COUN 502Developmental Analysis InstructionsThe purpose of this.docx

COUN 502
Developmental Analysis Instructions
The purpose of this paper is for you to demonstrate your ability
to apply a working knowledge of the theories, terminology, and
concepts of human growth and development. You will discuss
your own development over your lifetime and how it relates to
the developmental concepts discussed throughout this course.
You will analyze your life as it relates to the key aspects of
human growth and development. What are key developmental
times in your life and the influencing factors that led to who
you are today?
You will also incorporate your empirical studies related to your
chosen developmental aspect of your life. Also, use the course
readings or presentations to support what you propose about
your own development in your paper. Depending on your life
and the influences, there may be more attention placed during
one period of time. You are encouraged to glean information
from your mother about her pregnancy with you to see if there
were any notable issues during that time. Remember to include
your spiritual development with applicable research.
In addition, obtain as much information as you can about any
significant events in your early childhood years. How did you
do in those key developmental years? Did you approach all
developmental milestones with ease, or were there challenges?
Since this is a comprehensive paper, you will address your
development across your lifespan.
Finally, you will conclude your paper with addressing any
current lifestyle behaviors that may influence your aging
process. You will address these issues, how they will affect
your aging process, and what you plan to do about it.

Note: Your conclusion must offer suggestions for further study.
The body of the paper must be 8–10 pages (excluding the title
page, abstract, and reference page). This assignment must be
completed adhering strictly to current APA format.
You must include 8–10 peer-reviewed, relevant sources in your
paper (at least 7 of the sources must be empirical articles). The
sources must be less than 10 years old unless any of the
citations are linked to an author whose work is seminal to your
topic.
Submit this assignment via SafeAssign by 11:59 p.m. (ET) on
Sunday of Module/Week 7.
1. Citation:
Bocanegra, H. T., Braughton, M., Bradsberry, M., Howell, M.,
Logan, J., & Schwarz, E. B. (2017). Racial and ethnic
disparities in postpartum care and contraception in California’s
Medicaid program. American Journal of Obstetrics and
Gynecology,217(1). Retrieved from
doi:10.1016/j.ajog.2017.02.040
2. Identify the Purpose Statement
a. The purpose of this research study is “to assess racial/ethnic
variation in receipt of postpartum care and contraception among
low-income women in California” (Bocanegra, et al., 2017, p.1).
3.Identify the Population of Interest.
a. The population of interest is ” low-income women in
California”(Bocanegra, et al., 2017, p.1).
4. Identify the Study Variables from the purpose statement
a. Independent Variables
i. Racial and ethnic variation
b. Dependent Variables

i. Postpartum and contraceptive care
c. Extraneous Variables
i. Maternal Age
ii. Language
iii. Cesarean Delivery
iv. Medicaid Program
v. Residence in primary care shortage area (Bocanegra, et al.,
2017, p.1).
5. Identify the study time perspective: Retrospective or
Prospective.
a. This research study time is prospective because it is a
longitudinal cohort study and follows the outcomes of similar
individuals who differ in certain factors(Bocanegra, et al., 2017,
p.1).
6. Identify the Inclusion and Exclusion Criteria and the
resulting sample element (subject)
a. Inclusion
i. Pregnant women with deliveries of live births or cesarean
between November 6, 2011, and November 5, 2012 (Bocanegra,
et al., 2017, p.2).
ii. Pregnant women who receive Medical or family PACT.
iii. Women ages 15-44.
iv. Pregnant Women who reside in primary care shortage area.
b. Exclusion
i. “Women who were not enrolled consecutively in MediCal,
state based insurance or Family PACT from a range of 43 days
prior to delivery or 99 days after delivery”(Bocanegra, et al.,
2017, p.2).
ii. “Women with incomplete claims data or missing information
”(Bocanegra, et al., 2017, p.2).
c. Sample Element

i. A pregnant woman age 15-44 who had a live or cesarean birth
that received postpartum or contraceptive care through MediCal,
a state funded health insurance or family PACT. A woman that
had a life birth or caesarean delivery between November 6,
2011, and November 5, 2012. A woman who resided in primary
care shortage area during respective dates.
7.Identify the operationalized population of interest and critique
validity.
a. All pregnant women age 15-44 who had a live birth or
cesarean birth that received postpartum or contraceptive care
through MediCal, a state funded health insurance or family
PACT. All women that had a live birth or cesarean delivery
between November 6, 2011 and November 5, 2012. All women
who resided in primary care shortage area during respective
dates.
Validity:
Researchers for this study, studied pregnant women from
various ethnic background ages 15-44 who were receiving
health care coverage through MediCal or family PACT, between
November 6, 2011 and November 5, 2012 and resided within the
primary care shortage area. Researchers studied this cohort of
women to determine if there was a difference in the receipt of
postpartum or contraceptive care among various racial
backgrounds. Women who were not enrolled in state based
health coverage 43 days prior to delivery or 99 days after were
exclude. Women with missing or incomplete claims were not
included. “Deliveries that had claims with procedure or
diagnosis codes for cesarean delivery within 7 days of their
delivery date were considered cesarean. Deliveries with at least
one vaginal delivery procedure or diagnosis code were
considered vaginal. If no codes indicated mode of delivery, the
delivery type was considered missing. Women were assigned to
the publicly funded health care program (Medi-Cal Fee for
Service, Medi-Cal Managed Care health plans, or Family
PACT), where they were enrolled on the 99th day

postpartum”(Bocanegra, et al., 2017, p.2).
.
8.Describe the sampling method used and classify it. (ex.
convenience, random or nonrandom, etc). Discuss the
appropriateness and limitations of the sampling method.
a. The sampling method used was purposive sampling and the
classification is homogeneous sampling. The classification of
homogeneous sampling fits this study because the goal of this
type of sampling is to pull a sample of people who have similar
traits or characteristics. Purposive sampling is sampling of the
population based on the intention or purpose of the study.
Purposive sampling should be used when researchers want to
reject individuals who do not fit the profile of the individuals
that they wish to study. One benefit of purposive sampling is
that it is a type of sampling that allows the researcher to only
focus on individuals who meet research criteria pertaining to
their respective study. A problem with purposive sampling is
that it is not random making the method susceptible to
researcher bias. Purposive sampling is appropriate for this study
because it allows the researchers to focus on specific
individuals pertaining to purpose of their study.

Disparities in Access to Easy-to-Use Services for Children
with Special Health Care Needs
Myra Rosen-Reynoso2 • Michelle V. Porche1 • Ngai Kwan2 •
Christina Bethell3 •
Veronica Thomas2 • Julie Robertson4 • Eva Hawes4 • Susan
Foley2 •
Judith Palfrey5
Published online: 4 January 2016
� Springer Science+Business Media New York 2015
Abstract Objectives Families, clinicians and policy-
makers desire improved delivery of health and related
services for children with special health care needs
(CSHCN). We analyzed factors associated with ease of use
in obtaining such services. We also explored what were
specific difficulties or delays in receiving services. By
examining data from the National Survey of Children with
Special Health Care Needs (NS-CSHCN 2009–2010) and
using the revised criteria for ‘‘ease of use,’’ we were able to
assess the percentage of parents who reported that their

experiences seeking services for their children met those
criteria. Methods We performed Chi square tests to
examine associations between the independent variables
and their relationship to the difficulties or delays assessed
in the survey; including: eligibility, availability of services,
waiting lists, cost, and access to information. We used
logistic regression to determine the association of meeting
the ‘‘ease of use’’ criteria with socio-demographic,
complexity of need, and access variables. Results Overall, a
third of families of CSHCN (35.3 %) encounter difficulties,
delays, or frustrations in obtaining health and related ser-
vices. The lack of access to health and community services
in this study fell most heavily on children from racial/
ethnic minority backgrounds, those in poverty, and those
with complex emotional/behavioral or developmental
needs and functional limitations. Conclusions for Practice
CSHCN require services from a broad array of providers
across multiple systems. Unfortunately, there are certain

difficulties that hamper the accessibility of these systems.
These findings underscore the need for both practice-level
response and systems-level reform to ensure equitable dis-
tribution of health and community resources.
Keywords Special-needs children � Disparities � Survey �
Medical home
& Myra Rosen-Reynoso
[email protected]
Michelle V. Porche
[email protected]
Ngai Kwan
[email protected]
Christina Bethell
[email protected]
Veronica Thomas
[email protected]
Julie Robertson
[email protected]
Eva Hawes
[email protected]
Susan Foley
[email protected]
Judith Palfrey

[email protected]
1
School of Education, Boston University, Two Silber Way,
Boston, MA 02215, USA
2
Institute for Community Inclusion, University of
Massachusetts, Boston, 100 Morrissey Blvd., Boston,
MA 02125, USA
3
Johns Hopkins University, Baltimore, MD, USA
4
Oregon Health and Science University, Portland, OR, USA
5
Children’s Hospital Boston, 300 Longwood Avenue, Boston,
MA 02115, USA
123
Matern Child Health J (2016) 20:1041–1053
DOI 10.1007/s10995-015-1890-z
http://crossmark.crossref.org/dialog/?doi=10.1007/s10995-015-
1890-z&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s10995-015-
1890-z&domain=pdf

Significance Statement
What is already known on this subject? Differences in ease
of use of community-based services for parents of children
with special health care needs exist and are associated with
race/ethnicity and complexity of need.
What does this study add? Using the NS-CSHCN, this
study probes the specific types of difficulties and delays
that CSHCN encounter in their experiences accessing
health and related services. Large gaps are identified in
eligibility for community-based services as well as delays
in obtaining these services. The problems are most pro-
nounced for children from minority backgrounds, those in
poverty, those without health insurance and children with
complex emotional/behavioral and functional disorders.
The medical home plays a significant role in ameliorating
these problems, but less than half of CSHCN have access to
a medical home.
Introduction

An estimated 15.1 % of the U.S. child population have
special health care needs [30], defined as chronic physical,
developmental, behavioral, or emotional conditions
requiring a type or amount of health and related services
beyond typical needs [22]. These children depend on
obtaining a range of services (e.g., medical care, dental
care, specialized therapies, counseling, medical equipment,
special education, and early intervention) from the health
care and other systems (e.g., schools, child care centers,
community programs, home care) [25]. Yet over a third of
families report difficulties, delays, and frustration in
obtaining community-based services, thus not meeting ease
of use criteria [30]. In this paper, we present findings from
the 2009/2010 National Study of Children with Special
Health Care Needs (NS-CSHCN) describing correlates of
the provision of health and related services organized in an
‘‘easy to use’’ system of community-based services.
In 1989, the U.S. Maternal and Child Health Bureau

developed a National Agenda for Children with Special
Health Care Needs (CSHCN), calling for a comprehensive,
coordinated, culturally competent, community-based sys-
tems of services based on family-centered principles for
children and youth with special health care needs [25]. To
assess progress in this aim, a single question about ‘‘ease of
use’’ was added to the 2001 NS-CSHCN; only three-
quarters of parents reported that services were organized in
a way that ‘‘makes them easy to use’’ [26]. The 2005/2006
NS-CSHCN asked if there were ‘‘any difficulties trying to
use services,’’ and nearly 90 % of respondents reported
‘‘no’’ [24], obscuring details about the challenges families
face. In both cases, a single question about ‘‘ease of use’’
yielded little discrimination among groups of CSHCN, and
did not allow investigation of the various factors that
constitute ‘‘ease of use,’’ or information about specific
barriers or facilitators, which are critical for improving
service delivery for families. However, recent amendments

to the NS-CSHCN support more extensive investigation of
ease of use, enabling a more comprehensive understanding
of the difficulties that families of CSHCN face in obtaining
services.
The Technical Expert Panel for the 2009/2010 National
Survey revised the method of measurement and redefined
‘‘ease of use’’ as a multidimensional construct including
difficulties, delays and/or frustrations. In this paper, we
analyze the association of (1) child characteristics, (2)
socio-demographic factors, and (3) access measures (in-
surance and medical home) with the more elaborated ‘‘ease
of use’’ construct. We also investigate parental reports of
specific types of difficulties, delays and/or frustrations. To
our knowledge, this study is the first to provide analyses of
this multidimensional construct and related barriers for
parents of CSHCN based on socio-demographic charac-
teristics, complexity of condition(s), and provider
measures.

Background
Initial results using the single-item version of this measure
found racial disparities in reported ‘‘ease of use,’’ with
Black and Hispanic parents more likely than white parents
to report problems using services [26]. Hawaii-specific data
on the same 2001 NS-CSHCN found that families of
children with ‘‘above-routine service use, specialized
therapies, and mental health services’’ were the most likely
group to have difficulties using community-based services
[4]. Nageswaran et al. [23] using the 2005 NS-CSHCN
reported children with functional limitations were 4.8 times
more likely to experience difficulty than those without.
More recently, Strickland et al. [30] using the 2009–2010
NS-CSHCN, presented prevalence rates for six health care
system quality indicators (ease of use was one element in
this systems analysis). Findings of socio-demographic
disparities in the system quality of health care for CSHCN
informs this investigation of the elaborated ease of use

indicator in order to derive new knowledge that can be used
to improve experiences of families.
There is substantial evidence that families of CSHCN
encounter many obstacles within complex health and
related services systems, including difficulty acquiring
specialty services, therapies, respite care, genetic counsel-
ing, mental health services and dental health [11, 17, 18,
20, 32]. Ethnic and linguistic minority families, and urban
and rural families consistently report decreased access to
1042 Matern Child Health J (2016) 20:1041–1053
123
various services [9, 13, 26, 27, 31]. The lack of or incon-
sistent health insurance coverage, high cost of care and
other out-of-pocket costs pose considerable stumbling
blocks to care [1, 21]. Analysis of this latest data from the
2009/2010 NS-CSHCN provides an opportunity to identify
specific and cumulative difficulties, delays and/or frustra-

tions (eligibility, service availability, waiting list, cost, lack
of information) that vary by group characteristics.
Methods
Data Source
The 2009/2010 NS-CSHCN is a population-based, random-
digit-dial telephone survey of parents/guardians of
CSHCN. The State and Local Area Integrated Telephone
Survey mechanism provided the sampling frame [8]. The
Child and Adolescent Health Measurement Initiative’s
(CAHMI) CSHCN Screener was used for 372,698 children
under 18 years of age from 196,159 households to identify
40,242 CSHCN whose parents or legal guardians com-
pleted the in-depth telephone survey. Thus, all references
to ease of service use refer to parent/guardian reports.
Statistical adjustments were made to account for house-
holds without telephones and to reflect the total number of
children in the U.S. The dataset was weighted to the
American Community Survey (ACS) demographic esti-

mates of children; landline and cell phones use were
identified and included as part of weighting plan.
Study Variables
Dependent Variable
The CAHMI team revised the ‘‘ease of use’’ measure
through a systematic question development process. Items
were iteratively specified after 12 rounds of interviews.
Cognitive testing showed that the measure had face
validity, was understood as intended and was reliable.
Family focus groups before and during development con-
firmed the items represented the most essential components
of ‘‘ease of use.’’ Items were then pretested with 132
households, resulting in moderate internal consistency
(Cronbach’s Alpha = 0.691). Item correlations demon-
strated linked yet differentiated information (correlations
ranged from 0.249 to 0.424).
The ‘‘ease of use’’ measure is a dichotomous composite
variable derived from two sets of questions. First, parents

responded to the following six YES/NO items: ‘‘During the
past 12 months did you have any difficulties or delays
getting services for [child] because…
1. …[he/she] was not eligible for services?
2. …the services [he/she] needed were not available in
your area?
3. …there were waiting lists, backlogs, or other problems
getting appointments?
4. … of issues related to cost?
5. …you had trouble getting the information you needed?
6. …for any other reason?
Secondly, parents were asked, ‘‘During the past
12 months, how often have you been frustrated in your
efforts to get services for [child]?’’ responding on a 4-point
Likert scale (never, sometimes, usually, or always), which
was dichotomized as problematic (usually/always) or not
(sometimes/never). Families must report positively on two
criteria to meet the ‘‘ease of use’’ indicator: have no dif-
ficulties or delays in getting services (items 1–6); and, be
only ‘‘sometimes’’ or ‘‘never frustrated’’ in efforts to get

services.
Independent Variables
All composite variables are used as coded in the CAHMI
2012 public dataset and described below.
Child Characteristics Age was coded in developmental
categories: under 1 year old, 1–4 years old, 5–9 years old,
10–14 years old, and 15 years or above. Coding for race/
ethnicity was categorized by the National Center for Health
Statistics (NCHS) as non-Hispanic White, non-Hispanic
Black, Hispanic, non-Hispanic other race (including Asian,
American Indian, Alaska Native, or Native Hawaiian/
Pacific Islander, which was combined into ‘‘other’’ cate-
gory to meet the NCHS confidentiality standards due to
low numbers of respondents). Hereafter, the terms White,
Black, and Hispanic will be used as per the terms used in
the NS-CSHCN.
Family Characteristics and Household Descrip-
tors Parental education was coded as less than, equal to,

or greater than high school graduation. Household income
was based on federal poverty guidelines for a family of
four in the year 2009 and classified as 0–99%, 100–199 %,
200–399 %, and above 400 %. Primary household lan-
guage was coded as English or as language other than
English. Family structure was categorized as two-parent
biological/adopted family, two-parent step-parent family,
single mother, and other family structure.
Complexity of Needs Two items measured the complexity
of conditions: (1) CSHCN with Emotional Behavioral
Developmental conditions (EBD) (coded as 1/0); and (2)
met or did not meet (coded as 1/0) criteria for functional
Matern Child Health J (2016) 20:1041–1053 1043
123
limitations and/or other conditions not primarily managed
by medications.
Access Factors ‘‘Having a medical home’’ was assessed

through a composite of 19 survey questions with a score of
1/0 for meeting criteria of all five components: CSHCN
had (1) a personal doctor or nurse, (2) a usual source of
care, (3) family-centered care, (4) no problems with
referrals, and (5) care coordination. Insurance coverage
was measured as private only, public only, both private and
public, or uninsured.
Analyses
We conducted descriptive analyses to determine preva-
lence rates of dependent and independent variables.
Bivariate analyses and multivariate logistic regression were
used to assess associations between the independent vari-
ables and reported ‘‘ease of use.’’ Analyses were conducted
with Stata 11.0 SE software [29] using sample weights to
adjust for the complex survey design. The 2009/10 NS-
CSHCN included imputed data for the following variables:
household income, race/ethnicity, highest education level
of any parent in the household, primary household lan-

guage and total number of adults in the household (using
multiple imputation, commonly used for handling missing
at random nonresponse data in a survey that would hinder
analyses) [2]. Other missing data (i.e., cases where insur-
ance coverage was reported as ‘‘unknown’’) was handled
by listwise deletion.
Tests of collinearity in the multivariate analyses showed
no substantial correlations among independent variables.
Independent variables were included in the analyses in a
sequential manner, beginning with a base model (Model 1)
containing only the individual child characteristics, fol-
lowed by family demographics and structure variables
(Model 2). Because there is overlap for CSHCN who have
EBD and functional limitations (11.5 % of the sample have
both conditions), these two variables were entered sepa-
rately with EBD status (Model 3a) and functional limita-
tion (3b). Accessibility factors (insurance coverage and
having a medical home) were added separately to EBD in

Model 4a and to functional limitations in Model 4b.
Chi square tests were conducted to examine associations
between the independent variables and their relationship to
five of the six types of difficulties or delays assessed in the
survey including: eligibility of services; local availability
of services; waiting lists, backlogs or other problems get-
ting appointments; cost-related issues; and access to
information. Because ‘‘other reason’’ lacks specificity with
no further details available in the public dataset, it was
excluded from this analysis. The subset of respondents
included those who reported that they had experienced
difficulties, delays and/or frustrations.
Results
The weighted sample characteristics for CSHCN (Table 1)
consisted of more boys (59.5 %) than girls (40.5 %); racial/
ethnic distribution was more reflective of U.S. population
with 16.5 % Hispanic, 59.4 % Non-Hispanic White,
16.2 % Black, and 7.9 % other race. Few infants (1.5 %)

were identified, while children were represented across age
groups. Roughly 22 % of the sample fell within the lowest
Federal Poverty Level while over a quarter (27.2 %) were
above 400 % FPL. Only 6.7 % of the sample spoke a
language other than English at home. The majority of the
sample’s family structure consisted of two parent families
(57.1 %). With regards to complexity of needs, the sample
consisted of 31.4 % with EBD and 23.5 % with functional
limitations. Slightly more than half of the sample was
privately insured (52.8 %), while 35.5 % received public
insurance and only 3.5 % were uninsured. Forty-three
percent had a medical home.
Overall, 65.4 % of the sample reported that services met
the ease of use criteria. Table 1 shows group level results
with pair-wise Chi square tests that highlight characteris-
tics that showed statistically significant associations with
meeting ease of use criteria. The characteristics that were
negatively associated with meeting ease of use criteria

were male child, Black or Hispanic race/ethnicity, presence
of EBD and/or functional limitations, being at or below
200 % of poverty, speaking a language other than English,
living in a single parent household, and being uninsured.
Chi square results of reasons for failing to meet ease of
use criteria are shown in Table 2. There were differences
across all groups regarding eligibility, with higher rates
reported for boys, Hispanics, older children compared to
younger children, by parents with lower education and
income, in non-English speaking homes, for children with
more complex needs, and lacking insurance or a medical
home. Service availability barriers were associated with
having EBD and/or functional limitations, lower incomes,
single parent or reconstituted families, insurance status,
and not having a medical home. Although waiting lists
were reported as a problem affecting roughly half of all the
children, it was more likely a problem for children with
EBD. The barrier of service costs was associated with

males, older children, those CSHCN with EBD and/or
functional limitations, lower income and without medical
homes. Nearly 78 % of uninsured families indicated that
they had difficulties and delays due to cost. Lack of
information was more often reported for CSHCN who
were: male, non-White, reported to have EBD and/or
123
Table 1 Sample characteristics of CSHCN and bivariate
association of meeting ease of use criteria CSHCN
characteristics (total sample
weighted N = 10,322,416)
Sample characteristics of CSHCN Bivariate association
of meeting ease of use
criteria and CSHCN
characteristics
Sample weighted N Proportion
[95 % CI]

Proportion
[95 % CI]
Gender
Male 6,140,593 59.5 %
[58.6, 60.4]
65.7 %
[64.5, 66.9]
Female 4,181,822 40.5 %
[39.6, 41.4]
64.9 %
[63.5, 66.4]
Race/ethnicity
a. Hispanic
b,c
1,705,390 16.5 %
[15.8, 17.3]
59.3 %
[56.5, 62.0]
b. Non Hispanic White

a,c,d
6,133,799 59.4 %
[58.5, 60.4]
67.9 %
[66.9, 68.8]
c. Non Hispanic Black
a,b
1,673,062 16.2 %
[15.5, 17.0]
64.7 %
[62.0, 67.3]
d. Non Hispanic Other Race
b
810,165 7.9 %
[7.4, 8.4]
61.1 %
[57.6, 64.5]
Age categories
Under 1 year old 149,370 1.5 %

[1.3, 1.7]
70.9 %
[63.5, 77.3]
1–4 years 2,136,993 20.7 %
[19.9, 21.5]
67.2 %
[65.2, 69.2]
5–9 years 3,055,355 29.6 %
[28.8, 30.4]
65.4 %
[63.8, 67.0]
10–14 years 3,552,176 34.4 %
[33.5, 35.3]
64.5 %
[62.8, 66.1]
15 years and above 1,428,522 13.8 %
[13.2, 14.5]
64.3 %

[61.9, 66.6]
Parental education
a. High schoolb 1,127,731 10.9 %
[10.2, 11.7]
62.4 %
[58.8, 66.0]
b. High school
a
2,059,255 19.9 %
[19.2, 20.8]
65.2 %
[62.9, 67.4]
c. [ High school 7,135,431 69.1 %
[68.2, 70.1]
65.9 %
[64.9, 66.9]
Income
a. 0–99 % FPL
c,d
2,283,909 22.1 %

[21.3, 22.9]
59.8 %
[57.7, 61.9]
b. 100–199 % FPL
c,d
2,259,288 21.9 %
[21.1, 22.7]
59.4 %
[57.2, 61.6]
c. 200–399 % FPL
a,b,d
2,966,785 28.7 %
[27.9, 29.6]
65.5 %
[63.9, 67.1]
d. Above 400 % FPL
a,b,c
2,812,434 27.2 %
[26.5, 28.0]
74.7 %

[73.2, 76.0]
Household language
a. English
b
9,628,330 93.3 %
[92.7, 93.8]
66.0 %
[65.1, 66.9]
123
functional limitations, children of parents with lower than a
high school education, lowest poverty level, not living in a
two-parent family, without medical homes, and uninsured
or received public insurance.
There were statistically significant associations between
group characteristics and the mean total number of barriers
reported. The groups of CSHCN whose parents reported

the highest number of barriers were: 10–14 years (1.93
barriers), males (1.92 barriers), Hispanic (2.0 barriers),
reported to have EBD (2.08 barriers) or functional limita-
tions (2.08 barriers), children of parents who had less than
high school education (1.99 barriers), 0–99 % FPL (2.04
Table 1 continued
Sample characteristics of CSHCN Bivariate association
of meeting ease of use
criteria and CSHCN
characteristics
Sample weighted N Proportion
[95 % CI]
Proportion
[95 % CI]
b. Language other than English
a
694,086 6.7 %
[6.2, 7.3]
57.1 %

[52.5, 61.6]
Family structure
a. Two parent family [biological/adopted]
b,c,d
5,803,283 57.1 %
[56.2, 58.1]
69.3 %
[68.2, 70.4]
b. Two parent family [step parents]
a,c
981,395 9.7 %
[9.1, 10.2]
63.3 %
[60.4, 66.2]
c. Single mother
a,b
2,595,517 25.6 %
[24.7, 26.4]
59.1 %

[57.0, 61.1]
d. Other
a
777,679 7.7 %
[7.2, 8.2]
61.9 %
[58.5, 65.3]
Complexity of needs
a. With EBD
b
3,240,878 31.4 %
[30.5, 32.3]
49.7 %
[48.1, 51.4]
b. Without EBD
a
7,081,538 68.6 %
[67.7, 69.5]
72.6 %
[71.5, 73.6]

a. With functional limitations
b
2,423,017 23.5 %
[22.7, 24.3]
47.6 %
[45.6, 49.6]
b. Without functional limitations
a
7,899,399 76.5 %
[75.7, 77.3]
70.8 %
[69.5, 71.8]
Insurance
a. Private only
b,c,d
5,444,499 52.8 %
[51.9, 53.7]
71.9 %
[70.8, 72.9]

b. Public only
a,d
3,657,654 35.5 %
[34.6, 36.4]
60.4 %
[58.7, 62.1]
c. Both private and public
a,d
848,916 8.2 %
[7.7, 8.8]
60.3 %
[56.9, 63.5]
d. Uninsured
a,b,c
358,674 3.5 %
[3.1, 3.9]
30.5 %
[25.7, 35.9]
Medical home
a. Did not have medical home

b
5,883,781 57.0 %
[56.1, 57.9]
53.1 %
[51.8, 54.4]
b. Had medical home
a
4,438,635 43.0 %
[42.1, 43.9]
81.7 %
[80.7, 82.7]
FPL Federal Poverty Level
Superscripts
[a, b, c, d, e]
indicate corresponding pair-wise comparisons that are
significantly different at the 0.05 level
123
Table 2 Chi square tests of factors associated with experiencing

difficulties/delays in services for the sub-sample that reported
one or more
barriers to ease of use criteria
Sub-sample
weighted N
Eligibility Service
availability
Waiting
list
Cost Lack of
information
Mean total
no. of barriers
Gender p .05 p .05 p .05 p .05
Male 2,256,727 32.8 % 33.3 % 50.3 % 44.4 % 26.5 % 1.92
Female 1,579,280 27.8 % 30.5 % 51.6 % 39.8 % 24.1 % 1.80
Race/ethnicity p .001 p .05 p .001
Hispanic 751,456 37.3 % 34.4 % 50.5 % 42.6 % 29.9 % 2.00
Non Hispanic White 2,119,627 26.8 % 31.1 % 49.7 % 43.6 %
22.2 % 1.79
Non Hispanic Black 636,411 35.1 % 31.5 % 51.9 % 39.1 % 28.2

% 1.91
Non Hispanic
Other Race
338,436 32.5 % 35.3 % 57.8 % 42.1 % 31.0 % 2.04
Age categories p .05 p .01 p .001
Under 1 year old 45,397 19.9 % 25.9 % 40.0 % 31.2 % 33.5 %
1.56
1–4 years 752,701 28.4 % 30.6 % 51.9 % 37.1 % 22.9 % 1.77
5–9 years 1,141,955 29.8 % 31.1 % 52.5 % 42.4 % 26.4 % 1.89
10–14 years 1,351,447 34.1 % 34.6 % 48.9 % 44.5 % 25.4 %
1.93
15 years and above 554,429 28.5 % 31.0 % 52.1 % 46.2 % 26.6
% 1.90
Parental education p .05 p .01 p .001
High school 476,351 40.3 % 35.0 % 45.5 % 39.8 % 32.7 % 1.99
High school 763,455 34.6 % 35.4 % 52.1 % 41.3 % 25.9 % 1.93
[High school 2,606,123 27.9 % 30.7 % 51.6 % 43.4 % 24.0 %
1.84
Income p .05 p .05 p .001 p .001 p .001
0–99 % FPL 991,444 37.1 % 38.5 % 52.0 % 39.2 % 32.5 % 2.04
100–199 % FPL 983,503 33.8 % 33.9 % 50.4 % 46.9 % 25.1 %
1.95
200–399 % FPL 1,084,313 28.3 % 29.0 % 49.5 % 48.2 % 22.6
% 1.83

Above 400 % FPL 786,669 22.4 % 26.4 % 52.4 % 33.4 % 21.0
% 1.65
Household language p .05 p .01
English 3,525,273 29.7 % 31.6 % 51.2 % 42.9 % 25.2 % 1.87
Language other than English 320,656 42.1 % 38.0 % 47.6 %
38.0 % 28.8 % 1.97
Family structure p .05 p .05 p .05 p .01
Two parent family [biological/adopted] 1,924,004 27.6 % 30.0
% 50.8 % 42.4 % 23.7 % 1.81
Two parent family [step parents] 379,001 31.2 % 36.8 % 53.6 %
42.1 % 22.5 % 1.92
Single mother 1,147,846 36.0 % 35.2 % 52.3 % 44.7 % 28.5 %
2.01
Other 320,392 31.0 % 28.3 % 46.7 % 37.6 % 28.9 % 1.79
Complexity of needs p .001 p .001 p .001 p .05 p .001 p
.001
With EBD 2,085,344 35.7 % 36.5 % 55.2 % 44.9 % 31.0 % 2.08
Without EBD 1,760,585 26.5 % 28.5 % 47.4 % 40.5 % 20.8 %
1.70
p .01 p .001 p .001 p .05 p .001
With functional limitations 2,492,816 34.1 % 38.4 % 52.6 %
45.9 % 32.3 % 2.08
Without Functional limitations 1,353,114 28.9 % 28.8 % 50.1 %
40.7 % 21.7 % 1.77

Insurance p .05 p .05 p .05 p .05 p .05
Private only 1,573,671 22.9 % 26.3 % 47.9 % 42.5 % 20.3 %
1.67
Public only 1,530,144 34.2 % 36.6 % 55.3 % 37.6 % 31.1 %
2.00
Both private and public 348,609 31.0 % 38.8 % 52.9 % 36.1 %
23.8 % 1.87
Uninsured 264,019 59.8 % 35.0 % 43.9 % 77.8 % 27.8 % 2.45
Medical home p .05 p .05 p .01 p .001 p .001
Did not have medical home 2,856,982 33.6 % 35.2 % 53.8 %
44.1 % 29.0 % 2.00
Had medical home 845,162 19.5 % 21.4 % 42.2 % 37.0 % 10.8
% 1.41
FPL Federal Poverty Level
123
barriers), those speaking language other than English (1.97
barriers), uninsured (2.45barriers) and without a medical
home (2.00 barriers).
Multivariate Analyses
Demographic Correlates

Table 3 shows Hispanic parents were the least likely to
indicate that services met the criteria for ease of use across
models even when adjusting for family demographics,
while disparity diminished for Black CSHCN compared to
the White reference group after adjustment for all demo-
graphic variables, EBD and functional limitation variables
and access measures (Table 3 Models 4a and 4b). In these
final adjusted models (Table 3 Models 4a and 4b), reduced
odds of ‘‘ease of use’’ for girls with special health care
needs (for both EBD and functional limitations) was sta-
tistically significant. Further, families consisting of single
mothers had statistically significantly lower odds of finding
services easy to use across all models presented (OR
range = .745 to .859).
Complexity of Needs
The adjusted odds of CSHCN with EBD receiving services
that met the criteria for ‘‘ease of use’’ was .385 % less than
non-EBD children (Model 3a). Speaking a household lan-

guage other than English was a statistically significant
factor for reduced odds (OR = .782) of meeting the ‘‘ease
of use’’ criteria for CSHCN with functional limitations
(Model 3b).
Access Measures
In the final models (Table 3 Models 4a and 4b), factors
related to access, namely insurance coverage and access to
a medical home, were added into the models examining
CSHCN with EBD, as well as CSHCN with functional
limitations. Being uninsured compared to having private
insurance was associated with statistically significant
decreased odds (OR = .23) of reporting ‘‘ease of use’’ for
both CSHCN with EBD and CSHCN with functional lim-
itations. Families with public insurance also showed
smaller but statistically significant decreased odds of
reporting ‘‘ease of use’’ compared to those with private
insurance (for both EBD and functional limitations). In
contrast, meeting the criteria for ‘‘ease of use’’ of services

was positively associated with having a medical home.
Children, both with EBD and functional limitations, who
did not have a medical home had statistically significant
decreased odds of reporting easy-to-use services that were
similar in magnitude to being uninsured.
Discussion
More refined measures available in the 2009/2010 NS-
CSHCN allow for a nuanced understanding of specific
factors associated with ease of use and identification of
socio-demographic correlates of those factors. The lack of
access to health and community services in this study fell
most heavily on children from Hispanic and minority lan-
guage backgrounds, those in poverty, and those with more
complex conditions. In contrast to analysis with the origi-
nal single question measure [26] there was not a statisti-
cally significant disparity for Black children in adjusted
models. Results highlight family characteristics associated
with encountering problems and types of problems faced.

Such information is helpful for clinicians, policy makers,
and family organizations.
Eligibility for services was a primary factor for all high-
risk groups. Service availability and lackof information were
not as critical for more affluent families with private insur-
ance and a medical home. Being on a waiting list was a
difficulty for parents of children with EBD and/or functional
limitations. Cost was twice as likely to be named as a barrier
for parents of uninsured children compared to those insured.
Implications for Policy and Practice
When over a third of families of CSHCN encounter diffi-
culties, delays and frustrations in obtaining health and
related services, it is clear that the MCHB goal of having
‘‘easy to use’’ systems remains unrealized. In this time of
unprecedented health care reform, it is vital to pay attention
to whether or not these policy changes narrow the persis-
tent financial, organizational and sociocultural barriers that
families experience in accessing services, including the

impact of discrimination and language barriers in navi-
gating complex systems of care.
Inability to access primary and specialty care means
increased reliance on emergency services and increased
likelihood of hospitalization for preventable illness [6].
Such lack of access predisposes minority children and
those with complex problems to higher levels of adult
health consequences, as well as poorer school and career
functioning [7, 28].
Medical Home
A key finding is the protective nature of the medical home,
serving as a clarion call for public policies that promote
medical homes for all children. Although only 43 % of
CSHCN had a medical home, they were much more likely
to have services that were easy to use. Racial/ethnic and
language minority and poor children are less likely to have
123

T
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123
access to a medical home [30]. Yet even with access to a
medical home, racial disparities remain with black CSHCN
continuing to have higher odds of unmet needs compared
to white children [5]. When properly constituted, the
medical home can secure ease of use of health and related
services by creating strong referral networks with trusted
medical specialists and other providers. Emphasis on the
medical home within the Affordable Care Act supports
expansion of the coordination function and by extension
some relief of care coordination burden currently falling
upon families. Well-functioning medical homes incorpo-
rate medical and nonmedical community service referrals

into their standard operation to assure that families can
obtain the optimum benefit from early intervention,
schools, special education, speech, occupational and
physical therapy, counseling and family services, transition
planning and future career assessment.
Practice Recommendations
There is value in providers’ assessing their practices for
difficulties, delays, and/or frustrations, using strategies
such as parent advisory boards, focus groups, and/or peri-
odic parent surveys. Hearing directly from families about
transportation, wait times, practice hours, communication,
and referral pathways can inform the practice team about
how to improve services. Research with Latina mothers
found that the preference for bilingual practitioners was
secondary to the importance of good relationships with
providers and effective communication, whether in English
or Spanish [10]. School nurses and school-based health
centers can play important roles in care coordination and

communication across systems [3]. CSHCN have a dis-
proportionate vulnerability to any weaknesses or frag-
mentation in the systems they rely on [7], thus improving
communication between families, communities, and pro-
viders is essential for optimizing child outcomes.
Approximately one-quarter of families named lack of
information as a factor in experiencing difficulty or delay
in service, highlighting the contribution of up-to-date
information about educational, recreational, vocational,
and transition services in a comprehensible language.
Periodic updates of providers’ community-based resources
directories can help identify cultural brokers in cases
where language and cultural barriers inhibit ease of use.
Family peer support programs can facilitate the sharing of
critical knowledge that helps increase access to services.
A pilot project that tested family facilitators to lead
support groups for families with transition-age youth
showed that parents were effective leaders in sharing

information that empowered parents’ in accessing ser-
vices, while also providing emotional support and a sense
of belonging [16]. In addition, opportunities to meet with
families in similar circumstances may ease the strain of
enduring long wait lists for services, a factor named by
over half of the sample. For CSHCN with more complex
medical needs, the caregiver challenges include providing
care coordination, financial problems, family member
having to leave work, and difficulty accessing nonmedical
services [28]. Results from the 2005–2006 NS-CSHCN
found that 33.1 % of families reported difficulty in
accessing nonmedical services such as early intervention,
child care, vocational education, rehabilitation, and rela-
ted community programs [19]. These are important ser-
vices that can have profound impact on both parental
stress levels and child outcomes.
Many of the difficulties highlighted in this study reside
at the systems level, where essential health benefits should

include the primary care, specialty services, therapies and
mental health services that CSHCN require. Information
about benefits should be available in all languages and
written clearly so that caregivers with low literacy can
understand the services offered and how to obtain them. A
review of the research on use of medical interpreters found
that professional interpreters improved care more than ad
hoc interpreters and that quality of care was comparable for
patients without language barriers [15]. Continuous health
insurance coverage is essential for CSHCN. As the
Affordable Care Act is implemented and is designed to
take over gaps that the Children’s Health Insurance Plan
(CHIP) currently covers, access to benefits will need to be
monitored closely to assess coverage of CSHCN [12].
Limitations
The secondary nature of the data set did not allow us to
consider qualitative experiences in ‘‘ease of use’’ of ser-
vices, especially community-based services. The data are

based on parental self-report, which may be subject to
recall, positivity, or nonresponse bias. It should also be
highlighted that while our study focused on three minority
racial/ethnic groups, these populations are extremely
heterogeneous; therefore, caution should be exercised in
making generalizations that are based on these broad cat-
egories. Changes in the significance levels of racial/ethnic
disparities in ease of use across the logit models likely
reflect small effect sizes that are sensitive to the inclusion
of access variables in those models.
In conclusion, the challenge in the coming years is for
policy makers, clinicians, family-based organizations, and
other agencies to conduct targeted research on the persis-
tent socio-economic, racial/ethnic and linguistic disparities
in service availability. Findings from this study echo those
of other researchers that have indicated that a life course
approach to health and related services for CSHCN might
help minimize poor health outcomes [7, 14]. Essential to

123
this approach is the recognition that children’s health and
functioning are influenced by a myriad of factors including
their families, communities, and the broader system of
services, not simply their health care provider. Efforts to
address barriers for CSHCN so that they receive services
they need during developmentally sensitive periods will
reduce risk for poor outcomes and promote resilience and
healthy development.
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Maternal & Child Health Journal is a copyright of Springer,
2016. All Rights Reserved.
Disparities in Access to Easy-to-Use Services for Children with
Special Health Care NeedsAbstractSignificance
StatementIntroductionBackgroundMethodsData SourceStudy
VariablesDependent VariableIndependent VariablesChild
CharacteristicsFamily Characteristics and Household
DescriptorsComplexity of NeedsAccess
FactorsAnalysesResultsMultivariate AnalysesDemographic
CorrelatesComplexity of NeedsAccess
MeasuresDiscussionImplications for Policy and PracticeMedical
HomePractice RecommendationsLimitationsReferences
1. Citation:
Best, J., Day, L., Ingram, L., Msugrave, B., Rushing, H., &
Schooley, B. (2014).

Comparison of robotic vs. standard surgical procedure on
postoperative nursing
care of women undergoing total abdominal hysterectomy.
MEDSURG Nursing,
23(6), 414-421.
2. Purpose Statement: This study was conducted to determine if
in the postoperative
course there is a difference for women undergoing robotic-
assisted total abdominal
hysterectomy when compared to women undergoing traditional
(open) total abdominal
hysterectomy.
3. Population of interest: Women undergoing total abdominal
hysterectomy
4. Study Variables: Study variables are classified as
independent or dependent; the type of
data is also present. Extraneous factors as also listed below.
a. Independent
i. Type of surgery (robotic vs non-robotic/traditional)
● Nominal
b. Dependent

i. Length of surgery
● Interval/Ratio
ii. Total intraoperative intravenous fluid volume
● Interval/Ratio
iii. Estimated blood loss
● Interval/Ratio
iv. Physiological parameters (blood pressure, pulse, oxygen
saturation)
● Interval/Ratio
v. Pain intensity
● Interval/Ratio
vi. First ambulation
● Ordinal
vii. Length of stay
● Interval/Ratio
viii. Presence of complications
● Nominal
c. Extraneous Factors
i. Age

● Interval/Ratio
ii. Weight
● Interval/Ratio
5. Inclusion/Exclusion Criteria
a. Inclusion
i. Female gender
ii. Total abdominal hysterectomy procedures
iii. Performed between November 1, 2009 to November 30,
2010
iv. Patients from Novant Health Matthews Medical Center
b. Exclusion
i. No exclusion criteria stated in this study
c. Sample Element: One woman who had a total abdominal
hysterectomy at
Novant Health Matthews Medical Center between November 1,
2009 and
November 30, 2010.
6. Operational Population

a. All Women who underwent total abdominal hysterectomy by
either robotic
assistance or traditional open procedures from November 1,
2009 to November
30, 2010 at Novant Health Matthews Medical Center.
b. Validity: Six registered nurses were trained in the data
collection procedure at
Novant Health Matthews Medical Center. Inter-rater reliability
was established by
having several of the trained data collection nurses code each
chart.
c. Impact:
The not so good: This study is not generalizable to patients
outside of Novant
Health Matthews Medical Center as there could be regional
influences that affect
things such as the physician experience or patient length of
stay. The timeframe
for the procedure to have taken place can be a drawback as well
as a benefit. It
prevents us from being able to see advancements through
experience with the
procedures that physicians may have had.

The okay: The time frame for the date of the procedure and
specific type of
surgery narrow down the population to yield results more
applicable to
gynecologic surgery. Additionally, the timeframe of the
procedure also makes the
data more stable, as it gives readers a snapshot of how the lack
of education and
experience among hospital staff with gynecologic robotic
procedures affected
patient care.
7. Sampling Method
a. Random sampling; Convenience sample of medical records.
i. A limitation to this type of sampling occurred because of the
length of
time between the beginning of the project and the completion of
chart
reviews. This was partly due to the need to wait for approval
from the
hospital's overseeing institutional review board for chart
reviews.
However, a strength to this sampling method was it allowed for
a larger

sample size, which produced more accurate results that may be
generalized to this hospital.
8. Study Design
a. Retrospective; Exploratory review of existing medical
records.
9. Method
a. The methodology was adequately covered with the exception
of inclusion and
exclusion criteria for the data being collected, which was
minimal. Data was
obtained from 105 medical records and were recorded on a form
created
specifically for this study. Data analysis was done using the
statistical SPSS 18
software. Descriptive data was used to analyze demographic
data. To determine
significant differences in the length of surgery time, estimated
blood loss, total
intraoperative IV fluid volume, and physiological parameters,
independent t-tests
were performed on the data. Inter-rater reliability was
maintained by have several

of the trained data collection nurses code the same chart.
10. Results
a. Most of the items evaluated were found to have statistical
significance between
the two groups. Those items include length of time spent in the
PACU (p=0.04),
length of hospital stay (p<0.001), estimated blood loss
(p=0.000), and total
intraoperative IV fluids (p=0.000). There was also strong
correlation found
between the type of surgery (robotic or traditional) and the total
intraoperative IV
fluid administration and estimated blood loss. Numerous areas
showed no
statistical significance between the two groups, including age,
weight, blood
pressure within the first 24 hours, pulse rate within the first 24
hours, and
complication types or rates. Pain intensity rates were higher
among patients who
had the traditional (non-robotic) total abdominal hysterectomies
upon admission
to the surgical unit; however, there was no significant

difference in intensity of
pain 24 hours after surgery. The researchers concluded that this
could be due to
the fact that most robotic assisted surgery patients were
discharged before the first
24 hours. Research data was clearly reported through neat
tables, but was
minimally analyzed within the text. Extraneous variables were
not directly
addressed, nor was there discussion on how they were
controlled for. The set p
value was not stated in this study.
11. Discussion
a. The discussion section of this research focused on the
literature review portion.
To a lesser degree, they discussed the findings of this study and
what they mean.
The researchers had appropriate suggestions for future research
studies regarding
analgesic type used postoperatively in robotic assisted
surgeries. Restatement of
the study purpose was clear and helpful in reorienting the
discussion section to the

purpose of the research. There was also discussion about the
need for
perioperative education development as the staff education
program implemented
as a result of this study was both successful and beneficial.
Discussion of the
limitations of this research were adequate and included lack of
consistent
documentation which led to a lack of analysis of certain
variables. Another
limitation discussed in this research was the length of time
between the project's
initiation and the completion of chart review, which could have
skewed the
accuracy of the findings because of increased time for surgeons
to gain experience
in the robotic surgery style. Both positive and negative findings
were addressed in
the discussion section during the discussion of limitations.
Power was not
discussed in this study. Overall the discussion section was well
organized and
appropriately oriented to the research topic.

12. Summary
a. Author’s conclusion: The authors concluded that this
comparison research study
adds to the evidence of potential complications and benefits of
robotic assisted
gynecologic surgery, aiding to bridge the gap of the knowledge
deficit among
perioperative nurses. However, the researchers recommend
further studies be
performed regarding the care and outcomes of patient
undergoing other robotic
surgery.
b. My opinion on conclusion: Overall this research was well
organized. The major
fall back was the lack of discussion of this research study and
the focus being
mostly on the review of the literature. Since this was a
retrospective study, I
would recommend that more prospective studies be performed
regarding the
effects of length of surgery and surgical position on
postoperative plan of care. I
would also recommend further retrospective studies which have

a more
generalizable operational population be conducted. I would not
recommend
changing nursing practice and patient care until further studies
are done.
However, I do feel that this study was a helpful stepping stone
for further research
as well as eliciting further questions on this area in interest. I
agree with the
researchers when they said that this research “adds to the
evidence regarding
potential benefits and complications of robotic-assisted
gynecologic surgery”
(Best, Day, Ingram, Msugrave, Rushing, & Schooley, 2014).
c. Research summary:
“Comparison of robotic vs. standard surgical procedure on
postoperative nursing
care of women undergoing total abdominal hysterectomy” is an
exploratory study
which utilized retrospective chart review of women who
underwent total abdominal
hysterectomy procedures at Novant Health Matthews Medical
Center. This research

added to the current evidence of complications and benefits of
robotic assisted
gynecologic surgery. A need was assessed for this research
based on the observation
of an increase in robotic assisted surgical procedures with little
nursing literature
available regarding care needs of these patients. The researchers
compared the
documented postoperative care for women who underwent both
robotic assisted total
abdominal hysterectomy and traditional total abdominal
hysterectomy between
November 1, 2009 and November 30, 2010. Six trained nurses
evaluated charted
material regarding length of surgery time, estimated blood loss,
total intraoperative
IV fluid volume, and physiological parameters.
Extraneous factors were age and weight, which were evaluated
briefly but found
to have no significant difference between the robotic and non-
robotic group. There
was favorable statistical difference between the groups in
regard to length of time

spent in the PACU (p=0.04), length of hospital stay (p<0.001),
estimated blood loss
(p=0.000), and total intraoperative IV fluids (p=0.000), and
reported pain intensity
rates within the first 24 hours. Conclusion: this comparison
research study adds to the
evidence of potential complications and benefits of robotic
assisted gynecologic
surgery, aiding to bridge the gap of the knowledge deficit
among perioperative
nurses. Further studies are recommended regarding the care and
outcomes of patient
undergoing other types of robotic surgery.
Write the reference citation for the article using APA style –
Formatting of reference MUST be
appropriate for APA Style /5 pts
Identify the Purpose Statement /5 pts
Identify the Population of Interest /5 pts
Identify the Study Variables /5 pts
Classify study variables as Correlational, Independent,
Dependent, or Extraneous; Classify

level of measurement of study variables /15 pts
Identify the Inclusion and Exclusion Criteria and the resulting
sample element (subject)
/10 pts
Identify the operationalized population of interest and critique
validity. /10 pts
Describe the sampling method used and classify it. (ex.
convenience, random or nonrandom, etc)
Discuss the appropriateness and limitations of the sampling
method
/10 pts
Identify the study design and time perspective
/10 pts
Analyze the usefulness/completeness/clarity of the methods
section. (Do you understand what
was done in the study? Are there problems with it?)
/10 pts
Summarize and analyze the results including basic statistics.
(How were the study findings
reported? Were summary statistics reported appropriately and
extraneous variables addressed
and “controlled”? How clear was the reporting?)

/20 pts
Analyze the discussion. Was it in keeping with the reporting of
the finding? Were positive and
negative findings discussed? Was power discussed? Was it
appropriate?
/10 pts
Summarize the author’s conclusion. What they think, not what
you think. /10 pts
Give your informed and reasoned opinion about the conclusion
of the research. Would you
recommend any changes in patient care or nursing practice as a
result of this study?
/10 pts
Summarize the Research /15 pts
Total /150pts

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