The Critical Appraisal of the Research Evidence Associated with an Area of My Professional Practice - Coursework Example

The Critical Appraisal of the Research Evidence Associated With an Area of My Professional Practice By of 3154 Words [Date] Introduction Clinicians and nurses are always on the lookout for the best results from their practices. Although a nurse could be achieving good results, there is always the need to improve on the results, prompting the formal pursuance of research that would improve their weaknesses (Melnyk & Fineout-Overholt, 2005). There is great potential for improving a nurse’s knowledge from not only the nursing profession but also from the larger healthcare sector through critical appraisal of studies on specific areas of nursing. First, nurses stand to benefit greatly from interactions with experienced nursing researchers’ ideas and findings on nursing practices (Spring & Neville, 2014). Critical reviews of nursing research thus improve the experiences and knowledge of nurses in various practice areas. Hong Kong’s healthcare system has an increasing demand for evidence-based approaches. In particular, nurses face more serious evidence-based practice challenges given that the nature of their work requires that they rely on the available scientific evidences for decision making (Spring & Hitchcock, 2010). Observably, absence or lack of nurse representation in research would limit the growth and development of the profession (Duffy, Fisher & Munroe, 2008). Evidence-based practice in Hong Kong has numerous issues and implications in its establishment that need to be addressed through the critical analysis of the available and relevant researches. Despite the fact that evidence-based practice is a widely discussed concept in the literature, it is uncommon and not well adopted in nursing practice in Hong Kong and other countries. This paper critically appraises two journal articles on practice area relevant to Hong Kong. This critical appraisal is attained through the three important elements of evidence-based practice, namely systematic reviews, clinical guidelines and protocols. In essence the appraisal explores some of the current issues associated with evidence-based practice in Hong Kong. It then outlines specific suggestions to researchers, nursing practitioners, managers and academics so that the current nursing situation in Hong Kong is advanced. The appraisal is guided by a PICOT format question with the relevant population, intervention, comparison, outcome and time. Critical appraisal of research evidence is a key step in evidence-based practice in nursing. Through critical appraisal, the validity and usefulness of research evidence is established. This critical appraisal was conducted in three main steps, namely validity, generalizability and the strength of the recommendations. The critical appraisal focused on determining if the studies reviewed are valid. This process was supported by the use of critical of appraisal forms. It is worth noting that a variety of forms with different structures, contents, scoring, and emphasis exist. Under the recommendations to patients and clinical practice guidelines, the main factors considered were quality of the evidence, the balance among the desirable and undesirable effects, the resources used, clinical experiences, and patient preferences. The critical appraisal was systematic in its processes of identifying the strengths and weaknesses of the research articles and the assessment of the usefulness and validity of the research findings. The most important components of the critical appraisal done were thus, the assessment of the suitability of the study design for the research questions and a watchful evaluation of the main methodological features of the study design (Porta & Last, 2008). The other considerations during the critical appraisal were the appropriateness of the statistical methods, interpretation, potential conflicts of interest and the relevance of the studies to nursing practice. This paper critically appraises an article of a research entitled ‘Care of Older Dementia Patients in Acute Hospital Setting.’ Critical Appraisal of “Care of Older Dementia Patients in Acute Hospital Setting” In conducting the critical appraisal, the analysis uses the Polit and Beck (2010) and Roe (1998) framework of research evidence appraisal. This article was chosen because care for old dementia patients in acute hospital settings is a common encounter for nursing students and professionals in Hong Kong. Notably, in Hong King, healthcare professionals deal with old dementia patients in acute hospital settings quite differently. Hence, there is need to train, educate and inform the practices of Hong Kong healthcare professionals’ competencies and skills in addressing the needs of older dementia patients. Additionally, increasingly many older people are suffering from dementia in Hong Kong. The purpose of this critical appraisal is the provision and availing of knowledge on dementia-related nursing education, administration and care to nurses in Hong Kong. It also generates data and information to nurses on the desired characteristic of dementia nurses and their responsibilities and roles. The Study This study was ideal and necessary because it addresses the myriad challenges associated with caring for older dementia patients in acute hospital settings. Different healthcare professionals, especially nurses, have different methods of caring for older dementia patients, resulting in different experiences and results for patients and practitioners. This study will add to the previous work done on the subject of care for dementia patients in general and older patients in particular. This study thus sought and effectively used the qualitative approach to address the knowledge gap in healthcare for older dementia patients in acute hospital settings. The study was also selected for critical appraisal because its title is short and precise enough, thus allowing for the quick understanding of the research purpose, problem statement and objectives of the study. In other terms, the study’s title is unambiguous and quite concise, besides highlighting the content of the research study with the needed clarity. THE CASE Patient Problem Dementia, Acute Care, 70 Year-old male Intervention Education and training on cognitive and affective domains Comparison Traditional/standard nursing care for dementia Outcome Remission of dementia For the patient, the clinical question is: In older patients with dementia in acute hospital settings, is change in the approach to dementia to a standard care more affective at increasing the probability of remission in dementia? Literature Review Quite a good number of databases have information on which this study was built. For this research under appraisal, the literature review availed a comprehensive list of data bases used to search for print and electronic articles on dementia and the relevant keywords. The author targeted literature between 1980 and 2004. The articles reviewed covered a range of topics or issues. Nonetheless, there was little, if any evidence, that there had been any meaningful or self-evident change in nursing practices on older dementia patients from these studies. Study limitations and the sample size were the reasons for the apparent lack of change in the care for older dementia patients. The study’s literature review mentions just a few research articles of the forty seven sources gathered. This scenario could be attributed to study limitations. In particular, there was a study in which none of the patients was diagnosed with dementia, making the study quite limited for inclusion in the reviewed materials. Observably, in qualitative literature overview, the discussion of literature appears to be more limited than t is in other types of research (Chambless & Hollon, 1998). The literatures reviewed in the study helped in convincing the reader that perceptions on dementia nursing and care are limited and that nursing older dementia patients in acute hospitals ought to be addressed as a matter of urgency. Summarily, the literature review offered insights and detailed references, keywords and information on how the study was conducted. However, the research does not offer more recent literatures relevant to the study. It is advisable that researchers rely on the latest literatures and studies (Earl-Slater, 2002). Precisely, literatures ought not to be more than ten years old, preferably not older than five years. The reason this study did not rely on the latest literature could have been the intention of avoiding readers being influenced by previous materials. In addition, that dementia is today being used for political agendas could have prompted the researcher to use older literatures, enabling the identification of the actual gaps in dementia care. Study Methodology The study by Cowell relied on the qualitative approach to do the research, which was based on the naturalistic paradigm. Like other naturalistic researchers, this researcher appeared to favour details at of a specific group of people or certain situations. The main principle of this approach to research is the obtaining of awareness and appreciation of how individuals or groups perceive, view and experience the world. Qualitative research is an inquiry, which focuses on the manner in which communities and individuals perceive and understand their experiences and their worlds (Buysse & Wesley, 2006). This method is quite unlike quantitative research, which seeks to test a hypothesis and answer research questions based on a research framework. In this study under review, the researcher informs in the abstract that the study adopts an ethnographic approach, which serves as a picture of the target sample or population. Hence, the study writes about older dementia patients. The ethnographic and qualitative approaches rely on observational and interview as methods of data collection (Cowdell, 2010). Thus, as an ethnographer, the researcher sets out to learn from, and not to study, the members of a given group to understand their perceptions. Conclusively, the researcher uses the most appropriate approach to establish the experiences of patients and nurses in relation to the dementia care delivered by nurses and received by older patients. For purposes of data sampling, the study collected data between 2005 and 2006. The target groups were three wards for special older people. The researcher narrates that ethnographic observations and interviews were used. A total of 125 hours of observation were completed in two five-hour periods 7am and 8pm. The researcher then transcribed field notes and audio taped eighteen interviews. The researcher did not give any reason or rationale for the decision on the nature and the type of interviews used in the study, which ought to have been presented clearly and justified. The manner of data collected in relation to the methods used seemed satisfactory. However, the study had quite far-reaching limitations. An example of the limitations was the small sample size and the fact that the researcher used patients that had severe dementia, hence might have had cognitive impairment. Cognitive impairment might have influenced the results of the study. However, sample size is not a fundamental feature of the analysis of a qualitative research. Data Analysis In data analysis, the researcher transcribed the data accurately as soon as it was collection. The implication of this method of data analysis is that the researcher may be required to transliterate the interview as well. Ethical Considerations The main ethical consideration of the study was the observance of nurse researchers’ professional responsibility to design researches that support ethical principles and protect human rights, freedoms and dignity. The elements of this requirement observed in this study under review were informed consent from participants and their loved ones, gaining access, confidentiality, anonymity and avoidance of harm to patients and those close to them such as friends and family. In this study, Cowdell adhered to the ethical guidelines of nursing research besides adequately safeguarded the rights of the participants. This goal was achieved by incorporating the mentioned ethics principles in the research design. Importantly, ethical approval was obtained from the local NHS research ethics committee and the NHS Trust involved in the study. In addition, all the participants gave verbal consent before each period. Results The researcher used two subs headings within the findings, namely patient experience of care and nursing staff experiences of care delivery. In the findings section, the researcher applied some direct quotes from patients and nursing staffs, which the reader might find a bit biased, hence unreliable. That only a small sample of severe dementia patients was involved in the research could have been influenced or biased the study. Memory loss in severe dementia patients may have influenced the findings of the study, especially in the later stages of dementia. The researcher should have included newly diagnosed dementia patients that might still have perfect memories and good communication capabilities to express their feelings and perceptions (French, 2002). Nonetheless, the study’s findings have certain strengths. For instance, all the patients were diagnosed with dementia before being admitted to the hospital. Second, a mini-mental examination was conducted. The researcher also fails to mention anything on the organizational and environmental factors that might have had some influences on the results or some effects on the feelings, perspectives and experiences of nurses and patients. Discussion The researcher separates the discussion section from the findings, making it easy to read and understand the work. The findings are also well discussed within the article. The researcher manages to relate the discussions with the literature review and background information. The researcher also interpreted the major findings within the article before discussing and backing the up with references. The researcher also brought out the idea that little is known on acute hospital care from the perspective of older people with dementia (Cowdell, 2010). However, the researcher did not discuss the forms of dementia that the participating patients were diagnosed with and any cognitive skills impairment reported (Cowdell, 2010). The study used the Normans process, encouraging the researcher to account for her influence on the study (Cowdell, 2010). However, the researcher fails to elaborate that she could have influenced the results. The researcher used two methods to collect data, an approach referred to as triangulation collection. Triangulation improves the validity of a study by drawing on multiple references to answer research questions (Mason, Leavitt & Chaffee, 2006). By using triangulation in data collection, the researcher hoped to overcome potential biases of using a single data collection method, considering that no one method is perfect. A combination of methods thus has the potential to reduce deficits and biases of one method. Hence, by applying interviews and observations, the researcher enhanced the quality, reliability, validity and trustworthiness of the study (Cowdell, 2010). Unfortunately, the researcher did not give any recommendations of further research. Study Limitations Quite a number of limitations have been identified with the study. First, the researcher fails to mention the study’s limitation that the study was done on a small scale in one acute hospital. Therefore, the study findings cannot be comprehensively generalized. It can only be transferrable for convenience. Since the interpretation was done by the researcher, it could be biased. In addition, the researcher asserts that she did not return to the other participants to check data because she thought returning would be a burden to them (Cowdell, 2010). The researcher did not mention the potential effects of the Hawthorne effect on participant behaviour and performance. The Hawthorne effect has the potential of impacting the dependant variable. The Study’s Relevance to Practice The issues identified in the study by Cowdell have existed for quite a long time. For instance, that nursing professionals require further training, awareness and education on dementia care for older people is obvious. This education and training would be effective in assisting older dementia patients to receive more patient-focused care (Higgins & Green, 2008). The author feels it would be easy to change to more effective dementia care practices because of the huge evidence brought about by the study on the fact that nursing staff lacks knowledge and education in delivering nursing care to dementia patients (Cowdell, 2010). With most staff yearning for more knowledge and understanding in caring for older dementia patients, resources, cost and time management should be the only challenges to dementia care (DiCenso, Cullum & Ciliska, 1998). In addition, by having nursing journals with the right information available in wards, staff attitudes towards education and further training and use of evidenced base research, dementia care would greatly improve. Evaluation This section evaluates the Cowdell (2010) study, which seeks an expanded understanding of dementia care for older patients. Generally, the article has been well presented while its flow makes it easy to read and understand. Overall, the researcher opted for an appropriate method and approach. Nevertheless, the study had mistakes, especially in data sampling, an issues already explained in this appraisal. The data sampling mistakes might jeopardize the validity and reliability of the study. The critical appraisal of this study could be helpful to the author and readers in different ways. For instance, they may use this critique to expand their knowledge on research article analysis and appraisal, their understanding of the terminology and appraising nursing research (Cowdell, 2010). It may also make readers, nurses and the author more informed of how dementia patients perceive things and feel about the acute hospital setting and care offered (Cowdell, 2010). For current and future nursing professionals, this critique may be ideal as a basis for making changes on the delivery of dementia care to older patients. Summary of the Critical Appraisal ARTICLE TITLE: Care Of Older People With Dementia In An Acute Hospital Setting DATE: 2009 AUTHOR(S): Cowdell Fiona JOURNAL: Nursing Standard. 24, 23, 42-48 YEAR: 2009 TYPE: Non-Experimental Study AIM: To investigate the experiences of patients and nursing staff in relation to the care delivered to, and received by, older people with dementia in an acute hospital setting. METHOD: An ethnographic approach was used. Data were collected thorough observation and interviews involving patients and nursing staff. YES NO Does this study apply to my patient population? Yes No Strength of Study Design • Was sample size adequate and appropriate? YES • Were study participants randomized? NO • Was there an intervention? NO • If there was more than one group, were groups equally treated, except for the intervention? NOT APPLICABLE NOT APPLICABLE • Was there adequate description of the data collection methods YES • Was there a control group? NO Study Results Were results clearly presented? YES • Was an interpretation/analysis provided? YES Study Conclusions • Were conclusions based on clearly presented results? YES • Were study limitations identified and discussed? YES Pertinent Study Findings Care for older people with dementia in acute hospital settings is not always satisfactory. In general dementia patients find the delivery of care and the experience of being in hospital distressing. Nurses endeavor to provide best possible care, but this is not always attainable. Sub-optimal care can be explained by considering the effect of empathy and Bourdieu’s theory of practice. Recommendations There is a need to improve current practices in caring for older dementia patients. Approaches to education and practice development need to engage nurses in both cognitive and affective domains, so that nurses gain knowledge and an understanding of patients’ feelings and experiences. Will the results help me in caring for my patients? YES Evidence Rating (scales on back) Strength of Evidence Rating High (A) Good (B) Low/major flaws(C) According to the John Hopkins Hospital/University’s ranking of research evidence strength, this study falls in Level 3 because it is a qualitative study. Such a study is characterized by being explorative in nature. It collects data through interviews, observations, or focus groups. It acts as a starting point for studies of questions for which little research currently exists. Sample sizes are typically small and study results are used to design stronger studies that are more objective and quantifiable. References Buysse, V., and Wesley, P. W. (2006) "Evidence-Based Practice: How Did It Emerge and What Does It Really Mean for the Early Childhood Field?". Zero to Three, 27(2): 55. Chambless, D. L., and Hollon, S. D. (1998) "Defining Empirically Supported Therapies." J Consult Clinical Psychology, 66 (1): 18. Cowdell, F. (2010) “Care of older people with dementia in an acute hospital setting.” Nursing Standard, 24(23); 42-48. DiCenso, A., Cullum, N., and Ciliska, D. (1998) "Implementing Evidence-Based Nursing: Some Misconceptions." Evidence Based Nursing 1 (2): 40. Duffy, P., Fisher, C., and Munroe, D. (2008) "Nursing Knowledge, Skill and Attitudes Related To Evidenced Based Practice: Before Or After Organizational Supports." MEDSURG Nursing, 17(1): 55. Earl-Slater, A. (2002) The Handbook of clinical trials and other research. Radcliffe Publishing Ltd. French, P. (2002) "What Is The Evidence On Evidence-Based Nursing? An Epistemological Concern." Journal of Advance Nursing, 37(3): 250. Higgins, J. P. T., and Green, S. (2008) Cochrane handbook for systematic reviews of interventions version 5.0.1.The Cochrane Collaboration. Mason, D., Leavitt, J. K., and Chaffee, M. W. (2006) Policy and politics in nursing and health care, fifth edition. Elsevier. Melnyk, B. M., and Fineout-Overholt, E. (2005) "Making the Case for Evidence-Based Practice". In Melnyk, B.M.; Fineout-Overholt, E. Evidence-based practice in nursing & healthcare. A guide to best practice. Lippincot Williams & Wilkins. Porta, M., and Last, J. M. (2008) Dictionary of Epidemiology, fifth edition. OUP USA. Spring, B., and Hitchcock, K. (2010) "Evidence-Based Practice in Psychology." In Weiner, I. B., Craighead, W. E. Corsini’s Encyclopedia of psychology and behavioral science 2, fourth edition. Wiley. Spring, B.; Neville, K. (2014) "Evidence-Based Practice in Clinical Psychology." In Barlow, D. H. The Oxford handbook of clinical psychology. Oxford Library of Psychology Series. Oxford University Press. Read More