Critical Appraisal of a Medical Study - Assignment Example

Critical Appraisal of a Study 0 Context of the paper (Total: 2 marks 1 Is the appropriate? Why/why not mark) The of the paper is "Abdominal surgery, pain and anxiety: preoperative nursing intervention." The title is appropriate because the paper examines the consequences of preoperative nursing intervention towards pain and anxiety related to abdominal surgery. 1.2 What was the question that the research was designed to answer? (1 mark) The research question in this study was whether appropriate nursing intervention in the preoperative period of abdominal surgery decreases anxiety in the patients and has positive effects as far as attitudes towards pain in the post-operative period is concerned. 2.0 Research method (Total: 9 marks) 2.1 What research design did the researchers use? Was this appropriate? Why/why not? (3 marks) The research design employed in this study was randomized controlled trial. This design is a type of scientific experiment used specifically to test the efficacy of various health-related interventions as the one in study (preoperative nursing intervention). In this research design, interventions are allocated in a random fashion to the participants of the study so that the data interpretation and analysis is done in a non-biased manner (Lachin et al, 1988). Thus it can be said that the type of design chosen for this study was appropriate. 2.2 Describe the treatment of the intervention and control group received during the study. (2 marks) Both the study and the control groups received routine care like preoperative physical preparation and education about postoperative coughing and breathing. However, the study group received preoperative nursing intervention for pain which the control group did not receive. The intervention was delivered 1- 3 days prior to surgery for 20- 30 minutes per patient. The contents of the intervention were explanation of the causes of pain and other uncomfortable feelings which are likely to occur in the post-operative period, explanation of the influences of the postoperative pain and the importance of management of pain and early out-of-bed activities, teaching the patients methods to decrease pain with methods which are non-medicinal, encouragement of requests for analgesics in the post-operative period whenever pain is felt and discussion of setting pain control goal, encouragement of expression of various feelings and concerns related to postoperative pain and discomfort, selection of comfortable and favorite non-medicinal mode of pain relief and answering of the questions of the patient. These nursing interventions were administered to the patients and their caregivers in the study group. 2.3 What is the independent variable in this study? Why? (1 mark) The independent variable in the study is the nursing intervention provided to the patient in the study group. The variable is considered as independent because it is provided to all the participants in the study group and is not dependent on the outcome. 2.4 What is the dependent variable in this study? Why? (1 mark) The dependent variable is the outcome of the intervention provided. In the study the dependent variables are anxiety levels of the patients and attitude towards pain. These are dependent variables because they are dependent on the intervention provided. 2.5 How was the data collected? (2 marks) The data was collected by administering appropriate structured questionnaire in the preoperative and postoperative period. The questionnaire consisted of basic data like personal data, operative data and postoperative data. The personal data included "age, gender, height, weight, educational level, marital status, employment status; presence or absence of hypertension, diabetes or cardiovascular disease; previous surgical experiences, experience using analgesics, and maximum level of pain ever experienced." Operative and post-operative data were collected from the medical records of the patients. The scales used to assess the outcomes of the intervention were anxiety scale, pain attitude scale and Brief Pain Inventory. 3.0 External validity of the study (Total: 16 marks) 3.1 Who were the study participants? (1 mark) The study participants were those about to have abdominal surgery in a medical center in southern Taiwan. 3.2 How was the sample selected? Was this appropriate? Why/why not? (3 marks) The sample were selected based on inclusion criteria and exclusion criteria. The inclusion criteria for the study were "(1) were 20–70 years of age; (2) were not transferred to the intensive care unit after surgery; (3) could speak Chinese or Taiwanese; and (4) agreed to participate in the study. The exclusion criteria were "(1) were suffering from metastatic cancer; (2) were also undergoing surgery to other areas; (3) had cognitive disabilities or a history of mental illness; (4) were addicted to opioid, opiates or strong analgesics, or suffered from substance abuse; (5) had been suffering pain from other conditions; and (6) could not do any out-of-bed activities prior to surgery." The inclusion and exclusion criteria were appropriate for the study. 3.3 How many participants were in the study sample? How was this determined? Was this adequate? Why/why not? (4 marks) Initially 80 patients were recruited and then 18 were omitted because of positive exclusion criteria. Then 32 were recruited to the experimental group and 30 to the control group. The sample size was based on the predetermination done by using power analysis. The large effect size of alpha was 0.05 and power was 0.80. Thus, at least 30 participants in each group was determined to be adequate for this study. 3.4 How were the participants allocated into groups? Was this appropriate? Why/why not? (3 marks) The participants were allocated into the study and control groups through permuted randomization method using "envelope containing slips" method. This is appropriate so that there is no bias and the results are not affected. 3.5 Were there any differences between the participants in the intervention group and the control group? (2 marks) The distributions of various personal data in both the study and the control groups were homogenous. As far as the operative and postoperative data were concerned, the percentage of PCA use and opioid use following surgery did not differ significantly between the study and the control groups. Thus factors influencing the intensity of pain in the postoperative period were equally distributed. Also, the mean preintervention anxiety scores and mean preoperative, preintervention pain attitude score were similar in both the groups. Thus, the levels of pain attitude level and anxiety level were similar in both the groups. 3.6 What (if any) information is given about non responders/dropouts that would help the reader to decide if they were in some way different to those who remained in the study? (1 mark) 18 patients were dropped out because they were fulfilling the exclusion criteria. 3.7 Can the study findings be generalized to other settings? Why/why not? (2 marks) The study findings cannot be distributed to other setting because the participants of the study were drawn from patients of one particular hospital undergoing abdominal surgery only. 4.0 Internal validity (Total: 8 marks) 4.1 Define the concept of reliability and discuss how reliability has / has not been demonstrated in this study (3 marks) According to Joppe (2000; cited in Golafshani, 2003), reliability is "the extent to which results are consistent over time and an accurate representation of the total population under study is referred to as reliability and if the results of a study can be reproduced under a similar methodology, then the research instrument is considered to be reliable." The methodology of the study is simple and reliability can be tested only by performing this test again and again. 4.2 Define the concept of validity and discuss how validity has / has not been demonstrated in this study (3 marks) Validity in qualitative research determines "whether the research truly measures that which it was intended to measure or how truthful the research results are" (Julia, 2000; cited in Golafshani, 2003). Construct validity may be defined as the extent to which a scale measures a certain construct (Parahoo 2006) in which the link between conceptual definitions and operational definitions is examined. The essence of construct validity was intact in this study. This is because the definition of the intervention and the measures of outcome are definite. 4.3 Were participants and/or researchers blinded in this study? If YES state for what or whom blinding occurred? If NOT state the impact of the lack of blinding on the study results. (3 marks) The participants and researchers were blinded in this study. The participants were blinded to the group they were allocated to. The researchers were blinded to the the groups the participants fell into. 5.0 Results / Data Analysis (Total: 12 marks) 5.1 What differences in outcomes were identified between the intervention and control groups? (2 marks) The pain attitude scores in the study group was significantly more when compared to the control group. Also, the pain attitude between pre-test and post-test was significantly more in the study group. The results eventually showed that preoperative nursing intervention for pain in the preoperative period increased pain attitudes of the patient significantly. 5.2 What type of data analysis was used? Was this appropriate? Why/why not? (4 marks) Data analysis was done using Windows 8.0 software. Calculation of mean, standard deviation and frequency was done using this software. The differences between the study groups were tested using Chi-square tests and independent t-tests which are appropriate and the effects of the intervention was tested using ANOVA which is also appropriate. 5.3 Using all of the information from your analysis so far, decide whether or not the results of this study should be used to inform clinical practice? There is no definitive right or wrong answer here. Whatever you decide, you need to justify your decision based on the research literature. You are encouraged to synthesize your answers to the previous questions to help with your decision but must not simply restate your previous answers (6 marks). The intervention of the study is preoperative nursing intervention which was administered to the study or the experimental group. participants to the study were enrolled based on strict inclusion and exclusion criteria and randomization was done appropriately. Thus bias of the study is minimum The study is valid as far as internal validity and external validity is considered. the data was analyzed using appropriate software for the type of study and intervention. Thus, it can be said that the results of the study can be implemented for clinical practice. However, these results can be implemented only to hospitalized patients undergoing abdominal surgery as the results are not generalizable. References Golafshani, N. (2003). Understanding Reliability and Validity in Qualitative Research. The Qualitative Report, 8(4), 597- 607. Lachin, J.M., Matts, J.P., Wei, L.J. (1988). Randomization in Clinical Trials: Conclusions and Recommendations. Controlled Clinical Trials 9 (4), 365–74 Parahoo, L. (2006). Nursing research: Principles, Process, and Issues. London: Macmillan. Read More