Research_Report

RESEARCH REPORT Introduction Medical advances, rising patient expectations and the vast diversity of health services today, mean that health care professionals work in a progressively more complex field. The NHS executive, funded primary care research networks in England and Wales from 1998 in order to increase the capacity for research in primary care (Department of Health 2000). The number of research articles published in medical journals have increased substantially over the past few years (Britten N 2005). None the less, healthcare professionals still have strong concerns about a wide spread lack of understanding of the nature and uses of such research (Jack SM 2006). The following report will critically analyse the use of various theoretical approaches to research in the health care setting. We will explore methods of data collection and the different systems commonly used. The report will scrutinise ethical dimensions of research reports and what impact differing types of research activity has on the development of policy and practice. When any research is undertaken the first question should be ‘what sort of research should I use’. So many differing forms of research have been undertaken that it can be difficult to decide upon what technique to use. The frequently used types of research methods are quantitative and qualitative. At the most basic level, quantitative research methods are used when something needs to be measured, while qualitative methods are used when a question needs to be described and investigated in some depth (Shields, Twycross 2003). According to Cresswell (2003) one of the chief reasons for conducting a qualitative study is that the study is exploratory. The researcher seeks to listen to participants and build an understanding based on their ideas. Quantitative research on the other hand, includes a substantial amount of literature at the beginning of a study to provide direction for the research questions (2003 p32). There can be little doubt; research that involves the integration of quantitative and qualitative, has become increasingly common in recent years. While some writers express unease about the ‘whatever works’ position that underpins it e.g. Buchanan (1992). The combination of qualitative and quantitative has come to be seen as a distinctive research method in its own right. Whatever approach is decided upon the main objective is to improve patient care and from what we know, there doesn’t seem to be a superior approach that will provide all the answers. Method of Selection Searching the literature is the first step to investigating a topic. Hart (2001). Prescription errors are common. Jones (1978) and while many may be harmless and easily corrected there is the potential that a prescription error can have dangerous or even have fatal consequences. The materials used in this review were located by searching internet web sites, computer databases, indices, books, journals, reference and bibliography lists as suggested by Hart (2001). The electronic database BNJ (British Nursing Journal) was used and the key words ‘prescription errors’ narrowed the search. The Athens on line library was also used which enabled access to many journals, books and articles on the subject. To avoid any duplication of research and time wasting the search history was saved. Google was the main web site search engine utilised which gave access to previous papers and research articles. All information searched was saved to a computer folder which permitted further availability and the ability to refine in later sessions. Access to the medical centre library enabled information of audits on prescription errors to be available. Literature search is a time consuming process that requires determination and perseverance (Hek et al. 2002). The primary research article chosen was from the BMC (Biomed Central) Health Services Research. It is a contemporary research article on a subject which is a current and constant issue. Errors can occur in prescribing at various parts of the process from diagnosis and prescription to administration and usage. Failure to administer or incorrect dosages are the most common reported. (Simonsen et al 2011). The legal implications of prescribing errors are immense and vast research has been carried out to try and find a way to reduce or prevent such inaccuracy. Critique of Articles Due to the primacy placed on the use of evidence in the health care section, it is important to be able to critique published research. This will enable us to identify the strengths and weaknesses and facilitate in forming a judgement about the quality and relevance. The qualitative article that is going to be critiqued is: O’Kane,C.E, 2011 Newly qualified nurses experiences in the intensive care unit, Nursing in Critical Care, 17(1) 44-51. Title: The research paper title is concise and straight to the point but could be construed as a little vague. Nurses experiences in the intensive care unit, experiences with regards to what' The title should not be long and complicated and should reflect as much as possible what the research is about (Parahoo and Reid 1988). The title should explain exactly what is to follow and allow the reader a brief insight as to what the paper entails. According to Haggan M (2003) although it is a very small part of the research paper, the title plays an important role as the first point of contact between writer and potential reader and may decide whether or not the paper is read. Author: The author’s qualifications and professional experience is clearly stated. This gives a good indication of their knowledge and understanding of the subject and gives authority behind the reliability of the information provided. It also aids the reader’s interpretation of the article and understanding standpoint of the author. Abstract: The word abstract comes from the Latin abstractum which means a condensed form of a longer piece of writing. This is an important part of any academic article; it gives the reader a brief overview of what’s to come. The abstract in this research paper identifies the problem and gives an outline of the methodology used. According to M Marshall (1996) choosing a study sample is an essential step in any project since it is rarely practical, efficient or ethical to study whole populations. He goes on to say the aim of all sampling approaches are to draw a representative sample from the population, so that the results can then be generalized back to the population. The article gives details of the sample subjects being the newly qualified nurses and the more senior nurses in the ICU. It goes on to discuss fully qualified nurses that are new to the ICU department but none of these were included as samples. By including these it would have given a wider outlook of all the differing opinions. Introduction: The author acquaints the reader with the rationale behind the work and identifies the issues that the NQN (newly qualified nurses) tend to face in the department. There is an explanation as to the lack of research in this particular area but the author explains that the little research there is, highlights the recurring themes identified in this article. Literature review: The literature review is generally summarised in the introductory section or under a specific heading such as a review of the literature (Polit and Hungler 1997). They go on to say the purpose of the review is to discuss what is known, identify gaps in the knowledge, establish the significance of the study and situate the study within the current body of knowledge. The author has referenced original sources where information has been obtained and identified the limited research carried out. This highlights reoccurring themes like support mechanisms and socialization, this establishes a purpose for the research. Hypothesis: Experimental approaches which involve random assignment to treatments and control of extraneous variable have been the gold standard for educational psychology since the field evolved in the early 1900’s (Mayer R 2005, p74). He goes on to say “when properly implemented, they allow for drawing casual conclusions, such as the conclusion that a particular instructional method causes better learning outcomes” (p75). The author of the research article has based her hypothesis on a small number of nurse’s opinions. Many differing factors can influence opinion i.e. when interviewed were the individuals having a good day' Do they like working with their current work colleagues' People’s opinions regarding their work place tend to change on a regular basis. Every day, nurses must work against the clock, sudden switch back and forth, from intense to mundane tasks and confront stark suffering, grief and death in a way that few people do (Farrington 1995). People are effected by management instructional methods which vary from work place to work place. A group of nurses working in a small private hospital may find the transition into the ICU relatively smooth. To enable the research to be more valuable a variety of hospital ICU departments and staff need to be investigated, this would present a wider range of data. Operational Definition: Everything is vague to a degree, you do not realise till you have tried to make it precise and everything precise is so remote from everything that we normally think, that you cannot for a moment suppose that is what we really mean when we say what we think. Bertrand Russell (1918). No operational definitions are defined in the article. A well-defined operational definition at the beginning of the article would have allowed the authors to be clear about their concepts or terms before setting out to measure them. The purpose of the study is identified and the objectives stated which facilitates the communication between the author and those who use or read the report. Methodology: Despite research evidence and conventional wisdom that comparative healthcare information is complex and human processing capacities are limited, providing healthcare consumers with large amount of public healthcare reports has continued (Wilson TD. 1991). If this kind of information is to be used more effectively by consumers it is imperative that they make it easy to digest the information (Vaiana ME 2002). The author has used a comparative qualitative approach to this research article. This is an appropriate method for this type of study. Generally, descriptive qualitative studies require content analyses to create themes or patterns within the data (Polit and Beck, 2004). The strengths and weaknesses of the approach to this study are not defined anywhere in the paper, the author could have given a brief overview of how the paper would have differed by using a different approach or stated why this particular one was decided upon. One of the key issues differentiating between qualitative and quantitative research approaches is the nature of data. In quantitative, it is hard, objective and standardized but in qualitative, it is soft, rich and deep (depth vs. superficiality) (Corbetta, 2003). Subjects: The identification of the two participating groups chosen to interview is stated but the author did not expand on the basic information given. The only details specified were the NQN’s had been employed in the ICU for 1 year or less and the senior nurses were band 7 or above. A non-medical person reading this article could be wondering what is band 7' The author needed to increase the information given about her interviewees. Many differing factors could have influenced the interviews i.e. were they interviewed after a long hard shift' What was the relationship between interviewer and interviewee' Were the interviewees happy in their current working environment etc. The manner of interviewing conditions during the interview and how comfortable the informant is with the researcher may also affect reliability (Bernard et al 1986). Sample Selection: Purposive sampling was used in both phases. The author has focused on particular characteristics of both groups to come up with reoccurring findings. This form of sampling is synonymous with qualitative research, the author wanted to case study why particular people i.e. NQN and qualified nurses feel a certain way. According to (Snedecor 1939) preparation is needed in that one must know about the culture before one samples the population in order to find knowledgeable and reliable informants most efficiently. One way of choosing informants is best described by Allen (1971) Criteria are set on what would make a good informant and what would make a bad informant. Based on these, a list of qualification is composed. Data Collection: Audio tapes were used and transcribed verbatim. The author states that the interviews were semi structured and constructed through evidence from literature review. If the literature that had previously been reviewed by the author was referenced then the reader could have an insight as to the method of approach that was being taken. The key issue in data collection is not how we collect data it’s rather how we obtain useful data. It would have been constructive for the reader to see the format the information was acquired and what questions were asked. Some form of questioning can be guided by the author of the project to obtain certain evidence. If closed ended questioning techniques were used these can be restrictive i.e. this can limit the answers given and may not allow the respondents the choices that will echo their true feelings. Ethical Considerations: Ethical approval was gained by the local research ethics committee as human subjects were used in this research. There are various ethical codes of conduct that regulate researcher’s behaviour. These codes discuss many issues that potentially might arise in your research, as well as other issues associated with professional practice (Beauchamp & Bowie 1997). Informed consent has not been sought for this research project, this would have ensured that all participants were aware of what was being asked and notified of any potential negative consequences in participation. The author could have devised an information sheet and distributed it to all potential contributors. Confidentiality was kept but all participants were known to the author which could have hindered or helped the project. Results: Qualitative data may be reported in a discursive way and may include such features as actual quotes from interviews and discussions with focus groups. (Burns and Grove 2001). Nursing studies most frequently involve the use of interviews or questionnaires, socio-psychological scales, direct observation or a biophysical measure because these methods lend themselves to studying nursing phenomena (Polit and Hungler 1997). The findings were broken down into clusters and the themes were identified as expectations, challenges, preconceptions and support. These were illustrated in a graph which enhances the clarity of the results being presented. But like all forms of data collection the group interaction of the focus group can be affected by the personal characteristics of the participants such as class, gender and race. The researcher can also have less control over the conduct of the interview which could affect the quality of the data collected. (Minichiello et al 2004). Data Analysis: Qualitative data is analysed and processed once the researcher has all the collected information. The researcher will make judgements relating to aspects of phenomenon to pursue. For example, as they carry out more interviews they have to remember some of what was said in previous interviews. Parahoo (1997). The purpose of the article was to gain an insight into the phenomena rather than provide data on frequency or numerical material. Researchers are sometimes so engrossed in their studies that they may lose their impartialness. To ensure strictness, they could enlist someone to read through all the transcripts. Woodgate and Kristjanson (1996) explain how in their study of children’s pain they sought the help of others: All categories were independently reviewed by three researchers with expertise in qualitative analysis to confirm organization and relationships of the derived properties and categories. For a categorization to be validated all reviewers were required to agree. Discussion: According to Pilot and Hungler (1997) an important point to remember is that research does not necessarily prove a point and may only suggest a relationship or highlight an issue needing further investigation. The discussion in the article is centred on the themes which were identified in previous research and the papers findings. These could have been expended on by the author, as many different factors can effect peoples experiences in the ICU. There were two limitations stated in the research, the author could have developed this further and looked into the way the information was collected and how aspects can influence peoples statements/interviews. A review by Champion and Leach (1989) revealed that attitude is an important variable in research utilisation. In their study of 59 nurses from a community hospital in the USA, they reported that attitude was found to have the greatest correlation with research utilization. There are weaknesses in the article that could have been identified, the hospital size and number of patients could be one, if nurses are extremely busy and dealing with stress issues this can cloud their judgement. The limited number of nurses that were interviewed could have altered the findings, if a larger group from a variety of hospitals were chosen this could have identified different opinions and experiences making the research more credible. Conclusion: The conclusion is brief but is supported by the results obtained. The reader is reminded and given a brief overview of the point the author is trying to make which reinforces what the research is about. The implications are not discussed or elaborated on; the author needs to expand how they have come to this assumption and what the effects may be if the implication are not reinforced in future practice. Recommendations: There are no clear recommendations stated. The paper ascertains there is a lack of research in this particular subject and identifies that a larger scale study may enhance the results credibility. The contributors were known to the author but this was counteracted by the author stating the participants comfort and familiarity with the researcher outweighed the risk. This statement is a personal view, the interviewer may have been comfortable but that does not necessarily mean the participants were. According to Newell (1994) Interviews in nursing are ‘by and large poorly’ carried out. He goes on to say, the clinician is likely to receive inadequate or inappropriate information due to poor interviewing, with the result that any decisions made regarding the presenting problem are likely to be equally inadequate or inappropriate. Critique of Quantitative Article: Addington-Hall, J.M., & O’Callaghan, A.C, 2009, A comparison of the quality of care provided to cancer patients in the UK in the last three months of life in in-patient hospices compared with hospitals, from the perspective of bereaved relatives: results from a survey using the VOICES questionnaire, Palliative Medicine 23 190-1997. Title: The title of this article is extremely lengthy and risks losing the reader due to its lack of conciseness. According to Cormack (2000) research projects become known by their title so it is important to make it explicit and relatively brief while describing the proposed study. Too much information in a title can make it long and inelegant. The title should be clear concise and convey the essence of the research. The author could shorten the title but still give the reader the proposed core of the research, which would enable the reader at a quick glance to understand exactly what they are about to read. Authors: The author’s names are clearly annotated on the article along with what university, but the reader is not given the authors academic or professional qualifications. A brief insight into their backgrounds would have presented a reason why they were researching this particular subject and also allowed for familiarity between the reader and authors. Abstract: The abstract should be a short summary of the study and provide basic information. This article has an overview which is wordy and may lose readers. The abstract is to provide a succinct synopsis of the article which in turn will allow the reader to decide whether or not the article is of interest to them. If the article had an organised abstract which included a concise aim, design, method, sampling and the main findings, this would provide the essential information that the reader requires and present it in a simple defined way. Introduction: A general introduction to the subject of the research will include a discussion of its importance and of the need for it to be researched. The research problem is clearly identified, as will be the thinking process which prompted initiation of the research. Cormack (2000). The rationale for the study is explained and the author has stated that there are limitations due to the lack of research that has been conducted. The background and experience of the authors could have been given in the introduction which would have placed the work in a personal context. Literature Review: The ability to present up to date, relevant information clearly, concisely and logically is crucial. Even when the rational is convincing, the author needs to support it with such evidence as research findings, statistical data and to a letter extent, expert opinion. Parahoo (1997). The article explains that very little evaluations of in-patient hospice care have been carried out in the UK, so limited evidence exists. References relating to the material have been included which gives the reader a platform to the proposed literature. The author has given an overview of what research there is and some statistical data which provides brief but relevant material to put the study into the context of present knowledge. Hypothesis: A hypothesis can be defined as a tentative statement, in one sentence, about the relationship, if any, between two or more variables (Parahoo 1997). The authors haven’t given a hypothesis or set any objectives they have given the reader an outline of the data collected and identified that more research is needed in this area. The article is a comparison between the care provided by hospices and hospitals to cancer patients. The authors could have used the results from the little research that has already been conducted and set clear objectives to give the article more structure. Operational Definitions: No terms used are defined. There are key words but even these have no definitions. An operational definition assigns meaning to a concept by specifying the activities or procedures necessary for measurement. In essence, operational definitions describe what is measured and how it is measured. Grand and Kinney (1991). Definitions are an important part of any article as the reader needs to have a clear understanding of what is meant by notions or terms. Minichiello et al (2004) states that before a study can progress the researcher will usually clarify and define the variables under investigation and specify how the variable will be observed and measured in the actual research situation, this is known as an operation definition. Methodology: There is no clear statement about the chosen research approach to this article. According to Polit and Hungler (1997) a research report should contain a carefully and concisely worded problem statement identifying key variables. A quantitative approach may be chosen because the researcher wishes to collect information in a numerical form as the results will be based on rigour, objectivity and control. Burns and Grove (2001). In quantitative research the investigator maintains a detached, objective view in order to understand the facts. Duffy (1986). The article presents a comparison of hospice in-patient care and hospital care for cancer patients in the UK. There are some weaknesses and limitations of the research mentioned i.e. the suboptimal response rate and the challenging symptoms and complex needs that are the admission criteria for many UK hospices. The article does suggest that a randomised controlled trial design could answer definitely the question of whether hospice care leads to better outcomes than hospital care. Subjects: The subjects were the individuals who registered the deaths of the bereaved relatives. The author explains in great detail how the individuals were contacted and clarifies that they were all given chance to opt out of completing the questionnaire sent. In quantitative research the investigator maintains a detached, objective view in order to understand the facts (Duffy 1986). The strength of such a detached approach could have been identified as this would have given vigour to the impartiality and the avoidance of the researcher ensuing against biasing the objectivity of the research. Sample Selection: One of the crucial tasks in designing a research project is to decide on the number and characteristics of the respondents who will be invited to take part in the study (Parahoo 1997). The article explains the sample selection approach and describes the number of informants that were randomly drawn. It elucidates how out of 400 people originally approached, the sample size was then condensed to 40. There is an advantage of results attained by random sampling, it increases the likelihood of them being generalizable. The disadvantage and a weakness of the quantitative approach, is that random selection is time-consuming, with the results that many studies use more easily obtained opportunistic samples (Duffy 1985). Data Collection: Selecting the way data is collected can reflect the beliefs and values of the researcher, as Hughes (1980) states: No technique or method of investigation…is self-validating: its effectiveness, its very status as a research instrument making the world tractable to investigation, is dependent, ultimately, on philosophical justification. Whether they may be treated as such or not, research methods cannot be divorced from theory: as research tools they operate only within a given set of assumptions about the nature of society, the nature of man, the relationship between the two and how they may be known. There is strength in producing numbers as data; this establishes an ordered structured system. The data collection for the research article is explained and the validity of the questionnaires described. The opposing argument, suggesting the invalidity of numerical findings, is that data not displaying significance are often neglected, or alternatively attention is centred on a minority of the respondents leaving the majority unexplored, in other words there are ‘deviant cases’ (Cormack 1991). Ethical Considerations: The research has the approval of the Multi-centre Research Ethics Committee, the Local Research Ethics Committee and the Office of National Statistics (ONS). The ONS contacted the informants because of data protection legislation which maintained their anonymity and assured confidentiality. The ONS sent all informants a letter introducing the study, an information sheet and the questionnaire which allowed all potential informants to make a fully informed decision as to whether to partake in the study. Results: The way in which results are presented can be misleading, Stevens et al. (1993) explains: when an author writes that sixty per cent of respondents state that they drink alcohol because of stress, it must be explained that they were asked to choose from a list of reasons provided by the researcher. By not stating the format of the question, i.e. whether it was an open or a multiple-choice one, it is difficult for the reader to put the responses in context. The article displays tables with the findings, not only do they show numerical data and percentages but they give the reader the questions asked. The graphical material enhances the clarity of the results, but the presentation of such results could be clearer i.e. a simple chart with lines under each section would allow the reader to follow the results effortlessly. Data Analysis: An important feature of quantitative research is the ‘measurement’ of phenomena. Values and numbers are central to their understanding (Parahoo 1997). However one can question the reliability of quantitative research, especially when the data have been stripped from the natural context, or there have been random or accidental events which are assumed not to have happened (Comer 1991). The quantitative approach to the article is appropriate to the type of data displayed but the authors state that the McNemar test was used to assess the statistical significance of the differences in informants reports, but nowhere does it explain exactly what the McNemar test is. Discussion: The discussion draws upon the lack of previous research in this area and acknowledges several weaknesses. The authors explain why they decided to focus on views of the informants who had experienced both hospital and hospice care so they could give more informed evaluations. This may have depleted the final numbers of informants used but it gave a more comparative view. For every strength there appears to be a corresponding weakness in both quantitative and qualitative research, it is this dilemma that has fuelled the debate over which approach is superior. (Duffy 1986). Relying solely on a quantitative approach to answer research questions has been seen to have serious limitations (Metcalfe 1983). Conclusion: The conclusion is supported by the results obtained in the article. The data and statistics show that the bereaved relatives who have experience both hospice and hospital in-patient care, rate the hospice care more highly. It also explains how this outcome will present challenges to those who are responsible for raising funds for hospice care. There are no clear implications identified, the authors could have elaborated on the impact of the findings and proposed suggestions as to how to make hospital care more satisfactory. Recommendations: The authors have not given any recommendations or suggestions on further areas for research, nor have they demonstrated how any weakness in the research design could be rectified in future research. An important point to remember is that the research does not necessarily prove a point and may only suggest a relationship or highlight an issue needing further investigation (Parahoo and Reid 1988). Implications for practice The process of critically appraising research reports takes a long time. It cannot be hurried. It requires intensive, detailed reading and careful checking of the conclusion against the evidence provided. Full-time researchers often find this to be the most taxing and time-consuming part of their working lives. Church and Lyne (1994). The task of critiquing an article is a challenging and time consuming experience. It is imperative to stay objective whilst reading any research paper especially if you have a strong opinion on the subject in hand. Researchers can be at fault, there are many articles that only discuss the specific results that back up their particular views and outlook. If a researcher already has formed opinions on a matter, it would be easy to write an article with evidence to back up that particular view. Results from previous studies either positive or negative should be discussed in the research paper; this would allow the author to present a non-bias paper and allow them to give an explanation as to why results differ. It is essential that any researcher presents his or her data in a clear and unambiguous way. It is easy to forget, not everyone that reads your article will have the same in-depth knowledge that you have on the subject. Articles should be written in a way that informs the reader not confuses them and we should remember that although research is generally about answering questions, sometimes this just isn’t possible. This doesn’t mean that the article is useless, quite the contrary, the reader may learn more from the actual research process than any findings presented. As Pahahoo and Reid (1998) state: Critical reading of research helps to develop a research imagination. With practice, the individual’s sense of enquiry will be heightened as his or her disposition to passive acceptance of the written and spoken word diminishes. Health scepticism rather than negative, cynical attitudes will transform a fault finding activity into a learning experience which can only lead to the development of research-mindedness. Health services are always striving to improve standards and the services they provide and research papers are an imperative part of the process. This assignment has given an insight as to how important it is to present information whilst still remaining impartial. In my current working practice and many other practices, prescribing errors are a major issue that always have an enormous impact to patients, staff and the practice itself. According to Simonsen et al (2011) “ The casual relationships between knowledge, skills and risk of errors are common and involve factors such as perceived certainty, sense of coping and self-esteem, areas that are poorly investigated”. Having critiqued two different types of research article I have become aware that to be able to prepare any form of research on prescription errors I would have to look at the issue in a clear and un-bias way. My opinions can be stated in the research but they should not override the information provided. By following a structured format such as the Cormack’s critiquing framework it allows for the whole process to flow naturally, which in turn gives the author a scaffolding that enables them to establish a good research article. Conclusions and limitations of the work There is no right or wrong way to approach a research process. A quantitative study helps to substantiate an issue and suggests questions or hypotheses that are in need of investigation. In qualitative research the information helps validate the research problem whilst not restraining the opinions of the participants Parhaoo (1997). There are many limitations which can impact on research, interviewing participants can reveal limitations in itself, when more than one interviewer is used on the same project, one could have better interviewing skills which enables them to obtain more beneficial information. The interviewees may feel like they are required to give more socially desirable answers to questions in an interview environment, but would have given more truthful answers in a questionnaire where there is no immediate pressure. Questionnaires also have limitations; some ask questions and allow for the reader to write their own answers which can be very time consuming to decipher. Others can have closed questions and rating scales which enables them to be quickly analysed but these obviously limit the available answers the respondents are able to give. If you start a project with a firm opinion on the subject this can influence the results of the research article, an author can guide the article and questions asked, to provide the answers they want to publish. Gender, race, occupational setting, number of participants can all effect the results of research and it is important for the author to not treat their results as gospel. Stetler and DiMaggio (1991) point out: The conduct of research and the utilization of research are different processes. In the past, the former has received primary attention in educational programmes. It is perhaps time, that equal attention be given to both. Research findings are not an answer to a problem; they provide an insight to a problem being investigated which can help confirm or reject what is already known. As Cang (1979) explains: Anyone who tries to observe and remember and learn from experience, whether that experience has to do with forecasting the weather or caring for a patient under some given circumstances, is broadly speaking engaged in research. No questionnaires, no computers, no overalls are necessarily required: just the attempt to find out something about something. We now live in an age where we are constantly striving to improve the standards and services we provide. The health care profession play an important role in creating bodies of knowledge and then using it to better practice. It is vital that research be maintained and increased to achieve the recognition that is so rightly deserves. Word count 5900 References: Allen, H.B. 1971. Principles of informant selection. American Speech. 46:47-51. 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