20 Jolene’s Migraines

Jolene is a Registered Nurse (RN). After taking time off to have her first child she returned to work. She observed that she had migraines of varying severity every time she worked a twelve hour shift. She was able to fight through the migraines and do her job, but it was difficult, painful, exhausting, and possibly dangerous.

Jolene wondered what was causing the migraines. To answer this question she gathered available knowledge from friends and co-workers, the internet, and her health care provider. These sources gave many possible reasons for migraines^[1]. Jolene had taken science courses in preparation for nursing school, so she knew the best way to determine the cause was to use the scientific method.  She evaluated the list and eliminated the possible test conditions that didn’t apply or that she couldn’t change:

Each of the three variables remaining on the list could be tested, so each one could be used in a hypothesis. One-by-one Jolene would hypothesize that a test condition was the cause and then test the hypothesis by changing only that one condition and observing how it affected her migraine. For example her first stated hypothesis could be: dehydration is contributing to my migraines.  Her first test could be to stay well hydrated and observe how it affected her migraines. Sometimes it’s easier to compare results with a null hypothesis, which in this case would be: hydration level does not affect my migraines.

Jolene realized that more than one variable could be contributing to her migraines, and that changing one might only affect the severity of her migraines rather than prevent them, so she needed to do more than just observe, she needs to make a measurement of migraine severity. She decided to use the Wong-Baker 1-10  Pain Scale as her measurement tool (instrument).  She calibrated the scale with childbirth on the top, no pain on the bottom, and stepping on a Lego in the middle.

Finally, Jolene decided she would make multiple tests of each hypothesis by rotating through them. First, she kept track of her scores for the first week, but didn’t change her behavior. This was the first control week. The next week she made sure to drink more water, followed by a week of going to bed and getting up at the same time every day, and finally she made sure to have quick foods ready for breaks all of the third week.  Jolene repeated the cycle for 12 weeks, and kept track of her data in a table. To analyze the data she and added up the pain scores for the three shifts each week and put those results into a table.