In this proposed study, a triangulation or ‘mixed’ research method will be used as a methodological framework for quantitatively studying prevalence and early detection of adolescent suicide and self-harm. Ideally, the study will be a quantitative research study that intends to use both primary and secondary research methods (triangulation) to accomplish its purpose. As noted by Hawton, Saunders and O’Connor (2012), self-harm and suicide are significant sources of public health problems in our nation’s adolescents with self-harm statistics being high among teenagers and suicide rates being noted as the third most prevalent cause of death among American teenagers (NIH, 2008). The triangulation research design will help us in exploring self-harm and suicide and evaluate how nurses and other professionals can recognize signs of self-harm and interrupt a cycle that might lead to suicide; which is the purpose of this study. Hussein (2009) noted that triangulation is a concept that is defined as the application of several qualitative and quantitative techniques in studying a common phenomenon for the sole purpose of increasing the credibility and validity of the study. The primary research will be conducted by means of an online self-administered survey.
The Appropriateness of Triangulation Research Approach for this Study
Researchers have always argued that a good research practice often involves the utilization of multiple methods in order to enhance both the validity and reliability the research findings as indicated in the work of (Mathison, 1988). The choice of triangulation as the appropriate research design is inspired by the fact that helps in achieving improved clarity, research completeness and validity as noted by Fielding and Fielding (1986). According to Knafle and Gallo (1995), triangulation technique contributes to the overall quality of a research ‘only to the extent that it facilitates the achievement of some clearly articulated purpose’ (cited in Adami and Kiger, 2005). The convenience of triangulation in nursing research for confirmatory purposes is noted by Adami and Kiger (2005) to be heavily dependent on the principle that research should be a rigorous search for absolute and objective truth. Validity and completeness of findings on how nurses and other professionals can recognize signs of self-harm and interrupt a cycle that might lead to suicide are therefore our motivation for choosing triangulation technique for this study. The overarching objective of this study is to find ways of minimizing mortality and injury due to teenage self-harm and suicide among the American youths. This must be done with the highest level of clarity, validity and completeness that can only be achieved by means of triangulation.
Purpose of Research Proposal
Teenage mortality is an important public health issue because the majority of these deaths are preventable. Suicide is the third leading cause of death among adolescents and it is believed that 14 to 24 percent of teenagers have engaged in self-harm (NIH, 2008). Every two hours in the United States someone under the age of twenty four successfully commits suicide leaving behind a family and a community that is left to wonder why this has happened and also if there were measures that might have been able to prevent the death from happening (ASS, 2013). The purpose of this study is to explore how nurses and other professionals can recognize signs of self-harm and interrupt a cycle that might lead to suicide. Research into how nurses and professionals are coping with this pandemic will be explored. An important question will be how assessment tools can identify at risk youths. Nurses from many fields work with adolescents; these include those who work in clinics, in hospitals, in schools and in psychiatric units. This proposal intends to provide an outlook on how this pandemic can be mitigated through the involvement of nurses and others who work with adolescents.
Design of the Survey Instrument
The survey in this study will involve the design and use of online questionnaires. The design of the survey will begin by the development of a collection or bank of question items that will be suitable for answering the required research questions. The design as well as development of the survey instrument will involve six distinct steps or stages. The initial step will involve the examination of any existing models for suicide and self-harm evaluation by physicians and nurses. The second stage will involve the extrapolation of the essential items from the existing models for suicide and self-harm evaluation by physicians and nurses. The third stage will involve the examination of extant literature that reported the application of questionnaires in the evaluation of mental conditions (suicide and self-harm in particular). The fourth stage will involve the development of the criteria that was derived from the existing models for suicide and self-harm evaluation by physicians and nurses. The fifth stage will involve the design and construction of the online questionnaires to be administered to the target audience (Registered Nurses) via the appropriate channels. The fifth step will involve the piloting and revision of the questionnaires.
The primary research method to be used is random survey sampling through the use of questionnaires to the participants of the study. An online survey tool, Survey Monkey, will be used to conduct the primary research. Secondary sources will also be consulted in the research. These sources will be from reliable peer-reviewed journal articles, books, whitepapers, personal experiences, online and offline articles, newspapers and conference papers. The research will target or involve nurses who have dealt with this problem on a personal and professional level as well as research material that can be provided from the hundreds of online websites that are dedicated to helping adolescents who feel that suicide might be their only option.
Target Audience or Participants
The target audience will be nurses who work in all areas of nursing and are not limited to those who are working with youths. The benefit of working with all nurses, regardless of their chosen field is to determine if the adequate tools are in place to identify if a child is at risk or if better screening needs to be in place. The volunteers who are already working with adolescents appear to be ready and willing to co-operate to help identify how additional methods can be identified to assist with this crisis. Nurses are on the frontline of suicide prevention and identifying adolescents who are at risk. The participants’ gender will be both male and female and can include those who have worked with adolescents and nurses who are working in all fields. The sampling survey will involve a total of one hundred (130) RN’s.
This research will employ a random stratified sampling strategy. The sample population will be stratified according to state and type or nature of nursing career that they engage in (agency, ambulatory care, case management, critical care, emergency, informatics, research, psychiatric, perioperative (OR) etc). The sample will be selected from willing respondents who must all be registered nurses (RNs) and have been on the job for more than five years. The respondents will selected from sample pool of willing online participants who will answer to our request form participation in our online survey. In other words, the sample pool will be derived from various nursing website via their social media portals (Facebook and Twitter accounts) of the following websites;
In order to reach an extended audience and to avoid too much time wasted, the surveys will be published on the social media pages of the above mentioned websites (such as www.facebook.com/NurseZone for Nurse Zone (www.nursezone.com)).
Additionally, the research will involve professionals who have had experience with adolescents who might have suggested intent to self-harm or commit suicide. A routine Google search will bring up an abundance of websites that are dedicated to helping those who are feeling suicidal. These range from the US Governments Suicide prevention hotline to private groups dedicated to those with specific issues who have volunteers who have survived self-harm or suicidal intent and are now working with others, two such groups are To Write Love On Her Arms and Laura’s Playground. These websites are dedicated to helping youth who are struggling with suicidal thoughts. Through stratified sampling of professional nurses there will be greater precision as to how to interpret assessments and which set of youth are at greatest risk and how to follow through to help adolescents with self-harm history or who have attempted suicide.
Appropriateness of Sampling Technique
The choice for stratified random sampling for this research is inspired by its ability to reduce all forms of human bias in the process of selecting participants to be included in the sample. As a consequence stratified random sample can provide us with a study sample that is highly representative (Daniel, 2011, p.127). This technique also improves the degree of representation of certain groups within a given population (such as nurses who deal with stresses out teens). This means that it ensures that a given strata is not over-represented. This method reduces the sampling error since population statistics estimates are drawn from a known population. Our sampling will be of nurses and professionals working in the field to see if the appropriate tools are being used to identify those who are at the most risk. This would be a stratified sampling that will include professionals who have previous knowledge of adolescents through their own studies, personal lives and work experiences.
In the case of secondary data, the sources will be derived from peer-reviewed journal articles, books, whitepapers, personal experiences, online and offline articles, newspapers and conference papers. Only the most relevant and most credible sources will be included in this research. In order to choose the most relevant and credible secondary sources, an elaborate strategy aimed at authenticity, credibility, representativeness and meaning was used as described in the work of Scott (1990). All the sources will be evaluated for currency (must be up to date) (Stein, 2002).
Role and Bias of Researcher
The role of the researcher in this study will be to investigate by means of credible sources and latest information, the role of nurse-assisted early detection of adolescent suicide and self-harm in order to interrupt the deadly cycle that leads to suicide. This would be done by the formulation of objective research question and following a research methodology that is accurate, valid and free of any bias.
Bias is defined by Sica (2006) to be a type of systematic error that can ultimately influence scientific investigations and hence distort the overall measurement process. Panucci and Wilkins (2010) noted that the identification and avoidance of bias is the sole responsibility of the researcher. In order to avoid researcher bias, I will ensure that I formulate research questions that are not too leading. As a researcher, I recognize that I will be interviewing nurses who have already had experience with young people who might be prone to self-harm or suicide. It will be necessary to develop a suitable survey to allow for those with different experiences to ensure that the data is without bias. The survey needs to be refined to eliminate bias from those who might have considerable experience with adolescents who have followed through from self-harm, to completion of suicide. A potential bias or error in the survey can be recognized by realizing that individuals with more experience who are interviewed would be more inclined to take adolescents threats more seriously than those with only casual experience who might hear the adolescents concerns but might see them as maneuvers to get attention from parents or school authorities.
- Adami M.F., Kiger A. (2005) The Use f Triangulation For Completeness Purposes. Nurse Researcher. 12(4): 19-29
- American Association of Suicidology (2013). Youth Suicide Fact Sheet. Accessed on 13th August,2013 from https://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-161.pdf
- Daniel,J (2011).Sampling Essentials: Practical Guidelines for Making Sampling Choices. SAGE
- Fielding, N. G., & Fielding, J. L. (1986). Linking data: The articulation of qualitative and quantitative methods in social research. Beverly Hills, CA: Sage.
- Hawton, K., Saunders, K. E. A. & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. Lancet, 379, 2373-2382
- Hussein, A., 2009. The use of triangulation in social sciences research: Can qualitative and quantitative methods be combined? Journal of Comparative Social Research, (1): 1-12.
- Mathison, S., (1988). Why triangulate? Educational Researcher, 17(2): 13-19.
- National Institute of Mental health (2008). Suicide in the U.S.: Statistics and Prevention. NIH Publication No. 06-4594. Accessed on 13th August, 2013 from https://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml
- Panucci,CJ ., Wilkins., EG (2010).Identifying and Avoiding Bias in Research. Plast Reconstr Surg. 2010 August; 126(2): 619–625.
- Scott, John (1990) A Matter of Record: Documentary Sources in Social Research, Cambridge: Polity Press
- Sica, G.T. (2006) Bias in research studies. Radiology, 238 (3) 780-9.
- Stein. ,S (2002). Sociology on the web: a student guide