Qualitative proposal research regarding ARE DOCTORS SUPPORTIVE OR Thesis

Qualitative proposal research regarding ARE DOCTORS SUPPORTIVE OR OBSTICLES IN QUALITY IMPROVMENT PROGRAM - Thesis Example Physicians often view CQI as a threat to professional autonomy (McLaughlin & Kaluzny, 1990) and are skeptical that a management technique can improve patient outcomes. Structural barriers, including inadequate training (Shortell et al., 1995), longstanding social norms (Mittman, Tonesk, & Jacobson, 1992), and the fact that many physicians are independent providers (Chan & Ho, 1997), can also impede physician involvement in CQI and other changes in health care. Physician involvement in CQI becomes critical as quality improvement initiatives turn from administrative functions (e.g., streamlining outpatient registration) to clinical functions (e.g., increasing adherence to clinical practice guidelines). Unfortunately, traditional approaches to physician behavior change are unlikely to increase physician involvement in CQI. A meta-analysis of 102 studies examining the efficacy of continuing medical education strategies found that our most heavily used interventions, educational materials and conferences, tend to have little impact on physician behavior or patient outcomes in health care (Davis, Thomson, Oxman, & Haynes, 1995). There is growing recognition that the success of interventions may depend in part on individual readiness to change (Armstrong, Reyburn, & Jones, 1996; Cantillon & Jones, 1999; Davis et al., 1995). The transtheoretical model (TTM, also known as the stage model), one of the leading approaches to health behavior change, offers a promising approach to behavior change among health care professionals. The model systematically integrates the following four theoretical concepts central to change: The TTM understands change as progress, over time, through a series of stages: precontemplation, contemplation, preparation, action, and maintenance. Nearly 20 years of research on a variety of health behaviors have identified processes of change that work best in each stage to facilitate progress. This research can serve as a

Wgs Essay Example | Topics and Well Written Essays - 500 words

Wgs - Essay Example AWDF also mobilizes human, material and financial resources in order to foster gender parity in Africa, and to promote the rights of African women. AWDF believes that helping women organizations acquire enough skills, adequate livelihoods, information and the chance to actualize transformatory decisions gives rise to all-inclusive, dynamic and healthy communities (See: http://www.awdf.org/our-work/about). The problems that AWDF seeks to address are oppression of women’s rights, minimal political participation, conflicts, HIV/AIDS prevalence, economic disempowerment of women, and the absence of health and reproductive rights of women. AWDF sees these problems as social challenges as stark manifestation of the position of powerlessness into which patriarchal African societies relegated the womenfolk. In this light, AWDF describes these issues as thematic areas (goals). The failure to democratize has exacerbated women’s problems. Undemocratic governments lack stable mechanisms for the peaceful transfer of power from one regime to another. Political violence readily erupts after elections in Africa, with women suffering the heaviest casualty. Likewise, these governments, because of the absence of checks and balances, suffer a lot of excesses from the executive wing; with corruption, ineptitude and inequitable distribution of resources being prevalent. Women suffer the most in these governments due to the absence of affirmative action (See: http://www.fawe.org/). AWDF identifies itself explicitly as feminist. Nominally, the second initial of the acronym AWDF standing for ‘women’. Secondly, the aim of the organization underscores the restriction of its services to women, since AWDF asserts that its chief intent is funding African women’s organizations. Thirdly, AWDF staff comprises women only. Some of its leaders are Professor Bene Madunagu (Nigeria), Prudence Mabele (South Africa), Dr. Rose Mensah Kutin

Demand-side and Supply-side Policies on Economic Growth Case Study

Demand-side and Supply-side Policies on Economic Growth - Case Study Example These policies are either expansionary (catalyze spending in a recessionary economy) or contractionary (reduce spending in an inflationary economy). Also, supply side policies are those policies employed by the government to increase the country’s productivity hence shifting the aggregate curve outwards. They also are designed to affect an economy’s ability to produce goods and services. They increase the country’s aggregate productivity over time and improve the potential of the economy to produce. These policies are always expansionary with an aim increasing an economy’s production capacity which translates into increased living standards (Sloman, 2006). Demand side policies are further broken down to fiscal and monetary policies. Fiscal policies are those policies that are aimed at bringing changes in the government spending or taxes collected while monetary policies aim at bringing changes to the money supply engineered by the central bank. Expansionar y policies are then defined as those policies designed to stimulate economic growth through changes in real Gross Domestic Product (GDP) and the potential output of the economy (Economics Online, 2013). The policies are characterized and implemented in the demand side by any of the four categories of expenditure i.e. consumption expenditure, investment expenditure, government expenditure, or net export expenditure that constitutes the Gross Domestic Product (GDP). On the supply side, the expansionary policies are designed to add flavor to the capacity of production of the economy through labor policies (education, immigration, retirement), capital accumulation, research and development (seeking technological improvements), or promotion of resource availability. Monetary policies lower rates of interest that accompany an increase in money supply hence affecting investment expenditure. A monetary policy would increase the amount of local currency available in the exchange market which will then weaken the rates of exchange with other currencies. Also, the lower rates of interest will make the economy unattractive to investors when compared to other economies which will lead to a capital overflow resulting in the sale of domestic assets and the currency in the exchange market resulting in an ultimate weak currency. A weaker currency makes exports relatively cheaper to foreign buyers hence will stimulate the demand for the local goods while at the same time imports will be more expensive to domestic buyers leading to a reduced demand for imported goods (Pettinger, 2011). This will result in an increase in Net Export expenditure. In times of large deficits in the budget, fiscal policies tend to be missing from the policy maker’s ideologies. These policies are easy to legislate as they are politically popular and supported. Monetary expansionary policies are ineffective and unpredictable compared monetary contractionary (Sloman, 2006). In a case where the wea k economic growth or high level of unemployment worries the Federal Reserve, the policy will react by increasing bank reserves by open market purchase (where the central bank buys or sells government bonds on the open market to manipulate the short term interest rate and supply of base money in an economy) prompting banks to convert their reserves into loans to their customers.  

Ethical behavior in business Essay Example | Topics and Well Written Essays - 500 words

Ethical behavior in business - Essay Example This incident is a serious matter that should not be treated lightly. To clean up the mess the company has to invest millions of dollars, but the damage caused by the spillage hurt the ecosystem and killed thousands of animals. Big Dirty Oil faces an ethical dilemma in regard to how the firm should approach the problem. This essay includes the view and perspective of three stakeholders: CEO, local fisherman, and the shareholders of the company. The CEO of a company is the person that has the most power within an organization. When a firm faces any controversial situations the CEO must act as the spokesman of the organization. The oil spillage that occurred off the coast of British Columbia and Alaska was a major crisis that had to be attended to immediately. The CEO of the company must find a balance between doing the right thing and maximizing shareholders’ wealth. Maximizing shareholders’ wealth is the goal of all publicly traded companies. In light of the sensitive situation the CEO should have reacted in a different manner. The current position of the CEO is that the incident was a tragedy and he offered two million dollars to aid in the clean up. The proposal of the CEO was outrageous due to the fact that it could cost hundreds of millions of dollars to properly clean up the area. The CEO acted in an unethical manner. Instead of facing up to the problem he dismissed the protests against the company by ca lling the protesters â€Å"the outpourings of Greenies and other fanatics.† The reality was that the company had polluted thousands of square meters of water and killed thousands of fish and wildlife in the region. These creatures no longer had a habitat to live. The stance taken by the CEO was wrong. He cared more about the quarterly profits of the company than about the well being of thousands of animals and hundreds of fishermen that depended on fishing in the region everyday to support their families. The fishermen in

National and International Perspectives on Health (Mental Health Essay

National and International Perspectives on Health (Mental Health Nursing) - Essay Example The symptoms are sometimes responsible for major psychological and social problems especial at work and in relationships. If the disorder is left unattended, it may lead to serious mental conditions that may result into the death of victims. In the U.K for instance, the country has properly established intervention mechanisms that ensure children and other people suffering from this disorder are diagnosed and treated effectively. On the other hand, Sri Lanka has had to battle with this order for a very long time.This has been brought about by the country’s inferior structures and response to these problems and others related to it. Many children that have suffered this condition in Sri Lanka have ended up with serious mental problems compared to the United Kingdom and other countries where there are clearly defined systems and structures to address the problem. This paper examines the prevalence of PTSD and the impacts it has had to children in Sri Lanka and the United Kingdom. It compares how intervention mechanisms have been adopted in the two countries, including the future of mental health nursing as far as PTSD is concerned in the United Kingdom Sri Lanka has been on the path of recovery after having endured a 30 year period of armed conflict that has affected not only the economy of the country, but also has caused serious Post Traumatic Stress Disorders in children and other people in its population (Abeyasinghe 2012, 376). It is estimated that over 100, 000 of the country’s army were involved in various types of direct and indirect combat. The experiences during that time were hostile and pathetic; they included screams from all over, handling decomposing bodies of people among others. The trauma from the war is said to have led to serious psychological problems among the children and adults at large. The Sri Lankan government has responded to the increasing

Position of the Music Industry Prior to Introduction of Internet Essay Example for Free

Position of the Music Industry Prior to Introduction of Internet Essay In the music industry prior to the introduction of internet marketing there were different roles being played by different actors of the market. The usual way a product is prepared for market is to contract the artists. The artists who were the content providers record materials which are either their own or provided to them by other writers. This is clearly depicted in the figure below. Traditional Value Chain in the Music Industry Source: John B. Meisel and Timothy S. Sullivan The recordings will be done on the basis of the contracts entered into with the recording companies. Hence the power and control over the supply of the product remained with the record company. The recording company thus would be regarded as the holder of the major item of value in the supply chain being the exclusive rights over the recorded artists’ content. (Hardaker and Graham, 2001) Most of the part of the distribution is in the hands of the record companies and they also retain the rights to select the suppliers. The distribution and supplier selection is based on the record companies’ perception about the quality of the recording and the music, past reputation of the suppliers and the contract price for the recording. In return for the content in the form of recording, the artist is compensated by the provision of promotions for the recording and its merchandising in connection with the sales there of and the distribution of the content as a saleable commodity – CD for example. It was usual in the traditional music industry that the major record companies have their own distribution channels and businesses. Hence it would become necessary for a retailer to source his music products from different sources. Sometimes the retailer may have to place orders with major record companies and up to 20 other firms from the independent sector. The new releases of music albums or other sales of the record companies are usually handled by the wholesalers. If the retailer would like to follow the wholesaler route then he might have to order through only one wholesaler. The main wholesalers also offer another service called ‘rack jobbing’ which is a different method of supply being adopted by them. The function of a rack jobber includes the supply of complete package that contains records and other promotional and display materials. It is also the duty of the wholesaler to keep a regular stock usually on a sale or exchange basis. Just as the advancement in the telecommunication had its effect on all the other sectors from airline reservations to banking and related financial services the music recording industry has also been severely impacted both positively and negatively observes Eric de Fontenay. In fact the impact of internet on the music industry is much more profound than on any other industries. Despite the fact that the entertainment related products and services have taken their own time to develop and take advantage of the improvements in digital technology over the decades, during the intervening period the overall structure of the industry has remained dormant. The reasons for the industry to remain without major changes can be traced to the following reasons: 1. The cost of creation of content has always remained higher and this prohibited any new entrants in to the industry. 2. The structure of content ownership and rights of licensing system remained unaltered thereby keeping the structure of the industry in tact. 3. There has been a continuous necessity for the presence of a distribution network almost everywhere in the world irrespective of the geographical barriers. This has restricted the existing firms to make any changes in the structure. There was no possibility of new firms entering the market in view of the high capital intensive nature. 4. Similarly there had always been a constant scarcity for the distribution networks which also prevented any new forms of distribution or change in the structure of the distribution networks. (Eric de Fontenay) The internet has affected the music industry in so many ways. It has made the industry incur additional costs in completely restructuring itself. Further the internet has reduced the entry barriers. This was possible by a considerable increase in the number of downstream outlets having varied nature. At the same time the internet has provided the actors in the upstream end to enjoy greater control over the aspects of content ownership, production and distribution. This has created a distinct fear in the record labels that they cannot eliminate the possibility of getting bypassed by both the markets in the downstream and upstream. This impact has created the following reaction on the part of the traditional industry actors. They tried to impose the existing rules and procedures to the new medium so that they could exercise the same leverage and control over the market. The process by which they attempted to do it involves a twin aspects strategic approach. At one end they used legal channels to restrict the availability and use of the new technology in the Industry. On the other end they adopted new technologies to tackle the potential legal threats that would affect the control derived by them from the traditional systems. This strategy backfired and left them high and dry in the market while new information technology players like AOL, Microsoft, E Music and MP3 took advantage of the stalemate. They reacted aggressively by building their infrastructure and systems for the online marketing and distribution of music. They also involved themselves in the retailing of music over internet. The distribution of revenues in the music industry involves the portion of the performer. As per the contract terms the performer is to be paid a portion of the revenue each time there is a sale of the record. Before the money is paid to the performer the revenue is to be apportioned towards the expenses incurred by the company for marketing and distribution. This gives an opportunity for the artists to earn considerable amounts from the sale of products. For gaining maximum revenue the artists should control the publishing rights to their songs or they have the capacity to negotiate contracts with terms that are favourable to the artists. In the case of revenue distribution Internet has its impact on the industry in the following respects.

Concepts in Nursing Research Methods

Concepts in Nursing Research Methods Critique criteria The criteria used for this critique were derived from relevant nursing literature (Feninstein Horwitz, 1997; Cormack, 2000; Khan et al, 2003). About a dozen criteria were specified: design, sample, inclusion/exclusion criteria, time frame of study, data collection, reliability validity, and data analysis. Study Design Catlette (2005) used a qualitative design. While this approach has its merits, principally a greater degree of realism and richer data, it has a number of significant drawbacks (Coolican, 1994). Observations are typically unreliable. In other words, if the same nurses were interviewed on several different occasions, about workplace violence, using the same open-ended interview protocol, their responses may vary somewhat. Various biases creep in, often caused by situational factors (e.g. open-ended questions, a very violent week followed by a particularly calm week), or personal considerations (e.g. memory deficits). Furthermore there is low internal validity. This means that it is difficult to establish with any certainty the relationship between variables, due to the lack of statistical analysis (which can estimate the probability that results occurred by chance). For example, Catlettes interview data suggests a link between workplace violence and feelings of vulnerability amongst n urses. However, the extent to which the former variable causes the latter cannot be reliably established in a qualitative study. Winstanley and Whittington (2004) enjoy the precision of a quantitative design. While internal validity is high, the level of realism is questionable. Participants were ‘forced’ to respond to predetermined questions (e.g. on physical assault) using a fixed response format (e.g. ‘Once’, ‘More than once’). Thus, the data obtained was heavily influenced by the kind of questions asked and the particular response format used. In the real world, health care staff may perceive the level of aggression in terms that don’t match the questionnaire format. For example, a nurse may perceive physical assaults as ‘sporadic’ or ‘once in a blue moon’. Since these categorisations weren’t available in the questionnaire, the study effectively lacks a certain degree of realism. In a qualitative desi gn, subjects describe the world as they see it, rather than via terms imposed by the researcher. Sample Ideally a sample should be randomly selected so that it is representative of the population from which it was drawn, in this case nurses or health care professionals. This allows findings from a single study to be generalised to the wider community. Catlette (2005) used a convenience sample, meaning it wasn’t representative of nurses in general. Granted there are considerable practical and logistic difficulties in trying to recruit a random sample of nurses. Their busy schedules and irregular shifts, for example, hamper proper scientific selection. It is also quite common for small convenience samples to be used in qualitative studies, since it is often impractical to conduct in-depth interviews with large groups. Nevertheless, Catlette’s findings, while relevant to the particular trauma centres involved, are unlikely to apply to nurses in general. This is a serious limitation, since Catlettes stated objectives suggest a general interest in the level of violence in hosp ital emergency departments, rather than the particular trauma units from which subjects were drawn. Winstanley and Whittington (2004) also appear to have a used a convenience sample: they simply invited health care staff working in a general hospital, and who had regular contact with patients, to participate. Although the target sample was quite large (a bigger sample improves representation), only a minority of staff actually completed and returned questionnaires. All in all, participants weren’t recruited randomly, therefore the findings cannot be generalised to the wider population of health care staff. Inclusion/Exclusion Criteria Both studies seemed to have clear inclusion/exclusion criteria. Catlette (2005) only recruited and interviewed nurses who were registered, worked in a level 1 trauma centre, and had experienced workplace violence. A clear definition of what constituted violence was developed, helping to minimise any ambiguities about eligibility. Winstanley and Whittington (2004) also specify inclusion criteria. Only health care staff that had regular and substantial contact with patients were invited to participate. What constituted ‘regular’ and ‘substantial’ contact was well defined (e.g. daily contact with patients). The advantage of having clear inclusion/exclusion criteria is that it helps the researcher recruit a homogenous sample. If the participants in a study are too diverse, this effectively introduces additional sources of error that may obscure interesting themes, or relationships between variables. Findings may be more difficult to interpret. However, a major d isadvantage of a homogenous sample is that it is invariably ‘ad-hoc’, that is special or unique, and hence unlikely to reflect the wider community. Nevertheless, it can be argued that sample homogeneity isn’t problematic if the wider community of interest exactly matches the inclusion/exclusion criteria. For example, Winstanley and Whittington’s (2004) study was about patient aggression towards health care staff. Thus, the population of interest was invariably going to be staff that had regular contact with patients. In this respect the sample selected corresponds with the population of interest. However, randomly selecting nurses from the designate population would have provided a representative sample that permits useful generalisations. Simply using volunteers, as Winstanley and Whittington did is unscientific. Time frame of study Winstanley and Whittington’s (2004) study was effectively a retrospective (i.e. cross-sectional) survey. This means that data was collected at one point in time, specifically an 8-week period. Retrospective designs are considered inferior to prospective (i.e. longitudinal) designs in which data is collected on two or more occasions, over several weeks, months, or even years (Coolican, 2004). This method allows tentative causal inferences to be made – if a variable measured at Time 1 predicts or correlates with a factor measured at Time 2, then there is a possibility that former variable affected the latter, but not vice versa. Retrospective designs don’t allow for such inferences. Any correlations between variables are just that – correlations! There is no sequence that may help delineate possible causality. For example, in their introduction and statements of study aims, Winstanley and Whittington imply that particular professions (e.g. nurses, doctors) a nd hospital departments (e.g. medical, A E) may elicit different levels of physical aggression experienced by staff. Thus, profession/department seemed to be conceptualised as causal factors. However, although data analysis revealed relationships between these factors and physical aggression, there is no provision in the retrospective design to infer causality, since all the variables are measured simultaneously. A prospective method in which profession/department predicts experiences of physical assault several weeks subsequently would be more conclusive. Catlette (2005) doesn’t explicitly state the time frame for her study, albeit interviews typically take several days, weeks, or perhaps months to complete. Notions of prospective and retrospective designs are typically associated with quantitative studies, and rarely applied to qualitative research. This is because qualitative studies are often exploratory, merely seeking to identify interesting phenomena rather than estab lish causal relationships between variables. Nevertheless, interviewing participants on two or more separate occasions can be used to demonstrate the robustness and reliability of any themes observed. For example, if the same themes emerge during interviews conducted at two different points in time, this would suggest that the themes are significant rather than fleeting. Data Collection Catlette (2005) appears to have used semi-structured interviews for data collection (Coolican, 1994). By asking every interviewee pre-set but open-ended questions in a particular sequence, she avoided the inconsistency and sloppiness often associated with wholly unstructured (i.e. casual) interviews. It is possible the interviews were informal but guided, meaning that pre-set questions were asked, albeit in no particular order. Either way, a guided or semi-structured interview suffers from certain constraints. Asking specific questions, albeit open-minded ones, restricts the interviewers flexibility to ask follow-up questions depending on the interviewees response. Interviews are also heavily affected by interpersonal factors, such as lack of rapport, physical attraction, and psychological manipulation. Winstanley and Whittington (2004) collected data via a questionnaire. This method has a number of limitations. One is the typically low response rate. Of 1141 questionnaires posted ou t to participants, only 375 (33%) were returned, denoting a considerable waste of resources. Often the questionnaires returned represent an unusually keen sub-sample that may differ in key respects from the original target group. This means that the researcher has to devote time and resources establishing what these differences are, and how they might affect the results. Furthermore, because the final sample is smaller, statistical power is reduced, increasing the possibility of a type II error. Another limitation of questionnaires is the use of restricted (or ‘forced choice’) response format. For example, subjects in Winstanley and Whittingtons’ (2004) study were forced to choose from three options – ‘none’, ‘one’ or ‘more than one’. Thus, there is no room for participants to qualify their answers, for example by pointing out memory lapses (e.g. ‘I can’t remember’), or indicating ambiguous experie nces (e.g. ‘not sure’). All in all, these restrictions reduce the realism and richness of data collected. Interviewing subjects on the same issues, but using open-ended questions, will probably yield slight different outcomes to those reported by Winstanley and Whittington (2004). Another limitation is that the bulk of questionnaire communication is written. There is no provision to measure visual cues and gestures, which typically account for much of human communication, or even auditory cues. For example, a frown or grunt, may signify a particularly traumatising experiencing, which simply can’t be detected from questionnaire responses. Finally, questionnaires are often completed in the absence of the researcher (e.g. postal questionnaire), making it difficult to supervise the proceedings, or verify whether the subject is the same person who completed the questionnaire. Overall, these constraints negate the conclusiveness of Winstanley and Whittington’s ( 2004) findings. Data Analysis In line with standard procedure in qualitative research Catlette (2005) performed thematic analysis to identify recurring patterns in the data. Meaningful information was extracted from the interview transcripts, after which themes were identified using a coding system. Although a highly useful procedure, Braun and Clarke (2006) note that thematic analysis has certain disadvantages. One is the possible overlap between themes. Catlette identifies two themes – vulnerability and inadequate safety measures. Categories, and subcategories reported suggest considerable overlap between these dimensions (e.g. the sentiment ‘feeling unsafe’ may depict both feelings of vulnerability and an unsafe environment). Another weakness is the high correspondence between the data collection questions (i.e. interview guide) and themes identified. In other words, the themes reported merely reflect the questions asked during the interview (e.g. questions on safety, such as â€Å"How do you feel about the safety of your workplace?† are bound to produce safety-related responses, and hence themes). This suggests very limited analytic work was done to identify themes independent of the interview format. Another shortcoming of thematic analysis is failure to incorporate alternative or contradictive data in the results reported. Catlette offers little if any account of oddities in the data that don’t necessarily fit the two emerging themes. For example, the interviews revealed that violence wasn’t a concern during interactions with co-workers. Clearly this revelation is incompatible with the notion of vulnerability and lack of safety in the workplace. Yet, little is made of this inconsistency, making Catlettes’ rather ‘tidy’ themes appear rather suspicious. Few data sets in qualitative research are completely harmonious with no contradictions, so a study that fails to report these oddities is highly questionable. Winstanley and Wh ittington (2004) employed an inferential statistical test to analysis their data, consistent with the quantitative design of their study. Chi-square was used to test for significant trends in the frequency of physical assaults as a function of different health care professionals (e.g. nurses and doctors) and hospital departments (e.g. medical, surgical, A E). Chi-square was appropriate given that the data was categorical (i.e. in the form of frequencies). However, as a non-parametric test, chi-square lacks sensitivity. This combined with the limitations of frequency data (e.g. it fails to account for subtle degrees of variation between individual subjects or groups; for example, asking nurses if they’ve experienced aggression ‘once’ or ‘more than once’ fails to take into account any differences in the intensity and duration of these aggressive episodes), increases the risk of wrongly accepting the null-hypothesis. Reliability Validity A major methodological concern in scientific research is reliability and validity. Reliability refers to the consistency of observations, while validity depicts the authenticity of observations. Both issues are particularly pertinent in qualitative studies, due to the lack of structure, precision, and quantification. Catlette (2005) appears to have taken steps to enhance reliability/validity. She kept a journal throughout the duration of the study, in order to identify any biases that may corrupt the data. Interviews were conducted using a standard protocol, then the data was transcribed verbatim, and analysed using regular procedures. However, these measures may be inadequate. Coolican (1994) identifies several procedures for ensuring good reliability, none of which appears to have been used by Catlette: triangulation, analysis of negative cases, repetition of research cycle, and participant consultation. Triangulation involves verifying emerging themes using another data collection method other than open-ended interviews. For example a questionnaire measure of perceived workplace violence and safety strategies could have been administered or close-ended interviews conducted. Data from these alternative methods could then be compared with the original observations to gauge the degree of consistency in emerging themes. Analysis of negative cases involves scrutinising cases that don’t fit the emerging themes. Repetition of research cycle entails repeatedly reviewing assumptions and inferences, to further verify emerging themes. Finally participant consultation involves communicating with participants to see if observations from the study match their own experiences. None of these measures seem to have been applied in Catlette’s study, raising serious concerns about the stability and authenticity of her observations. Winstanley and Whittington’s’ (2004) study doesn’t appear to have fared much better. Although the numerical preci sion inherent in quantitative designs offers some degree of reliability and validity, this is by no means guaranteed, and has to be demonstrated empirically. They fail to report any Cronbach Alpha reliability coefficients for the questionnaire used. Thus, it is unclear if the items in this instrument were internally consistent. Test-retest reliability wasn’t reported either, again raising questions about the consistency of participants responses over time. A badly designed questionnaire (e.g. one with ambiguous statements, or grammatical errors) could easily confuse participants, leading to irregularities in their responses over time. No information on validity is provided either. Normally, validity could be demonstrated by correlating data from the questionnaire with data from another measure of experiences of aggression (a high correlation would indicate good validity), submitting the questionnaire to a team of judges to ascertain if the content addresses all forms of human aggression (e.g. indirect forms of aggression, such as spreading rumours or social exclusion don’t appear to have been assessed), and even performing factor analysis to establish construct validity (i.e. verify the dimensions of aggression assumed to be measured by items in the questionnaire). These inadequacies render the findings from Winstanley and Whittington’s (2004) study inconclusive. For example, the claim that aggression is â€Å"widespread† is questionable because not all forms of aggression were measured. Overall, both studies are fairly categorical in their conclusions. Winstanley and Whittington (2004) surmise that their data demonstrates the significant levels of aggression to which hospital staff are exposed. Catlette (2005) reaches a similar conclusion, emphasising the vulnerability and lack of safety perceived by nurses. However, both studies suffer from various analytic and methodological constraints. Perhaps the most serious of these is the apparent absence of reliability and validity measures that may reveal any volatility or misrepresentations in the data. These limitations mean that any conclusions have to be regarded as tentative, subject to further research. Bibliography Braun, V. Clarke, V. (2006) Using thematic analysis in psychology. Qualitative  Research in Psychology, 3, pp.77-101. Catlette, M. (2005) A descriptive study of the perceptions of workplace violence and  safety strategies of nurses working in Level I trauma centres. Journal of  Emergency Nursing, 31, 519-525. Coolican, H. (1994) Research Methods and Statistics in Psychology, London, Hodder   Stoughton. Cormack, D. (2000) The Research Process in Nursing: Fourth Edition. London:  Blackwell Science. Eastabrooks, C.A. (1998) Will evidence-based nursing practice make practice perfect.  Canadian Journal of Nursing Research. 30, pp.15-36. Feninstein, A. R., Horwitz, R. I. (1997) Problems in the evidence of evidence-based medicine. American Journal of Medicine 103, 529-535. Khan, K., Kunz, R., Kleijnen, J. Antes, G. (2003) Systematic Reviews to Support  Evidence-based Medicine: How to Review and Apply Findings of Healthcare  Research. Oxford: Royal Society of Medicine Press. Winstanley, S. Whittington, R. (2004) Aggression towards health care staff in a UK  general hospital: variation among professions and departments. Journal of  Clinical Nursing, 13, pp.3-10.