The Procedure of Removal of the Urinary Catheter at Midnight - Assignment Example

Guided Critique of a research paper Critique of the paper: Kelleher, M.M (2002).Removal of urinary catheters: midnight vs. 0600 hrs. British Journal of nursing, 11(2), 84-90. 1. CONTEXT OF THE PAPER 1.1 Is the tile appropriate? Why / why not? The title of the paper is appropriate, exactly conveying the context of the article. It gives a bird’s eye view of its content. The title exactly explains the purpose of the study very clearly and to a extent about the procedure to be followed as condition one- removal of the urinary catheter at midnight to be compared to condition two- removal at 0600 hours. 1.2 Does the abstract summarize the main features of the paper? The abstract is precise and is full in itself. It summarizes the content of the article. The abstract is different in another way that it even gives out the justification for the study, the previous studies points and recommendation from the author. The abstract thus is an item in itself, reporting clearly the aim of the present study, what the previous study has reported, how is it different from the previous studies. Then the methodology, sample size, selection criteria, experiment method is explained without ambiguity. The results that would give the perfect picture are given and even the valid, staunch discussion point is provided. The abstract also provides a peek view on the recommendation done by the study. In nutshell the abstract acts as a good mirror, showing off what exactly to expect in the article. 1.3 What was the question that the research was designed to answer? The study is designed to answer the question, as which optimum time to remove the indwelling catheter following urological surgery. Was it the traditional time of removal at 0600 hours or at midnight? This question, the study tries to answer after reviewing all previous studies, their findings and trying to analyze a very practical procedure in terms of quantitative data, thus trying to answer the point as which is optimal. (Giacomini, Cook, 2000). Thus the study tries to quantitatively provide an answer to the question as which is better, removal at midnight or at 0600 hours. 2.0 RESEARCH METHOD 2.1 what research design did the researchers use? Was this appropriate? Why/ why not? The research design used by the researcher in this study is randomized clinical trial. This seems to be appropriate as this study as a matter of fact tends to analyze and find out the better of two methods. For this randomized clinical trial seems to be very effective. The random selection of the participants would offer an unbiased field for the study that would provide formidable results. The randomized clinical trial is a type of scientific experiment that is used in nursing and healthcare. According to Lachin (1998), 'RCTs are considered the most reliable form of scientific evidence in healthcare because they eliminate spurious causality and bias'RCTs involves the random allocation of different interventions (or treatments) to subjects. This ensures that known and unknown confounding factors are evenly distributed between treatment groups. The Trials may be open, blind or double-blind. In an open trial, the researcher knows the full details of the treatment and so does the patient. In a single-blind trial, the researcher knows the details of the treatment but the patient does not. In a double-blind trial, one researcher allocates a series of numbers to 'new treatment' or 'old treatment'. The second researcher is told the numbers, but not what they have been allocated to. Since the second researcher does not know, they cannot possibly tell the patient, directly or otherwise, and cannot give in to patient pressure to give them the new treatment. Thus in this study it is a single blind randomized study, where the researcher knows but the patient doesn’t know which treatment he is administered with. (Lachin etal., 1988) 2.2 What is the independent variable? The independent variable that could affect the study is the time of removal of catheter that has an influence on the final result of the study mainly the urine output and discharge time. 2.3 What is dependent variable? The dependent variable in the study is the urine output or voided urine volume which was influenced by the independent variable the time of removal of intrauterine catheter. 2.4 Name two potential extraneous variables? The two extraneous variables might be presence of any other metabolic condition in patient that might influence the urine output as hormonal variations and the external temperature that might influence the urine output are the two other factors that might give a wrong manipulation in the results. (Crowe etal., 1994) 2.5 Are the measurement strategies adequately described? The measurement strategies as how, when the results are measured and calculated is adequately described. Also the instrument used the error factor possibilities and its negation was all adequately described. (Chalmers, 1993) 3.0 EXTERNAL VALIDITY OF THE STUDY 3.1 Who were the study participants? The study participants were the patients who had undergone urological surgery. The patients who don’t have any other medical complication are selected for the study. The participants who are around specific age groups were selected. (Young, & Becker, 1998). 3.2 How was the sample selected? Was this appropriate? The sample selection criteria were kept as patients in selected age group who had undergone urological surgery without any other complication. The sample selected seems to be appropriate, but the sample size could have been more to give a more signifactory. (Chanda & Johnston, 1999). 3.3 How many participants were in the study sample? How was this determined? Was this adequate? A total of 160 participants were selected for the study. The samples were selected from the group of patients undergoing urological surgery and who are administered with intra uterine catheter and without any other medical complication. The sample size could have been still higher that could have given a strong statistical significance. Many studies have proved the fact that for obtaining statistically significant results that can be confidently reproduced with validity, a requisition of large sample size is mandatory. So a large sample size would have given more satisfactory results. 3.4 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? The researcher has mentioned that drop outs were the patients who out of some unknown reasons though accepted initially at the time of study refused to participate in the study. This fact provided helps the reader to decide that the drop outs were due to logical reason and not due to any adverse effects that might have arose from the study experiment. ( Lillibridge & Watt, 2000) 3.5 Comment on the generalisability of the study result. One unique aspect of the study is its generisability. The researcher has selected a very simple and clear methodology, with selected variables. This gives the study both generisability and replicability. The study though performed on patients who have undergone urology surgery can also be repeated on patients who have to be kept on urinary catheter for any surgical reasons to see the pattern of results. Thus this gives a generisability to the study. 4.0 INTERNAL VALIDITY (total 10 marks) 4.1 Is there evidence of the reliability of the outcome measures? If yes, site evidence of their reliability. If no, please states which measures were not reliable and why? The outcome measure of the net urine output and the discharge time taken as indicator are both very reliable outcome measures. The urine output is measured twice and the mean statistical difference is calculated. Any statistical error is also accounted for. 4.2 Is there evidence of the validity of all of the measures? If yes, site evidence of their validity. If no, please state which measures were not valid and why? But when validity is focused the study doesn’t describe at length various measures taken to establish the validity of the results. Namely whether same person measured the urine output and was any other conditions that might increase the urine volume was not accounted properly. Also the researcher didn’t provide enough evidence that this might be the only factor responsible for the early discharge of the patients. 4.3 Was their blinding of outcome measures in the study? If yes state for what or for whom blinding occurred? If not state the impact of the lack of blinding on the study results. The study was planned to be a randomized clinical trial. So this calls for the person who measures he output to be blinded to avoid any bias in the result. The patients and the measurer were blinded to avoid any occurrence of bias in the study. The study planned to single blind study, where the participants were blinded and not the researcher. The participants were not informed about the pattern of the study and the patients were randomly selected avoiding any chance of bias. 5.0 DATA ANALYSIS (total 10 marks) 5.1 what methods data analysis are used? Are they appropriate? Why/why not?) The study has a very simple methodology and statistical technique. Basically the researcher took two group, a study and control group with the aim to compare and establish the most effective of and useful method of two. For that the researcher took one measurable- quantitative data, the first and second urine output data and the qualitative measurement of the discharge time. The researcher calculated the mean and then the statistical difference followed by the probability significance to conclude which is statistically significant. Regarding the discharge time, it was a very simple one on one comparison of the total number of days taken for discharge. (Colditz,1989) The method selected for the study is quite appropriate and justifying for the total number of variables and sample size taken. 5.2 Using all the information from your analysis so far, decide whether or not you recommend the results of this study is used for clinical practice? There is no definitive right or wrong answer here. If you think the report has a serious flaw that could lead to misinterpretation of the study findings, it should not be used as a base for practice. If you believe that the research is without serious flaws, then it may form a basis for practice, but you may have other reasons for rejecting it. Whatever you decide, you need to justify your decision. You may draw oh your answers to the previous questions to help with your decision. After analyzing the article and critiquely evaluating the article it could be said that the study doesn’t have any serious flaws and could be implemented as basis for practice. At the out set the study is set out with a very clear aim of finding out which is effective clinically and more advantageous for the patients, whether removal of IUCD at midnight or 0600 hours after surgery. After analyzing a battery of articles that has reported about this particular area, the researcher takes us to the methodology section. The sample population selection, sample size criteria, path and time period of the study are very well explained. Then the tabulation and data analysis that is very logical and reasonable for the selected parameters. The analysis again is simple and is very logical of comparing the first and second volume of voided urine volume and the discharge time. To avoid any bias the researcher has planned this to be blinded random clinical trial with a reasonable sample size. The result obtained is again cleverly explained and discussed by the researcher, ending up with a strong recommendation of bringing in the proposed method into practice. Reference: 1. Kelleher, M.M (2002).Removal of urinary catheters: midnight vs. 0600 hrs.British Journal of nursing, 11(2), 84-90. 2. Chanda, M., & Johnston, S. (1999). Post-operative urinary catheterization in gynecology. Journal of Society of Obstetricians and Gynecologist of Canada, 21(7), 650-660. 3. Crowe, H., Clift, R., & Bolton, D. (1994). Randomized study of the effect of midnight removal of urinary catheters. Urologic Nursing, 14(1), 18-20. 4. Lillibridge, J., & Watt, E. (2000). Timing of urinary catheter removal: A descriptive study. Urologic Nursing, 20(6), 375-380. 5. Young, S.B., & Becker, J. (1998). Postoperative urinary drainage. Clinical Obstetrics andGynecology, 41(3), 735-743. 6. Giacomini MK, Cook DJ. Users' guides to the medical literature XXIII. Qualitative research in health care A. Are the Results of the Study Valid? JAMA. 2000 Jul 19;284(3):357-362 7. Chalmers TC, Celano P, Sacks HS, Smith H. Bias in treatment assignment in controlled clinical trials. N Engl J Med 1993;309:1358-61. 8. Colditz GA, Miller JA, Mosteller JF. How study design affects outcome in comparisons of therapy. I. Medical. Statistics in Medicine 1989;8:441-54. 9. Lachin JM, Matts JP, Wei LJ (Dec 1988). "Randomization in Clinical Trials: Conclusions and Recommendations". Controlled Clinical Trials 9 (4): 365-74 Read More