Research and Health - Case Study Example

RESEARCH AND HEALTH Question 1 The study on how 10 adults with cerebral palsy and their complexity in communicating was ethically approved by committee in University Of Sydney Human Research Ethics Committee and an NGO which successfully helped in recruitment of participants. The ten adults who were recruited as participants through the NGO which normally gave various services to cerebral palsy patients suffered from, CNN and cerebral palsy. Using a sample of only ten participants would produce precise results as it was easy to fully interview them and record their outcomes. However, this would increase the chances of the sampling error when giving the results (Sheldon 2001). The results that will be derived from this study have a higher chance of being biased, as when you consider eight participants out of ten confirming that they successfully communicated with the nurses translates to 80 percent. This method that the patients used might be adopted from this study but it will not be a representative of all the patients who suffer from cerebral palsy and find it difficult to communicate with nurses during hospitalization (Sheldon 2001). This is normally due to the chance play which is normally exaggerated when small samples are used. Although such samples make it easy for data collection, analysis and interpretation, there is a possibility that the precise results produced are not a representative of the group of people being studied. If may be the sample size was 100 then if only 8 patients contend that they used certain methods to communicate with the nurses, then this would translate to 8 percent which might be more representative of people suffering from cerebral palsy (Flemming 2008). Using a small sample size interferes with the credibility, transferability and dependability of the outcomes. Using the speech pathology unit head to invite the adults suffering from CNN and cerebral palsy and had been hospitalized in the past two years for three days or more, was a good way of ensuring that the participants recruited for the study matched the criteria since the head of this speech department would produce the most correct recent statistics. By involving those patients who could be in a position to serve as self informants that is ensuring they were not disabled intellectually and could communicate through functional methods would make it easy to conduct interviews which would in turn lead to precision in data collection. By each participant signing a consent form or having it done by a witness who they instructed, improves the credibility of this study since it is a proof that they volunteered to participate. The participants used different methods normally used by those who suffer from cerebral palsy such as dysarthric speech and Augmentative and Alternative Communication (AAC) during interviews without any assistance from friends or family members (Balandin et al 2007). The non-use of interpreters from outside gives more precision on the data collected since the participants answered the questions during the interview in the best way they understood them. It is known that interpreters might twist the question in the best way they understand it, which might confuse the participants leading to collection of wrong data. Having different methods of communication that are used by the participants gives randomization to the study since analysis on each method can be separately done (Sheldon 2001). The researcher takes into consideration that the method that a participant uses during the interview, is likely to be the one they use during hospitalization when communicating to the nurses (Jackie and Dicenso 2008). Using people with CNN and disability for the pilot study enabled the researcher to know the type of interview protocol they needed to come up with. Pilot studies always serve the purpose of knowing the techniques to use during the real study and to learn if there is any ground that is not fully covered in preparation for the interview. This improves the dependability and credibility of data to be collected during the real study. By using both open ended and closed questions for the interview protocol, the researcher can be able to gather a lot of data. The participants will give their own views in questions that are open ended and their input will not be ignored during analysis (Rolfe 2006). This will give a lot of insight to different thoughts by patients which might be different from the traditional ones that are upheld by everyone. The conducting of the interviews took three weeks and for one hour by the same interviewer. Using the same interviewer decreases the level of biasness and the time delegated for the interviews was sufficient in collecting all the data that was needed. By asking the participants to clarify any responses ensured accuracy and reliability of data. The use of frequencies in data analysis is good since they provide the best simple results that can be understood by anyone. Using both qualitative and quantitative methods in data analysis increases the transferability, dependability and credibility of the data (Jackie and Dicenso 2008). Question 2 Ways through which qualitative research can contribute to improved clinical practice Qualitative research is responsible for producing practice which is evidence based. The hallmark of a practitioner who uses evidence based practices is the ability to reflect on the clinical decisions that are made and minimize uncertainties clinically. This evidence based approach is responsible for guiding the practice of many practitioners into the right direction. Most nurses have the desire of doing what they perceive as the best as far as their patients are concerned. Health care which is evidence based is responsible for providing the best strategies that aid most professionals within the health care sector to base their careers wholly on practices that are evidence- based. This fundamentally means that the evidence which is perceived as the best after any research is integrated into the practice with a lot of expertise clinically and taking into consideration the values of the patients (Sheldon 2001). Observational studies that are mostly used in research are where the researcher has no control over the intervention and bases the research on observing effects that are produced by routine conditions. Examples are studying death rates in patients suffering from a similar condition, and are recipients of a certain surgical operation. This can be compared to death rates of another set of patients with the same condition but receiving a different surgical operation. Through these two sets of studies, each treatment can be properly evaluated and this can help in determining key risk factors that decrease or increase this condition (Winch 2004). This will help in decreasing the occurrence of such risk factors in the future and the best intervention will be derived from such studies. This will help in treating the disease in the future. This shows that research can be used to address problems and risk factors that have contributed to deaths of patients and prevent them from happening in the future from the evidence that is gathered at the end of the research. There is constant need for professionals in the health care sector to update their knowledge on a regular basis since new and better interventions keep on being discovered constantly. Sometimes the traditional methods used on treating diseases keep on failing as the disease may have become resistant to a certain drug or the causative organisms gone through some mutations which cause them to resist the treatment. A good example is the Xtreme Drug Resistant TB (XDR- TB) which is common in people with HIV and AIDS. This TB is resistant to the antibiotics and drugs that are used in treatment of the multi- drug resistant TB in HIV. The information of this disease was published after a research was carried out in South Africa by medical researchers. This disease had claimed a lot of lives in the sub-Saharan Africa especially of those with HIV and AIDS. This study provided clinicians with better information to deal with it and avert further loss of life in the world. Thus, it is safe to say that research is responsible for saving of lives in clinical practices since new discoveries are made (Winch 2004). Question3 Promotion of inquiry culture To promote the culture of inquiry in the health care work place can be done by encouraging all the health professionals in all levels to use evidence based treatment in attending to their patients. The meetings that are held by staff every week at different levels can have an item on the agenda where all developments that are inquiry focused can be discussed. This can include presentation of the developmental activity that an individual is engaged in with the results they have achieved so far and how this will make the provision of treatment in the hospital better (Winter2001). This will encourage most people to engage in research since they will see that they are seriously taken and appreciated. The newsletters that are published at the place of work can carry brief reports on researches initiated by workers and provide details on where to fully access them. Most members of the staff will feel proud if their reports are published in the hospital newsletter and they will be encouraged to engage in other researches in the future. Those members of the staff who have not engaged in any research activities will feel challenged after reading the reports from their colleagues in the newsletter and this will give them a nudge in the right direction since most people love recognition. By publishing these reports, people can become more inquisitive as they can focus on developing and improving on the reports that are already published. The health institution can allocate time to workers so that they can engage in activities that are developmental and also prioritise the allocation of funds to such activities during budgeting (Winter2001). However, staffs needs to be nudged to get involved in such activities as a requirement but not as an indulgence since this will avert loss of resources. Promotions for staff in work places can be based on the number of researches that an individual engages in as this is likely to encourage positive competition and innovativeness. Every individual is focused on ensuring that their career grows within a certain period of time and everyone wants to be at the top of the pyramid. If this appraisal is to be based on the number of researches an individual has been engaged in and successfully completed, this would increase the inquiry culture within the institution and work place. People will work hard to come up with research studies which in the long run will ensure that a lot of harmless competition and innovativeness will be created. This will be of a great advantage to the hospital since evidence- based practice will take root in the treatment of any illnesses (Winter2001). The appraisal strategy will not be limited to the staff since leadership has a lot of influence on developing the culture of inquiry within the organization or workplace. Their promotion will be based on the number of developmental work and how involved they were in it within the team or department. The managers will in turn exert the power that is needed to encourage the members of their department or team to be more engaged in research and they will also take such involvements seriously (Winter2001). Question 4 Muscle strengthening program From the guide, it is clear that most fractures on the hips are as a result of falling from a height of standing or from a less height. This rate is known to be on the increase due to age and is higher on people aged over 65 years and especially if they are women. The program recommended that prevention of falls can be done by using a muscle strengthening program and training on balance (Dawn et al 2004). This has to be prescribed individually by a health profession who is trained in a setting that provides primary care in health. The guideline presented very strong evidence that recommended that exercising was good when integrated in the care plan among those older people who were frail. Most of these older people who lived in a community have been associated with the risk of falling. The group exercise that has appeared more effective is modified Tai Chi, when practiced by older people who are over 65 and exhibit poor balance and strength (Dawn et al 2004). When this exercise was done for 48 weeks it was less effective, but when it was done for a whole year, within the same group it was very effective. It was found out that those who had lower limb strength impairment, slow in reaction and poor balance had their rate of falling lowered by 40 percent after taking place in the exercise. This was in comparison to people in the same age group and exhibiting the same impairments, who were not taking part in the exercise (Dawn et al 2004). Since older people normally have a deficiency of vitamin D, it is good to supplement it in their diets and lives. The present evidence is insufficient on the confirmation that supplementation of vitamin D singularly, will not lead to a reduction of the hip fracture incidences. Consequently, it has been proved that a combination of vitamin D and calcium supplement will effectively lead to the reduction of hip fracture among the 65 years old and plus. A plan for giving supplementation on a daily basis consisting of calcium and vitamin D is highly recommended for this vulnerable group as it will lead to the reduction of hip fracture. This group of older people who live under institution care has been known to be at a high risk of getting hip fractures during falls due to the reduction in bone density (New Zealand Guidelines Group 2003). This daily supplementation will go along way in strengthening their bones and prevent fractures in case of a fall. This supplementation should be given most to those who have been put on corticosteroid therapy and are in old age. The evidence that this supplement works is the effect that this therapy has on the Bone mineral density (BMD). It has also been known that biosphosphonates also effectively reduce the fracturing of hips and other parts in women who are below 80 years and dwell in a community. Integrating exercise and a daily take of calcium and vitamin D supplements will be a good program for strengthening muscles and reducing falls (New Zealand Guidelines Group 2003). A systematic review for the basis of such a recommendation A practice can be termed as meaningful, appropriate, effective and feasible through the derivation of expertise, experience, inference, deduction or through results from an inquiry which can be used as evidence. Results that are derived from a research study which is well designed and has its roots firmly planted on methodological position are known to provide evidence that is more credible (Needleman 2002). This is in comparison with personal opinions or anecdotes which are likely to be highly biased. There has been a rise in practices that are evidence based and this has called for the evidence to be systematically reviewed. This systematic review is aimed at developing of a guideline that can be used in evidence based practices and ensure that the guidelines are fully utilised. This supports the orthodoxy that when a systematic review is done on any evidence which is derived from the results of researches that are experimental, will in turn elevate such results into superiority. This superior position will be calculated in terms of the applicability and quality that is brought into the practice. This practice will mostly disregard most results from those researches that are non-quantifiable as it is only interested in interpretation and subjectivity as a basis for a practice whose evidence is legitimate (Needleman 2002). There is an approach which is pluralistic when it comes to taking evidence which is considered to count in any practices within the health care. This evidence to be reviewed should include either quantitative or qualitative evidence. If the review is done on both quantitative and qualitative evidence it will even be better in any clinical practices (Needleman 2002). Therefore, from the above reviews it can be safe to say that systematic review refers to the process through which a summary and a synthesis of results from experiments and other studies that are quantitative is drawn. The expansion of this process can be done to include findings that have been generated via all rigorous research forms and those from controlled trials that are randomised. Whenever this systematic review is being done, it is also good to consider that the evidence from the results is not only effective but it is also feasible and appropriate. The term appropriateness means that the care meets the needs that are self perceived by the person it is being offered to. Feasibility will refer to the activity or intervention utility and practicality and factors that may have an effect on the decision being made by the clinicians, patients and policy makers (Needleman 2002). The systematic review of evidence ensures that all the practices that are evidence based makes clinical decisions that accord equal weight to the best evidence which is available. They also have a superior care delivery where preferences of clients are taken into consideration and the judgement which is given by the professionals and staffs also takes into consideration the evidence that is available and perceived as the best. The evidence which is cyclically generated due to the questions that keep on arising in the medical practice, has to go through appraisal and synthesis (systematic review) so as to transfer it to the service care setting and to professionals in health who will utilise it and assess the impacts it will have on the outcomes of health and their practices professionally (Needleman 2002). Bibliography Balandin, S et al 2007Communicating with nurses: The experiences of 10 adults with Cerebral palsy and complex communication needs: journal of applied nursing research, Elsevier publisher, Vol. 20 pp 56-62 Dawn, I et al 2004, exercise and falls, retrieved on may 25 2009 from Flemming, K 2008, asking answerable questions, retrieved on may 30 2009 from http://ebn.bmj.com/cgi/content/full/1/2/36 http://74.125.95.132/search?q=cache:JP_9jCEI3HAJ:www.laterlifetraining.co.uk/documents/Sportexpiece2004.pdf+How+to+do+it%E2%80%99+article:Gardner+MM,+Buchner+DM,+Robertson+MC,Campbell+AJ.+Practical+implementation+of+anexercise-based+falls+prevention+program.+Age+Ageing+2001%3B+30:77-83.&cd=8&hl=en&ct=clnk&gl=ke Jackie, R & Dicenso, A 2008, Identifying the best research design to fit the question: quantative design, retrieved on May 30th 2009 from http://journals.bmj.com/cgi/reprintform Needleman, I 2002, a guide to systematic reviews: journal of Clin periodontal, Blackwell Munksgaard, Vol. 29 (3) pp 6-9 New Zealand Guidelines Group 2003, Prevention of hip fracture amongst people aged 65 years and over, retrieved on May 30 from http://www.nzgg.org.nz/guidelines/0006/hip_Fracture_Prevention_Fulltext.pdf Rolfe, G 2006, Validity, trustworthiness and rigour: quality and the idea of qualitative research: Journal of advanced nursing, Blackwell publishers, Vol. 53(3) pp. 304-310 Sheldon, T 2001, Biostatistics and study design: journal of AACNN clinical issues, Elsevier publishers, Vol.12 (4) pp 546-559 Winch, S 2004, Read, Think, Do: a method for fitting research evidence into practice: journal of advanced nursing, Blackwell publishers, Vol. 50 (1) pp 20-26 Winter, R 2001, a handbook for action research in health and social care, Routledge publisher, pp 21-24 Read More