Critiquing evidence based practice research - Article Example

?CRITIQUING EVIDENCE BASED PRACTICE RESEARCH Preamble The research is a quantitative kind of research undertaken to examine the differences between various methods of blood pressure (BP) measurement in patients with irregular heart rhythms. The research seeks to make a comparison between automated BP measurement devices and manual BP measurement devices. The devices and methods chosen within this research are both non-invasive methods. Patients used in the study suffer from Atrial Fibrillation, a condition commonly associated with heartbeat disorder, producing irregular heartbeats(Roy et al. 2008). The researchers found limited information available regarding the accuracy of different non-invasive BP measurement devices in patients with irregular heart rhythms. The title of the research implies the comparison of BP measurement devices is non-invasive device but fails to make clarifications of the devices. This becomes clarified in the research through identifying automated and manual non-invasive BP measurement devices, which should have been identified by the title. Introduction The research seeks to identify the accuracy of different BP measurement devices in hospitalised patients suffering from heart rhythm disorder. The problem of accuracy in the results from different measurement methods lacks significance since in general nursing practice; BP measurement is performed using the automated non-invasive devices for hospitalised patients. The manual non-invasive devices are commonly utilised in outpatient sections of the hospitals. While the quantitative approach of research remains appropriate for this kind of research, a better analysis would have been making comparison between different automated BP measurement devices. This would be significant to the nursing profession as these are the devices utilised in all hospitals in acquiring the blood pressure of hospitalised patients(Pickering et al. 2005). The utilisation of automated devices within the hospital environment has been preferred because of patient comfort. Discomforts might cause patient movements, which result in blood pressure alteration. The research question has been stated explicitly within the context of the research. Explanations offered for development of the research questions and subsequent research variable identified within the research have also been clearly stated. The materials utilised in reviewing the existing condition have significant relevance to the study, and clearly identify the problem as defined by the researchers. The available information regarding the problem being researched justifies the need to undertake further research on the identified problem. This would provide increased understanding of the factors contributing to occurrence of the problem stated. The conceptual framework and rationale behind the study have been appropriately identified within the research the identification of the variables and research problem has been based primarily on the utilised academic sources of reference for the research. Methods The study was undertaken in a community hospital with the approval of the hospital’s investigational review board. The approval granted by this board signifies accreditation of the study, and subsequent satisfaction of the requirements stipulated by the institution in undertaking professional studies. Despite the approval from the investigational board, the patients’ rights might have been violated as they were not informed of any research being undertaken. The information provided to the researchers was provided in agreement with the institution and lacked approval or acceptance from the patients. The privacy agreement by the hospital not to divulge patients’ information became breached by providing details of patients’ conditions, which the researchers utilised in making their sample selection. The study was not subjected to external reviewing except by the hospital board. While the study takes actions to prevent patient risk, it presents no benefits to the participants. The results of the study would however become beneficial to other patients and the professional healthcare workers. The main aim of the research was to analyse the accuracy of non-invasive automated and manual BP measurement devices in patients suffering from heart rhythm disorder. The study utilised a cross over design, which would be best for analysing the research findings(Jones & Kenward 2003). All participants were to become their own control, receive both tests and blinding would not be essential for the study. The methods being utilised in the study did not involve presenting permanent effects on the patients; hence the efficient utilisation of cross over design. The washout period provided between allocating the tests presents a significant challenge to the reliability of the results. Since the individuals suffer from heart rhythm disorder, during the period between the tests, the blood pressure could experience significant variance, which would be recorded as difference in the results. The data collection points were appropriate as they occur immediately after performing the test. The selection of the population was accurately undertaken based on medical information obtained from the medical facility. This was essential part in eliminating attrition in the participants. The selected sample and chosen participants have been clearly identified and the selection process adequately described within the study. The details of qualification for participation clearly define the individuals excluded from participation within the study. The study participants remained limited to individuals diagnosed with irregular heart rhythms and within hospital ward. Various demographics were also applied including age and arm circumference in establishing credible selection criteria for the participants. Individuals diagnosed with other medical conditions were excluded from participation within the study. The utilisation of convenience method was best applicable within the situation as the researchers could not seek authority from participants. They relied on the medical information to establish convenience in selecting the participants. The sample size utilised represents an adequate number in establishing sufficient and reliable findings in such clinical trials. Sampling bias might have occurred as a non-random selection method was utilised. The data collection method utilised instruments selected and meeting the requirements of medical standards. The equipments were utilised in the appropriate methods described by the manufacture’s manual for the different measurement devices. The key variables identified within the study were effectively analysed and measured within the study. The researchers utilised the best possible data collection method of undertaking measurements themselves other than relying on information provided by medical workers within the hospital(Mehdi 2004). This works in supporting the reliability of the data collected when making analysis and conclusions. The choice of instruments utilised indicates that they could present reliable data as the researchers were quite familiar with the application of the instruments; hence the data becomes heavily reliable. The study provides a vivid description of the procedures performed in collecting the data. This includes the sequence for administering the different interventions identified by the researcher. Within the selected sample, each participant received both interventions as the study required. The procedure was repeated in a similar manner across all participants eliminating possibility of bias in the collected data. A single investigator performed the intervention and obtained the statistical information from the intervention. This could have produced minimal bias in the results if the individuals presented an inaccurate reading. Since the researchers were efficiently trained and familiar with the equipment being utilised, the possibility of such bias occurring becomes significantly minimised. Results The results were analysed through the utilisation of the paired student t-test in determination of the differences observed from results provided by the 2 blood pressure measurement devices. Descriptive statistics were utilised in undertaking the summarisation of the fundamental elements observed from the collected data. The description provided remains based on the initial description provided including the variance in age of participants, and the recorded blood pressure levels from both tests. The standard deviation of these variables has been calculated in establishing accuracy and relationship between the variables. Descriptive analysis aided in the presentation of data according to various demographics, defined by the researchers before commencing the research. The agreement between the different measurement devices has been effectively analysed utilising the Bland-Altman method of analysis. A plot was established in presenting the collected data in a graphical form for easy comparison between the main variables. This method was utilised in presenting the differences in blood pressures, as recorded utilising the manual and automated devices. The utilisation of this method enables researchers to compare variables and establish presence of fixed bias based on the results from the plotted graph(Hanneman 2008). The difference in mean becomes essential in establishing bias within the results. The research identifies several factors which could have contributed to the established differences in recorded blood pressure using different methods. Multiple regression has been effectively utilised in seeking to establish the possibility of external factors which could contribute to the observed difference(Armstrong 2012). The heart rate difference between the monitor and the automated device has been identified as a possible source of the notable difference in blood pressure. The utilisation of this method has enabled the researchers to establish the effects of the device utilised on the recorded outcomes, and subsequent blood pressure. The researchers have utilised these methods in seeking to establish credibility and reliability of the results from the research. The extensive utilisation of different analytical methods has provided the researchers with information aiding in identification of confounding variables within the study. These include element like patient comfort, which could have significant effects on the results recorded. The application of this analysis was not based on intention-to-treat but rather on establishment of accuracy in measurement techniques. The application of different methods of analysing results remains essertnail in the minimisation of type I and type II errors; which remains common in most research studies(Good & Hardin 2012). The occurrence of these errors has been significantly minimised through the utilisation of different data analysis methods within the study. The findings of the treatise have been summarised using different statistical presentations according to the requirement of the method utilised. The graphs and tables have been utilised in presenting summaries of different information contained within the report. Tabulation of information is essential in ensuring the information remains easy to comprehend for other people who might require the information. The testing process yields numerous results and classification of this information becomes essential in eliminating confusion and creating clarity. The presentation of the findings of the study has been undertaken efficiently and clearly through the tables and explanations to the information contained in those graphs and tables. The presentation of these results effectively supports comparison with other similar results through conducting a meta-analysis. The results of this research can be effectively subjected to comparison with findings of similar researches undertaken elsewhere. The findings present critical information which can be utilised in clinical based practice in different settings. Discussion The research identifies significant differences between blood pressure recorded using automated devices and that recorded using manual devices. These discussions contained within the study can be identified as being consistent with the research conceptual framework. The research intended to make comparisons between different measurement methods utilising non-invasive methods. The conditions of the participants during the time of the research were similar during both testing durations, and comfort levels were maintained when administering both interventions. The study utilised a single automated machine and discussions regarding automated devices can only be generalised. This study discussion remains within the limitation of the study as the study sought to make a comparison between an automated device and a manual device. Reference has not been made seeking to provide specifications of the automated device utilised; hence the results can be generalised to apply to different automated BP measurement devices. The research provides sufficient discussion regarding the clinical implications of the research findings and application in future. Significant differences recorded in the blood pressure measurement utilising automated measurement devices implies unreliability of these devices. Automated BP measurement devices continue to be utilised in providing guidelines in making therapeutic decisions by medical practitioners. Despite the clinical implications presented by the study, these devices have continually provided reliable information; which has been effectively utilised when administering treatment. These devices provide real time pressure records as patients rest within hospital wards. The efficacy of automated systems enables medical staff to monitor patients’ blood pressure easily. The suggestion to refrain from utilisation of automated blood pressure measurement in acute care situations presents a surmountable professional challenge. The automated devices have been effectively utilised in situations where patients lack the capacity to make movements. In acute care hospitals automated systems ensure continuous monitoring. Utilising a manual measurement method would involve an individual sitting next to a patient and continuously checking the blood pressure; which would be both difficult and impractical. Further research utilising different automated measurement devices could be utilised in establishing the efficiency of different automated measurement devices. Such comparison could establish an informed analysis regarding the different devices available, and the subsequent reliability of these devices. Critical issues The research report has been presented in a professional manner and many of the details are clearly identified. The terminologies utilised within the report make the research a reference point for utilisation by practicing nurses. The organisation and presentation of the research depicts immense understanding of the underlying issues facing many nurses in utilising blood pressure measurements when administering therapy to patients. The presentation of the results can enable individuals interested in the topic covered to gain essential knowledge regarding different measurement methods(Burrows 2004). The research identifies the need to ensure patients’ comfort before measuring their blood pressure. The researchers have sufficient knowledge in clinical nursing and are practicing nurses during the time of undertaking the study. Having a nursing background provides the researchers with increased understanding of the dynamics involved within the nursing profession. The individuals have the capacity to effectively identify challenges facing many other professionals within the industry. The process of conducting the research could therefore become credible based on the evidence of involvement of the researchers in such activities, like measuring blood pressure(Cutcliffe & Ward 2007). This eliminates a significant amount of doubt on the capacity of the researchers to perform the procedures described. The results presented within the research become reliable because of the researcher professional qualification. The involvement of a researcher working in a different hospital however would provide objectivity to the results provided(Polit & Beck 2008). Though not mentioned in the research, if the study was undertaken within the facility where the researchers work, a significant level of researcher bias might be present. This can easily discredit the reliability and credibility of the results and findings. The research indentifies limited research on accuracy of automated blood pressure measurement devices, but fails to provide any relevant solutions regarding the presented problem. The comparison of a manual device with an automated device appears irrelevant in establishing accuracy of automated devices. With notable differences in results, one cannot accurately determine which device presents accurate information. Application of more than three devices would have yielded more accurate information seeking to establish accuracy level of different devices. Despite having been utilised for longer periods, manual devices cannot be assumed to provide accurate data. A research using approximately five different testing methods could establish accuracy through comparison of consistency in the results. Increased researching on automated blood pressure measurement still requires to be undertaken to ascertain the clinical implications presented by the report. References Armstrong, J.S., 2012. Illusions in Regression Analysis. International Journal of Forecasting, 28(3), p.689. Burrows, E.A., 2004. Critiquing Nursing Research. Journal of Advanced Nursing, 46(4), p.460. Cutcliffe, J.R. & Ward, M.F., 2007. Critiquing Nursing Research 2nd ed., London: Quay Books Ltd. Good, P.I. & Hardin, J.W., 2012. Common Errors in Statistics (And How to Avoid Them) 4th ed., New Jersey: Willey. Hanneman, S.K., 2008. Design, analysis, and interpretation of method-comparison studies. AACN Advanced Critical Care, 19(2), pp.223–234. Jones, B. & Kenward, M.G., 2003. Design and Analysis of Cross-Over Trials 2nd ed., London: Chapman and Hall. Mehdi, N., 2004. Statistical Questions in Evidence Based Medicine, New York: Oxford University Press. Pickering, T.G. et al., 2005. Recommendations for blood pressure measurement in humans and experimental animals part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Coun. Circulation, 111(5), pp.697–716. Polit, D.F. & Beck, C.T., 2008. Nursing research: Generating and assessing evidence for nursing practice 8th ed., St. Louis: Lippincott, Williams & Wilkins. Roy, D. et al., 2008. Rhythm control versus rate control for atrial fibrillation and heart failure. New England Journal of Medicine, 358(25), pp.2667–2677.  Read More