The factorial survey: An experimental method to replicate real world problems

Background: Vignettes are used by nurse researchers use to determine how cl inical judgments about patient care situations are made. However, when vign ettes are designed there is often a restriction on the number of characteri stics studied, which oversimplifies the richness and complexity of real wor ld healthcare situations. Objectives: The purpose of this article is to describe a factorial survey. Its multilevel design of independent variables allows for real world comple xity in a way not tested by a sample set of four to six identical vignettes . Nurses' judgments about patients' confusion and the application of restra ints are used to illustrate the method. Method: The factorial survey is an experimental design that can be develope d in three steps: (a) identifying and using the variables, (b) writing a co herent vignette, and (c) randomly generating the vignettes. Results: The un it of analysis is the vignette and Ordinary Least Squares (OLS) regression is used for analyses. In the example provided on confusion recognition and restraint use, patient characteristics accounted for the majority of explai ned variance in confusion recognition of (40%, R-2 = 0.40) and restraint in tervention for (43%, R-2 = 0.43). The results for both models were striking ly similar as the same patient characteristics all were significant predict ors for confusion recognition and restraint use. Conclusions: The versatility of the factorial survey lies in the researcher 's ability to use it to test judgments in a variety of complex clinical sim ulations, to aid in concept development, and to identify consensus and disa greement among nurses. The multilevel design of the independent variables a llows for real world complexity in a way not tested by a sample set of four to six identical vignettes.