Correlation, Association and Causation…Is It Time for a Review?

correlationWhen I returned to higher education for my Master’s Degree, my end point was to become credentialed so I could begin my dream job as an inpatient nurse practitioner. This was a new role in 1993 and I will admit that as a single woman who  could afford only one year away from the paycheck, I was committed to getting in and out of my Master’s courses at Boston College quickly and efficiently. In particular, I had no aptitude or desire to become a researcher. My mind was clear that I would go through the “hoops” of the beginning research course (mandatory) and then “never do research again.”  I can hear your laughter now….

So, on day one of my Master’s year, I entered Research 101 for Nurses; thoroughly prepared to hate it, pretty sure I might not pass it, and very clear that it was not pertinent to my clinical life. (Yes, one can be quite naïve, even at age 35). Amazingly, I entered a classroom taught by the most wonderful teacher of my entire academic life (I’m including grade school here too). I’ve long forgotten her name but I’ll never forget her. She taught me to love and appreciate the science of science. For 18 rapid weeks, she taught a basic exercise. Each week we were given a nursing research paper to read and then in each class, we reviewed it and discussed the paper’s merits. She, of course, chose increasingly complex papers with a variety of study designs and writing skills. Some papers were good, some terrible, some stated what they did not find, some overstated conclusions….you get the idea. Our class thrived! It sounds so naïve to admit, but we were empowered to realize that just because the researchers said it, it might not be true…because of design flaw, overreaching results, and other errors, glaring and subtle.

Our professor also taught us to appreciate that while we may not be researchers, we were intelligent…and that research should not be sloppy, unreadable, or beyond our understanding. It was up to the writer to tell us what their question was, what was known about it, explain the study design, tell us how they did it, discuss their results against their question and draw some conclusions based on what they found. She demystified the process and actually taught us to critically analyze what we read….or as my Mother said, “Don’t automatically believe everything you read”. The fact that the reader of research had a responsibility in the process changed us from observers to participants. An amazing teacher with an amazing gift.

So, research became very relevant in my clinical role and subsequent professional life….if, for no other reason, than for me to critically read research and analyze its credibility. Since entering the field of obesity care, this analysis has become increasingly important. I’m not sure if is the weight bias/discrimination inherent in the specialty or the infancy of our understanding of the causes and biology of obesity…but often the “studies” that “prove” some aspect of obesity do not pass the rigor that I was taught in Research 101. Popular press articles and studies presented at conferences and professional journals that conclude association or correlation are often misinterpreted as evidence of causation.

With the flood of open access predatory publications, this issue has moved to the forefront in my mind. These journals, with their non-existent or shoddy peer reviews processes, lack of editing and oversight, and an emphasis of meeting the needs of authors, not readers, are publishing flawed articles. On a continuum these papers range from  poorly done, uninspired studies that couldn’t find a legitimate publication home, to deeply deceptive junk science reporting results that have the potential for real patient harm.

So, my thought is that it may be timely to review basic research principles at conferences, journals, and classrooms….sincerely. It has been a long time for many of us since Research 101. With so much information bombarding us daily through so many mediums, it is easy to just skim the headlines or read the conclusion of the paper. An emphasis on critical analysis of research (or what is presented as research) might remind us and our readers to take a moment to read the fine print.

 

Centers of Excellence in Nursing Education

National League for Nursing Announces New Centers of Excellence™

Selected Schools to Be Recognized During 2011 NLN Education Summit

New York, NY — July 27, 2011 — Eight schools of nursing, representing programs across the academic spectrum, have been chosen NLN Centers of Excellence, the League has announced. These schools will be formally recognized at a special presentation on Friday, September 23 at 9:00 am at the NLN’s annual Education Summit in Orlando, FL. The four-day gathering every year draws a capacity crowd of nurse faculty, deans, administrators, and professionals from allied health organizations. The COE presentation will directly follow the NLN CEO Summit Address at 8:30 am.”Schools work hard to earn the coveted COE designation,” said NLN CEO Beverly Malone, PhD, RN, FAAN. “What we seek are measurable results and best practices, and the NLN is pleased to publicly name those schools that have demonstrated their understanding of excellence in the concrete terms that the COE application demands.” Schools may earn COE status in one of three categories: Enhancing Student Learning and Professional Development; Promoting the Pedagogical Expertise of Faculty; or Enhancing the Science of Nursing Education.

Six of this year’s eight schools are repeat COE designees, with two—Excelsior College in Albany, NY and University of North Carolina at Greensboro—earning their third consecutive COE designation. This has entitled them to now carry the COE designation for an additional year, from 2011 to 2016. (COE schools are now designated for a four-year period; until 2011, the initial designation was for three years.) Excelsior has been chosen in the category of Enhancing Student Learning and Professional Development, UNC-Greensboro in Promoting the Pedagogical Expertise of Faculty.

The other four repeat Centers of Excellence are currently completing their initial term, all for Enhancing Student Learning and Professional Development. Duquesne University (Pittsburgh, PA); East Carolina University (Greenville, NC); Regis College (Weston, MA); and Trinitas School of Nursing (Elizabeth, NJ) will carry the designation from 2011-2015.

First-time designees Collin College (McKinney, TX), for Enhancing Student Learning and Professional Development, and University of Connecticut (Storrs, CT), for Promoting the Pedagogical Expertise of Faculty, have been named Centers of Excellence for the 2011-2015 term.

Each year since 2004, the NLN has invited nursing schools to apply for COE status, based on their ability to demonstrate sustained excellence in faculty development, nursing education research, or student learning and professional development. Schools must also have a proven commitment to continuous quality improvement.

Throughout the four or more years that schools carry the COE designation, they are expected to serve as advisers and sounding boards to other nursing programs that seek to gain COE distinction. “The COE banner carries with it a responsibility to the entire academic community,” noted Cathleen Shultz, PhD, RN, CNE, FAAN, president of the NLN. “We expect that COE schools will help educate and inspire others, thus elevating the standards of excellence throughout all levels of higher education in nursing.”

Also, each year, students enrolled in COE schools have an opportunity to share their thoughts on the meaning of excellence in nursing education, what fosters excellence, and what it means to them to be part of a COE-designated nursing program. As in years past, the winner of the Student Excellence Paper Competition will be announced at the COE presentation. She is Tuesday Majors from Indiana University School of Nursing. Her winning submission is entitled “Excellence in Nursing Education.”

Seven Decades of Service to Rural and Medically Underserved Families: New Frontier Nursing University Name Becomes Official

HYDEN, Ky., July 6, 2011 /PRNewswire/ — Providing compassionate care for women and families in rural and medically underserved areas for more than 70 years, students and graduates of the Frontier School of Midwifery and Family Nursing have garnered national recognition for their dedication to Frontier’s mission. Proudly, the school has now officially become Frontier Nursing University as of July 1, 2011.

This nationally recognized institution traces its humble beginnings and commitment to service to Mary Breckinridge, a visionary and trailblazing woman who, in 1925, established the Frontier Nursing Service, traveling on horseback through the hills of Eastern Kentucky to serve as a nurse-midwife for mothers during childbirth. Established in 1939, the school was an outgrowth of Mrs. Breckinridge’s dedication, offering the country’s first rural-based nurse-midwifery education program. Over the course of the ensuing decades, students and graduates have expanded her legacy of care by providing health services to women and families in rural communities around the world. In 1970, the school created the first family nurse practitioner program in the United States, and in 2005, the women’s health care nurse practitioner program was added.

Today, Frontier’s educational programs are recognized for their excellence not only across America, but also worldwide. Close to 1,100 students from all 50 states and several foreign countries are enrolled in either Frontier’s Doctor of Nursing Practice or Master of Science in Nursing degree programs, which combine superb online course offerings and real-world practicum.

Dr. Susan Stone, DNSc, CNM, FACNM, President and Dean

Dr. Susan Stone, Frontier’s visionary President and Dean and a certified nurse-midwife, explained: “This new name represents a milestone in the history of our institution: we are a University recognized for our outstanding graduate degree programs, both domestically and worldwide. We’ve just been honored by US News and World Report as being within the top 15 of nurse-midwifery and family nurse practitioner programs in the USA and ranked within the top 50 on their list of graduate schools of nursing nationwide.

“The evolution of the name of our institution reflects both the amazing ‘chronicle’ of our past, as well as the incredible opportunities that lie in our future. All of these milestones are directly attributable to the vision of Mary Breckinridge, the dedication of our board, faculty and staff, and to the increasing worldwide demand for educated women’s and family healthcare professionals.  Combining the Frontier Nursing heritage with our academic excellence as a University, we will more appropriately define the status of our unique institution. As we continue to educate nurses to become nurse-midwives and nurse practitioners, we will fulfill our mission to serve rural and medically underserved communities, while reinforcing our commitment to prepare nurses and midwives for advanced practice both domestically and internationally.”

Click here to learn more about the name change and the mission and purpose of Frontier Nursing University.