Clinical Guidelines for Acute Stroke Management - Essay Example

Article Critique Introduction One method of building on the information that we already have is through reviewing the works of the other practitioners in our field of study (Allen & Earl, 2010). This can be attained through the application of systematic approaches to acquiring, confirming and developing on the information that is already contained. This allows the use of updated information when it comes to the actual field practice, for instance, when it comes to dealing with patients if such information is related to the nursing profession (Helen et al., 2010). To attain this, it is important to engage in the application and review of the research findings related to the relevant field of study (Stebbins, 2001). This paper seeks to provide a critical review of an article about the management of acute stroke, in order to generate a body of information that could be applied by nursing professionals in their field of practice. The purpose of the paper is to identify the different types of evidence, along with the strengths and weaknesses of the author through the application of the appraisal tools. Title and Abstract The title of the article- continence management in acute stroke: a survey of current practices in Australia is well phrased. The authors consider the key words that assist the readers to understand what the article focus on and in which region. The articles abstract outlines the main key points of the article. These include the aim of the article, the background, methodology, results and the conclusions. The aim of the study which is determining the recent national urinary incontinence management practices in Australian acute stroke units and their concordance with the National Stroke Foundation guidelines (Jordan et al, 2011), is well spelt out. The background of the study also states clearly the cause of urinary incontinence and its effect although the authors do not include the necessary recommendations nurses should take in the management of urinary incontinence. The methodology and the results are well explained while the conclusion summarizes clearly the article and gives the authors’ views regarding the management of the urinary incontinence (Ploeg, 1999). Overall, the abstract is well presented as it offers the reader a clear picture of what is detailed in the article. The authors have presented the abstract clearly using qualitative research (Creswell, 2003). This can be evidenced by their style of writing as they eliminates the use of self, the sample size is described in the methodology, and the article is well organized whereby, the results and discussions are separated (Strauss, 1990). Literature review / Background / Introduction The authors have provided an introduction and a literature review from peer reviewed work by other authors. This background gives readers an overview of the causes and the consequences of urinary incontinence as put forth by other researchers. The literature presents information that supports the researchers’ position regarding the subject of the article (Denzin and Lincoln, 2000). The authors have written the literature review critically. This means that, they have considered previous works which assist in further understanding. However, they have not outlined the weaknesses of previous work which they need to improve in their current research. The review comprises of current secondary sources of data which are very efficient and reliable in such a study (Beth, 2010). Secondary sources of data including books, journals, and articles among others are applicable in quantitative research. They are deemed to provide accurate data that cannot be obtained in primary research. Ethical considerations While conducting research, researchers should put in mind the phenomenon of ethical considerations. It is vital for them to know the ethics that are behind their research activities (Nigel et al., 1998). In our case study, the ethical considerations were considered. The approval to carry on with the research was acquired from human research ethics committee from a university. This was to ensure that, the researchers do not violate various considerations such as confidentiality of information, fair consideration and permission to conduct such a research. This is in accordance with the policy of the International Development Research Centre (IDRC) which requires that, research involving human subjects be performed in agreement with high ethical standards (Janet, 2007). Both qualitative and quantitative research should be carried out while considering ethical standards. The strength of this article is that, it obeys the policy of IDRC by putting in mind the ethical considerations that are required in every research. Analysis of the methods Aim of the study This study was directed at determining the contemporary continence practice in the Australian Acute Stroke Units and assess whether they comply with the National Stroke Foundation guideline recommendations (Jordan et al., 2011). One of the strength concerning this article is the fact that the author has outlined the main purpose of the study, which gives the readers a clear picture of what the article is all about. Furthermore, the aim is clear and specific outlining the main issues the paper seeks to resolve (Ogundipe, 2005). Sampling The study was conducted among hospitals that had dedicated Acute Stroke Units. However only those that were considered eligible according to the National Stroke Foundation were considered for the study. This included hospitals from New South Wales, Victoria, Tasmania, Western Australia, Australian Capital Territory, Queensland and South Australia (Jordan, et al. 2011). However, the major reason as to why the hospitals from the Northern territory were not included is that there were no identified units in this region. The total number of the identified units was fifty-four and forty-two were considered for the study since the other twelve did not meet the eligibility requirements. One senior nurse from each of the forty-two units was required to complete a telephone interview (Jordan et al., 2011). The study involved all the hospitals that had stroke units and this is a major strength since it does not apply the sampling method that often generates biased results that may not be a representative of the whole population. This is indeed an adequate sample since it considered all the eligible hospitals without having to leave others out, which therefore assures that the findings will reveal the actual information about the current practice without the use of generalization (Nancy & Susan, 2005). The other strength is that the article is clear to outline the reason as to why some hospitals were disqualified from the study. This is because they were not meeting the eligibility criteria, which outlines that the study was dedicated at attaining its objective of ensuring that the management practices were only surveyed among the hospitals that were conforming to the National Stroke Foundation requirements (National Stroke Foundation, 2005). However, only one senior nurse from each of the selected hospitals was required to complete the interview, and this is a challenge since it could be better if two or more nurses could be interviewed in order to get wider perspectives and avoid generalizing ideas (Hill et al., 2009). Design A cross-sectional study design was applied. This is a fast method of study, is applied to study a large number of participants at a little effort, and costs (Bland, 2001). One of the strengths about the design method applied however is that it is cost –effective, basing on the fact that this was a broad study that aimed to involve all the hospitals that had stroke units. . This is a descriptive study and therefore cross-sectional design serves as a best method that could be applied to attain the required information (Creswell, 2003). Data collection Data was obtained through telephone surveys whereby a senior nurse from each of the participating hospitals was interviewed. One of the advantages about this method of data collection is that it can be applied to obtain information from a vast population considering the fact that this is a qualitative study that seeks to attain information that only concerns the particular case studied. The scope of reach using the telephone surveys is wide, considering the fact that this study involved participants from a wider geographical area (Cary et al., 2001). It is also cost effective since the researcher does not have to incur travel costs. It is also quick in obtaining the required information. Discussion and interpretation of the findings The discussion fits with the data since it seeks to provide an in depth analysis of the data collected. These have been well elaborated to provide answers to the aim of the study. Previous research studies have well been used to incorporate the work of other researchers who have as well attempted to study this subject. The limitations encountered in the process of the study have also been outlined, for instance the researcher has outlined that it was probable that some of the responses were biased. This provides readers with the insight the results are not perfect and there is room for some criticism (Basil, 2000). The article has also outlined the implications fro practice, which are appropriate and should be adopted to ensure effective management. This provides a way forward for the professionals in this field about the measures that should be adopted to ensure effective service delivery and the management of acute stroke (Marilynn and Janet, 2010). Recommendations The authors give recommendations for the management of urinary incontinence in the clinical guidelines for acute stroke management (Jordan et al., 2011). These recommendations reflects fully what other recent clinical evidence suggests. Application of these recommendations will assist individuals with urinary incontinence to manage their conditions in the best way possible (Janet, 2007). The recommendations put forth support the whole idea of this research as they are in line with the subject matter. Clinical implementation Any research carried out should give recommendations that can be adopted in order to mitigate or solve the study problem. I think this s study is of great help in nursing practices. The reason behind this is that, the literature which focuses on the causes and effects of urinary incontinence and the recommendations given by the authors for the management of the conditions are very applicable in nursing practices and can be implemented to improve the current practices (Bailey et al., 2002). These recommendations as outlined by the author include: Clinical Guidelines for Acute Stroke Management Patients having suspected continence complexities be assessed by qualified personnel A portable bladder ultrasound scan may be employed in the diagnosis and the management of urinary continence Indwelling catheters shouldn’t be employed as an preliminary management strategy Development of a management plan for post discharge prior to patients discharge Clinical Guidelines for Stroke Rehabilitation and Recovery Individuals suffering from urinary dysfunction ought to be managed using a functional approach Indwelling catheters should not be used for individuals with urinary retention Use of a whole team approach for individuals with functional incontinence Advanced tests incase incontinence persists In my view, these recommendations are suitable as they will assist nurses to manage and treat urinary incontinence effectively and efficiently therefore reducing the diseases outcomes (National Stroke Foundation, 2007). Application of these recommendations in nursing practices will also be feasible in that, these practices are very practical and they are meant to assist in solving the study problem. Organizations, the nurses, family and the patients will benefit greatly once these recommendations are implemented in nursing practices. This is because; the benefits of implementing are very possible to offset the risks and costs of a modification in such a practice. To the family, burden and costs of treatment will reduce, to the patients, effective management practices will ensure effective management, while to the nurses, they will have developed new skills which will assist them cope with such conditions in future. Various authors have researched on this area and agreed with the above recommendations for the management of urinary incontinence. The National Health and Medical Research Council (1998), and the National Stroke Foundation, (2007) have carried out similar research in our area of study and gave the same recommendations. Steps taken to progress the research According to the recommendations provided by the author, there seems to be no evidence to demonstrate the effectiveness of the interventions for managing urinary incontinence. The specific guidelines that were developed by the Australia’s National Stroke Foundation were based on the few existing evidence. This therefore shows that there is need to carry out more studies to provide more evidence regarding the effectiveness of the management interventions. This has been pointed out by other research studies as well, for instance Scottish Intercollegiate Guidelines Network (2008) and the European Stroke Organization (2008). The author also identifies that there is a disparity between the clinical care delivery and the best practice. In addition very little is known about the compliance of the Australian Acute Stroke Units with the National Stroke Foundation recommendations regarding urinary incontinence. This fact has been backed up by other health services research such as the Scottish Intercollegiate Guidelines Network (2008) and a study that was conducted by the Royal College of Physicians of London in 2008. However, the next research that will be conducted should involve at least two participants from each of the identified hospitals in order to have a wider perspective from the respondents. It is also necessary to conduct actual field surveys, if possible employ the observation method in order to enhance accuracy and validity of the results (Royal College of Physicians of London, 2008), since it could be possible that the respondents could have hidden some required information. It is also necessary to include a theoretical framework to ensure the variables under survey are clearly outlined. Conclusion In conclusion, analyzing an article critically assists readers to understand the article better. Critically evaluating an article involves looking at the strengths and weaknesses of the article, and offering recommendations on such weaknesses. This paper has critically analyzed an article- continence management in acute stroke: a survey of current practices in Australia. The assessment involved considering how qualitative and quantitative the research has been carried out. It is apparent from the critique that, the authors presented the research well using both the qualitative and quantitative methods. This is evidenced by the fact that, secondary and primary sources of data and analysis were used in the research which offers reliable information. This recommendations put forth by the authors are very applicable in nursing practice. Use of these recommended practices can assist nurses in improving their current practices (David et al, 2008), while it is also very beneficial to the family, the patient and the organization in general. The benefits of implementing these recommendations outdo the costs of not implementing. Therefore, this research has been beneficial as it has assisted in offering the necessary information required in assessment, treatment, and management of urinary incontinence, which assist in improving the patients’ outcomes. References Allen, R., and Earl, R. (2010). Research methods for social work. London: Cengage Learning Bailey, C., Froggatt, K., Field, D, and Krishnasamy, M. (2002). The nursing contribution to qualitative research in palliative care: a critical evaluation. J Adv Nursing, 40, (1):48-60. Basil B. Bernstein (2000). Pedagogy, symbolic control, and identity: theory, research, critique. New York: Rowman & Littlefield Beth, L. R. (2010). Guidelines for Critique of Research Reports. 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The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischemic attack 2008. Cere- brovascular Disease 25, 457–507. Read More