Nursing Critique Comparison of the

SAMPLE EXCERPT:

The source of information was general health status determining survey, not one formulated to extract data on suicidal behavior. There was only one specific question pertaining to suicide," have you attempted to kill yourself in the past 12 months?" This is perhaps too limited. It precludes those individuals who may have attempted it before that period, and those who may have tried just inflicting harm to themselves, or had suicidal thoughts. Thus it ignores the potential cases of attempted suicide.

Hypothesis

The Resilience Model is a reliable means of evaluating the effects of the interaction between sociocontextual factors, risky behavior and protective mechanisms on attempted suicides in adolescents from different ethnic backgrounds. Using the logistic regression method to compare variables means of intervention that are culturally sensitive and that focus on protective mechanisms such as religion, and social activities can be employed.

Definition of Terms

The ability of some adolescents to thrive despite adverse conditions and others to attempt self-harmful behavior as a measure of resilience. Conceptually this was defined as an interaction between risk factors such as physical and sexual abuse, depression, history of suicide attempts in the family or social circle and protective mechanisms such as spiritual and social values. Combined with internal factors such as depression and stress all these factors form a youth resilience model that defines the concept on which suicide preventative strategy could be based.

This concept can be further defined using reliability factors such as Cronbach's alpha and logistical regression to measure the validity and exact extent to which these variables affect suicide attempts. Using these methods to measure reliability and validity of the results an operational definition can be given to the resilience concept.

Research Design

This study was a secondary analysis of previously collected data in the form of a self-administered survey encompassing 10,059 students in public schools across Connecticut. The questions on the survey had been obtained from previous research and from another health survey conducted in Minnesota. [Rew et al., 2001] The items were designed to evaluate adolescent health needs and identify risky behavior and protective mechanisms. This design was at risk of validity due to possible ambiguity of the items, interaction of the variables, inadequate operationalization of the factors involved, and due to the fact that the subjects were self-selected.

Setting

The survey was taken in more than 50 public schools across five geographic service delivery areas of Connecticut in1996. [Rew et al., 2001] The setting encompassed five socioeconomic strata but was limited in geography to one state only and thus also the social environment is limited. The study variables can thus be externally affected.

Population and Sample

The population surveyed was 7th, 9th, and 11th grade public school students belonging to Caucasian, Black American, and Hispanic Latino minorities only. Individuals were chosen by stratified random sampling, which is a method by which subjects are chosen from different sub-groups of a certain population at random. This particular sample was adequate in size consisting of over 10,000 students. Both girls and boys were included, and the population as a whole supposedly consisted of an average group of adolescents in America. However many ethnic minorities were missed and if percentages per population are being considered this could be a significant exclusion and lead to sample bias. The language used in the survey may have influenced the response and the sensitive nature of the questions may have led to a lack of response both factors causing the sample to be biased.

Since the study was to compare adolescent suicide rates in different ethnic groups thus the stratified sample method had the advantage of testing American adolescents yet categorizing them according to race and gender. Thus both the adolescent population and sub-population are assessed at the same time for the effect of the resilience model variables on their attempts at suicide.

This was a survey that retained the anonymity of the subjects and there was no compulsion to answer all the questions as seen by the fact that some data is incomplete for e.g. In questions of physical and sexual abuse. The subjects were randomly chosen and not specifically isolated for certain characteristics that may have been personally embarrassing such as choosing students suspected of; having behavior disturbances, abusive backgrounds, or groups with a higher tendency towards suicide such as gays and lesbians. This protected their right to privacy.

All data was analyzed using the same techniques and the test questions were uniform for all students, formulated at a basic 6th grade level so they would not be misunderstood by any and even translated versions available in Spanish.

Data Collection Methods

The survey was self administered, cross-sectional (attempted once only), multi-variate and conducted on students in classrooms of various public schools in Connecticut in 1996. [Rew et al., 2001] It consisted of questions to evaluate the health status and risk and protective factors related to adolescents. It was a good way of collecting a large amount of information, serious and often personal by retaining anonymity and simplicity. It is made vulnerable however by the possibility of non-response due to inability to answer from lack of comprehension, or unwillingness to respond.

Data collection Instruments

The survey was composed of 225 questions formulated by a statewide advisory body to assess adolescent health needs and risk and protective factors.. [Rew et al., 2001] The questions also attempted to assess the influence of various factors related to the resilience concept on attempted suicide rates. Different variables were measured by previously identified items on the survey and assigned operational significance and analyzed according to subscale reliability using the Cronbach alph method. Keeping the survey in simple, 6th grade level English, providing Spanish translations, and asking questions that could obtain sensitive information indirectly helped reduce the chances of error due to no response, and as the results for the logistic regression of the variables shows support for the resilience method. Logistic regression allows flexibility, prediction of probability for each case, and forming discrete predictions from variables that may be discrete, continuous, dichotomous or mixed. It was thus an ideal method of analysis for this particular study.

Data Analysis

The information gathered was presented in the form of text and also in tables. The questions of percentage of attempted suicides and their comparison in different ethnic backgrounds and gender were answered using both. The variables involved and the interaction and influence of each on the attempted suicide rate and each other was also described and evaluated using tables and reliability factors.

Conclusions were formed on the basis of each piece of data described.

Discussion of Findings

Some of the findings of this study reinforced previous research but other figures gave new insight into future approaches to the problem of attempted suicide. It was found that female had the highest rate of suicide attempts, the same as previous studies but also was discovered that it was the Hispanic Latino girls that were at greatest risk.. [Rew et al., 2001] This could be sample bias but there was a significant disparity in the results so as to make further investigation necessary. The large percentage of sexual abuse in this group is also a possible influential factor that needs to be explored.

The lowest attempted suicide rates in Caucasian males and the significantly disparate figures for Black American males in this study and previous ones are also highlighted.. [Rew et al., 2001].

Examination of variable statistical significance showed that the correlations between risk and protective factors supported the resilience model but that this was mostly due to the large sample size and not strong relationships. The discussion also emphasizes the fact that all previous research on the effects of connectedness, religion, social support as protective mechanisms was further collaborated with the results of the survey. Sexual and physical abuse, depression, attempted suicides amongst family or friends were proven once again to be significant risk factors. The study identifies the groups at risk in the adolescent population and advocates the use of this data to form interventional approaches that would target the encouragement of religious and social activity along with early detection of stress and depression in these youngsters to provide mental health care. [Rew et al., 2001] It summarizes the results of the study, explains the weak points and limitations, while advising further research into new data.

Conclusion

The conclusion identifies the ethnic-gender group found to be most at risk through the analysis of the data. Also a possible influencing variable, sexual abuse, is determined. The conclusion does not give any comparisons of the data from other ethnic-gender groups. It is simple and advises culturally sensitive interventions to reduce attempted suicides.

Implications

The conclusion that girls are more at risk of attempting suicide than boys, that Hispanic Latino females are especially so, and that most attempted suicide of both genders involve a history of sexual or physical abuse will help serve as guidelines for medical parishioners especially…