Target Weight Achievement and Ultrafiltration Rate Thresholds - Research Paper Example

Evidence Table

A1 Quantitative Article:

Flythe, J. E., Assimon, M. M., & Overman, R. A. (2017). Target weight achievement and ultrafiltration rate thresholds: potential patient implications. BMC Nephrology.

Background or Introduction

The purpose statement which states, "Higher infiltration rates and extracellular hypovolemia and hypervolemia are associated with adverse outcome in maintenance hemodialysis patients," is evidently supported by the research presented in the article. The research provided in the article focuses on potential implications on patients resulting from weight achievement and UF rate thresholds. The study, conducted by Flythe, Assimon, and Overman is well structured, with an abstract that presents the information from data collected and conclusions made. As a structured study, the article comprises of an introduction that presents the purpose statement and the related concepts to be analyzed through the paper

Review of the Literature

The study analyses 13 literal works evident in the introduction section of the article. The review uses articles dated between 2007 and 2016, providing sufficient information for a 10-year period. The fact that the review is within the introduction shows that it was not thorough enough. Even with this, however, the review provides the required information for the topic. This information covers specific concepts later discussed in the paper; these include;

• Interdialytic weight gain,
• Fluid retention and the impacts it has on weight gain,
• Issues associated with hemodialysis, and the
• Implications of specific dialytic process of facilities

Discussion of Methodology

The study was carried out using quantitative methodology and the descriptive design. As a quantitative study, the researchers, used the data from a 2012 database, considering 152, 196 hemodialysis patients in the United States. Using the descriptive design, the researchers described the monthly dialysis and facility target weight patterns of achievement of the patients. The researchers also examined the characteristics of these patients across the differences in the facilities and the weight achievement status.

Data Analysis

Through statistical analysis methods, the researchers used the SAS version 9.4 to analyze the data collected. The researcher combined several statistical methods, which included the chi square test, t-test, and the multivariable logistic regression methods respectively. To arrive at conclusions, the researchers computed the cumulative theoretical fluid related weight gain after one month. The weight gain within this period however related to what the results after capping UF rates at 13ml/h/kg without any concurrent extension of treatment times or the reduction of the IDWG

Researcher’s Conclusion

The researchers found that the weight achievement patterns do vary across the different clinical subgroups. Based on the research purpose the researchers also found that the implementation of maximum ultrafiltration rate without any attention to the extracellular volume status tends to lead weight gain related to fluid quantity. Based on the problem statement these conclusions make sense in relation to the nursing practice

A2. Researcher’s Conclusion

Author's conclusion- Target weight achievement patterns vary across clinical subgroups. Implementation of a maximum UF rate threshold without adequate attention to extracellular volume status may lead to fluid-related weight gain

Evidently, the four sections closely relate to the conclusions made by the researchers. From the beginning, the researcher's present arguments that show implications UF rate thresholds and target weight achievements have on patients. Most of the arguments in this revolve around the impacts it has on weight gain. Even the data used for the study (data from the single dialysis organization) support the purpose statement for the study. The methods employed for the research also aimed at measuring target weight achievement and the impacts UF rates have on individual weights. The statistical analysis methods with their intended targets also support the conclusions made. This is evident with the fact that the T-tests and the chi square methodologies were used to analyze the differences in facility characteristics while the logistic regression model was used to measure the adjusted associations between annual facility characteristics and characteristics of target weight measure.

A3. Protection and Considerations

The research conducted in 2017, used data from 2012 to make its conclusions on the purpose statement. The study even with the mention of the specific ages does not mention the identities of the involved participants. The study did not involve actual participants but only the facilities 2012 data on patients related to the study, this means that no consent was required for the study. However, even with these, the study was still approved by the UNC Chapel Hill institutional review board.

A4. Strengths and Limitations

The large sample size for the study represents a strength as its findings can be generalized to the whole population. The data analysis methodology presents also presents results for a larger sample size, which can also be generalized for the larger population. The quality of research also presents another strength or the study. These revolve around the fact that the conclusions of the study came from a sample from facilities related to the topic being investigated.

The limitations of the study revolve around the fact that it fails to ascertain the deeper and the underlying meanings and the explanations of data. The information also presents a certain level of positivism that revolves more around proving the specific problem without the generalization of the deeper underlying causes; in that, it makes a snapshot of the phenomenon.

A5. Evidence Application

Even with the limitation, the study is important in the field of nursing as it provides well-analyzed information on the importance of reconsidering the weight measure of patients and the importance of developing a near measure to counter balance the UF rate performance measures. As medical practitioners striving to protect their patients from specific illnesses and issues, for example, the one presented in the study (protection from the consequences resulting from the overly fluid removal) the information presented is also effective for future use and also for future research. This is because it provides the importance of applying for vigilance protection from aggression fluid removal and other associated issues of dialysis.

B1 Qualitative Article:

Salmon, S., & McLaws, M.-L. (2015). Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam. American Journal of Infection Control.

Background or Introduction

The purpose statement which states, "It is accepted by hospital clinical governance that every clinician's "duty of care" includes hand hygiene, yet globally, health care workers (HCWs) continue to struggle with compliance," is based on the intended study for the importance of hand hygiene compliance in Vietnam. The purpose statement is clearly described and easy to understand as it is closely related to the topic of the study. The study conducted by Salmon, McLaws is well structured, as it comprises of an abstract section, background section, methodology section, results section and the conclusion sections. The abstract presents the information in the entire study including a summary of the information from all the sections in the paper. For example, the section on background provides the purpose statement and a statement about the methodology used and its importance to the study.

Review of the Literature

The researchers through the introduction reviewed sixteen articles. All these articles are dated between 2000 and 2015 providing the information on the topic over a scope of fifteen years. Even with the large scope, the articles covered the topics of;

• Hand hygiene,
• Examples of the existing laws, and
• The levels of compliance with the existing hand hygiene laws. The articles also provide summaries of the issues related to poor hand hygiene and the benefits of proper hand hygiene.

Discussion of Methodology

The researchers employed the qualitative methodology to carry out their study. Under this, they employed ethnographic research and used focus group discussions for data collection. The researcher conducted twelve focus group discussion from six public hospitals in Hanoi Vietnam. The researcher also used tape recordings to gather and store the data collected gathered during the discussions. Each focus group comprised of between 8-12 participants.

Data Analysis

The information from the focus groups was recorded in audiotapes. These audiotapes comprised of full sessions of each of the focus group, which was later transcribed using the standard word processing software. The transcripts were later proofread and translated to the English language, which helped ensure an accurate translation. The transcripts were then read by the researchers who later identified themes from the dialogues and sub-themes related to the topic. To avoid ambiguity, the researchers referred to the original transcripts for clarification. After agreeing on the themes, the researchers then tested the framework around the thematic codes, which was later tested against the samples and later refined.

Researcher’s Conclusion

The conclusion of the study showed that the limited resources are amplified by overcrowding and dual bed occupancy in Vietnam. The researchers also concluded that without any systematic duty of patient care, the changes to the guidelines and resources provided might not improve compliance. To the researcher, this meant that the introduction of routine hand hygiene should start with the creation of awareness. This awareness creation includes education focusing on the duty of care. These conclusions make sense and apply to the nursing practices in relation to hand hygiene.

B2. Researcher’s Conclusion

Authors Conclusions- Limited resources in Vietnam are amplified by overcrowded conditions and dual bed occupancy. Without a systematic systemic duty of care to patient safety, changes to guidelines and resources might not immediately improve compliance. Thus, introducing routine hand hygiene must start with education programs focusing on duty of care

Each section from the introduction to the results section support the conclusions in the article. The introduction provides a reason as for why hand hygiene is important and why it is closely related to nursing practice. The methodology, on the other hand, focuses more on gathering information of the same from public hospitals involving participants with better understanding of the existing situations. The results present the conclusions of the study; they show that there exists a limited access to hand hygiene solutions which are amplified by specific situations presented in the conclusions which in turn hinder how effectiveness and the applicability of the results.

B3. Protection and Considerations

The study involves actual participants, which in turn means that there is need to follow specific ethical standards. These standards are evident in the anonymity of the participants, in that only the number of the participants is mentioned. Involving the relevant bodies such as the staff of the National Institute of Hygiene and Epidemiology and hospital staff show the level of compliance with the ethical standards of conducting research.

B4. Strengths and Limitations

The thickness of the results produced in the study is one of the major strengths of the study. The information presented is detailed and provides opinions and experiences of the participants interpreting the meaning of the actions. Through using actual participants, focus groups the study produces results that revolve around a holistic understanding of human experiences in specific settings as related to the topic. This enables the researcher to get the inner perspectives of the communities in relation to hand sanitation and also help them discover the deeper challenges faced by the participants.

A limitation of the study includes the fact that the data presented leaves the contextual sensitiveness focusing more on meaning and experience. The sample size also presents a major limitation from the fact that few people represent the whole population. This challenge revolves around the generalizability involves in qualitative method of data collection

B5. Evidence Application

Proper hand hygiene is one of the most important components of proper health, however, in today's world, it is one of the most challenging concepts in ensuring there exists a healthy society. The study, therefore, provides important information, which is necessary to ensure there exists proper care. As evident, the main challenge, especially within the less developed countries, revolves around the lack of awareness and poor compliance with regulation. The study from the research itself and the conclusions provide information that would play an important role in ensuring there exists better regulations, for both current and future use.