N415 Module 1 The Research Process Traced Through One Study Example

Why Is There Water in the Bottle? Following the Research Process Through a Survey of Nurses on Humidifying Low-Flow Oxygen

Student Name

Pre-licensure BSN Program, Aspen University

N415: Research / Evidence-Based Practices

Instructor Name

Month Day, Year

Why Is There Water in the Bottle? Following the Research Process Through a Survey of Nurses on Humidifying Low-Flow Oxygen

On my first shift on a medical unit, I noticed that every patient receiving oxygen through a nasal cannula at 2 or 3 liters a minute had a plastic bottle of sterile water bubbling on the flowmeter. When I asked why, a nurse said the water keeps the nose from drying out, and a respiratory therapist said she was not sure it did. That disagreement is a research question in plain clothes. This paper follows the steps of the research process through one published study on the problem, a survey of nurses' knowledge, attitudes and practices about low-flow oxygen and humidification (Tang et al., 2024), to show how a clinical question becomes findings a unit can weigh.

From a Clinical Problem to a Research Purpose

Every study begins with a problem and a purpose (Polit & Beck, 2021). Tang et al. (2024) started from a practical problem: nurses set up and manage most low-flow oxygen in hospitals, yet little was known about what they understood about humidifying it. Their stated aim was to investigate nurses' knowledge, attitudes and practices regarding low-flow oxygen therapy and humidification, and a second aim followed from the analysis, to identify which factors were linked with better practice. The purpose was descriptive and correlational rather than experimental. The authors were not testing whether dry oxygen harms patients; they were asking what nurses know and do, which is a different and earlier question.

Literature Review and Framework

The authors grounded the problem in earlier evidence, including a meta-analysis concluding that routine humidification of low-flow oxygen is not justified and that dry oxygen reduced contamination of humidifier bottles without a measurable loss of comfort (Wen et al., 2017). That review is what makes the question worth asking: if the evidence points one way and practice goes another, the gap may lie in what clinicians know. The study used the knowledge, attitude and practice model as its framework. The model assumes that knowledge shapes attitudes and that both shape behavior, and it gave the authors both their three questionnaire sections and the paths they later tested.

Design, Setting and Sample

Tang and colleagues surveyed the nursing staff of a single hospital in Shanghai between January and March 2024, a cross-sectional design. A cross-sectional design captures a group at one point in time, which suits a question about current knowledge but cannot show that training causes better practice. The authors calculated a minimum sample of 165, five to twenty times the 33 questionnaire items, and raised it to 207 to allow for non-response. They received 399 responses. Four were completed in under 60 seconds, one respondent declined, and 151 failed built-in trap questions, leaving 243 valid questionnaires. Most respondents were women (93.8%), 38.3% had worked more than 10 years, and 76.1% said they used humidification equipment in their daily practice.

Measurement and Instrument Testing

The questionnaire was written from guidelines and published studies and reviewed by one respiratory expert and three nursing experts. Its testing is the most instructive part of the study for a new reader of research. In the first small pilot, the knowledge section produced a Cronbach's alpha of -0.244, which means its items did not hang together at all, so the authors rebuilt that section to ask how familiar nurses were with key statements rather than asking them to pick correct answers. After a second pilot, the revised instrument reached an alpha of 0.868, and in the final sample the whole questionnaire reached 0.905. The final version had nine demographic items and seven items each for attitude and practice, plus the rebuilt knowledge section.

Ethical Protections

The hospital's ethics committee approved the study, participants gave written informed consent, and the electronic questionnaire was anonymous, limited to one submission per device and completed through a code on the participant's phone. Because the questions asked about the respondents' own practice, anonymity mattered: a nurse admitting that she does not know why the bottle is there needs to trust that her manager will not see the answer.

Data Collection and Analysis

Data were analyzed with standard statistical software. Scores were described with means and standard deviations, and differences between groups were tested with t tests or nonparametric tests depending on the distribution. Spearman correlation examined links among knowledge, attitudes and practices. Practice scores were then split at 70% of the possible total, and logistic regression tested which factors predicted proactive practice. Finally, structural equation modeling tested the paths the framework proposed, from training and experience to knowledge, from knowledge to attitudes, and from both to practice.

Findings

Mean scores were 11.11 for knowledge, 29.14 of a possible 35 for attitudes and 28.07 of 35 for practice. The authors described knowledge as inadequate and practice as inactive despite positive attitudes. In the regression model, each additional knowledge point was associated with higher odds of proactive practice (odds ratio 1.302) and so was each attitude point (odds ratio 1.196). Nurses who had received training in low-flow oxygen therapy, 63% of the sample, scored higher on all three scales, and the path analysis supported direct effects of training and clinical experience on knowledge (Tang et al., 2024).

What the Findings Can and Cannot Tell a Unit

The study shows that a large group of hospital nurses used humidifiers routinely and understood the evidence poorly, and that training went with better knowledge. It cannot show that training caused the difference, because the data came from one moment, and it cannot say anything about patients' comfort, since no patient was studied. The sample came from one hospital in a country where humidifying all oxygen has been customary (Wen et al., 2017), and nearly four in ten responses were discarded, which may have removed the least engaged nurses and made the remaining scores look better. For my unit, the study's value is that it makes the next question sharper: not what nurses believe, but what happens to patients when the bottle is removed.

Conclusion

Traced step by step, one modest survey shows the whole research process: a practical problem, a purpose, a framework drawn from the literature, a design matched to the question, a sample with a calculated target, an instrument that failed and was repaired, ethical safeguards, an analysis plan and findings stated with their limits. It also shows why a nurse cannot stop at one study. The survey explains why the bottle stays on the flowmeter; deciding whether it should stay requires trials and reviews that measure what patients feel.

References

Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

Tang, N., Li, H., Zhang, J., Ling, H., Shi, L., Zhang, H., Guo, Q., & Yu, R. (2024). Nurses' knowledge, attitude, and practice of low-flow oxygen therapy and humidification. Frontiers in Medicine, 11, Article 1460079. https://doi.org/10.3389/fmed.2024.1460079

Wen, Z., Wang, W., Zhang, H., Wu, C., Ding, J., & Shen, M. (2017). Is humidified better than non-humidified low-flow oxygen therapy? A systematic review and meta-analysis. Journal of Advanced Nursing, 73(11), 2522-2533. https://doi.org/10.1111/jan.13323