCISE 16 Questions to Be Graded
Follow your instructor's directions to submit your answers to the following questions for grading. Your instructor may ask you to write your answers below and submit them as a hard copy for grading. Alternatively, your instructor may ask you to use the space below for notes and submit your answers online at http://evolve.elsevier.com/Grove/Statistics/ under “Questions to Be Graded.”

Name: _______________________________________________________ Class: _____________________

Date: ___________________________________________________________________________________

1. What do degrees of freedom (df) mean? Canbulat et al. (2015) did not provide the dfs in their study. Why is it important to know the df for a t ratio? Using the df formula, calculate the df for this study.

2. What are the means and standard deviations (SDs) for age for the Buzzy intervention and control groups? What statistical analysis is conducted to determine the difference in means for age for the two groups? Was this an appropriate analysis technique? Provide a rationale for your answer.

3. What are the t value and p value for age? What do these results mean?

4. What are the assumptions for conducting the independent samples t-test?

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5. Are the groups in this study independent or dependent? Provide a rationale for your answer.

6. What is the null hypothesis for procedural self-reported pain measured with the Wong Baker Faces Scale (WBFS) for the two groups? Was this null hypothesis accepted or rejected in this study? Provide a rationale for your answer.

7. Should a Bonferroni procedure be conducted in this study? Provide a rationale for your answer.

8. What variable has a result of t = −6.135, p = 0.000? What does the result mean?

9. In your opinion, is it an expected or unexpected finding that both t values on Table 2 were found to be statistically significant. Provide a rationale for your answer.

10. Describe one potential clinical benefit for pediatric patients to receive the Buzzy intervention that combined cold and vibration

Exercise 17
Understanding Paired or Dependent Samples t-Test
Statistical Technique in Review
The paired or dependent samples t-test is a parametric statistical procedure calculated to determine differences between two sets of repeated measures data from one group of people. The scores used in the analysis might be obtained from the same subjects under different conditions, such as the one group pretest–posttest design. With this type of design, a single group of subjects experiences the pretest, treatment, and posttest. Subjects are referred to as serving as their own control during the pretest, which is then compared with the posttest scores following the treatment. Paired scores also result from a one-group repeated measures design, where one group of participants is exposed to different levels of an intervention. For example, one group of participants might be exposed to two different doses of a medication and the outcomes for each participant for each dose of medication are measured, resulting in paired scores. The one group design is considered a weak quasi-experimental design because it is difficult to determine the effects of a treatment without a comparison to a separate control group (Shadish, Cook, & Campbell, 2002).

A less common type of paired groups is when the groups are matched as part of the design to ensure similarities between the two groups and thus reduce the effect of extraneous variables (Grove, Burns, & Gray, 2013; Shadish et al., 2002). For example, two groups might be matched on demographic variables such as gender, age, and severity of illness to reduce the extraneous effects of these variables on the study results. The assumptions for the paired samples t-test are as follows:

1. The distribution of scores is normal or approximately normal.

2. The dependent variable(s) is(are) measured at interval or ratio levels.

3. Repeated measures data are collected from one group of subjects, resulting in paired scores.

4. The differences between the paired scores are independent.

Research Article
Source
Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37(3), 185–193.

Introduction
Despite the widespread use of the artificial sweetener aspartame in drinks and food, there are concern and controversy about the mixed research evidence on its neurobehavioral 172effects. Thus Lindseth and colleagues (2014) conducted a one-group repeated measures design to determine the neurobehavioral effects of consuming both low- and high-aspartame diets in a sample of 28 college students. “The participants served as their own controls. . . . A random assignment of the diets was used to avoid an error of variance for possible systematic effects of order” (Lindseth et al., 2014, p. 187). “Healthy adults who consumed a study-prepared high-aspartame diet (25 mg/kg body weight/day) for 8 days and a low-aspartame diet (10 mg/kg body weight/day) for 8 days, with a 2-week washout between the diets, were examined for within-subject differences in cognition, depression, mood, and headache. Measures included weight of foods consumed containing aspartame, mood and depression scales, and cognitive tests for working memory and spatial orientation. When consuming high-aspartame diets, participants had more irritable mood, exhibited more depression, and performed worse on spatial orientation tests. Aspartame consumption did not influence working memory. Given that the higher intake level tested here was well below the maximum acceptable daily intake level of 40–50 mg/kg body weight/day, careful consideration is warranted when consuming food products that may affect neurobehavioral health” (Lindseth et al., 2014, p. 185).

Relevant Study Results
“The mean age of the study participants was 20.8 years (SD = 2.5). The average number of years of education was 13.4 (SD = 1.0), and the mean body mass index was 24.1 (SD = 3.5). . . . Based on Vandenberg MRT scores, spatial orientation scores were significantly better for participants after their low-aspartame intake period than after their high intake period (Table 2). Two participants had clinically significant cognitive impairment after consuming high-aspartame diets. . . . Participants were significantly more depressed after they consumed the high-aspartame diet compared to when they consumed the low-aspartame diet (Table 2). . . . Only one participant reported a headache; no difference in headache incidence between high- and low-aspartame intake periods could be established” (Lindseth et al., 2014, p. 190).

TABLE 2

WITHIN-SUBJECT DIFFERENCES IN NEUROBEHAVIOR SCORES AFTER HIGH AND LOW ASPARTAME INTAKE (N = 28)

Variable M SD Paired t-Test p
Spatial orientation
High-aspartame 14.1 4.2 2.4 .03*
Low-aspartame 16.6 4.3
Working memory
High-aspartame 730.0 152.7 1.5 N.S.
Low-aspartame 761.1 201.6
Mood (irritability)
High-aspartame 33.4 9.0 3.4 .002**
Low-aspartame 30.5 7.3
Depression
High-aspartame 36.8 7.0 3.8 .001**
Low-aspartame 34.4 6.2
image

*p < .05.

**p < .01.

M = Mean; SD = Standard deviation; N.S. = Nonsignificant.

Lindseth, G. N., Coolahan, S. E., Petros, T. V., & Lindseth, P. D. (2014). Neurobehavioral effects of aspartame consumption. Research in Nursing & Health, 37(3), p. 190