Test Bank for Health Informatics: An Interprofessional Approach, 1st Edition

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Chapter 1: Introduction: The Evolution of Health InformaticsTest BankMULTIPLE CHOICE1.The historical roots of computer science can be traced to:a.language development, especially English.b.mathematics and engineering.c.library science.d.medicine and nursing.ANS:BThe historical roots of computer science can be traced back to mathematics and engineering.The historical roots of information science began in library science. Language developmentand medicine and nursing are not the roots of computer science.DIF:Cognitive Level: UnderstandREF:p. 32.The historical roots of information science can be traced to:a.language development, especially English.b.mathematics and engineering.c.library science.d.medicine and nursing.ANS:CThe historical roots of information science began in library science. The historical roots ofcomputer science can be traced back to mathematics and engineering. Language developmentand medicine and nursing are not the roots of information science.DIF:Cognitive Level: UnderstandREF:pp. 3-43.The first book to include the term nursing informatics in the title was written in the:a.1960s.b.1970s.c.1980s.d.1990s.ANS:CThe first book to include the term nursing informatics in the title was published in 1988.DIF:Cognitive Level: RememberREF:p. 64.As knowledge develops and expands within a discipline, which information source willinclude the oldest but best organized representation of that knowledge?a.Conference presentationsb.Conference proceedingsc.Journal articlesd.BooksANS:D

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The information source that includes the oldest but best organized representation ofknowledge is books.DIF:Cognitive Level: ApplyREF:p. 55.Which technical development created a tension between centralized and decentralizedcomputer management in healthcare?a.The development of punch cardsb.The elimination of punch cardsc.The development of the mainframe computerd.The development of the personal computerANS:DThe development of the personal computer created tension between centralized anddecentralized computer management in healthcare. The other responses highlight aspects ofdecentralized computer management.DIF:Cognitive Level: ApplyREF:p. 36.Which of the following is not a member organization but rather a group of organizations?a.AMIAb.HIMSSc.AHIMAd.ANIANS:DThe Alliance for Nursing Informatics (ANI) is an organization of organizations. This is not amember group. AMIA, HIMSS, and AHIMA are all member groups.DIF:Cognitive Level: RememberREF:p. 77.Which statement concerning educational programs in health informatics is correct?a.All health informatics programs are offered at the graduate level.b.Informatics programs offered by medical schools always require students to haveearned an MD for admission.c.All health informatics programs are located within health-related departments orschools such as nursing, medicine, or pharmacy.d.Health informatics programs range from certificate programs offered at thecommunity college level to post-doctoral programs offered at major researchinstitutions.ANS:DThe correct response is health informatics programs range from certificate programs offered atthe community college level to post-doctoral programs offered at major research institutions.Not all informatics programs require an MD, are at the graduate level, or are located withinschools of health sciences.DIF:Cognitive Level: ApplyREF:pp. 9-108.Which statement related to certification in health informatics is correct?a.A master’s in nursing is required to sit for the NI examination offered by ANCC.b.To be certified in clinicalinformatics in association with AMIA, one must first be

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a physician.c.There are no specific educational requirements for CPHIMS certification throughHIMSS, but three years of full-time clinical experience in health IT is required.d.To be certified as CPHIMS, you must be a nurse.ANS:BTo be certified in clinical informatics in association with AMIA, one must firstbe a physician.You do not need to have an MSN to sit for the NI exam by the ANCC. There are specificrequirements for CPHIMS, but being a nurse is not one of them.DIF:Cognitive Level: ApplyREF:p. 11MULTIPLE RESPONSE9.The term informatics is derived from:(Select all that apply.)a.Dutch.b.English.c.Russian.d.Arabic.e.French.ANS:B, C, EThe term informatics was derived from the following languages: English, Russian, andFrench.DIF:Cognitive Level: UnderstandREF:p. 410.When the AMIA model is used, which subfields are categorized as clinical informatics?(Select all that apply.)a.Medical informaticsb.Nursing informaticsc.Dental informaticsd.Chemical informaticse.Business informaticsANS:A, B, CWhen theAMIA model is used, the following disciplines are categorized as clinicalinformatics: medical informatics, nursing informatics, and dental informatics. The otherresponses are not clinically related.DIF:Cognitive Level: AnalyzeREF:p. 14

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Chapter 2: Theoretical Foundations of Health InformaticsTest BankMULTIPLE CHOICE1.What is the primary difference between an open and closed system?a.An open system has no boundary, and therefore there are no limits to the inputsand outputs between an open system and the environment.b.An open system has a semipermeable boundary and therefore will filter both inputsand outputs when interacting with the environment.c.A closed system has a semipermeable boundary and therefore will filter bothinputs and outputs when interacting with the environment.d.A closed system does not have a boundary and therefore will not interact with theenvironment.ANS:BWith an open system the boundary is semipermeable, thereby controlling what will beaccepted as input and what will be permitted to leave the system.DIF:Cognitive Level: UnderstandREF:p. 202.The primary characteristics used to analyze an open system include:a.structure, purpose, and functions.b.sub-system, target system, and super-system.c.boundary, attributes, and environment.d.hierarchical, web, and hybrid.ANS:AUsing these three characteristics, one can determine why the system exists, what functions itperforms to achieve its purpose, and how it is structured to achieve its purpose.DIF:Cognitive Level: AnalyzeREF:p. 203.A change made to any aspect of an open system, whether it is a health care system or acomputer system, will produce change in other aspects of that same system. As a result, anychange can produce unintended consequences. This process is called:a.dynamic homeostasis.b.semi-planned change.c.negentropy.d.reverberation.ANS:DChange within any part of the system will be reflected across the total system through aprocess termed reverberation. Reverberation is reflected in the intended and unintendedconsequences of system change.DIF:Cognitive Level: RememberREF:p. 234.Chaotic systems are in a constant state of change. This degree or scope of change that canoccur has been described as the butterfly effect. The butterfly effect refers to:

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a.a minor change in input can create a major change in output, or a major change ininput can result in minor changes in output.b.a major change in input will create a major change in output, and a minor changein input will create minor changes in output.c.a minor change in input can create a minor change in output; however, a majorchange in input will result in minor changes in output.d.a minor change in input may create a major change in output; however, a majorchange in input will create a major change in output.ANS:AChaotic systems are dynamic systems with reiterative feedback loops. A minor change ininput can create a major change in output. This is often described as the butterfly effect. Abutterfly’s flapping wings in California can over time become a hurricane in New York.DIF:Cognitive Level: AnalyzeREF:p. 245.Which statement describes the measurement of information as defined by the Shannon andWeaver model?a.The amount of information is measured by the amount of data in the message.b.The amount of information is measured by the number of meanings that can beassigned to a message.c.The amount of information is measured by the extent the message decreasesentropy.d.The amount of information is measured by the number of characters used to createthe message.ANS:CBy decreasing entropy one decreases uncertainty. If a coin is thrown into the air, it may landon either of two possible sides, heads up or tails up. Once it lands, the other side of the coincan be determined. The options are coded zero (0) and one (1) and are the basis for buildingcomputer code.DIF:Cognitive Level: RememberREF:pp. 25-266.The number 190 is an example of:a.data.b.information.c.knowledge.d.wisdom.ANS:AThe number 190 could refer to anything such as a person’s weight, blood glucoselevel, orsystolic blood pressure reading and therefore has no meaning by itself.DIF:Cognitive Level: ApplyREF:p. 267.Knowing when and how to use knowledge is referred to as:a.procedural knowledge.b.cognitive knowledge.c.decision support system.d.wisdom.

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ANS:DWisdom is defined as the appropriate use of knowledge in managing or solving humanproblems. It is knowing when and how to use knowledge in managing patient need(s) orproblem(s).DIF:Cognitive Level: RememberREF:pp. 26-278.Which concepts are used to describe the different types of learning outcomes and can be usedto write learning objectives?a.Input, throughput, and outputb.Adult learning theories, constructionist theories, and learning stylesc.Cognitive, affective, and psychomotord.Short, intermediate, and long-term memoryANS:CLearning is defined as an increase in knowledge, a change in attitude or values, or thedevelopment of new skills.DIF:Cognitive Level: ApplyREF:p. 30-319.Which group will test out new technology but are not usually seen as leaders within anorganization?a.Innovatorsb.Early adoptersc.Early majorityd.Late majorityANS:AInnovators will test out a new technology; however, they are too far ahead of the social groupto be seen as leaders by other members of the social system. Early adopters are seen as muchmore discreet in their selection of new technology and are therefore better at selling a newtechnology to a group of potential users.DIF:Cognitive Level: UnderstandREF:p. 33MULTIPLE RESPONSE10.The systems life cycle (SLC) is a guide for informatics projects. Typical phases of the SLCinclude (select all that apply):a.implementation.b.planning.c.evaluation.d.security.e.diagnosis.ANS:A, B, CAccording to published reports, the SLC contains between 3 and 7 stages. The three that arecommon in each of these reports are implementation, planning, and evaluation.DIF:Cognitive Level: RememberREF:p. 35

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Chapter 3: Evidence-Based Practice and InformaticsTest BankMULTIPLE CHOICE1.Knowledge is the point of convergence across the areas of:a.evidence-based practice, quality assurance, and informatics.b.evidence-based practice, improvement, and informatics.c.evidence-based practice, quality assurance, and improvement.d.improvement, quality assurance, and informatics.ANS:BKnowledge is the point of convergence across the areas of evidence-based practice,informatics, and improvement. None of the other answers include all of these aspects.DIF:Cognitive Level: RememberREF:p. 422.Which two hurdles does the STAR Model address in employing evidence-based practice?a.The volume and form of knowledgeb.The quality and form of knowledgec.The volume and outcomes of knowledged.The adequacy and form of knowledgeANS:AThe STAR Model addresses two major hurdles in employing evidence-based practice (EBP).These two hurdles are the volume of current professional knowledge and the form ofknowledge that healthcare professionals attempt to apply in practice.DIF:Cognitive Level: RememberREF:pp. 43-443.What is the form of knowledge in discovery research?a.Single research studiesb.Meta-synthesisc.Systematic reviewd.Meta-analysisANS:ADiscovery research represents knowledge produced in the form of single research studies. Theother three choices represent synthesis of multiple studies.DIF:Cognitive Level: RememberREF:p. 444.Which typeof review is considered the most rigorous?a.Literature reviewsb.Systematic reviewsc.Integrative reviewsd.Single study reviewsANS:B

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Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, andreviews of the literature, with systematic reviews being the most rigorous approach toevidence summary.DIF:Cognitive Level: RememberREF:pp. 44-455.A facility calls in experts to review evidence developed in research and develop guidelines forclinical practice. Which stage of EBP is represented?a.Evidence summaryb.Translation to guidelinesc.Practice integrationd.Evaluation of process and outcomesANS:BIn the third stage of EBP, translation, experts are called on to consider the evidence summary,fill in gaps with consensus expert opinion, and merge research knowledge with expertise toproduce clinical practice guidelines (CPGs).DIF:Cognitive Level: UnderstandREF:pp. 46-476.Which indicators have been established for healthcare improvement and for public reporting?a.Quality indicatorsb.Efficiency indicatorsc.Cost indicatorsd.Longevity indicatorsANS:AEvaluation of specific outcomes has risen to a high level of public interest. Asa result, qualityindicators are being established for health improvement and public reporting.DIF:Cognitive Level: KnowledgeREF:p. 50MULTIPLE RESPONSE7.The goal of the intersection of informatics and evidence-based practice is to transformhealthcare to be:(select all that apply.)a.reliable.b.safe.c.effective.d.efficient.ANS:A, B, CThe field of informatics and the concept of evidence-based practice (EBP) intersect at thecrucial junction of knowledge for clinical decisions with the goal of transforming healthcareto be reliable, safe, and effective. While efficiency is always a goal in healthcare, it is not aprimary goal of EBP.DIF:Cognitive Level: KnowledgeREF:p. 408.Which of the following are evidence summaries:(select all that apply.)a.Literature reviews

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b.Systematic reviewsc.Integrative reviewsd.Single study reviewsANS:A, B, CEvidence summaries include evidence synthesis, systematic reviews, integrative reviews, andreviews of the literature.DIF:Cognitive Level: KnowledgeREF:pp. 44-459.Using the STAR Model, which of the following points indicate knowledge transformation hasoccurred?(Select all that apply.)a.Discovery researchb.Evidence summaryc.Translation to guidelinesd.Practice integratione.Testing the hypothesisf.Evaluation of process and outcomesANS:A, B, C, D, FThe knowledge transformation process in the STAR Model occurs at five points, which can beconceptualized as a five-point star. These five points include discovery research, evidencesummary, translation to guidelines, practice integration, and evaluation of process andoutcomes. Testing the hypothesis is not a specific point in the STAR Model.DIF:Cognitive Level: KnowledgeREF:pp. 43-4410.Standardized terminology is requisite for:(Select all that apply.)a.naming evidence.b.classifying evidence.c.tagging evidence.d.locating evidence.e.simplifying evidence.ANS:A, B, C, DStandardized terminology is requisite for naming, classifying, tagging, and locating evidencein order to use it in practice.DIF:Cognitive Level: KnowledgeREF:p. 42

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Chapter 4: Knowledge Discovery, Data Mining, and Practice-Based EvidenceTest BankMULTIPLE CHOICE1.Which measure is most important for evaluating the performance of classifiers, models thatpredict class membership?a.Root mean squared error (RMSE)b.Area under the receiver operating characteristic (ROC) curvec.Percentage of correctly classified casesd.Hosmer-Lemeshow statisticANS:BThe area under the receiver operating characteristic (ROC) curve is the most important overallmeasure of classifier performance.DIF:Cognitive Level: RememberREF:p. 622.Which specialized method(s) is (are) used in knowledge discovery and data mining?a.Stratified samplingb.Conceptual analytic methodsc.Selection of the optimal subset of variables/features for use in modelingd.Machine learningANS:CKnowledge discovery and data mining (KDDM) makes use of specialized analytic methods,characteristically machine learning, to identify patterns in a semi-automated fashion.DIF:Cognitive Level: RememberREF:p. 563.The process of knowledge discovery and data mining is best characterized as:a.machine learning, use of statistical methods, large amounts of data.b.a process wherein patients are selected for clinical trials.c.“fishing” for information in data.d.cleaning data for further analysis using other methods.ANS:AKnowledge discovery and data mining (KDDM) is a process in which machine learning andstatistical methods are applied to analyze large amounts of data.DIF:Cognitive Level: RememberREF:p. 564.Which characteristic is an advantage that practice-based evidence studies have over RCTs?a.Large sample sizes can be obtained easily.b.Multiple sites are typically enrolled, resulting in greater generalizability.c.Study efficacy is greater.d.Multiple variables can be studied.ANS:C

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Practice-based evidence (PBE) designs trade away the internal validity of RCTs for externalvalidity.PBE designs have high external validity because they include virtually all patientswith, or at risk for, the condition under study, as well as potential confounders that could altertreatment responses. PBE designs attempt to minimize threats to internal validity by trying tocollect information on all patient variables–demographic, medical, nursing, functional, andsocioeconomic–that might account for differences in outcome. By doing so, PBE designsminimize the need for compensating statistical techniques such as instrumental variables andpropensity scoring to mitigate selection bias effects, unknown sources of variance, and threatsto internal validity.DIF:Cognitive Level: UnderstandREF:pp. 62-645.Which is not a common step in a practice-based evidence study?a.Assemble a multidisciplinary project teamb.Measure patient severityc.Obtain patient consentd.Collect dataANS:CIt is not necessary to obtain patient consent when treatment is not altered.DIF:Cognitive Level: UnderstandREF:pp. 66-676.Practice-based evidence studies differ from traditional observational designs in several mainways. What is one of those main differences?a.Exhaustive attention paid to patient characteristicsb.Excluding clinicians in the study design to improve treatment efficacyc.Use of small sample sizes and specific patient sources/settingsd.General, unstructured documentation of interventionsANS:APractice-based evidence involves intense attention to patient characteristics; includingclinicians in the design; use of large sample sizes and diverse patient sources/settings; anddetailed, standardized structured documentation of interventions.DIF:Cognitive Level: ApplyREF:p. 56MULTIPLE RESPONSE7.Which methods are examples of data mining?(Select all that apply.)a.Decision treesb.Stratified random samplingc.Bayesian networksd.Artificial neural networkse.Factor analysisANS:A, C, DDecision trees, Bayesian networks, and artificial neural networks are methods commonly usedin data mining.DIF:Cognitive Level: RememberREF:p. 61; Table 4-2

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8.Practice-based evidence requires close partnering with informatics specialists to: (select allthat apply)a.design screens and terms to capture interventions.b.create and maintain the databases required for PBE studies.c.upgrade EHR modules so all sites are on the same version of software.d.ensure all end users are trained.ANS:A, BWhile upgrades are an informatics responsibility, sites do not have to be on the same versionof software to do PBE studies.DIF:Cognitive Level: UnderstandREF:pp. 66-679.In which aspects does practice-based evidence differ from evidence-based practice? (select allthat apply)a.PBE incorporates patient choices in decision-making.b.EBP determines best practices using best evidence like results from RCTs.c.PBE includes family involvement.d.PBE is prospective, while EBP is retrospective.e.PBE attempts to capture the complexity and variability of actual clinical care.ANS:B, D, EEBP refers to identifying the evidence for clinical practice and conducting practice accordingto the best evidence. PBE is an innovative prospective research design that uses data gatheredfrom current practice to identify what care processes work in the real world. PBE studydesigns attempt to capture the complexity presented by patient and treatment differences,offering a naturalistic view of treatment by examining what actually happens in the careprocess, not altering or standardizing the treatment regimen to evaluate efficacy of a particularintervention, as one does in an RCT or other types of experimental designs.EBP is aboutusing evidence to guide practice. PBE is about obtaining evidence from practice.DIF:Cognitive Level: AnalyzeREF:pp. 62-64COMPLETION10.___________________ refers to the assignment of individual records or rows in a data set to aspecific purpose: model development (training, incremental testing of models duringdevelopment) or validation (data held out from the development process for the purpose ofunbiased performance estimation).ANS:PartitioningPartitioning refers to the assignment of individual records or rows in a data set to a specificpurpose: model development (training, incremental testing of models during development) orvalidation (data held out from the development process for the purpose of unbiasedperformance estimation).DIF:Cognitive Level: RememberREF:p. 59

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Chapter 5: Program Evaluation and Research TechniquesTest BankMULTIPLE CHOICE1.Your organization hires you to conduct a formative evaluation of a new informaticsintervention. Which areas would you focus on in a formative evaluation?a.Cost, patient safety, and patient outcomesb.Intervention fidelity, implementation quality, and types of personnelc.Errors, change in provider decision-making, and costd.Unintended outcomes, delays in implementation, and costANS:BIntervention fidelity, implementation quality, and types of personnel are areas that would befocused upon in formative evaluation. Results of the formative evaluation are used asfeedback to the program for continuous improvement.DIF:Cognitive Level: ApplyREF:p. 732.Which statement is true regarding the differences between research and evaluation?a.Evaluation is concerned with the goals of a specific program and usually hasmultiple stakeholders as compared to research, which has specific scientifichypotheses and fewer stakeholders.b.Evaluation studies have higher generalizability, whereas research is concernedwith only internal generalizability.c.Evaluation studies use few methods, whereas research studies use multiplemethods.d.Evaluation studies have longer timelines and more resources, compared to researchwith shorter timelines and fewer resources.ANS:AEvaluation is concerned with the goals of a specific program, whereas research focuses on aspecific scientific hypothesis. There are also fewer stakeholders in research than in evaluation.The scope of research is limited, whereas evaluation has a much broader scope. There aremany components in evaluation that cannot be easily put into one category.DIF:Cognitive Level: UnderstandREF:pp. 72-743.Which list includes the 3 levels of theory relevant to evaluation?a.Program, summative, and interpersonal theoriesb.Scientific, formative, and descriptive theoriesc.Scientific, implementation models, and program theoriesd.Scientific, statistical, and modelsANS:CThe three levels of theory relevant to evaluation are scientific theories, implementationmodels, and program theories. The other choices are either not theories or are specifictheories, not levels of theory.DIF:Cognitive Level: RememberREF:p. 75

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4.You decide to base the evaluation plan of your informatics project on the theory of plannedbehavior. Which constructs will you use to develop your measurements?a.Values, normative expectations, others’ beliefs, and overall prior knowledgeb.Values, beliefs about self-efficacy, normative beliefs, and intrinsic motivationc.Values, expectations of others, behaviors, and perceived self-efficacyd.Habit, normative expectations, beliefs about resources, and overall priorknowledgeANS:CThe theory of planned behavior focuses on the ability to predict intentions and behavior as afunction of beliefs about the value of an outcome, the likelihood that the outcome will occurgiven the behavior, beliefs about the expectations of others, and self-efficacy beliefs about thepersonal ability to engage in the activity.DIF:Cognitive Level: UnderstandREF:p. 755.The stages of change identified in diffusion of innovation theory are:a.contemplation, persuasion, action, and knowledge.b.knowledge, persuasion, decision, implementation, and confirmation.c.awareness, understanding, action, implementation, and confirmation.d.contemplation, decision, action, and knowledge.ANS:BThe stages of change identified in the diffusion of innovation theory are knowledge,persuasion, decision, implementation, and confirmation. The stages of change are one way tounderstand and evaluate how the change has occurred.DIF:Cognitive Level: RememberREF:p. 756.If you choose to evaluate an informatics intervention by examining the impact on a clinician’sability to think ahead about future events, which level of situation awareness would you bemeasuring?a.Socialb.Perceptionc.Comprehensiond.ProjectionANS:DProjections are expectations of outcomes in the future. Projections are driven by implicittheories and knowledge about the causal mechanisms underlying events.DIF:Cognitive Level: UnderstandREF:p. 757.UTAUT is a theory of:a.user’s knowledge of social networks.b.acceptance and use of technology.c.decision-making skills.d.technology support options.ANS:B

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The unified theory of acceptance and use of technology (UTUAT) assesses factors associatedwith effective use.DIF:Cognitive Level: UnderstandREF:pp. 76-778.You decide to interview all the key stakeholders involved in an informatics intervention aspart of the planning process. Together you identify the resources available, the likely barriers,and the short-term and long-term objectives. Which kind of theoretical model are you using?a.Scientific theoryb.Theory of planned behaviorc.Logic modeld.Diffusion modelANS:CProgram theory models consist of the implicit ideas and beliefs of key stakeholders. A logicmodel is a representation of components and mechanisms of the program. Basically, a logicmodel is a systematic and visual way to present and share your understanding of therelationship among the resources you have to operate your program, the activities you plan,and the changes or results you hope to achieve.DIF:Cognitive Level: ApplyREF:pp. 79-809.In a social network analysis, each node is usually a(n):a.individual or unit of analysis.b.event.c.location.d.attitude.ANS:ANodes are individuals, and lines are connections. The size of the line is oftenthe number ofinteractions between individuals, and the size of the node is the number of interactions withthat unit.DIF:Cognitive Level: UnderstandREF:p. 83MULTIPLE RESPONSE10.You decide to conduct an evaluation of a new informatics intervention for nurses in the ICU.You decide to use only qualitative methods. Which methods would be conducted?(Select allthat apply.)a.Observing nurses in the ICU at randomly selected time periods and recording theiractivitiesb.Conducting semi-structured interviews and conducting thematic analysisc.Collecting log reports for computer access, grouping sites accessed by nurses intosimilar categories, and seeing what the categories look liked.Measuring the amount of time nurses spent on the computerANS:A, B, CRandom observations, semi-structured interviews, and categorization without counting are allexamples of qualitative activities. Counting, measuring, and calibrating are quantitativeactivities.

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