Engaging in Evidence Based Practice and Clinical Effectiveness - Assignment Example

Engaging in Evidence Based Practice and Clinical Effectiveness Table of Contents Introduction 3 Critical Appraisal – Randomised Controlled Trials 3 Section A: Are the Results of the Trial Valid? 4 Section B: What are the Results? 7 Section C: Will the Results Help Locally? 9 Conclusion 12 References 13 Bibliography 16 Appendix (Action Plan) 18 Introduction Discussion in this paper is intended to critique a quantitative research article titled “Explaining the effects of two different strategies for promoting hand hygiene amid hospital nurses: a process evaluation alongside a cluster randomized controlled trial” by Huis & et. al. (2013). The study aimed at addressing an increasingly stimulating issue of modern healthcare practices – promoting hand hygiene to control infections. The implications of encouraging hand hygiene has attracted interventions of many kind those have apparently stimulated the entire diagnostic culture and healthcare pattern that is evident within clinical practices. In many of the past researches, at least in those obtainable readily, emphasis is laid on understanding the importance associated with hand hygiene (Dore & Blottie`re, 2015; Arck & Hecher, 2013; Howe & et. al., 2013; Harris & et. al., 2012; Ziauddeen & et. al., 2012). It is with this consideration that Huis & et. al. (2013), attempts to fill the gap with a combined analysis of the process as well as data collected to identify the strategies that implies the respective changes in hand hygiene processes that are used in hospitals, controlling the health consequences associated with the same. Hence, the researchers utilised a randomised controlled trial method to obtain data and scrutinize the findings that are related with the issue in concern. In order to deliver a better and detailed insight to the research method applied in Huis & et. al. (2013), this critique paper will make use of the Critical Appraisal Skills Programme (CASP) relevant for a randomised controlled trial study. Critical Appraisal – Randomised Controlled Trials Utilisation of Randomised Controlled Trials in medical research studies have long been into practice. It is said to be most effective in studies, which are aimed at assessing the cause and effect relationship of an identified health risk with the intervention provided (Sibbald & Roland, 1998). There are certain merits and demerits of the technique over non-random control trials, which can be identified in terms of non-bias allocation of participants to keep as much similarities as possible amid the control groups prior to conducting a comparative analysis. Nevertheless, these factors do not completely secure the technique to be bias free (Stolberg & et. al., 2004). Ethical considerations to the method have also been subjected to substantial criticisms in the past decade owing to the comparatively higher degree of dependency on the judgmental attributes of the researchers (Solomon & et. al., 2008). To be mentioned in this context that the above stated criterion are to be included for the following discussion in order to critique the randomised controlled trial technique used in Huis & et. al. (2013). Section A: Are the Results of the Trial Valid? Arguably, irrelevant to the research approach taken into consideration, ensuring that it is focused on a precisely defined issue is highly essential not only to ensure internal validity of the superior level but also to gain precision in detailing findings with increased scope of the study findings (Solomon & et. al., 2008). Examining the same notion in the context of Huis & et. al. (2013), offers a clear view to the focus of the trial implemented in this research. As per the given criterion, focus of the trial can be examined with the help of the studied population with consideration to the intervention type, the comparator(s) defined and the outcomes thus considered (CASP, 2013). Correspondingly, the population considered in Huis & et. al. (2013) comprised of participants belonging from three hospitals in Netherlands that included one medical center and other two general hospitals. The sample size was 67 comprising of affiliated nurses belonging to different wards within the selected hospitals. In the following study conducted, the strategies with respect to helping hand were implemented within a period of six months. In addition to this, the follow up measures were also taken with respect to the implementation of strategies concerning the issue that was associated with the needs of maintaining hygiene. The strategies received by the nursing wards include education, feedback, reminders and optimisation of materials as well as other facilities. Furthermore, the evaluation method preferred in case of the particular research includes evaluation of the impact of hand hygiene strategies on nurses as well as evaluation of experiences associated with the implementation of new strategies. Another method used in the research study for collecting relevant data includes observation method, questionnaire survey as well as gathering information regarding the number of visitors of the official site (Huis & et. al. (2013). Hence, it can be affirmed that the trial implemented in the study addressed a ‘clearly focused issue’ regarding maintenance of the hygiene in hospital nurses through the effective integration of hang wash as a part of the routine practise. Another consideration was provided for testing the validity of the results that were attained from the trail that were conducted using randomised division of the participant group into an experimental group or control group. Referring to the study method applied in Huis & et. al. (2013), it can be visibly observed that the conditions applied by the researchers to select participants were based on randomised trial at nursing wards of the selected hospital units that were being subjected to hand hygiene practices. To ensure that the selection of the participants is entirely randomised, the study overlooked any application of run-in period or test prior to randomisation. In addition, the allocation was also concealed from the selected participants, as they were enrolled in different intervention techniques by the researchers, with considerable significance to prevent face to face interaction between the selected participants. Therefore, chances of bias in the randomised trial groups get reduced largely, although it increases complexities in filtering the data collected in an error free manner. A limitation of the study was noted to be the lower response that was collected with respect to questionnaire distributed amid the nurses of the participation units. Potentially, this particular limitation may have an effect on the ultimate reliability of the outcomes generated in Huis & et. al. (2013). Blinding in clinical randomised controlled trials is asserted as essential in order to eliminate the slightest chance of biasness from the data received from the participants (Viera & Bangdiwala, 2007). In simple terms, it refers to the strategy of keeping the participants uninformed about the features or responses of the other participants so that the perceptions of the individuals are kept uninfluenced hence, effective elimination of biasness is possible successfully. It is also argued to be helping in controlling the retention rate of participants, augmenting validity of the overall research (Schulz & Grimes, 2002). It is owing to such worthiness that the effectiveness of the strategies that are taken by the researchers to blind the participants also acts as a major determinant to the appropriateness of results obtained through the randomised controlled trial method. In compliance to this particular aspect, Huis & et. al. (2013), noted that observation and questionnaire that were provided to the nurses in the study undertaken was applied for availing the overall objectives of the study. This spares a possible chance of biasness and self-infliction of data. However, this particular criticism cannot be strongly justified in account that the findings were presented in details with substantial efforts made to validate the results on the basis of chosen clinical comparators. As already mentioned above, it is necessary to maintain a degree of homogeneity in the selection of participants, irrespective of which group they were intended to belong. This is only possible when the selection of the participants take place on the basis of defined criteria, which in the case of Huis & et. al. (2013) was conducted with due emphasis to the different nursing wards in the selected hospitals. In addition, a number of diverse strategies were applied with respect to hand hygiene. These strategies at the end helped to reduce biasness and obtain results from the interventions in a more reliable manner. This could be duly obtained as the groups had similar characteristics prior to their trials. Huis & et. al. (2013) apparently stated in their study intension to treat analysis as applied according to experimental or control group. In addition to this the ward selected were analysed with respect to the implications of improved hygiene strategy as applied in the selected hospitals. Another vital concern in determining the effectiveness of randomised controlled trial method is the continuation and unhindered implementation of the entire process. Mohr & et. al. (2009) affirmed in this regard that during its implementation, owing to its high dependency on the study about the population, researchers might be forced to stop the process and re-instigate the same, which shall ultimately impose crucial effects to the viability, validity and reliability of the study results. Stating precisely, even though the study faced no such situation to withdraw or stop the process before time, the response rate over the determined population was limited. Section B: What are the Results? Drawing inferences from the above discussion, the reliability of the results obtained through the specified research in Huis & et. al. (2013) may not be considered as entirely valid or reliable owing to the gaps persistent in terms of laying and examining the respondent groups consisting of the ‘state-of the–art group’, team, and ‘leader-directed group’ as well as in terms of clarity in applying all the features of randomised controlled trial. Nevertheless, the researchers paid due emphasis to draw precise findings based on the study process. The results thus obtained revealed that the hand hygiene compliance for the participants had little or negligible difference between the two groups. To be precise, the difference of the hand hygiene compliance measured after trial within the intervention groups treated through remote support revealed a p-value of less than 0.05 while the other group was measured to be occupying a p-value of less than 0.01. Although this proves that the effectiveness of hand hygiene compliance is more effective in leader-directed group strategy, it gives insignificant scope to assert whether such a difference shall be considered while assessing the performance of state-of-the-art group (Huis & et. al., 2013). The results of the study, as observed in the context of Huis & et. al., (2013) indicated substantially greater improvement in the effectiveness of both the groups in enhancing the level of compliance to hand hygiene by patients, measuring a difference of only 0.04, i.e., p < 0.05 and p < 0.01 from the baseline, which was apparently similar to the performances of both the groups. It must be noted in this context that the outcome was measured on the basis of hand hygiene compliance from the baseline. The above-mentioned results were inferred based on the outcomes wherein findings suggest that the effects of hand hygiene compliance on hospital were having a p-value of less than 0.05. On the contrary, smaller effects on the hospital for hand hygiene compliance by nurses was having a p-value of less than 0.01. In addition, based on the findings generated from both the groups, it can be interpreted that there existed a positive correlation amongst the variables of changes underlying hand hygiene compliance by nurses in comparison to their experiences and feedback regarding their performance, which revealed a p-value of less than 0.05. Apparently, the results obtained justified the hypotheses developed in the study appropriately. Although this indicates a successful accomplishment of the study objectives rather a critical view to the findings revealed that there can be certain chances of selective reporting of the outcomes, which may therefore, arise as a major cause of biasness in the study. Arguably, selective reporting has been an issue of considerable attention among researchers, wherein the researchers intend to hide negative data from being disclosed in opposition to the hypothesis developed, giving a sound visualisation of favourable study towards the facts only (Salandra, 2015). Critically observing the data and facts disclosed in the study, a slight chance of such selective reporting can be identified to be persistent hence, the results may not be considered as completely valid. The results obtained however had strong statistical justifications with the existence of a positive correlation between the variables, which is quite common within similar studies. Considering the results’ statistical significance, the inference can be quoted as positive. Section C: Will the Results Help Locally? It can be understood from the discussion that there is a need to emphasize on the fact that experience of nurses regarding maintenance of adequate hand hygiene can have a positive impact on the well-being of patients and can further promote the use of hygiene care amongst the nurses, patients and others (Oakley & et. al., 2006). The results obtained from the study can be of great help to the researchers conducting similar types of study in future, as well as for people associated with the medical background since it can provide them with an in-depth knowledge and understanding of the importance of hand washing and its role in mitigating healthcare issues associated with infections. Additionally, the study can also help nurses, doctors and other medical professionals with knowledge regarding the significance of leadership in the field of clinical research and its contribution towards the development of better healthcare standards by focusing on the need to adopt hand washing. In addition, the findings can provide substantial help locally in medical field, since it emphasizes on the development of social influence and hygiene, based on the development of hygiene behaviour. In addition, findings can further help local population since they tend to focus on the implementation of strategies associated with hand hygiene improvement through the use of leadership skills and competencies. Hence, it cannot be argued that the population of interest is different from the trial since a majority of the populaces selected for this particular study were associated with the field of medical care (Grol & Grimshaw, 2003). Considering the outcomes obtained from the research study, it is worth mentioning that most importantly all of the clinical outcomes were considered appropriate throughout the process of conducting the study. Additionally, there is a need to consider the fact that the study outcomes were based on the variables of strategy receipt and delivery similar level of anticipations for the study. Moreover, the outcomes associated with effectiveness of the hand hygiene strategies can be generalized owing to the use of statistical tools underlying quantitative analysis of the data. Moreover, it can be argued that the need for the randomized trial was clinically described since the trial helped in gaining vital understanding of the actions that were being deployed by nurses towards ensuring compliance with the Hand Hygiene (HH) standards as defined by the World Health Organization (WHO). Moreover, the outcomes suggested the development of sustainable understanding of the research questions and further outlined the comparison of role of nurses in maintaining hand hygiene compliance prior to and after conducting the study (Naikoba & Hayward 2001). Generalisability of the outcomes can further be ensured owing to the inclusion of several components in the questionnaire to arrive at definite outcomes. These include several factors such as feedback, leadership, education and setting norms and targets. Furthermore, the outcomes suggest that the level of hand hygiene i.e. “HH compliance” amongst the nurse enhanced by a p-value of 0.002 amongst those belonging to leader-directed group, which reflects an enhancement in the level of hand hygiene compliance amongst nurses (Hulscher & et. al., 2003). The study provided benefit in assessing the comparative strengths and weakness of the strategies towards ensuring an increase in hand hygiene compliance among nurses engaged in providing medical care. Process-based evaluations underlying the study helped in gaining a better understanding of the hand hygiene strategies and the relationship existing between the hand hygiene strategies and nurses’ compliance with the same. Conducting the study based on a process-based evaluation played an important role in gaining a theoretical understanding of the strategies and the manner in which such strategies were helpful in enhancing the level of compliance associated with maintaining appropriate levels of hand hygiene. Additionally, the process-based evaluation was utilized in the randomized group, which further enhanced the validity and reliability of the outcomes. The study helped in concentrating on the need to ensure compliance of hand hygiene and further signified the role of managers in motivating nurses for ensuring the same. Managers and other staff members belonging to the hospitals that were undertaken to conduct the study with nurse, were committed towards conducting the study and ensured their full participation whenever needed. In addition, the benefits outweighed the harms and costs since the data collection was conducted with the help of questionnaire surveys, which helped in reducing costs associated with conducting the study. An extensive pilot testing was conducted that ensured the surveyed participants are free to ensure their participation. However, since the study was conducted in a field of a medical profession, hence, many of the participants failed to turn up and the response rate was limited to 48%. This was one of the fundamental limitations of the study. However, the limitation did not result in lowering the validation of the study since the responses were able to determine the role of nurses in maintaining compliance with the hand hygiene and further played an important role in determining the role of leadership in enhancing the outcomes to maintain hand hygiene and prevent unnecessary transfer of infections (Jumaa, 2005). Conclusion The aforementioned study provides an understanding of the various factors associated with the development of hand hygiene in hospital and compliance of the same by the nurses. Moreover, the study also provides an understanding of the use of the process evaluation technique in development of several mechanisms that play an important role in progression of the strategies associated with hand hygiene. Correspondingly with the diverse use of the strategies and with the use of pragmatism based randomized trial method the study effectively outlined the role of leadership in improving the implications that are associated with hand hygiene, thereby resulting in enhancement of the same and prevent from the transmission of diseases among the patients. References Arck, P. C. & Hecher, K., 2013. Fetomaternal Immune Cross-Talk and Its Consequences for Maternal and Offspring’s Health. Nature Medicine, Vol. 19, No. 5, pp. 548-556. Dore, J. & Blottie`re, H., 2015. The Influence of Diet on the Gut Microbiota and Its Consequences for Health. Current Opinion in Biotechnology, Vol. 32, pp. 195-199. Harris, K. & et. al., 2012. Is the Gut Microbiota a New Factor Contributing to Obesity and Its Metabolic Disorders? Journal of Obesity, pp. 1-14. Grol, R. & Grimshaw, J., 2003. From Best Evidence to Best Practice: Effective Implementation of Change in Patients Care. Lancet Vol. 362, pp. 1225–1230. Huis, A. & et. al., 2013. Explaining the Effects of Two Different Strategies for Promoting Hand Hygiene in Hospital Nurses: A Process Evaluation alongside a Cluster Randomized Controlled Trial. Implementation Science, Vol. 8, No. 41, pp. 1-13. Hulscher M. E. & et. al., 2003. Process Evaluation on Quality Improvement Interventions. Qual Saf Health Care, Vol. 12, pp. 40–46. Howe, L. R. & et. al., 2013. Molecular Pathways: Adipose Inflammation as a Mediator of Obesity-Associated Cancer. Clinical Cancer Research, Vol.19, No. 22, pp. 6074-6083. Jumaa, P. A., 2005. Hand Hygiene: Simple and Complex. International Journal of Infectious Diseases, Vol. 9, pp. 3–14. Mohr, D. C. & et. al., 2009. The Selection and Design of Control Conditions for Randomized Controlled Trials of Psychological Interventions. Psychother Psychosom, Vol. 78, pp. 275–284. Naikoba, S. & Hayward A., 2001. The Effectiveness Of Interventions Aimed At Increasing Handwashing In Healthcare Workers - A Systematic Review. J Hosp Infect, Vol. 47, pp. 173–180. Oakley A, & et. al., 2006. Process Evaluation in Randomized Controlled Trials of Complex Interventions. BMJ, Vol. 332, pp. 413–416. Salandra, R., 2015. Selective Reporting In Industrial Research: The Effect of Innovation, Uncertainty of Science and Competition on Firm Motivation. Imperial College Business School, pp. 1-17. Schulz, K. F. & Grimes, D. A., 2002. Blinding In Randomised Trials: Hiding Who Got What. Lancet, Vol. 359, pp. 696–700. Sibbald, B. & Roland, M., 1998. Understanding Controlled Trials: Why Are Randomised Controlled Trials Important? BMJ, Vol. 316. [Online] Available at: http://www.bmj.com/content/316/7126/201 [Accessed June 02, 2015]. Solomon, P. & et. al., 2008. Randomized Controlled Trials: Design and Implementation for Community-Based Psychosocial Interventions: Design and Implementation for Community-Based Psychosocial Interventions. Oxford University Press. Stolberg, H. O. & et. al., 2004. Fundamentals of Clinical Research for Radiologists. AJR, Vol. 183, pp. 1539-1544. Viera, A. J. & Bangdiwala, S. I., 2007. Eliminating Bias in Randomized Controlled Trials: Importance of Allocation Concealment and Masking. Research Series, Vol. 39, No. 2, pp. 132-137. Ziauddeen, H. & et. al., 2012. Obesity And The Brain: How Convincing Is The Addiction Model? Nature Reviews, Vol. 13, pp. 279-286. Bibliography Bulpitt, C., 2012. Randomised Controlled Clinical Trials. Springer Science & Business Media. Boswell, C. & Cannon, S., 2014. Introduction to Nursing Research: Incorporating Evidence-based Practice. Jones & Bartlett Publishers. Chow, S. & Liu, J., 2004. Design and Analysis of Clinical Trials: Concepts and Methodologies. John Wiley & Sons. Hoskins, C. N. & Mariano, C., 2004. Research in Nursing and Health: Understanding and Using Quantitative and Qualitative Methods, 2nd Edition. Springer Publishing Company. Hoffmann, T. & et. al., 2009. Evidence-Based Practice Across the Health Professions. Elsevier Australia. LoBiondo-Wood, G., & et. al., 2013. Study Guide for Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences. Moule, P. & Goodman, M., 2009. Nursing Research: An Introduction. SAGE. Newman, I. & Benz, C. R., 1998. Qualitative-quantitative Research Methodology: Exploring the Interactive Continuum. SIU Press. Polit, D. F. & Beck, C. T., 2013. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. Lippincott Williams & Wilkins. Solomon, P. & et. al., 2008. Randomized Controlled Trials: Design and Implementation for Community-Based Psychosocial Interventions: Design and Implementation for Community-Based Psychosocial Interventions. Oxford University Press. Appendix (Action Plan) Student Number Cohort number Date Position and place of work Staff nurse, surgical wards, internal medicine wards, intensive care units, pediatric wards. Chosen topic to examine “Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomized controlled trial”. Explain why did you choose this topic? The concerned topic was selected with the expectation to develop proper in-depth knowledge with respect to the importance of hand hygiene strategies for nurses in order to provide effective health services. One piece of peer reviewed evidence that you intend to critically appraise. Huis, A. & et. al., 2013. Explaining the Effects of Two Different Strategies for Promoting Hand Hygiene in Hospital Nurses: A Process Evaluation alongside a Cluster Randomized Controlled Trial. Implementation Science, Vol. 8, No. 41, pp. 1-13. The research method of the selected evidence. Quantitative research strategy was selected to analyze information gathered through the questionnaire. How could this influence your future practice? The article provides a better understanding of providing medication along with maintaining hand hygiene compliance, since it would allow ensuring that the transfer of infections are restricted. Critical appraisal tool to be used Randomized Controlled Trials Comments/feedback Read More