NUR 028 (Nursing Research 2-Lecture)

STUDENT ACTIVITY SHEET BS NURSING/THIRD YEAR

Session # 9

Materials:
LESSON TITLE: THREATS TO INTERNAL AND EXTERNAL Book, pen and notebook
VALIDITY
Textbook:
LEARNING OUTCOME: Barrientos-Tan, C. (2011). A Research Guide in
Upon completion of this lesson, the nursing student will be able Nursing Education: Building an Evidence-Based
to: Practice. Pasay City: Philippines, Visprint Inc.

1. Discuss internal and external threats to validity.

References:
Polit, Denise F. & Beck, Cheryl T. (2012). Nursing
research: Generating and assessing evidence for
nursing research (9th ed.), Philadelphia, PA:
Wolters Kluwer Health/ Lippincott Williams &
Wilkins.

LESSON REVIEW (5 minutes)

The instructor will open a box of rolled papers with your’ assigned numbers. The students whose numbers will be picked
by the instructor will answer one of the following questions:
1. What is the difference between sensitivity and specificity?
2. How are true positives and true negatives computed?

MAIN LESSON (30 minutes)

Internal Validity
This means the degree to which changes in the dependent variable (effects) can be attributed to the independent
variable (cause).

Threats to Internal Validity

a. Selection Bias
This exists when study results are attributed to the experimental treatment, when in fact results are due to
differences among the subjects even before the treatment.

Example:
In a study which aims to help people stop smoking using a “smoking cessation intervention (SCI),” (new
treatment) there were 20 volunteers who offered to stop smoking, (experimental group), and 20 volunteers
who refused to stop smoking (control group). However, the experimental group may have been motivated to
stop smoking even before the treatment started, hence, the selection process may have a biased effect on
the results of the study.

b. History
This occurs when some events besides the experimental treatment takes place during the course of the study
and affects or influences the dependent variable.

Example:

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 The incidence of prenatal training among pregnant women after 2 weeks of teaching program, but during the
teaching process, an article is published on the rise of maternal complications. This “history” factor could
result in the increased incidence of prenatal training among pregnant women.

c. Maturation
This take place when changes within the subjects occur during the experimental study thus may influence
study results.

Example:
The subjects may have gained in height and weight at the time when the pre-test and the post-test were being
administered. If the nurse is interested in gain in weight and height of malnourished children, she will keep in
mind that change in their size may occur during the treatment of course of the study.

d. Testing
Possible testing threat in studies in which a pre-test is a requisite. This refers to the influence of the pre-test,
which already projects the result of the post-test scores.

Example:
Test Scores of the actual study subjects may be altered in the post-test as a result of their knowledge of the
pre-test results.

e. Instrumentation Change
The existence of a difference between pre-test and post test results caused by change in the accuracy of the
instrument of the ratings, rather than the results of the experimental treatment.

Example:
A change or breakdown of a mechanical instrument such as the sphygmomanometer used in taking the blood
pressure affects the accuracy of reading throughout the study.

f. Mortality
This happens when a difference exists between the subject dropout rates of either the experimental group
and the control group.

Example:
If a large experimental group or control group scored very low in a pre-test, some of the subjects may have
dropped out of the study. Thus, the average scores in the post-test of either the experimental group or control
group would be correspondingly low.

External Validity
This is the degree to which study results can be influenced or affected by external factors or populations and settings.

Threats to external validity

a. Hawthorne Effect
Hawthorne effect occurs when study participants respond in a particular manner, or there is obvious change
of behaviour because they are aware that they are being observed.

Dealing with this problem is handled by having a control group that is subject to the same conditions as the
treatment group, then administering a placebo to the control group.

The study is termed a blind experiment when the subject does not know whether he or she is receiving the
treatment or a placebo.

Example:
A student nurse applies correct techniques in doing nursing procedures while the researcher observes her.

b. Experimenter Effect
This refers to a threat to the study which results when the researcher’s behaviour influences the behaviour of
the subjects, such as the researcher’s facial expression, gender and clothing among others.

c. Reactive Effect of the Pre-Test

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 This occurs when the subjects have been sensitized to the treatment by taking the pre-test and thereafter
influence the post-test results.

d. Halo Effect
This is the tendency of the researcher to rate the subject high or low because of the impression he has on the
latter.

Example:
A student nurse known to be intelligent is exempted in taking the post test. The teacher with that impression
will give the students the highest score.

For the researcher to minimize threats to external validity, the double blind method may be used to remove
the observer’s bias. This means that neither the subject nor the observer knows the specific research
objective or the specific subjects who belong to the experimental or control group. Hence, the observer
cannot distort the data.

If the double blind method is not feasible, the double observer method may be used to determine the extent
of bias between the two observers as they both observe and record the subjects’ performance on a
dependent variable.

CHECK FOR UNDERSTANDING (15 minutes)

Short Quiz. You are to read and analyze the questions carefully then write your answer in CAPITAL letters only. Erasures
and superimpositions will be marked wrong. (10 points)

1. A researcher made known to the subjects that they are under observation. This may result to:
a. Experimenter effect
b. Halo effect
c. Hawthorne effect
d. Reactive effect

ANSWER: ________

2. A study was conducted on the level of skills in DR among level 2 students. Two of the students are on the dean’s
list. The researchers are fully aware of this and they assume that these students are skillful in DR, a threat to
external validity called:
a. Experimenter effect
b. Halo effect
c. Hawthorne effect
d. Reactive effect

ANSWER: ________

Situation: Researcher B is scheduled for a 6- month data gathering in the dialysis department for a clinical trial of a new
medication for CKD. He had started the clinical trial 3 months ago. Due to the pandemic however, some dialysis clients
were not able to participate because of the community quarantine imposed by the government.

3. If the clients will continue with the clinical trial after two months, there can be changes in their body which can be
brought about by the stress in the pandemic, a threat to validity called:
a. History
b. Maturation
c. Mortality
d. Selection bias

ANSWER: ________

4. When the CKD participants believe that the gentle demeanor and smile of the researchers have a therapeutic
effect on their condition, it can be assumed that this is a:
a. Experimenter effect
b. Instrumentation change

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 c. Hawthorne effect
d. Reactive effect

ANSWER: ________

5. Due to the influx of dialysis patients after the extreme community quarantine, there was an influx of clients in the
dialysis ward. As a result, the breakdown of two hemodialysis machines may cause:
a. Experimenter effect
b. Instrumentation change
c. Hawthorne effect
d. Selection bias

ANSWER: ________

6. Some of the clients lose their motivation and are not willing to continue as subjects in the study because of
unavailability of transportation and challenging financial obligations. This is called:
a. Mortality
b. Maturation
c. Selection bias
d. Reactive effect

ANSWER: ________

7. The degree to which study results can be generalized to other settings or samples
a. External Validity
b. Internal Validity
c. Construct Validity
d. None of the above

ANSWER: ________

8. This is the degree to which study results can be influenced or affected by external factors or populations and
settings.
a. External Validity
b. Internal Validity
c. Construct Validity
d. None of the above

ANSWER: ________

9. To prevent the hawthorne effect, the participants do not know whether he or she is receiving the new drug for
CKD. This is a:
a. Blind study
b. Double blind study
c. Double observer study
d. None of the above

ANSWER: ________

10. It is a study when neither the doctor observer nor the client subject knows the specific research objective or the
specific subjects who belong to the experimental or control group.
a. Blind study
b. Double blind study
c. Double observer study
d. None of the above

ANSWER: ________

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RATIONALIZATION ACTIVITY
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to
discuss among their classmates.

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LESSON WRAP-UP (10 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: Microlecture

The teacher will ask you to choose and recite an outcome sentence. The following are the outcome sentences:

I learned………

I was surprised…….

I’m beginning to wonder……..

I rediscovered……………..

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